Pharmacological and Parenteral Therapies I

As a nurse, it is particularly important to understand the REASON that medications are being administered to a particular patient in a particular situation. “Because the doctor ordered it” is never a complete reasoning of why a medication should be administered. Recalling the lessons of anatomy and physiology is key to understanding how the medication is supposed to work. In addition to this, EVERY PATIENT IS DIFFERENT, therefore even though there are expected outcomes to each medication as it is given, it must be noted that each patient may have a very different and individualized reaction to medications.

As a nurse, it can be very difficult and daunting to attempt to memorize every single medication that may be given. Therefore, it is better to try to understand the FAMILIES of medication. i.e. “beta-blockers” or “platelet inhibitors” and how they work. This can help when starting to learn different medications. Also, in nursing practice, certain medications will be more utilized in different practice areas.

The most important part of pharmacology is to understand that as a nurse giving the medication, you are the last layer of protection for the patient. Sometimes an order can be wrong, or a medication can be the wrong kind of medication. It is good to ask questions and get help. Using resources such as drug guides and pharmacists is very important to help keep patients safe. It is better to KNOW THAT YOU DON’T KNOW THAN ASSUME YOU DO AND BE WRONG

Administer Blood Products and Evaluate Client Response: 

  • Administering blood products, such as packed red blood cells, platelets, or plasma, is a critical nursing skill often performed in cases of severe anemia, bleeding disorders, or surgical procedures. 
  • There must always be a physician order for blood product administration. 
  • The nurse ensures compatibility between the blood product and the patient’s blood type to prevent transfusion reactions.
  • In almost all facilities it is now policy that TWO nurses double check the blood. Also, many facilities require two nurses to observe the procurement of the blood type specimen when it is drawn, and a special arm band placed on the patient to link them to that particular specimen.

Continuous monitoring during the transfusion includes vital signs:

(e.g., blood pressure, heart rate, respiratory rate, temperature), assessment for signs of adverse reactions (e.g., fever, chills, rash, shortness of breath), and documentation of the transfusion process.

Nurses are trained to respond immediately to any signs of a  transfusion reaction and follow the institution’s protocols for stopping the transfusion and providing appropriate treatment.

The first 15 minutes are key to observation during blood product administration and ANY TIME a product is administered. The nurse should stay with the patient at least for the first minute. Ensuring that the patient is in an area that is easily monitored and can readily communicate any problems to nurses is very important.

Administration of Blood Products: 

Administering blood products is a crucial aspect of healthcare, often performed in cases of significant blood loss, anemia, bleeding disorders, or during surgical procedures. Blood products commonly administered include packed red blood cells (PRBCs), platelets, fresh frozen plasma (FFP), and cryoprecipitate. Here are some key points about the administration process: 

Compatibility and Crossmatching: Before any blood transfusion, it’s essential to ensure compatibility between the donor blood and the recipient. This is done through blood typing and crossmatching. Crossmatching involves mixing a sample of the patient’s blood with the donor’s blood to check for reactions.

Consent: Informed consent from the patient or their authorized representative is obtained before the transfusion.  Implied consent can take place in emergency situations such as trauma victims who are unconscious with severe bleeding. 

Vital Signs Monitoring: During the transfusion, the nurse closely monitors the patient’s vital signs, including blood pressure, heart rate, respiratory rate, and temperature. This monitoring occurs before, during, and after the transfusion to detect any adverse reactions. 

Transfusion Rate: Blood products are typically administered at a prescribed rate, often starting slowly to monitor for reactions. The rate can be adjusted based on the patient’s tolerance. 

Documentation: Nurses document the transfusion process meticulously, including the type and volume of blood product administered, vital signs, and any adverse reactions. 

Types of Transfusion Reactions:

Transfusion reactions can occur when the recipient’s immune system reacts to components in the donor’s blood. There are several types of transfusion reactions, each with its own set of signs and symptoms: 

Acute Hemolytic Reaction: 

  • Cause: Incompatibility between donor and recipient blood, typically due to ABO or Rh incompatibility. 
  • Symptoms: Symptoms can be severe and include fever, chills, hematuria, chest or back pain, hypotension, and jaundice. 
  • Treatment: Stop the transfusion immediately. Provide supportive care, such as intravenous fluids and medications to manage symptoms. Report the reaction to the blood bank and healthcare provider. 

Febrile Non-Hemolytic Reaction: 

  • Cause: Reaction to white blood cell antigens in the donor blood.
  • Symptoms: Fever, chills, and occasionally headache or nausea. 
  • Treatment: Stop the transfusion, if necessary, administer antipyretic medications (e.g., acetaminophen), and monitor vital signs. Transfusing leukoreduced blood products can prevent future reactions.

Allergic Reaction: 

  • Cause: Sensitivity to allergens in the donor blood, such as proteins or plasma components. 
  • Symptoms: Itchy skin, rash, hives, swelling, or more severe symptoms like shortness of breath or anaphylaxis in severe cases. 
  • Treatment: Stop the transfusion, administer antihistamines or corticosteroids if indicated, and manage anaphylaxis with epinephrine as necessary. 

Transfusion-Related Acute Lung Injury (TRALI):

  • Cause: A rare reaction involving donor antibodies that react with recipient white blood cells or lung tissue. 
  • Symptoms: Sudden onset of severe respiratory distress, hypoxia, and pulmonary edema. 
  • Treatment: Provide respiratory support, including oxygen therapy and mechanical ventilation, if needed. Report the reaction to the blood bank. 

Transfusion-Associated Circulatory Overload (TACO):

  • Cause: Rapid administration of a large volume of blood products, leading to volume overload. 
  • Symptoms: Symptoms of congestive heart failure, including shortness of breath, elevated blood pressure, and edema. 
  • Treatment: Slow the transfusion rate, administer diuretics if necessary, and provide supportive care for heart failure symptoms. 

Access and/or Maintain Central Venous Access Devices (CVADs): 

Central venous access devices, like central lines, PICC lines, and ports, are used for long-term administration of medications, chemotherapy, parenteral nutrition, or frequent blood draws. Nurses must maintain strict aseptic techniques when accessing these devices to prevent infections. 

Regular care includes changing the dressing, flushing the line with sterile solutions, and checking for complications like catheter-related bloodstream infections. When accessing CVADs, nurses verify placement using radiographic confirmation and ensure the device is functioning correctly. 

Types of Central Venous Access Devices: 

Central Venous Catheter (CVC): 

CVCs are typically inserted into a large vein in the neck (internal jugular), chest (subclavian), or groin (femoral). There are single-lumen, double-lumen, and triple-lumen CVCs to accommodate different treatment needs.CVCs are used for a variety of purposes, including administering medications, parenteral nutrition, and hemodialysis. 

Peripherally Inserted Central Catheter (PICC): 

PICCs are long, flexible catheters inserted through a peripheral vein in the arm (usually the basilic or cephalic vein) and threaded into the central venous system.They are commonly used for extended IV therapy, such as antibiotics, chemotherapy, and total parenteral nutrition(TPN). PICCs are less invasive than CVCs and are often preferred for long-term therapies. 

Implanted Port: 

An implanted port is a device placed beneath the skin in the chest or upper arm, with a catheter that leads to a central vein. Ports are primarily used for patients who require long-term IV therapies but want a discreet and less visible access point. They are accessed using a non-coring needle through the skin when needed. 

Tunneled Central Venous Catheter: 

Tunneled catheters are inserted through a small incision in the chest or neck and then tunneled under the skin to exit at a separate site.These catheters are typically used for long-term hemodialysis or chemotherapy. 

Management of Central Venous Access Devices: 

Proper management of CVADs is essential to prevent complications and maintain their functionality.

Here are key considerations:

Aseptic Technique: 

Strict aseptic (sterile) technique is paramount during CVAD insertion, dressing changes, and access to reduce the risk of infection. Healthcare providers should wear sterile gloves, use chlorhexidine for skin preparation, and maintain a sterile field. 

Dressing Changes: 

Dressing changes are performed regularly (usually every 7 days or per facility protocol) to keep the insertion site clean and dry. Transparent dressings are often used, allowing for visualization of the site. 

Flushing and Locking: 

Flushing with a sterile, preservative-free saline solution is performed to maintain catheter patency, prevent occlusions, and reduce the risk of clot formation. Locking with heparin or citrate solutions may be necessary to prevent thrombosis when the catheter is not in use.

Assessment and Monitoring: 

Routine assessment of the CVAD includes checking for signs of infection, dislodgement, or malfunction.Monitoring for signs of catheter-related bloodstream infections (CRBSI) is critical. 

Verification of catheter tip placement should be confirmed by X ray or other appropriate methods. 

Patient Education: 

Patients and caregivers should receive education on CVAD care, including signs of infection or complications, flushing protocols, and dressing changes. Patients should also be informed about restrictions on activities (e.g., avoiding heavy lifting to prevent catheter dislodgement). 

Documentation: 
Comprehensive and accurate documentation is essential for tracking CVAD care, including dressing changes, flushes, and any complications or interventions. 

Use Clear and Legible Handwriting or Typing: 

Ensure that all entries in patient records are clear and legible. If you are using electronic health records (EHRs), type entries using proper spelling and grammar. 

  • Include Date and Time: 

Document each entry with the date and time of the event or assessment. This helps establish a chronological timeline of care.

  • Document Objective Data: 

Record objective, measurable information such as vital signs, laboratory results, and physical assessments. Avoid documenting opinions, assumptions, or hearsay. 

  • Use Appropriate Medical Terminology: 

Use correct medical terminology and abbreviations, following institutional policies and standards. Avoid using jargon or slang. Be Concise and Relevant: 

  • Be Concise and Relevant: 

Document only pertinent information that is related to the patient’s condition and care. Avoid unnecessary details or information that does not contribute to the patient’s treatment. 

  • Avoid Blank Spaces: 

Do not leave blank spaces in the documentation. If a section does not apply to the patient’s care, write “N/A” or “Not Applicable” to indicate this. 

  • Chart in Real-Time: 

Document assessments, interventions, and changes in the patient’s condition as they occur. Avoid “charting by exception” if your facility does not endorse this practice. 

  • Use Correct Patient Identification: 

Always verify the patient’s identity before documenting care.Use at least two patient identifiers (e.g., name and date of birth). 

  • Document All Medications: 

Record all medications administered, including dosage, route, time, and any adverse reactions. Follow medication administration policies. 

  • Include Patient Responses: 

Document the patient’s response to treatments, medications, and interventions. This helps evaluate the effectiveness of care. 

  • Maintain Privacy and Confidentiality: 

Protect patient confidentiality at all times. Do not share sensitive patient information with unauthorized individuals. 

  • Use Standard Documentation Forms:

Use institution-approved forms and templates for documentation. Familiarize yourself with the EHR system in use at your facility. 

  • Document Changes in Care Plan: 

If there are changes in the patient’s care plan, update the documentation to reflect these changes and the reasons behind them. 

  • Record Patient Education: 

Document any patient education provided, including topics discussed and the patient’s understanding or questions. 

  • Sign and Authenticate Entries: 

Sign all entries with your full name and professional credentials. Some facilities may require an electronic signature for EHRs. 

  • Correct Errors Appropriately: 

If you make an error in documentation, strike through the mistake with a single line, write “error,” your initials, and the date and time of the correction. Do not erase or use correction fluid. 

  • Follow Legal and Ethical Standards: 

Adhere to legal and ethical guidelines in documentation, including informed consent, advance directives, and reporting of adverse events. 

  • Document Pain Assessments: 

Use a pain scale to assess and document the patient’s pain level, and follow up with interventions and reassessments as necessary. 

  • Collaborative Documentation: 

Collaborate with other healthcare team members and ensure interdisciplinary communication through documentation.

  • Review and Validate Documentation: 

Regularly review and validate your documentation to ensure accuracy and completeness. 

  • Complication Management:

Promptly address complications such as infection, occlusions, catheter dislodgement, and thrombosis.In some cases, catheter removal and replacement may be necessary. 

Infection: 

Infection is a significant concern in intravenous therapy. It occurs when microorganisms, such as bacteria or fungi, enter the bloodstream through the IV catheter or its surrounding site. This can lead to local or systemic infections.

Key points to consider include: 

Prevention: Proper hand hygiene, aseptic technique during catheter insertion, and regular site care are essential to prevent infections. 

Signs and Symptoms: Watch for signs of infection, including redness, warmth, swelling, pain, or purulent drainage at the insertion site, as well as systemic symptoms like fever and chills. Interventions: If an infection is suspected, it is crucial to promptly remove the catheter, administer appropriate antibiotics, and monitor the patient closely.

Occlusions: 

An occlusion occurs when there is a blockage in the IV catheter or tubing, preventing the flow of fluids or medications. 

These blockages can be partial or complete and may result from various factors, including: 

Causes: Occlusions can be caused by clot formation (thrombosis), medication precipitates, kinks in tubing, or mechanical issues. 

Prevention: Regular flushing of catheters with saline or heparin, proper catheter care and avoiding abrupt changes in tubing position can help prevent occlusions. 

Interventions: If an occlusion occurs, assess the cause and address it accordingly. For instance, if it’s due to a clot, you may need to use a thrombolytic agent to clear the blockage or consider catheter replacement. 

Type of OcclusionDescriptionNursing
Interventions
Thrombotic
Occlusion
Formation of a blood clot within the
catheter or tubing, obstructing fluid flow.
1. Stop the infusion immediately. 2. Assess the catheter and tubing for signs of clot formation (e.g., sluggish flow).
3. Attempt to aspirate blood from the
catheter to confirm the occlusion. 4. Administer a
thrombolytic agent as ordered, following.
institutional protocols.
5. Monitor the patient for signs of bleeding or
complications.
Mechanical
Occlusion
Physical obstruction of the catheter or tubing, often caused by
kinking or
compression.
1. Identify and address the cause of the
mechanical
obstruction (e.g.,
unkink the tubing).
2. Assess for any signs of catheter or tubing damage.
3. Consider replacing the catheter or tubing if necessary.
Medication
Precipitate Occlusion
Precipitation of
medications within the catheter, resulting in blockage.
1. Stop the infusion immediately.
2. Assess the catheter for any visible
precipitate or
cloudiness in the
tubing.
3. Flush the catheter with a compatible solution as prescribed (e.g.,
normal saline) to
dissolve the
precipitate.
4. Confirm patency.
before restarting the infusion.
Infiltration OcclusionExtravasation of
intravenous fluids or medications into the surrounding tissue, causing tissue damage and potential catheter obstruction.
1. Stop the infusion immediately.
2. Assess the infiltration site for signs of
swelling, pain, or
coolness.
3. Elevate the affected limb if appropriate.
4. Remove the catheter gently to
minimize tissue.
trauma.
5. Provide appropriate wound care as
needed.
Embolism OcclusionThe presence of an embolus (e.g., air,
thrombus) within the catheter or tubing that obstructs flow.
1. Stop the infusion immediately. 2. Assess for signs of the specific type of
embolism (e.g., air embolism,
thromboembolism) and initiate
corresponding
interventions (as
previously discussed).
Catheter-Related OcclusionCatheter lumen
blockage due to
intraluminal or
extraluminal factors such as fibrin sheath formation, bacterial biofilm, or catheter tip migration.
1. Confirm the type and location of the occlusion using
appropriate diagnostic methods (e.g.,
catheter tip x-ray).
2. Consult with the healthcare.
provider for further management, which may include catheter exchange or removal.
Partial OcclusionPartial blockage of the catheter, allowing
some fluid flow but impeding the desired infusion rate.
1. Assess the infusion rate and flow
characteristics.
2. Attempt to aspirate blood from the
catheter to confirm partial occlusion.
3. Troubleshoot and address any issues affecting the infusion (e.g., adjust the height of the IV bag, check for kinks).

Catheter Dislodgement: 

Catheter dislodgement happens when the IV catheter is unintentionally removed or partially pulled out from the vein. This can disrupt therapy and potentially lead to complications. 

Key points to consider include: 

  • Prevention: Securely tape and stabilize the catheter to prevent accidental dislodgement. Educate patients about the importance of not tampering with the catheter. 
  • Signs and Symptoms: Observe for signs such as infusion rate changes, pain, swelling, or catheter exposure. 
  • Interventions: If a catheter is dislodged, it should be removed, and a new one should be inserted following proper aseptic technique. 

Thrombosis: 

Thrombosis refers to the formation of blood clots within the IV catheter or the surrounding veins. Thrombosis can impede blood flow, lead to catheter malfunction, and increase the risk of embolism.

Key considerations include: 

  • Risk Factors: Certain factors, such as prolonged catheter dwell time, hypercoagulability, and catheter size, can increase the risk of thrombosis. 
  • Prevention: Regular flushing with saline or heparin can help prevent catheter-related thrombosis. Also, consider using smaller gauge catheters when appropriate. 
  • Interventions: If thrombosis is suspected, the catheter may need to be removed, and anticoagulant therapy may be indicated.  Ultrasound imaging may be used to confirm the diagnosis. 

 

Catheter dislodgement is a concern not only for peripheral IV catheters but also for central venous catheters (CVCs), which are inserted into larger central veins, such as the subclavian, internal jugular, or femoral veins. Dislodgement of a central line can have serious consequences, including air embolism, infection, and loss of access for critical medications and therapies. Here’s an expanded discussion on catheter dislodgement for central lines and nursing interventions: 

Catheter Dislodgement with Central Lines: 

Central lines are typically used for more extended periods and for critical therapies, making the risk of dislodgement a significant concern. Catheter dislodgement in central lines can occur due to various reasons: 

Mechanical Causes: These include patient movement, accidental tugging on the catheter, or inadequate securement. Infusion-Related Causes: Forceful or rapid infusion of fluids or medications can create tension on the catheter, potentially leading to dislodgement. 

Nursing Interventions for Catheter Dislodgement with Central Lines: 

  • Assessment: Regular assessment of the central line site and catheter placement is crucial. Any suspicion of catheter dislodgement should trigger a thorough assessment. 
  • Immediate Response: If catheter dislodgement is suspected or confirmed, the following steps should be taken: 
  • Stop Infusion: Immediately stop any infusions running through the catheter. 
  • Position the Patient: Place the patient in a position that reduces the risk of air embolism (typically in a Trendelenburg or left lateral decubitus position) and ask them to perform a Valsalva maneuver.  
  • (deep breath and bearing down) to prevent air entry into the central vein. 
  • Cover the Site: Apply a sterile occlusive dressing to the catheter site to prevent air entry and reduce the risk of infection. Notify Healthcare Team: Inform the healthcare provider and the interventional radiology team or vascular access team (if available) immediately for further assessment and guidance. 
  • Assess for Complications: Continuously monitor the patient for signs of complications such as air embolism, which can include sudden dyspnea, chest pain, hypotension, and altered mental status. If suspected, initiate appropriate interventions such as administering 100% oxygen and notifying the rapid response team. 
  • Reposition or Replace the Catheter: The healthcare provider may attempt to reposition the dislodged catheter using fluoroscopy or ultrasound guidance. If repositioning is unsuccessful or if there are concerns about catheter integrity, a new central line may need to be inserted. 
  • Prevention: Emphasize the importance of securement techniques, patient education on catheter care and limitations, and the need to report any discomfort or changes at the central line site. Documentation: Thoroughly document the incident, including the assessment findings, actions taken, healthcare provider notifications, and the patient’s response. 

Catheter dislodgement in central lines is a critical event that requires swift and appropriate nursing interventions to minimize potential harm to the patient.  Nurses play a vital role in prevention, early detection, and management of central line complications to ensure the safety and well-being of their patients. 

Type of EmbolismDescriptionNursing
Interventions
Air EmbolismIntroduction of air into the vascular system. Can occur during
catheter dislodgement or invasive
procedures.
1. Place the patient in a left lateral decubitus or Trendelenburg
position.
2.
Administer 100%
oxygen.
3. Notify the healthcare.
provider and rapid response team.
ThromboembolismFormation of a blood clot (thrombus) that dislodges and travels through the
bloodstream. Can lead to pulmonary.
embolism, stroke, or myocardial infarction.
1. Administer
anticoagulant therapy as ordered (e.g.,
heparin).
2.
Elevate the affected limb (if lower extremity thromboembolism is suspected).
3. Monitor for signs of complications (e.g., dyspnea, chest pain, altered mental status).
Pulmonary EmbolismA blood clot that
travels to the
pulmonary arteries, blocking blood flow to the lungs. Often
originates from deep vein thrombosis.
(DVT).
1. Administer oxygen to maintain adequate oxygenation.
2. Administer
anticoagulant therapy (e.g., heparin) and thrombolytics if
indicated.
3.
Monitor vital signs and oxygen saturation.
4. Prepare for diagnostic tests (e.g., CT pulmonary
angiography).
Fat EmbolismThe release of fat
globules into the
bloodstream, typically after a long bone
fracture or orthopedic surgery. Can lead to respiratory and
neurological
symptoms.
1. Administer oxygen to support
oxygenation.
2. Ensure mechanical ventilation if.
necessary.
3. Monitor for signs of neurological.
impairment (e.g.,
confusion).
4. Surgical fixation of fractures may be.
required.
Amniotic Fluid
Embolism
Occurs during
childbirth when
amniotic fluid, fetal cells, or debris enter the maternal
circulation. Can lead to severe respiratory and cardiovascular distress.
1. Administer oxygen and ventilatory
support.
2.
Administer
vasopressors for
hemodynamic
support.
3.
Monitor for
coagulopathy and
initiate appropriate treatments.
4. Prepare for emergent cesarean section if necessary.
Septic EmbolismThe spread of
bacterial or fungal infections through the bloodstream, leading to the formation of septic emboli. Can affect multiple organs.
1. Administer broad spectrum antibiotics as ordered.
2. Supportive care for affected organs (e.g., respiratory support, fluid resuscitation).
3. Monitor for sepsis related.
complications.

Perform Calculations Needed for Medication Administration: 

Medication calculations are essential to ensure patients receive the correct dosage based on their weight, age, and the medication’s concentration. Common calculations include determining drug dosages, infusion rates, and preparing medication solutions or intravenous drips. Accuracy is paramount to prevent medication errors and potential harm to the patient. 

Nurses use a variety of calculation methods, such as dimensional analysis or ratio proportion, to perform these calculations safely. 

Ratio-Proportion Method: 

This method involves setting up a ratio based on the ordered dose and available dose strength. 

You can use the formula: Desired dose/Available dose = Quantity to administer. For example, if the ordered dose is 2 mg, and the available dose is 1 mg/tablet, you would calculate: 2 mg / 1 mg = 2 tablets to administer. 

Dimensional Analysis (DA) Method: 

DA is a systematic approach that uses conversion factors and unit cancellation to calculate medication dosages. You start with the ordered dose and convert it into the desired unit using conversion factors. For example, if the ordered dose is 500 mg and the available dose is 250 mg/5 mL, you would set up the calculation as follows: 

    • (500 mg * 5 mL) / 250 mg = 10 mL to administer. 
  • Administering Parental Medications Hand Hygiene: Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer before handling parenteral medications. 
  • Verify the Medication Order: Double-check the medication order for accuracy, including the medication name, dosage, route, and frequency. 
  • Patient Assessment: Assess the patient’s medical history, allergies, current medications, vital signs, and any contraindications to the selected parenteral route. 
  • Medication Preparation: Use aseptic technique when preparing parenteral medications to prevent contamination. Ensure the medication is properly labeled, and check the expiration date. Prepare only one medication at a time to avoid mix-ups. 
  • Needle and Syringe Selection: Select the appropriate needle and syringe size based on the route of administration and the volume of the medication. 
  • Air Bubble Removal: Remove air bubbles from the syringe to ensure accurate dosage delivery. 
  • Site Preparation: Cleanse the injection site with an antiseptic solution and allow it to dry before injection. 
  • Safe Injection Technique: Administer the medication using the correct technique for the chosen route.
  1. Intravenous (IV): Administer medications directly into a vein. Intramuscular (IM): Administer into a muscle. 
  2. Subcutaneous (SC): Administer just beneath the skin.
  3. Intradermal (ID): Administer just below the epidermis. 
  4. Intrathecal: Administer into the spinal canal. 
  5. Needle Insertion Angle: Pay attention to the appropriate angle of needle insertion for IM, SC,  and ID injections to ensure proper deposition of the medication. 
  • Aspiration (for IM injections): Before injecting the medication in an IM site, gently pull back on the plunger to check for blood return. If blood is aspirated, do not inject the medication, as you may be in a blood vessel. 
  • Injection Speed: Administer medications at the appropriate rate to prevent discomfort and ensure proper absorption. 
  • Monitor for Adverse Reactions: Observe the patient for immediate adverse reactions during and after parenteral medication administration. 
  • Documentation: Accurately document all aspects of medication administration, including the date, time, medication name, dose, route, and any adverse reactions or patient responses. 
  • Disposal: Properly dispose of used needles and syringes in designated sharps containers to prevent needlestick injuries. 
  • Patient Education: Educate the patient about the administered medication, its purpose, potential side effects, and any post-administration instructions. 

Follow-Up: Schedule follow-up appointments to monitor the patient’s response to the medication and make necessary adjustments to the treatment plan.

Parenteral
Medication Type
Types of Medications AdministeredNursing
Interventions
Intravenous (IV)
Medications
Antibiotics, pain
medications, fluids, chemotherapy
1. Verify medication order and
compatibility with IV solution. 2. Assess IV site for infection,
infiltration, or
phlebitis. 3. Monitor vital signs during IV infusion. 4. Ensure patent and secure IV line. 5. Educate
patients about side effects and reporting.
Intramuscular (IM) MedicationsVaccines, antibiotics, certain medications1. Choose appropriate needle length and
gauge. 2. Administer into a large muscle mass. 3. Aspirate for blood before injection. 4. Apply pressure to injection site post
withdrawal. 5. Educate patients about side effects and self-care.
Subcutaneous (SC) MedicationsInsulin, heparin,
vaccines
1. Use smaller-gauge needle for SC
injections. 2. Rotate injection sites to
prevent tissue.
damage. 3. Administer at a 45- or 90-degree angle based on body habitus. 4. Educate patients for self
administration when appropriate.
Intradermal (ID)
Medications
Tuberculosis skin
tests, allergy testing
1. Use small-gauge needle to create a
wheal under the skin. 2. Administer at a 5- to 15-degree angle. 3. Instruct patients not to rub the injection site.
Epidural and
Intrathecal
Medications
Pain management, anesthesia, neurologic conditions1. Collaborate with anesthesiologist or specialist. 2. Ensure proper patient
positioning. 3. Monitor for complications such as respiratory
depression. 4. Educate patients about
potential side effects.
Parenteral
Medication Type
Types of Medications AdministeredNursing
Interventions
Epidural and
Intrathecal
Medications
Pain management, anesthesia, neurologic conditions1. Collaborate with anesthesiologist or specialist. 2. Ensure proper patient
positioning. 3. Monitor for complications such as respiratory
depression. 4. Educate patients about
potential side effects.
Central Venous
Catheter (CVC)
Medications
Total parenteral
nutrition (TPN),
chemotherapy, long term antibiotics
1. Ensure aseptic
technique during CVC access. 2. Confirm proper catheter tip placement. 3. Monitor for catheter-related infections. 4. Educate patients on catheter care and signs of
infection.

Intravenous Piggyback (IVPB) Medications 

Additional antibiotics, electrolytes, secondary infusions 

  1. Check compatibility with primary IV  Solution.
  2. Use a separate IV line or port for IVPB. 
  3. Administer per IV infusion rate guidelines. 
  4. Monitor patients on catheter care and signs of infection.

 

Evaluate Client Response to Medication: 

After medication administration, nurses continuously monitor patients for both therapeutic effects and adverse reactions. Monitoring includes assessing vital signs, physical and mental status, laboratory values (e.g., serum drug levels), and the patient’s reported symptoms. 

If adverse effects occur, nurses take appropriate actions, which may include notifying the healthcare provider, adjusting the medication regimen, or providing supportive care. 

Evaluating therapeutic response ensures that the medication is effectively addressing the patient’s health condition. 

Educate Client About Medications: 

Patient education is a fundamental nursing responsibility to ensure medication safety and adherence. 

Nurses provide comprehensive information to patients and their families about the medications they are taking. 

This education includes the medication’s name, purpose, dosage instructions, potential side effects, drug interactions, and precautions. 

 Patients are encouraged to ask questions, clarify doubts, and express concerns about their medications.


Prepare and Administer Medications Using Rights of Medication Administration: 

The “Five Rights” of medication administration (Right Patient, Right Medication, Right Dose, Right Route, and Right Time) form the foundation for safe medication practices. Nurses verify these rights before administering any medication to prevent errors. 

Additional safety checks include confirming patient allergies, assessing the appropriateness of the medication order, and ensuring the medication is prepared and administered accurately.    

Documentation of each medication administration is essential to maintain a complete record of the patient’s medication history and response. 

  • Verify the Five Rights: Before administering any medication, double-check the “Five Rights” to ensure that you are giving the right medication to the right patient, in the right dose, by the right route, and at the right time. 
  • Patient Identification: Confirm the patient’s identity using at least two unique identifiers (e.g., name and date of birth) to prevent medication errors. 
  • Review the Medication Order: Thoroughly review the medication order for accuracy. Ensure it includes the patient’s name, medication name, dosage, route, frequency, and any specific instructions. 
  • Assess the Patient: Conduct a patient assessment to check for allergies, current medications, medical history, vital signs, and any contraindications or potential drug interactions. 
  • Check Medication Labels: Verify the medication label against the medication order to ensure they match. Pay attention to the medication name, strength, expiration date, and any special handling instructions. 
  • Prepare Medications in a Clean Area: Prepare medications in a clean and well-lit area. Avoid distractions and interruptions during the preparation process. Use Appropriate Personal Protective Equipment (PPE): Depending on the medication and route of administration, wear the necessary PPE, such as gloves, masks, or gowns. Administer the Medication According to the Prescribed.
  • Route: Ensure that you are using the correct route of administration (e.g., oral, IV, IM, SC) as specified in the medication order. Educate the Patient: Inform the patient about the medication, including its purpose, potential side effects, and any special instructions for taking it. 
  • Observe for Allergic Reactions: Stay with the patient for a period after administering the medication to monitor for any immediate allergic reactions or adverse effects. 
  • Document Administration: Accurately document the medication administration in the patient’s medical record. Include details such as the date, time, medication name, dose, route, and the patient’s response. 
  • Properly Dispose of Waste: Dispose of any used supplies and medications appropriately, following institutional guidelines and environmental regulations. 
  • Medication Reconciliation: Regularly review the patient’s medication list to ensure it is up-to-date and accurate. Address any discrepancies or potential drug interactions. 
  • Stay Informed: Stay updated on the latest medication guidelines, dosage recommendations, and best practices through ongoing education and training. 
  • Report Medication Errors: If a medication error occurs, report it immediately to the appropriate authority, such as a supervisor or the hospital’s medication safety officer. Follow the organization’s established procedures for error reporting and documentation. 
  • Maintain Patient Privacy and Dignity: Respect the patient’s privacy and dignity during the medication administration process. Use curtains or screens when needed and ensure the patient is comfortable. 
  • Seek Clarification: If you have any doubts or concerns about the medication order, dosage calculation, or administration process, seek clarification from a pharmacist or prescriber before proceeding. 
  • Follow Manufacturer’s Instructions: Adhere to any specific instructions provided by the medication manufacturer, especially when dealing with special dosage forms, reconstitution, or dilution. 
Medication TypeRules for Administration
Tablets/Capsules1. Check the medication order for accuracy.
2. Administer with a full glass of water, unless
otherwise specified.
3. Ensure the patient can swallow tablets or
capsules safely. Consider breaking or crushing
them if necessary and if allowed by prescriber.
Liquid Medications1. Measure the exact dose using a calibrated
medication cup or oral syringe.
2. Administer slowly along the inner cheek,
allowing the patient to swallow gradually.
3. Encourage water intake after administration.
Suspensions1. Shake the suspension well before measuring
the dose.
2. Measure the exact dose using a calibrated
medication cup or oral syringe.
3. Administer slowly along the inner cheek,
allowing the patient to swallow gradually.
Enteric-Coated Tablets1. Do not crush, break, or chew these tablets, as
it may interfere with their delayed release
properties.
Chewable Tablets1. Administer these tablets directly to the
patient to chew and swallow.
Sublingual/ Buccal Tabs1. Place the tablet under the tongue (sublingual)
or between the cheek and gum (buccal).
2. Instruct the patient not to swallow until the
tablet has dissolved completely.
Effervescent Tablets1. Dissolve the tablet in a glass of water before
administration. Ensure the patient drinks the entire solution.
tablet has dissolved completely
Effervescent Tablets1. Dissolve the tablet in a glass of water before
administration. Ensure the patient drinks the
entire solution.
Medication TypeRules for Administration
Orally Disintegrating Tablets (ODT)1. Place the tablet on the patient’s tongue and allow it to dissolve without chewing or swallowing.
Oral Powders1. Mix the powder with a specified amount of liquid or food, as directed, before administration.
Oral Drops/Solutions1. Measure the exact dose using a calibrated dropper or oral syringe.
2. Administer the drops or solution slowly into the patient's mouth.
Troches/Lozenges1. Instruct the patient to let the troche or lozenge dissolve slowly in their mouth without chewing or swallowing.
Oral Dissolving Strips1. Place the strip on the patient’s tongue and allow it to dissolve without chewing or swallowing.
Oral Sprays1. Administer the prescribed number of sprays into the mouth, following the specific instructions for the medication.

Titrating Dosage of Medication Based on Assessment and Ordered Parameters: 

Interventions:

  1. Monitor the patient’s vital signs, symptoms, and response to the medication. 
  2. Collaborate with the healthcare team to determine appropriate titration protocols. 
  3. Educate the patient about the importance of reporting any changes in symptoms or side effects. 

Dispose of Medications Safely:

Interventions:

  1. Follow institutional guidelines and local regulations for proper medication disposal. 
  2. Educate patients on safe medication disposal practices at home, such as using medication take-back programs or disposal pouches. 

Handle and Maintain Medication in a Safe and Controlled Environment: 

Interventions: 

  1. Ensure that medications are stored in designated, locked storage areas. 
  2. Regularly check medication expiration dates and remove expired medications. 
  3. Maintain proper temperature and humidity conditions for medications, especially those requiring refrigeration. 

Evaluate Appropriateness and Accuracy of Medication Order for the Client: 

Interventions: 

  1. Verify the medication order with the prescriber if there are any concerns about appropriateness or accuracy. 
  2. Check the patient’s allergies and potential drug interactions before administration. 
  3. Use a structured verification process, such as the “Five Rights” of medication administration, to ensure accuracy. 

Handle and Administer High-Risk Medications Safely: 

Interventions: 

  1. Implement additional safety checks, such as using a two person verification process for high-risk medications. 
  2. Educate the patient about the medication and potential side effects. 
  3. Monitor the patient closely after administration for any adverse reactions. 

Monitor Intravenous Infusion and Maintain Site: 

Interventions: 

  1. Check the IV infusion rate according to the prescribed order and adjust as needed. 
  2. Inspect the IV site regularly for signs of infiltration or phlebitis, such as redness, swelling, or pain. 
  3. Maintain aseptic technique during IV site care and dressing changes.
CharacteristicInfiltrationPhlebitis
DescriptionIV fluids or
medications enter.
surrounding tissue
Inflammation of the vein where the IV is inserted
Signs and Symptoms- Edema (swelling) around site-
Coolness or blanching of skin - Pain or discomfort-
Sluggish or stopped infusion
- Redness, warmth, or tenderness - Pain or discomfort - Swelling or
induration -
Palpable cord-like vein
Nursing
Interventions
1. Stop infusion
2. Remove catheter.
Gently
3. Elevate affected limb (if
appropriate) 4. Apply warm.
Compress
5.Document incident
1. Stop infusion if
Suspected reaction
2.Remove catheter gently
3. Apply warm, moist compress
4. Administer pain relief or anti-inflammatory meds (if ordered)
5. Document incident and extent of
Phlebitis
6. Assess for systemic signs of infection
7. Consider alternative access sites if recurrent
CausesLeakage of IV fluids or medicationsMechanical irritation, chemical irritation, or infection
Common TriggersCatheter dislodgment, high infusion
pressures
Prolonged catheter dwell time, irritating medications, poor
catheter care
PreventionSecure catheter
properly, monitor site regularly
Proper catheter
insertion technique, use less-irritating.
solutions, maintain aseptic technique
ComplicationsTissue damage,
potential infection
Progression to
cellulitis or
bloodstream infection

Administer Medications for Pain Management: 

Interventions:

  1. Assess the patient’s pain intensity using a standardized pain scale. 
  2. Administer pain medications as ordered by the healthcare provider. 
  3. Monitor for pain relief and assess for potential side effects, such as respiratory depression with opioids. 
MedicationIndicationsCommon Side
Effects
Adverse
Effects
Nursing
Considerations
Contraindications
Acetaminophen
(Tylenol)
Mild to
moderate pain, fever
Nausea,
liver
toxicity
(rare)
Hepatotoxicity,
severe
skin
reactions, overdose risk
Monitor
liver
function
in long
term use. Avoid
alcohol
consumption.
Educate
on
maximum daily
dose.
Severe
liver
disease,
alcoholism
Ibuprofen (Advil,
Motrin)
Pain,
inflammation, fever
Upset
stomach, heartburn, ulcers
Gastrointestinal
bleeding, renal
impairment
Administer with
food or
milk.
Monitor
renal
function
and signs of
bleeding. Educate
on
potential
GI and
cardiovascular
risks.
Peptic
ulcers,
kidney
disease
Naproxen (Aleve)Pain,
inflammation
Stomach pain,
nausea,
ulcers
Gastrointestinal
bleeding, renal
impairment
Administer with
food or
milk.
Monitor
renal
function
and signs of
bleeding. Educate
on
potential
GI and
cardiovascular
risks.
Peptic
ulcers,
kidney
disease
AspirinPain,
inflammation, fever, heart
conditions
Upset
stomach, bleeding
Gastrointestinal
bleeding, bleeding
disorders
Administer with
food or
milk.
Monitor
for
bleeding. Educate
on the risk of Reye’s syndrome in children with viral infections.
Bleeding
disorders, children
MorphineSevere
pain,
post
surgery,
cancer
pain
Drowsiness,
constipation,
nausea
Respiratory
depression,
addiction, overdose risk
Administer with
caution in opioid
naive
patients.
Monitor
respirator y rate and bowel
function. Educate
on signs
of
overdose and
withdrawal.
Respiratory
depression, opioids
OxycodoneModerate to severe painDrowsiness,
constipation,
nausea
Respirator y
depression,
addiction, overdose risk
Administer with
caution in opioid
naive
patients.
Monitor
respirator y rate and bowel
function. Educate
on signs
of
overdose and
withdrawal.
Respirator y
depression, opioids
HydrocodoneModerate to severe painDrowsiness,
constipation,
nausea
Respiratory
depression,
addiction, overdose risk
Administer with
caution in opioid
naive
patients.
Monitor
respirator y rate and bowel
function. Educate
on signs
of
overdose and
withdrawal.
Respiratory
depression, opioids
TramadolModerate to
moderately severe
pain
Dizziness, nausea,
constipation
Seizures, serotonin syndrome, respirator y
depression
Monitor
for signs
of
serotonin syndrome. Educate
on the risk of
seizures, especially in patients with a
history of seizures.
Seizures, serotonin syndrome
CodeineMild to
moderate pain,
cough
Drowsiness,
constipation,
nausea
Respirator y
depression,
addiction, overdose risk
Administer with
caution in opioid
naive
patients.
Monitor
respirator y rate and bowel
function. Educate
on signs
of
overdose and
withdrawal.
Respirator y
depression, opioids
FentanylSevere
pain,
chronic
pain,
anesthesia
induction
Drowsiness,
constipation
Respirator y
depression,
addiction, overdose risk
Administer with
caution in opioid
naive
patients.
Monitor
respirator y rate and bowel
function. Educate
on signs
of
overdose and
withdrawal.
Respirator y
depression, opioids
HydromorphoneModerate to severe painDrowsiness,
constipation,
nausea
Respirator y
depression,
addiction, overdose risk
Administer with
caution in opioid
naive
patients.
Monitor
respirator y rate and bowel
function. Educate
on signs
of
overdose and
withdrawal.
Respiratory
depression, opioids
BuprenorphinePain,
opioid
addiction treatment
Nausea,
headache, constipation
Respirator y
depression,
withdrawal risk
Administer
sublingually or as a transdermal patch.
Monitor
for signs
of opioid
withdrawal or
overdose. Educate
on proper use and
potential
risks.
Severe
respirator y disease
GabapentinNeuropathic pain,
seizures, restless
legs
syndrome
Dizziness, drowsiness, dry
mouth
Suicidal
thoughts, severe
skin
reactions
Monitor
for
changes
in mood
or
behavior. Educate
on the risk of suicidal thoughts, especially in younger patients.
Hypersensitivity to gabapentin or
pregabalin
PregabalinNeuropathic pain,
seizures, fibromyalgia
Dizziness, drowsiness, dry
mouth
Suicidal
thoughts, severe
skin
reactions
Monitor
for
changes
in mood
or
behavior. Educate
on the risk of suicidal thoughts, especially in younger patients.
Hypersensitivity to pregabalin
Lidocaine (Topical)Localized pain reliefSkin
irritation, redness,
itching
Allergic
reactions, systemic toxicity
Apply as
directed, avoid.
broken
skin or
mucous
membranes.
Monitor
for signs
of
systemic toxicity.
Educate
on proper application and
potential
risks.
Hypersensitivity,
heart
block
Ketorolac (Toradol)Short
term
management of
moderate to severe pain
Nausea,
stomach
pain,
ulcers
Gastrointestinal
bleeding, renal
impairment
Administer for a
limited
duration
(Usually
less than 5 days).
Monitor
renal
function
and signs of
bleeding. Educate
on
potential
GI and
renal
risks.
Active
peptic
ulcers,
renal
impairment
Celecoxib (Celebrex)Pain,
inflammation
Upset
stomach, headache
Cardiovascular
events, GI bleeding
risk
Administer with
food.
Monitor
blood
pressure
and signs of GI
bleeding. Educate
on
potential
cardiovascular and GI risks.
Allergy to sulfonamides, heart disease

Handle and Administer Controlled Substances Within Regulatory Guidelines: 

Interventions: 

  Strictly adhere to legal and regulatory guidelines for controlled substance administration and documentation. Use secure storage and access control measures for controlled substances. 

Educate the healthcare team and patients about the risks associated with controlled substances. 

Storage: 

Controlled substances must be stored in a securely locked, substantially constructed cabinet or cart. 

Access to these areas should be limited to only authorized personnel. 

Administration: 

Verify physician’s orders for clarity and appropriateness. Double-check doses with another nurse before administering, especially with high-risk medications like narcotics. Always administer the drug personally and never leave it unattended. 

Documentation: 

Document immediately after administration to ensure accurate tracking. Utilize proper documentation forms or electronic health record systems that allow for tracking and auditing of controlled substance administration. Record the patient’s name, drug name, dose, route, and time of administration, as well as the name of the person administering the drug. 

Waste and Disposal: 

Any waste of a controlled substance (e.g., a broken vial) needs to be documented and witnessed by another nurse or authorized person. Controlled substances should be disposed of according to facility policy and federal and state regulations, often requiring specific disposal methods or return to a designated pharmacy. 

Counting: 

Regularly count the stock of controlled substances, typically at the beginning and end of each shift. This should be a witnessed process. Any discrepancies should be reported immediately. 

Patient Assessment: 

Regularly assess the patient for pain or the need for the controlled substance to ensure the drug is achieving the desired effect and to monitor for potential adverse reactions.Be vigilant about the potential for drug-seeking behaviors in patients and report any concerns. 

Education: 

Ensure that patients and their families understand the nature of controlled substances, their side effects, and the risks associated with misuse. 

Instruct patients on the proper storage and disposal of these medications at home. 

Reporting: 

If there’s suspicion or evidence of diversion (someone diverting the drug for their own use or sale), it should be reported immediately according to facility policy and potentially to regulatory bodies. 

Continuing Education: 

Regularly participate in training and education about controlled substances, their effects, and proper handling procedures. 

Collaboration: 

Collaborate with pharmacists, physicians and other members of the healthcare team to ensure safe and effective use of controlled substances. 

Audit and Monitoring: 

Many facilities utilize electronic systems to monitor the administration of controlled substances, which can flag potential issues like a nurse administering a higher-than average number of narcotic doses. Always adhere to your specific facility’s policy and procedures, and remain updated on federal, state, and local regulations regarding controlled substances.

Neurological Medications

MedicationIndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Acetylcholinesterase
Inhibitors
Alzheimer’s Disease,
Dementia
Nausea,
vomiting,
diarrhea,
headache,
dizziness
Bradycardia, GI bleeding, seizuresMonitor for GI distress; administer.
with meals, assess for
bradycardia; educate.
patients on risks and
benefits.
Dopamine
Agonists
Parkinson’s Disease,
Restless
Legs
Syndrome
Nausea,
dizziness,
orthostatic hypotension, hallucination s
Impulse
control
disorders,
psychosis
Monitor for motor.
fluctuations; assess for
neuropsychiatric side
effects.
educate on safety.
precautions.
Antiepileptic Drugs
(AEDs)
Epilepsy,
Seizure
Disorders
Drowsiness, dizziness,
weight gain, liver toxicity
Stevens
Johnson
syndrome,
blood
disorders
Monitor
serum drug levels.
educate on consistent.
dosing and potential
drug
interactions.
Selective
Serotonin
Reuptake
Inhibitors
(SSRIs)
Depression, Anxiety
Disorders
Nausea,
insomnia,
sexual
dysfunction
Serotonin
syndrome,
suicidal
ideation
Monitor for signs of
serotonin
syndrome.
assess for
worsening
depression; educate on gradual dose changes.
Antipsychotic
Medications
Schizophrenia, Bipolar
Disorder
Extrapyramidal
symptoms
(EPS),
weight gain, sedation
Neuroleptic malignant
syndrome
(NMS),
agranulocytosis
Monitor for EPS.
educate on EPS.
management; assess for signs of
NMS.
Migraine
Medications
Migraine
Headaches
Dizziness,
fatigue,
chest
pressure
Serotonin
syndrome,
medication overuse
headache
Educate on proper use (acute vs.
preventive); assess for
medication overuse.
monitor for serotonin.
syndrome.
Donepezil
(Acetylcholinesterase
Inhibitor)
Alzheimer’s Disease,
Dementia
Nausea,
vomiting,
diarrhea,
headache,
dizziness
Bradycardia, GI bleeding, seizuresMonitor for GI distress; administer.
with meals, assess for
bradycardia; educate.
patients on risks and
benefits.
Levodopa/
Carbidopa (Dopamine Agonist)
Parkinson’s Disease,
Restless
Legs
Syndrome
Nausea,
dizziness,
orthostatic hypotension, hallucination s
Impulse
control
disorders,
psychosis
Monitor for motor.
fluctuations; assess for
neuropsychiatric side
effects.
educate on safety.
precautions.
Valproic
Acid
(Antiepileptic Drug -
AED)
Epilepsy,
Seizure
Disorders
Drowsiness, dizziness,
weight gain, liver toxicity
Stevens
Johnson
syndrome,
blood
disorders
Monitor
serum drug levels.
educate on consistent.
dosing and potential
drug
interactions.
Sertraline
(Selective
Serotonin
Reuptake
Inhibitor -
SSRI)
Depression, Anxiety
Disorders
Nausea,
insomnia,
sexual
dysfunction
Serotonin
syndrome,
suicidal
ideation
Monitor for signs of
serotonin
syndrome.
assess for
worsening
depression; educate on gradual dose changes.
Risperidone (Antipsychotic
Medication)
Schizophrenia, Bipolar
Disorder
Extrapyramidal
symptoms
(EPS),
weight gain, sedation
Neuroleptic malignant
syndrome
(NMS),
agranulocytosis
Monitor for EPS.
educate on EPS.
management; assess for signs of
NMS.
Sumatriptan (Migraine Medication)Migraine
Headaches
Dizziness,
fatigue,
chest
pressure
Serotonin
syndrome,
medication overuse
headache
Educate on proper use (acute vs.
preventive); assess for
medication overuse.
monitor for serotonin.
syndrome.
Lamotrigine (Antiepileptic Drug -
AED)
Epilepsy,
Bipolar
Disorder
Dizziness,
headache,
rash, blurred vision
Stevens
Johnson
syndrome,
aseptic
meningitis
Monitor for rash,
especially
during initial weeks.
educate on the
importance of gradual
dose
titration.
Gabapentin (Antiepileptic Drug -
AED)
Epilepsy,
Neuropathic Pain
Drowsiness, dizziness,
peripheral
edema
Mood
changes,
suicidal
ideation
Assess for
mood
changes and suicidal
thoughts.
educate on gradual dose adjustments.
Amitriptyline (Tricyclic Antidepressant)Depression, Neuropathic PainDry mouth, constipation, drowsinessOrthostatic hypotension, cardiac
arrhythmias
Monitor for orthostatic hypotension; educate on safety.
precautions when
changing
positions.
Haloperidol (Antipsychotic
Medication)
Schizophrenia, DeliriumExtrapyramidal
symptoms
(EPS),
sedation,
dry mouth
Neuroleptic malignant
syndrome
(NMS), QT
prolongation
Monitor for EPS.
educate on EPS.
management; assess for signs of
NMS.
monitor ECG for QT
prolongation.
Topiramate (Antiepileptic Drug -
AED)
Epilepsy,
Migraine
Prophylaxis
Cognitive
impairment, weight loss, paresthesia
Metabolic
acidosis,
acute
narrow
angle
glaucoma
Monitor for cognitive.
changes.
assess for
metabolic
acidosis.
educate on glaucoma.
risks.
Baclofen
(Muscle
Relaxant)
Muscle
Spasticity,
Spinal Cord Injury
Drowsiness, weakness,
dizziness
Respiratory depression, hallucination sMonitor for CNS
depression; educate on safe use and withdrawal protocols.
Phenytoin
(Antiepileptic Drug -
AED)
Epilepsy,
Seizure
Disorders
Nausea,
dizziness,
gingival
hyperplasia
Stevens
Johnson
syndrome,
agranulocytosis
Monitor
serum drug levels.
assess for
gingival
hyperplasia; educate on good oral.
hygiene.
Carbamazepine
(Antiepileptic Drug -
AED)
Epilepsy,
Bipolar
Disorder
Dizziness,
drowsiness, rash
Aplastic
anemia,
agranulocytosis
Monitor
complete
blood
counts.
assess for
rash,
especially
during initial weeks.
Escitalopram
(Selective
Serotonin
Reuptake
Inhibitor -
SSRI)
Depression, Anxiety
Disorders
Nausea,
insomnia,
sexual
dysfunction
Serotonin
syndrome,
suicidal
ideation
Monitor for signs of
serotonin
syndrome.
assess for
worsening
depression.
Olanzapine (Antipsychotic
Medication)
Schizophrenia, Bipolar
Disorder
Weight gain, sedation,
dry mouth
Metabolic
syndrome,
hyperglycemia
Monitor
weight and glucose
levels.
educate on dietary and lifestyle.
changes.
Pregabalin (Antiepileptic Drug -
AED)
Epilepsy,
Neuropathic Pain
Dizziness,
peripheral
edema,
weight gain
Suicidal
ideation,
angioedema
Assess for
mood
changes and suicidal
thoughts.
monitor for angioedema.
Memantine (NMDA
Receptor
Antagonist)
Alzheimer’s DiseaseDizziness,
headache,
confusion
Hallucination s, seizuresEducate on gradual dose titration.
monitor for cognitive.
changes.
Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Rivastigmine
(Cholinesterase
Inhibitor)
Alzheimer’s Disease,
Dementia
Nausea,
vomiting,
diarrhea,
dizziness
Bradycardia, GI bleeding, seizuresMonitor for GI distress; administer.
with meals, assess for
bradycardia; educate.
patients on risks and
benefits.
Ropinirole (Dopamine Agonist)Parkinson’s Disease,
Restless
Legs
Syndrome
Nausea,
dizziness,
orthostatic hypotension, hallucination s
Impulse
control
disorders,
psychosis
Monitor for motor.
fluctuations; assess for
neuropsychiatric side
effects.
educate on safety.
precautions.
Lacosamide (Antiepileptic Drug -
AED)
Epilepsy,
Seizure
Disorders
Dizziness,
headache,
blurred
vision
Cardiac
arrhythmias, suicidal
ideation
Monitor ECG for cardiac effects.
assess for
changes in mood and
behavior.
educate on gradual dose adjustments.
Duloxetine (Serotonin Norepinephrine
Reuptake
Inhibitor -
SNRI)
Depression, Neuropathic PainNausea, dry mouth,
constipation
Serotonin
syndrome,
hepatotoxicity
Monitor for signs of
serotonin
syndrome.
assess liver function.
educate on potential.
side effects.
Quetiapine (Antipsychotic
Medication)
Schizophrenia, Bipolar
Disorder
Weight gain, sedation,
dry mouth
Neuroleptic malignant
syndrome
(NMS),
hyperglycemia
Monitor
weight and glucose
levels.
educate on dietary and lifestyle.
changes.
assess for
signs of
NMS.
Zolmitriptan (Migraine Medication)Migraine
Headaches
Dizziness,
fatigue,
throat
tightness
Serotonin
syndrome,
medication overuse
headache
Educate on proper use (acute vs.
preventive); assess for
medication overuse.
monitor for serotonin.
syndrome.
Lorazepam (Benzodiazepine)Anxiety,
Seizure
Disorders
Drowsiness, dizziness,
sedation
Respiratory depression, paradoxical reactionsMonitor
respiratory status.
assess for
paradoxical reactions.
educate on potential for dependence.
Tizanidine (Muscle
Relaxant)
Muscle
Spasticity,
Spinal Cord Injury
Drowsiness, dry mouth, hypotensionHepatotoxicity,
hallucination s
Educate on gradual dose titration.
monitor liver function.
assess for
CNS effects.
Mirtazapine (Atypical
Antidepressant)
Depression, Anxiety
Disorders
Weight gain, increased.
appetite,
drowsiness
Serotonin
syndrome,
agranulocytosis
Monitor for signs of
serotonin
syndrome.
assess for
changes in weight and mood.
Clozapine
(Antipsychotic
Medication)
Schizophrenia,
Treatment
Resistant
Psychosis
Weight gain, sialorrhea
(Excessive
salivation), sedation
Agranulocytosis,
myocarditis
Monitor
white blood cell counts; assess for
signs of
agranulocytosis and
cardiac
symptoms.
Pregabalin (Antiepileptic Drug -
AED)
Epilepsy,
Neuropathic Pain
Dizziness,
peripheral
edema,
weight gain
Suicidal
ideation,
angioedema
Assess for
mood
changes and suicidal
thoughts.
monitor for angioedema.
Amantadine (Dopamine Agonist)Parkinson’s Disease,
Influenza
Prophylaxis
Livedo
reticularis,
dizziness,
confusion
Hallucination s, seizuresMonitor for central.
nervous
system
(CNS)
effects.
assess skin changes.

Increased ICP Treatment

Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
MannitolIncreased
Intracranial Pressure
(ICP),
Cerebral
Edema
Diuresis,
electrolyte
imbalances, dehydration
Pulmonary
edema,
hypotension, hypernatremia
Monitor
serum
electrolytes, fluid
balance, and urine output; assess for
signs of
dehydration and
pulmonary
edema.
Hypertonic Saline
Solution
Increased
ICP, Cerebral Edema
Hypernatremia,
electrolyte
imbalances
Fluid
overload,
hypotension, rebound.
intracranial hypertension
Monitor
serum
sodium
levels,
neurological status, and vital signs; administer.
slowly to
prevent
complication s.
Dexamethasone
(Steroid)
Cerebral
Edema
(Associated with tumors or
inflammation)
Hyperglycemia, mood
changes,
gastrointestinal upset
Immunodeficiency,
adrenal
suppression
Monitor
blood
glucose
levels.
educate
patients on the
importance of tapering the
medication.
PropofolInduction
and
Maintenance of
Anesthesia, Sedation
(ICU)
Respiratory depression, hypotension, bradycardiaPropofol
infusion
syndrome
(Rare but
serious)
Continuously monitor
vital signs
and
neurological status
during
infusion; use with caution in critically ill patients.

Ophthalmic (Eye) Medications

Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Latanoprost (Prostaglandin Analog)Glaucoma,
Ocular
Hypertension
Stinging, eye redness,
eyelash
changes
Iris
pigmentation, eyelash
growth,
macular
edema
Instruct
patients to
apply in the evening.
monitor for changes in eye color.
and vision.
Timolol
(Beta
Blocker)
Glaucoma,
Ocular
Hypertension
Burning,
stinging,
blurred
vision
Bradycardia, bronchospasm, heart
block
Assess for
contraindications (e.g., heart or
respiratory conditions); monitor
heart rate.
Brimonidine (Alpha
Agonist)
Glaucoma,
Ocular
Hypertension
Dry mouth, eye
irritation,
fatigue
Allergic
reactions,
hypotension, CNS effects
Advise
patients on proper
instillation
technique.
monitor
blood
pressure.
Dorzolamide (Carbonic Anhydrase Inhibitor)Glaucoma,
Ocular
Hypertension
Bitter taste, eye burning, blurred.
vision
Metabolic
acidosis,
Stevens
Johnson
syndrome
Monitor for signs of
metabolic
acidosis.
educate on proper.
administration.
Prednisolone
(Corticosteroid)
Ocular
Inflammation, Allergic
Conjunctivitis
Temporary stinging,
blurred
vision
Increased
intraocular pressure,
cataracts,
delayed
wound
healing
Caution in
glaucoma
patients.
monitor for elevated.
IOP.
Ciprofloxacin
(Antibiotic)
Bacterial Eye InfectionsBurning,
itching,
redness
Allergic
reactions,
corneal
deposits,
secondary
infections
Educate on proper hand hygiene and administration, monitor.
for adverse reactions.

Ear Medications

Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Acetic Acid SolutionOtitis
Externa
(Swimmer’s Ear)
Temporary stinging,
burning
Allergic
reactions,
irritation,
pain
Educate on proper.
administration; ensure.
the ear canal is free from obstructions.
Ciprofloxacin
Dexamethasone
(Combination)
Otitis Media with
Otorrhea
Ear
discomfort, itching
Allergic
reactions,
secondary
infections
Monitor for signs of
infection.
educate on appropriate administration technique.
Hydrocortis one (Topical Corticosteroid)Otitis
Externa,
Otitis Media
Temporary stinging,
itching
Thinning of the ear canal skin,
delayed
wound
healing
Caution in
patients with perforated
eardrum.
monitor for adverse.
effects on
the ear
canal.
Neomycin Polymyxin B
Hydrocortis one
(Combination)
Otitis
Externa
Temporary stinging,
itching
Allergic
reactions,
ototoxicity, fungal
infections
Assess for
signs of
ototoxicity; educate on appropriate use and
duration.
Gentamicin (Aminoglycoside
Antibiotic)
Severe Otitis ExternaEar
discomfort, temporary
hearing loss
Ototoxicity, vestibular
disturbances
Monitor
hearing.
caution in
patients with perforated
eardrum.
educate on proper.
administration.
Acetaminophen (Oral)Ear Pain
(Analgesic)
Nausea,
stomach
upset
Liver toxicity (rare at
therapeutic doses)
Administer as directed for pain.
relief.
educate on appropriate dosing.

Cardiovascular Medications

MedicationIndicationsSide
Effects
Adverse
Effects
Nursing
Interventions
Contraindications
ACE
Inhibitors (e.g., Lisinopril, Enalapril)
Hypertension, heart failure,
post
myocardia l
infarction.
Cough,
elevated
blood
urea
nitrogen, hyperkalemia
Angioedema, renal failureMonitor
blood
pressure, renal
function, and
potassium levels.
History of angioedema, bilateral
renal
artery
stenosis.
Beta
Blockers (e.g., Metoprolol,
Atenolol)
Hypertension,
angina,
heart
failure,
arrhythmias.
Fatigue,
bradycardia,
hypotension
Heart
block,
bronchospasm
Monitor
heart rate and blood pressure, teach.
patient to rise slowly
Asthma,
bradycardia.
Calcium
Channel
Blockers
(e.g., Amlodipine,
Diltiazem)
Hypertension,
angina,
arrhythmias.
Peripheral edema,
constipation, dizziness
Severe
hypotension,
bradycardia
Monitor
blood
pressure, heart rate, and signs of edema.
Severe
hypotension, heart block.
Diuretics (e.g., Furosemide,
Hydrochlorothiazide)
Hypertension, heart failure,
edema.
Electrolyte
imbalance s,
dehydration
Ototoxicity (with
loop
diuretics)
Monitor
blood
pressure, renal
function, and
electrolytes. Potassium can go down
Anuria,
severe
renal
impairment.
Nitrates (e.g., Nitroglycerin)Angina,
heart
failure.
Headache,
dizziness, hypotension
Reflex
tachycardia
Monitor
blood
pressure educate. on
appropriate use and storage (med is light-sensitive over time).
Use of
phosphodiesterase
inhibitors like
sildenafil.(Viagra)
MedicationIndicationsSide
Effects
Adverse
Effects
Nursing
Interventions
Contraindications
Anticoagulants (e.g.,
Warfarin, Heparin)
Prevent and treat thromboembolic.
disorders
Bleeding, anemiaHemorrhage,
heparin
induced
thrombocytopenia
(HIT)
Monitor INR/PT
(warfarin), aPTT
(heparin), signs of
Bleeding
Dietary education
Active
bleeding, thrombocytopenia, severe
hypertension
Antiplatelets (e.g.,
Aspirin,
Clopidogrel)
Prevent
thrombus formation in arterial circulation
GI upset, rashGI
bleeding, thrombocytopenia
Monitor
for signs
of
bleeding, platelet
count
Peptic
ulcer
disease,
active
bleeding
Statins (e.g.,
Atorvastatin,
Simvastatin)
Lower LDL cholesterolGI upset, muscle
aches
Rhabdomyolysis,
hepatotoxicity
Monitor
liver
enzymes, CK levels if muscle pain
Liver
disease,
unexplained
elevated
liver
enzymes
ARBs
(e.g.,
Losartan, Valsartan)
Hypertension, heart failure,
diabetic
nephropathy
Dizziness, hyperkalemiaRenal
dysfunction,
angioedema
Monitor
blood
pressure, renal
function, potassium levels
Pregnancy, bilateral renal
artery
stenosis
Alpha
Blockers
(e.g., Doxazosin,
Prazosin)
Hypertension,
benign
prostatic
hyperplasia
Dizziness, headacheOrthostatic
hypotension,
tachycardia
Monitor
blood
pressure, advise to rise slowly from
sitting/
lying
positions
Severe
hepatic
impairment
MedicationIndicationsSide
Effects
Adverse
Effects
Nursing
Interventions
Contraindications
Aldosterone
Antagonists (e.g.,
Spironolactone)
Heart
failure,
Hypertension
Gynecomastia,
menstrual irregularities
HyperkalemiaMonitor
potassium levels,
avoid
additional potassium supplementation
Acute
kidney
injury,
hyperkalemia
Cardiac
Glycoside s(e.g., Digoxin)
Heart
failure,
Atrial
fibrillation
Fatigue,
visual
disturbances
Digoxin
toxicity
(Arrhythmias,
confusion)
Monitor
serum
digoxin
levels,
check
apical
pulse
before
administration
Ventricular
fibrillation, digoxin
toxicity
Direct
acting
vasodilators(e.g.,
Hydralazine,
Minoxidil)
HypertensionHeadache,
palpitation s
Reflex
tachycardia, sodium retention
Monitor
blood
pressure
closely,
check for edema
Coronary artery
disease,
mitral
valve
rheumatic heart
disease
(For
Minoxidil)
Class I
Antiarrhythmics (e.g.,
Quinidine, Lidocaine)
Ventricular
arrhythmias
Nausea,
diarrhea
Torsade’s de pointes (Quinidine), CNS
effects
(Lidocaine)
Monitor
for EKG
changes, check for therapeutic plasma.
levels
Heart
block,
severe
hypotension (for
Lidocaine)
Class III
Antiarrhythmics (e.g.,
Amiodarone)
Supraventricular and ventricular
arrhythmias
Photosensitivity, GI
upset
Pulmonary fibrosis, thyroid
dysfunction
Monitor
EKG, lung and
thyroid
function
tests
Severe
sinus
bradycardia, heart
block
Beta
Adrenergic
Blockers (e.g., Carvedilol,
Labetalol)
Hypertension, Heart failureFatigue,
dizziness
Bradycardia,
hypotension
Monitor
heart rate and blood pressure, advise.
against
abrupt
cessation
Asthma,
sinus
bradycardia

Medication for Dysrhythmias

MedicationIndicationsSide
Effects
Adverse
Effects
Nursing
Interventions
Contraindications
Class Ia
Antiarrhythmics (e.g.,
Quinidine, Procainamide,
Disopyramide)
Atrial and ventricular
arrhythmias
Dizziness, nausea,
blurred
vision
Ventricular
tachycardia, heart
block
Monitor
EKG
regularly, observe.
for
hypotension
Myasthenia gravis
(Disopyramide)
Class Ib
Antiarrhythmics (e.g.,
Lidocaine, Mexiletine)
Ventricular
arrhythmias
Drowsiness, tremorsCNS
disturbances,
respirator y arrest
Monitor
EKG and
CNS
status,
ensure
rapid IV
access
Third
degree
heart
block
Class Ic
Antiarrhythmics (e.g.,
Flecainide,
Propafenone)
Supraventricular and ventricular
arrhythmias
Dizziness, visual
disturbances
Worsening heart
failure,
ventricular
arrhythmias
Monitor
EKG,
observe
for signs
of heart
failure
Recent
myocardia l
infarction, severe
heart
failure
Class II
Antiarrhythmics (e.g.,
Propranolol,
Esmolol)
Supraventricular
tachycardia, atrial
fibrillation/ flutter
Fatigue,
dizziness
Bradycardia,
bronchospasm
Monitor
heart rate and blood pressure, check
lung
function
Asthma,
second or third
degree
heart
block
Class IV
Antiarrhythmics (e.g.,
Verapamil, Diltiazem)
Supraventricular
tachycardia
Constipation,
headache
Heart
block,
hypotension
Monitor
blood
pressure
and heart rate,
assess for constipation
Severe
hypotension, heart block
Other
Agents (e.g.,
Adenosine, Digoxin, Magnesium)
Paroxysm al
supraventricular
tachycardia
(Adenosine), atrial
fibrillation/ flutter
(Digoxin)
Flushing, chest
discomfort
(Adenosine).
fatigue,
anorexia
(Digoxin)
Heart
block,
ventricular
fibrillation (Adenosine); digoxin toxicity
Monitor
EKG
during
Adenosine administration.
monitor
serum
digoxin
levels and EKG for
Digoxin
Second or third
degree
heart
block
(Unless
pacemaker present), Wolff
Parkinson -White
syndrome
Potassium

Channel
Blockers
(e.g., Amiodarone ne,
Sotalol,
Dofetilide)
Atrial and ventricular
arrhythmias
Fatigue,
nausea
Pulmonary fibrosis (Amiodarone),
torsade’s
de pointes (Sotalol,
Dofetilide)
Monitor
for
respirator y issues,
EKG
changes; periodic
ophthalmic exams
for
Amiodarone
Hypokalemia, QT
prolongation
AdenosineParoxysm al
supraventricular
tachycardia (PSVT)
Flushing, chest
Discomfort.
Pt feels as though they “are dying”
Arrhythmias,
transient heart
block
Administer rapidly ACLS Med
over 1-2
seconds
in a large vein,
monitor
EKG
Atrial
fibrillation, atrial
flutter,
ventricular
tachycardia
AtropineSymptomatic
bradycardia
Dry
mouth,
urinary
retention
Tachycardia,
palpitation s
Monitor
heart rate and
rhythm,
blood
pressure
Uncompensated
shock,
hypersensitivity
Digitalis
Glycoside(e.g., Digoxin)
Atrial
fibrillation, heart
failure
Visual
disturbances,
fatigue
Digoxin
toxicity,
arrhythmias
Monitor
apical
pulse,
serum
potassium, and
digoxin
levels
Ventricular
fibrillation, hypersensitivity
Magnesium SulfateTorsade’s de
pointes,
hypomagnesemia
related
arrhythmias
Diarrhea, flushingHypotension,
respirator y
depression
Monitor
serum
magnesium levels,
deep
tendon
reflexes
Kidney
failure,
heart
block
DronedaroneAtrial
fibrillation, atrial
flutter
Diarrhea, nauseaLiver
failure,
pulmonary toxicity
Monitor
liver
function, respirator y status
Permanent atrial
fibrillation, severe
heart
failure

Respiratory Medications

Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Albuterol
(Short
Acting
Beta
Agonist)
Asthma,
COPD
Tremors,
palpitations, headache
Tachycardia, arrhythmias, hypokalemiaAssess
respiratory status
before and after
administration; monitor
heart rate
and
potassium
levels.
Ipratropium (Anticholinergic)COPDDry mouth, throat
irritation
Urinary
retention,
glaucoma,
paradoxical bronchospasm
Assess for
contraindications.
educate on proper.
inhalation
technique.
Fluticasone /Salmeterol (Combination)Asthma,
COPD
Thrush,
hoarseness, headache
Increased
risk of
pneumonia, adrenal
suppression
Rinse mouth after use.
monitor for respiratory infections.
educate on proper use.
Montelukast
(Leukotriene Modifier)
Asthma,
Allergic
Rhinitis
Headache,
abdominal
pain,
insomnia
Mood
changes,
neuropsychi atric events
Assess for
changes in mood and
behavior.
take in the
evening for asthma.
Diphenhydramine
(Antihistamine)
Allergic
Rhinitis,
Cough
Drowsiness, dry mouth, blurred.
vision
Sedation,
anticholinergic effects
Caution with activities
requiring
alertness.
assess for
dry mouth.
Prednisone (Corticosteroid)Asthma,
COPD,
Allergic
Reactions
Increased
appetite,
weight gain, mood
changes
Immunodeficiency,
adrenal
suppression
Taper doses when
discontinuing; monitor
for signs of infection.
educate on risks and
benefits.
Budesonide (Inhaled
Corticosteroid)
Asthma,
COPD
Sore throat, hoarseness, oral
candidiasis
Adrenal
suppression, osteoporosis, cataracts
Rinse mouth after
inhalation.
use spacer with MDI.
monitor
bone health in long-term use.
Tiotropium (Long
Acting
Anticholinergic)
COPDDry mouth, constipation, urinary
retention
Glaucoma,
paradoxical bronchospasm,
arrhythmias
Assess for
contraindications.
educate on proper.
inhalation
technique.
Aclidinium (Long
Acting
Anticholinergic)
COPDHeadache,
dry mouth, sinusitis
Urinary
retention,
glaucoma,
paradoxical bronchospasm
Monitor for urinary.
symptoms; assess for
contraindications.
Methylprednisolone
(Systemic
Corticosteroid)
Severe
Asthma,
Acute
Exacerbation s
Increased
appetite,
mood
changes,
insomnia
Hyperglycemia, GI
bleeding,
immunosuppression
Monitor
blood
glucose
levels.
assess for
signs of
infection.
Cromolyn
Sodium
(Mast Cell
Stabilizer)
Asthma,
Allergic
Rhinitis
Cough,
throat
irritation,
headache
Anaphylaxis (rare),
bronchospasm, rash
Educate on regular use for
prophylaxis; does not
provide
immediate
relief.
Omalizumab (Anti-IgE Monoclonal Antibody)Severe
Allergic
Asthma
Injection site reactions,
headache,
fatigue
Anaphylaxis (rare),
malignancies,
thrombosis
Administer by a
healthcare
provider.
monitor for hypersensitivity.
reactions.
Zafirlukast (Leukotriene Receptor Antagonist)Asthma,
Exercise
Induced
Bronchoconstriction
Headache,
abdominal
pain,
diarrhea
Neuropsychiatric events, Churg
Strauss
syndrome
Educate on long-term.
use; monitor for mood.
changes and eosinophilia.

Oncology Medications

Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
CisplatinVarious
cancers
including
ovarian,
testicular,
lung
Nausea,
vomiting,
kidney
toxicity
Nephrotoxicity,
ototoxicity, peripheral
neuropathy
Monitor
renal
function.
assess
hearing and neuropathy; administer.
adequate
hydration
and
antiemetics.
PaclitaxelBreast,
ovarian, lung cancer,
Kaposi's
sarcoma
Peripheral
neuropathy, alopecia
Hypersensitivity
reactions,
bone
marrow
suppression
Pre
medicate
with
corticosteroids and
antihistamines; monitor for infusion reactions.
ImatinibChronic
Myeloid
Leukemia
(CML),
Gastrointestinal Stromal Tumors
(GISTs)
Edema,
muscle
cramps, rash
Myelosuppression,
hepatotoxicity, heart
failure
Monitor CBC and liver
function.
educate on medication adherence.
RituximabNon
Hodgkin
Lymphoma, CLL,
Rheumatoid Arthritis
Infusion
reactions,
fever
Serious
infections,
heart
arrhythmias, tumor lysis syndrome
Administer in an infusion center.
monitor for signs of
infection and cardiac
effects.
TrastuzumabHER2-
Positive
Breast
Cancer
Cardiotoxicity, infusion
reactions
Heart failure, pulmonary
toxicity,
neutropenia
Monitor
cardiac
function
(e.g., LVEF); assess for
signs of
infusion
reactions.
EtoposideVarious
cancers
including
lung,
testicular
Nausea,
vomiting,
hair loss
Bone
marrow
suppression, secondary
leukemia
Monitor
CBC.
educate on potential.
long-term
effects.
MedicationIndicationsSide
Effects
Adverse
Effects
Nursing
Considerations
Contraindications
DoxorubicinVarious
cancers,
including breast,
lung, and blood
cancers
Nausea,
vomiting, hair loss, cardiotoxicity
Cardiomyopathy,
bone
marrow
suppression
Monitor
cardiac
function, administer through a central
line,
assess for signs of
infection
Severe
heart
disease
PaclitaxelOvarian,
breast,
lung, and other
cancers
Neuropath y,
hypersensitivity
reactions, hair loss
Bone
marrow
suppression, severe allergic
reactions
Pre
medicate with
steroids
and
antihistamines,
monitor
for
hypersensitivity
Severe
hypersensitivity/
allergy
Methotrex ateVarious
cancers,
including leukemia
and non
Hodgkin
lymphoma
Nausea,
mouth
sores,
hepatotoxicity, bone marrow
suppression
Renal
dysfunction, severe mucositis
Administer with
leucovorin rescue,
monitor
renal
function, encourage
hydration
Impaired renal
function, pregnancy
CisplatinVarious
cancers,
including testicular, ovarian,
and lung
cancer
Nausea,
vomiting, kidney
toxicity,
peripheral neuropath y
Nephrotoxicity,
hearing
loss,
electrolyte
imbalance s
Hydrate
adequately, monitor renal.
function, assess.
hearing
Impaired
renal
function, hearing
loss
CyclophosphamideMultiple
cancer
types,
including lymphoma s and
breast
cancer
Nausea,
vomiting, alopecia, hemorrhagic
cystitis
Bone
marrow
suppression,
bladder
toxicity
Encourage hydration, administer with
MESNA to prevent.
cystitis,
monitor
CBC
Severe
bone
marrow
dysfunction
5-
Fluorouracil
(5-FU)
Colorectal, breast,
and other cancers
Diarrhea, mucositis, hand-foot syndromeBone
marrow
suppression, severe gastrointestinal
toxicity
Monitor
for signs
of
gastrointestinal
toxicity,
educate
on hand
foot
syndrome
Bone
marrow
dysfunction,
pregnancy
ImatinibChronic
myeloid
leukemia
(CML),
gastrointestinal
stromal
tumors
(GIST)
Edema,
muscle
cramps,
rash,
myelosuppression
Hepatotoxicity, fluid retention, cardiotoxicityMonitor
CBC, liver function, educate.
on fluid
intake
Severe
liver
disease
RituximabNon
Hodgkin
lymphoma, chronic
lymphocytic
leukemia
(CLL)
Infusion
reactions, fever
Serious
infections, cardiotoxicity
Pre
medicate with
corticosteroids and antihistamines,
monitor
for
reactions
Severe
infections
TamoxifenHormone receptor
positive
breast
cancer
Hot
flashes,
mood
swings
Risk of
endometrial cancer, thromboembolism
Monitor
for signs
of
endometrial cancer, educate.
on
thromboembolic
risks
History of blood
clots,
endometrial cancer
BevacizumabColorectal, lung, and other
cancers
Hypertension,
bleeding
GI
perforation,
impaired
wound
healing
Monitor
blood
pressure, assess for bleeding, educate.
on wound care
Severe
hypertension,
bleeding
disorders

Critical Care Medications

MedicationIndicationsSide
Effects
Adverse
Effects
Nursing
Interventions
Contraindications
Adrenergic
Agonists
-
Epinephrine
Cardiac
arrest,
anaphylaxis, asthma attacks
Palpitation s,
tachycardia, anxiety
Hypertension,
arrhythmias
Monitor
vital
signs,
especially heart rate and
rhythm.
monitor
for chest pain
Narrow
angle
glaucoma, shock
(Other
than
anaphylactic)
-
Norepinephrine
(Levophed)
Shock,
hypotension
Palpitations, anxietyTissue
necrosis
(If
extravasation),
arrhythmias
Monitor
blood
pressure, ensure.
the IV site is patent
Hypotension due to blood
volume
deficit
Benzodiazepines
-
Diazepam (Valium)
Anxiety,
seizures, muscle
spasms
Drowsiness,
dizziness
Respirator y
depression,
dependency
Monitor
respirator y rate,
avoid
alcohol
with use
Myasthenia gravis,
acute
narrow
angle
glaucoma, severe
respirator y
insufficiency, sleep
apnea
Antiarrhythmics
-
Amiodarone
Ventricular and
supraventricular
tachyarrhythmias
Nausea,
dizziness
Pulmonary fibrosis, hepatic
injury
Monitor
for
respirator y issues,
EKG
changes; periodic
ophthalmic exams
Severe
sinus
node
dysfunction,
second
or third
degree
heart
block
-
Lidocaine
Ventricular
arrhythmias, local
anesthesia
Drowsiness, tremorsSeizures, respirator y arrestMonitor
EKG, CNS changes
Severe
heart
block,
Stokes
Adams
syndrome
Antidotes
-
Naloxone (Narcan)
Opioid
overdose
Tremors, hyperventilationOpioid
withdrawal
symptoms
Monitor
respirator y status,
might
require
repeated dosing
Patients
known to be.
hypersensitive to
naloxone or any of
its other
ingredient s
-
Flumazenil
Benzodiazepine
overdose
Nausea,
vomiting
SeizuresMonitor
CNS
changes, respirator y status
Seizure
patients
receiving benzodiazepine
treatment, tricyclic
antidepressant
overdose
Vasoactive e Agents
-
Dopamine
Shock,
heart
failure
Tachycardia, anxietyArrhythmias, tissue necrosisTitrate
based on hemodynamic
response, monitor
blood
pressure
and heart rate
Pheochromocytoma,
uncorrected
tachyarrhythmias
-
Vasopressin
Diabetes
insipidus, GI
bleeding, septic
shock
Abdominal pain,
tremor
Water
intoxication, angina
Monitor
fluid
status and electrolytes, blood pressure
Hypersensitivity to vasopressin or its
components
Other
Agents
- Sodium BicarbonateMetabolic acidosis, certain
drug
overdoses
Hypernatremia,
metabolic alkalosis
HypokalemiaMonitor
electrolytes,
especially potassium and
sodium
levels
Metabolic or
respirator y
alkalosis, hypocalcemia
MedicationIndicationsSide
Effects
Adverse
Effects
Nursing
Interventions
Contraindications
Anticoagulants
- HeparinDVT
prophylaxis,
pulmonary embolism, ACS
Bleeding, thrombocytopeniaHeparin
induced
thrombocytopenia
(HIT)
Monitor aPTT,
watch for signs of
bleeding
Uncontrolled
bleeding, thrombocytopenia, heparin
induced
thrombocytopenia
history
- Warfarin (Coumadin)Atrial
fibrillation, DVT
treatment and
prevention
Bleeding, headacheSevere
bleeding, necrosis
Monitor
INR,
educate
about
consistent vitamin K intake
Pregnancy,
uncontrolled
hypertension
Bronchodilators
-
Albuterol
Asthma,
COPD
Tremors, palpitation sTachycardia
hypokalemia
Monitor
heart rate, potassium levels,
and
respirator y status
Tachycardia due to
cardiac
conditions
Sedatives
- Propofol (Diprivan)Sedation in ICU,
anesthesia
induction
Hypotension,
respirator y
depression
Propofol
infusion
syndrome (rare)
Monitor
blood
pressure, respirator y rate; use with a
dedicated IV line due to risk of contamination
Soy or
egg
allergy, in children
for
sedation
in ICU allergy, in children for
sedation
respiratory status
Nitrates
-
Nitroglycerin
Angina,
heart
failure,
hypertensive
emergencies
Flushing, headacheHypotension, reflex tachycardiaMonitor
blood
pressure
and heart rate, use
gloves
when?
applying
patches
Use with
PDE
inhibitors like
sildenafil (Viagra)
Antiseizure
-
Phenytoin (Dilantin)
Seizure
disorders, status
epilepticus
Nystagmus,
drowsiness
Gingival
hyperplasia, Steven Johnson
syndrome
Monitor
serum
drug
levels,
monitor
for rash
Bradycardia, heart
block,
hypersensitivity
Antipsychotics
-
Haloperidol (Haldol)
Schizophrenia,
acute
psychosis, agitation
Extrapyramidal
symptoms,
drowsiness
Tardive
dyskinesia, QT
prolongation
Monitor
EKG for
QT
prolongation,
monitor
for
extrapyramidal
symptoms

GI Medications

Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Omeprazole (Proton
Pump
Inhibitor)
GERD,
Ulcers,
Zollinger
Ellison
Syndrome
Headache,
abdominal
pain,
diarrhea
Risk of C.
difficile
infection,
fractures,
hypomagnesemia
Administer before.
meals.
monitor
magnesium levels.
educate on long-term.
use.
Ranitidine
(H2
Blocker)
GERD,
Ulcers,
Heartburn
Headache,
dizziness,
constipation
Hepatitis,
thrombocytopenia,
confusion
Assess liver function.
monitor
platelet
count.
educate on potential.
interactions.
Metoclopramide
(Prokinetic)
Gastroparesis, Nausea,
Vomiting
Drowsiness, restlessness, diarrheaExtrapyramidal
symptoms, tardive
dyskinesia
Use for
short-term; monitor for movement.
disorders.
caution with CNS effects.
Docusate
Sodium
(Stool
Softener)
ConstipationAbdominal
cramps,
diarrhea
Electrolyte
imbalances, dependence
Promote
dietary fiber and fluid
intake.
educate on long-term.
use.
Loperamide (Antidiarrheal)DiarrheaDizziness,
constipation
Cardiac
arrhythmias, toxic
megacolon
Caution in
patients with severe
infections.
monitor for dehydration.
Sucralfate (Mucosal
Protectant)
Peptic
Ulcers
Constipation, dry mouthAluminum
toxicity,
hypersensitivity
reactions
Administer on an empty stomach.
separate
from other
medications.
Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Laxatives
(e.g.,
Senna)
ConstipationAbdominal
cramps,
diarrhea
Electrolyte
imbalances, dependence
Encourage
dietary and fluid intake; use short.
term.
monitor for dehydration.
Ondansetron
(Antiemetic)
Nausea,
Vomiting
Headache,
constipation, fatigue
QT
prolongation, serotonin
syndrome
Assess ECG for QT
prolongation; monitor for signs of
serotonin
syndrome.
Simethicone
(Antiflatulent)
Gas and
Bloating
No
significant
side effects
Rare
hypersensitivity
reactions
Educate on proper.
administration; generally considered safe.
Psyllium
(Bulk
Forming
Laxative)
Constipation, Irritable
Bowel
Syndrome
Abdominal
cramps,
diarrhea
Risk of
choking,
bowel
obstruction
Administer with
adequate
fluids.
educate on appropriate use.
Bismuth
Subsalicylate
(Antidiarrheal)
Diarrhea,
Upset
Stomach
Darkening of tongue and stoolReye's
syndrome
(rare),
salicylate
toxicity
Educate on use in
children.
avoid in
certain
populations (e.g., aspirin allergy).
Pancrealipase
(Pancreatic Enzyme)
Pancreatic
Insufficiency
Abdominal
pain,
diarrhea,
nausea
Allergic
reactions,
hyperuricemia
Administer with meals; monitor for hypersensitivity; assess uric acid.
levels.

Renal | Urinary Medications

Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
Furosemide (Loop
Diuretic)
Edema,
Hypertension, Heart
Failure
Hypokalemia,
dehydration
Ototoxicity, electrolyte
imbalances, hypotension
Monitor
electrolytes, especially
potassium; encourage.
potassium
rich foods.
Spironolactone
(Potassium -Sparing
Diuretic)
Edema,
Hypertension
Hyperkalemia,
gynecomastia
Renal
dysfunction, metabolic
acidosis,
hyponatremia
Monitor
potassium
levels.
educate on potassium.
restriction; monitor
renal
function.
Tamsulosin (Alpha
Blocker)
Benign
Prostatic
Hyperplasia (BPH)
Dizziness,
retrograde
ejaculation
Orthostatic hypotension, priapism,
floppy iris
syndrome
Administer at bedtime; educate on potential.
side effects.
Doxazosin (Alpha
Blocker)
Hypertension n, BPHDizziness,
fatigue,
headache
Orthostatic hypotension, priapism,
heart
palpitations
Monitor
blood
pressure.
administer at bedtime.
Phenazopyridine
(Urinary
Analgesic)
Urinary Tract PainOrange
urine,
headache,
GI upset
Hemolytic
anemia
(rare),
allergic
reactions,
methemoglobinemia
Educate on short-term use, caution in patients.
with G6PD deficiency.
Methenamine ne (Urinary Antibacteri al)Chronic
Urinary Tract Infections
GI upset,
headache,
rash
Crystalluria, nephrolithiasis is,
hepatotoxicity y
Encourage
adequate
fluid intake; monitor for crystalluria.
Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
considerations
Hydrochlorothiazide
(Thiazide
Diuretic)
Hypertension, EdemaHypokalemia, increased urinationElectrolyte
Imbalances, dehydration, hyperglycemia
Monitor
electrolytes, especially
potassium; educate on potassium.
rich foods.
Desmopressin
(Antidiuretic Hormone Analog)
Diabetes
Insipidus,
Nocturnal
Enuresis
Headache,
nasal
congestion
Water
intoxication, hyponatremia a, fluid
retention
Monitor
serum
sodium
levels.
assess for
fluid
overload.
Mannitol
(Osmotic
Diuretic)
Cerebral
Edema,
Intraocular
Pressure
Increased
urination,
fluid
overload
Dehydration, electrolyte
imbalances, hypernatremia
Administer IV
cautiously, monitor for signs of
dehydration.
Nitrofurantoin (Urinary Antibiotic)Urinary Tract InfectionsNausea,
diarrhea,
headache
Pulmonary
reactions,
hepatotoxicity hemolytic anemia
Educate on proper.
administration n with food; monitor for adverse.
effects.
Darifenacin (Anticholinergic)Overactive BladderDry mouth, constipation, blurred.
vision
Urinary
retention,
confusion,
heatstroke
Monitor for urinary.
retention.
caution in
elderly
patients.
Allopurinol (Uric Acid
Reducer)
Gout,
Hyperuricemia ia
Rash,
nausea,
elevated
liver
enzymes
Severe skin reactions,
bone
marrow
suppression
Assess for
hypersensitive
encourage
hydration.
monitor
renal and
liver
function.

Endocrine Medications

Generic
Name
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
consideration
Levothyroxine eHypothyroidismNervousness, weight
loss,
insomnia
Cardiac
arrhythmias, allergic
reactions,
Monitor
thyroid
function
regularly.
Administer on an empty stomach.
Watch for
signs of
overmedicate on
(tachycardia, restlessness). Adjust
dose
carefully.
MetforminType 2
Diabetes
Nausea,
diarrhea,
metallic
taste
Lactic
acidosis,
hypoglycemia a, vitamin
B12
deficiency
Monitor
blood
glucose
levels.
Assess renal function.
Educate on GI side.
effects.
Discontinue before
contrast
studies.
Insulin
(Various
types)
Diabetes
(Various
types)
Hypoglycemia a, weight
gain
Hypoglycemia a,
hyperglycemia,
lipodystrophy y
Administer subcutaneous sly, rotate.
injection
sites.
Monitor
blood
glucose
closely.
Adjust doses based on
carbohydrate e intake and activity
levels.
PrednisoneAdrenal
insufficiency,
Inflammatory y
Increased
appetite,
mood
swings,
Cushing's
syndrome,
osteoporosis,
Monitor for signs of
adrenal
insufficiency during
tapering.
Taper
gradually
when?
discontinuing g. Educate.
on potential side effects.
AlendronateOsteoporosisAbdominal
pain,
nausea,
esophagitis
Osteonecrosis is of the jaw, atypical.
femur
fractures
Administer with a full
glass of
water on an empty
stomach.
Remain
upright for
30 minutes after taking to reduce.
esophageal irritation.
Thyrotropin AlfaThyroid
cancer
Injection site pain,
nausea,
fatigue
Cardiac
arrhythmias, allergic
reactions
Administer as a
subcutaneous injection. Monitor for hypersensitive
reactions.
Evaluate
thyroid
function
before and after
treatment.
Growth
Hormone
(Somatropin)
Growth
hormone
deficiency
Headache,
joint pain,
fluid
retention
Intracranial hypertension, scoliosisAdminister by
subcutaneous injection.
Monitor
growth
velocity and assess for
side effects regularly.
Avoid abrupt discontinuity on.
Medication (Generic
Name)
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
considerations
Liraglutide (GLP-1
Agonist)
Type 2
Diabetes,
Obesity
Nausea,
diarrhea,
headache
Pancreatitis, thyroid
tumors,
hypoglycemia a
Monitor for signs of
pancreatitis; educate on hypoglycemia a symptom.
Pioglitazone e
(Thiazolidine)
Type 2
Diabetes
Weight gain, edema,
headache
Heart failure, hepatotoxicity y, fracturesAssess for
heart failure symptoms; monitor liver function.
Desmopressin
(Antidiuretic Hormone Analog)
Diabetes
Insipidus
Hyponatremia, headache, nauseaWater
intoxication, seizures,
hypotension
Monitor
serum
sodium
levels.
assess for
fluid
overload.
Mifepristone
(Glucocorticoid
Receptor
Antagonist)
Cushing's
Syndrome
Nausea,
fatigue,
headache
Adrenal
insufficiency, vaginal
bleeding
Monitor for signs of
adrenal
insufficiency; educate on bleeding.
risks.
Somatropin (Growth
Hormone)
Growth
Hormone
Deficiency
Injection site reactions,
headache
Intracranial hypertension, scoliosisMonitor
growth and development; educate on injection.
technique.
Generic
Name
IndicationsCommon
Side Effects
Adverse
Effects
Nursing
Considerations
MetoprololHypertension, angina,
heart failure
Fatigue,
dizziness,
bradycardia
Heart block, hypotension, bronchospasmMonitor
blood
pressure and heart rate
regularly.
Hold for low heart rate.
and blood
pressure.
Educate on orthostatic hypotension. Avoid abrupt discontinuati on.
HydrocortisoneAdrenal
insufficiency, anti
inflammatory
Increased
appetite,
mood
changes
Cushing's
syndrome,
adrenal
crisis,
infections
Monitor
adrenal
function.
Taper when discontinuing. Educate.
on signs of adrenal
crisis.
Administer with food or milk to
reduce GI.
irritation.
DesmopressinDiabetes
insipidus,
nocturnal
enuresis
Headache,
nausea, fluid retention
Hyponatremia, seizures, water
intoxication
Monitor fluid balance and sodium
levels.
Administer intranasal or oral forms.
carefully.
Educate on fluid.
restriction if necessary.
GlipizideType 2
Diabetes
Hypoglycemia, weight
gain
Hypoglycemia, jaundice, hematologic disturbancesMonitor
blood
glucose
levels.
Administer with meals. Educate on signs and
management of
hypoglycemia.
CalcitoninHypercalcemia, Paget’s disease of
bone
Flushing,
nausea,
nasal
irritation
Hypocalcemia, allergic
reactions
Administer intranasally or
subcutaneously. Monitor serum
calcium
levels.
Educate on signs of
hypocalcemia and
allergic
reactions.
ExenatideType 2
Diabetes
Nausea,
diarrhea,
hypoglycemia
Pancreatitis, renal
impairment, hypersensitivity
Administer subcutaneously. Monitor blood
glucose
levels and
renal
function.
Educate on GI side.
effects and signs of
pancreatitis.
Propylthiouracil (PTU)HyperthyroidismRash, joint
pain, liver
dysfunction
Agranulocytosis, severe hepatotoxicityMonitor
thyroid
function and liver
function.
Educate on signs of
agranulocytosis and
liver toxicity. Administer with meals.
PrednisoloneInflammatory conditions, immune
suppression
Weight gain, mood
swings,
insomnia
Cushing's
syndrome,
peptic
ulcers,
infections
Administer with food or milk to
reduce GI.
irritation.
Taper
gradually
when?
discontinuing. Monitor
for signs of adrenal
insufficiency. Educate on potential.
side effects.
EstradiolHormone
replacement therapy,
contraception
Breast
tenderness, breakthrough bleeding
Thromboembolism,
breast
cancer,
endometrial hyperplasia
Monitor
blood
pressure and lipid profiles. Educate on the risks and benefits of hormone.
replacement therapy.
TestosteroneHypogonadism, gender affirming.
hormone
therapy
Acne, mood changes,
increased
hair growth
Cardiovascular events,
liver
dysfunction, masculinization
Monitor
hormone
levels, liver function,
and
cardiovascular risk
factors.
Educate on expected.
changes and potential
risks.
LeuprolideProstate
cancer,
endometriosis
Hot flashes, fatigue,
injection site reactions
Osteoporosis, mood
changes,
pituitary
apoplexy
Administer by
subcutaneous or
intramuscular injection.
Monitor
bone density and
hormone
levels.
Educate on side effects and
precautions.
Thyroid
Extract
(Desiccated thyroid)
HypothyroidismWeight loss, anxiety,
insomnia
Cardiac
arrhythmias, hyperthyroid ism
Monitor
thyroid
function and symptoms. Adjust doses carefully.
Educate on proper.
administration and
potential
side effects.
Parathyroid Hormone
(Teriparatide)
OsteoporosisNausea,
dizziness,
leg cramps
Hypercalcemia,
osteosarcoma
Administer by
subcutaneous injection. Monitor
calcium
levels.
Educate on proper.
administration and signs of
hypercalcemia or bone
pain.
ExemestaneBreast
cancer
Hot flashes, fatigue, joint painOsteoporosis, liver
dysfunction, mood
changes
Monitor liver function.
Educate on potential.
side effects and the
importance of
adherence.

Insulin

Insulin TypePeak TimeNursing
Considerations
Rapid-Acting Insulin1 to 2 hours- Administer just
before or after meals.
- Educate patients on the importance of
meal timing.
Short-Acting Insulin2 to 4 hours- Administer 30
minutes to 1 hour
before meals.
- Monitor for
hypoglycemia.
Intermediate-Acting Insulin4 to 12 hours- Often administered twice daily.
- Educate patients on the need for a bedtime snack.
Long-Acting InsulinMinimal to no peak- Administer once
daily at the same time each day.
- Monitor for
hypoglycemia.
Ultra-Long-Acting InsulinMinimal peak- Administer once
daily at the same time each day.
Premixed InsulinVaries based on
components
- Administer before meals.
- Educate on meal timing and blood
glucose monitoring.

There are many more considerations than these when administering insulin. “Regular” insulin can go by different names Humalog or Novolog and each is different depending on how it is derived. Also, it is extremely important to keep in mind the peak times of when the insulin should be working so that you can recheck on the patient to be sure that sugar is not dropping too low.
NEW diabetic require a great deal of education regarding insulin and insulin self administration and many times there will be diabetes educators who help with this education not just at time of diagnosis, but also will follow the patient after discharge home.
MOST facilities require 2 licensed staff to check the type and dose of insulin prior to administration due to the potential for mix up and mis-dose, and it’s high-risk status

Otito-Umoren