Below is a list of reference drug sites that you can use to find information for you drug studies.

Mims.com.ph

MIMS is one of my favorite sites when looking for those “hard do find drugs”. It has a good sum of information for each drug. You’ll have to register (for free) to access its database. Also, MIMS publishes a yearly drug reference book which you can buy on your favorite bookstores.

Druglib.com

DrugLib.com is one of the most comprehensive drug database I have ever seen so far. It provides almost all the information you need related to your drug interest.

RNpedia.com

Although RNpedia.com doesn’t have a  vast reference for drugs, what I like about it is its formatting of commonly used drugs.

Drugs.com

Who among student nurses does not know this website? Its probably the most used and most sough-after drug reference site. I cannot blame you because it is the most complete and dynamically updated drug reference site.

Nursingcrib.com

Nursingcrib has been providing not just information about drugs, but also about nursing.

Nurseslabs.com

Of course, we may not have the vast list of drugs (yet), we do have references about the commonly used drugs that are not found yet on reference books.

Have we missed anything?

Did we forget to mention as drug reference website you might know? Therefore, comment below!

6 Drug Reference Sites You Must Bookmark! Original source at: Nurseslabs

Generic name

Brand name: Niazid

General Action: Antituberculotic

This medication is used with other medications to treat active tuberculosis (TB) infections or alone to prevent those who have a positive TB test from developing symptoms of TB. Isoniazid belongs to a class of drugs known as antibiotics that are active against tuberculosis. Interferes with lipid and nucleic acid biosynthesis in actively growing tubercle bacilli.

Indications

• Tuberculosis of all forms
• Prophylaxis in specific patients who are tuberculin reactors (positive Mantoux test) or who are considered to be high risk for TB.

Contraindication

Isoniazid is contraindicated in patients who develop severe hypersensitivity reactions, including drug -induced hepatitis; previous isoniazid-associated hepatic injury; severe adverse reactions to isoniazid such as drug fever, chills, arthritis; and acute liver disease of any etiology.

Stock dose

Tablets: 100,300 mg; syrup 50mg/5ml; injection 100 mg/ml

Side effects

• Peripheral neuropathy
• Nausea and vomitting
• Thrombocytopenia
• Local irritation at IM site
• Epigastric distress
• Elevated AST

Nursing Responsibilities

• History: allergy to the drug.
• Can cause peripheral neuropathy which is manifested by tingling sensation on extremities. It can be prevented through use of supplemental vitamin B6 (pyridoxine).
• Physical: skin color, lesions, T; orientation, reflexes, peripheral sensirivity, bilaterally grip strength ophthalmologic examination; R, adventitious sounds; liver evaluation; CBC;LFTs renal fxn tests, blood glucose.
• Give in an empty stomach 1 hr before or 2 after meals; may be given with food if GI UPSET OCCURS.
• Give in a single daily dose. Reverse parenteral dose for pt unable to take oral meds.
• Dec. foods containing tyramine or histamine in pt diet.
• Consult doctor and arrange for daily pyridoxine in diabetic, alcoholic or malnourished pt also for pt that develops peripheral neuritis, and those with HIV.
• Family health teachings:
  • Take this drug in single daily dose.
  • Take drug on an empty stomach, 1 hour before or 2 hours after meals. If GI distress occurs, may be taken with food.
  • Take this drug regularly, avoid missing doses, do not discontinue without first consulting your health care provider.
  • Do not drink alcohol or drink as little as possible. There is an inc. risk of heap if these two drugs are combined.
  • Avoid foods containing tyramine, consult a dietitian to obtain a list of foods containing tyramine or histamine.
  • Have periodic medical check-ups, including an eye examination and blood test, to evaluate the drug effects.
  • Report for weakness, fatigue, loss of appetite, n/v, yellowing of skin or eyes, darkening of the urine, numbness or tingling in hands or feet,

Isoniazid (Niazid) Drug Study Original source at: Nurseslabs

Generic Name:

Brand Name: Apo-Clonazepam (CAN), Gen-Clonazepam (CAN), Klonopin, Klonopin Wafers, Nu-Clonazepam (CAN), Rivotril (CAN)

Other Info: Pregnancy Category X, Controlled Substance C-IV

Drug classes: Benzodiazepine, Antiepileptic

Therapeutic actions

Exact mechanisms not understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter.

Indications

• Used alone or as adjunct in treatment of Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures; may be useful in patients with absence (petit mal) seizures who have not responded to succinimides; up to 30% of patients show loss of effectiveness of drug, often within 3 mo of therapy (may respond to dosage adjustment); treatment of panic disorder with or without agoraphobia
• Unlabeled uses: Periodic leg movements during sleep; hypokinetic dysarthria, acute manic episodes, multifocal tic disorders, neuralgias

Contraindications and cautions

• Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs; pregnancy (risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (“floppy infant” syndrome), lactation (infants become lethargic and lose weight).
• Use cautiously with impaired liver or renal function, debilitation.

Available forms: Tablets—0.5, 1, 2 mg; orally disintegrating tablets—0.125, 0.25, 0.5, 1, 2 mg

Dosages

Individualize dosage; increase dosage gradually to avoid adverse effects; drug is available only in oral dosage forms.

ADULTS

Seizure disorders: Initial dose should not exceed 1.5 mg/day PO divided into three doses; increase in increments of 0.5–1 mg PO every 3 days until seizures are adequately controlled or until side effects preclude further increases. Maximum recommended dosage is 20 mg/day.

Panic disorders: Initial dose 0.25 mg PO bid; gradually increase to a target dose of 1 mg/day.

PEDIATRIC PATIENTS > 10 YR OR 30 KG

Initially, 0.01–0.03 mg/kg/day PO; do not exceed 0.05 mg/kg/day PO, given in two or three doses. Increase dosage by not more than 0.25–0.5 mg every third day until a daily maintenance dose of 0.1–0.2 mg/kg has been reached, unless seizures are controlled by lower dosage or side effects preclude increases. Whenever possible, divide daily dose into three equal doses, or give largest dose at bedtime.

Pharmacokinetics

Metabolism: Hepatic; T_1/2: 18–50 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

• CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility,episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment
• CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema
• Dermatologic: Urticaria, pruritus, rash, dermatitis
• EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion
• GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, encoporesis
• GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
• Hematologic: Elevations of blood enzymes—LDH, alkaline phosphatase, AST, ALT; blood dyscrasias: agranulocytosis, leukopenia
• Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia. Drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for longer than 4 mo

Interactions

Drug-drug

• Increased CNS depression with alcohol
• Increased effect with cimetidine, disulfiram, omeprazole, hormonal contraceptives
• Decreased effect with theophylline
• Risk of increased digoxin levels and toxicity; monitor patient carefully

Nursing considerations

CLINICAL ALERT!

Name confusion has occurred between Klonopin (clonazepam) and clonidine; use caution.

Assessment

• History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication; pregnancy; lactation; liver or renal impairment, debilitation.
• Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests.

Interventions

• Monitor addiction-prone patients carefully because of their predisposition to habituation and drug dependence.
• Monitor liver function and blood counts periodically in patients on long-term therapy.
• WARNING: Taper dosage gradually after long-term therapy, especially in patients with epilepsy; substitute another antiepileptic.
• Monitor patient for therapeutic drug levels: 20–80 ng/mL.
• If the patient has epilepsy, arrange for patient to wear medical alert identification indicating patient has epilepsy and is receiving drug therapy.

Teaching points

• Take drug exactly as prescribed; do not stop taking drug (long-term therapy) without consulting health care provider.
• Avoid alcohol, sleep-inducing, or over-the-counter drugs.
• Avoid pregnancy; serious adverse effects can occur. Using barrier contraceptives is advised while taking this drug.
• It would be advisable to wear or carry a medical alert identification indicating your diagnosis and drug therapy.
• You may experience these side effects: Drowsiness, dizziness (may become less pronounced; avoid driving or engaging in other dangerous activities); GI upset (take drug with food); fatigue; dreams; crying; nervousness; depression, emotional changes; bed-wetting, urinary incontinence.
• Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.

Source and Other References: (1) (2) (3)

Clonazepam (Clonazepam) Drug Study Original source at: Nurseslabs

Generic Name:

Brand Name: Pontocaine

Action: Anesthetics

Indication: Provides brief local anesthetics.

Contraindication: Hypersensitivity, low plasma cholinesterase concentrations, complete heart block, pyrogenic infection

Stock Dose: 1 ampule

Side Effects: restlessness, paresthesia, dizziness, nausea and vomiting, muscle twitching, numbness of the tongue and perioral region, light headedness, respiratory failure, coma, hypotension, bradycardia, arrhythmias, cardiac arrest

Nursing Intervention:

• Monitor ECG, blood pressure and respiratory status frequently.
• Assess degree of numbness of the affected part.
• IM injections are recommended if ECG monitoring is not available.
• Explain the purpose of the medication.
• Notify HCP if adverse reaction occurs.

Tetracaine HCl (Pontocaine) Drug Study Original source at: Nurseslabs

Brand Name: Novo-Pen VK (CAN), Veetids

Classification: Antibiotic, Penicillin (acid stable)

Pregnancy Category B 

Dosage & Route

Available forms : Tablets—250, 500 mg; powder for oral solution—125, 250 mg/5 mL

ADULTS AND PATIENTS > 12 YR

• Fusospirochetal infections: 250–500 mg q 6–8 hr PO.
• Streptococcal infections (including otitis media, URIs of mild to moderate severity, scarlet fever, erysipelas): 125–250 mg q 6–8 hr PO for 10 days. Or, 500 mg q 12 hr for 10 days.
• Pneumococcal infections: 250–500 mg q 6 hr PO until afebrile for 48 hr.
• Staphylococcal infections of skin and soft tissues: 250–500 mg q 6–8 hr PO.
• Prophylaxis against bacterial endocarditis, dental or upper respiratory procedures: 2 g PO 30 min–1 hr before the procedure, then 500 mg q 6 hr for eight doses.
• Alternate prophylaxis: 1 million units penicillin G IM mixed with 600,000 units procaine penicillin G 30 min–1 hr before the procedure, then 500 mg penicillin V PO q 6 hr for eight doses.
• Lyme disease: 500 mg PO qid for 10–20 days.
• Mild, uncomplicated cutaneous anthrax: 200–500 mg PO qid.

ADULTS AND PATIENTS > 9 YR

• Anthrax prophylaxis: 7.5 mg/kg PO qid.

PEDIATRIC PATIENTS < 12 YR

• 15–62.5 mg/kg/day PO given q 6–8 hr. Calculate doses according to weight.

• Prophylaxis against bacterial endocarditis, dental or upper respiratory procedures:
• < 60 lb: 1 g PO 30 min–1 hr before the procedure, then 250 mg q 6 hr for eight doses.
• > 60 lb: 2 g PO 30 min–1 hr before the procedure, then 500 mg q 6 hr for eight doses.

• Alternate prophylaxis for children: < 30 kg: 30,000 units penicillin G/kg IM mixed with 600,000 units procaine penicillin G 30 min–1 hr before the procedure and then 250 mg penicillin V PO q 6 hr for eight doses.
• Sickle cell anemia as prophylaxis of S. pneumoniae septicemia: 125 mg PO bid.
• Mild, uncomplicated cutaneous anthrax in children > 2 yr: 25–50 mg/kg daily in two or four divided doses.

PEDIATRIC PATIENTS < 9 YR

• Anthrax prophylaxis: 50 mg/kg/day PO in four divided doses.

Therapeutic actions 

• Bactericidal: Inhibits cell wall synthesis of sensitive organisms, causing cell death.

Indications 

• Mild to moderately severe infections caused by sensitive organisms—streptococci, pneumococci, staphylococci, fusospirochetes
• Prophylaxis against bacterial endocarditis in patients with valvular heart disease undergoing dental or upper respiratory tract surgery
• Unlabeled uses: Prophylactic treatment of children with sickle cell anemia, mild to moderate anaerobic infections, Lyme disease, post-exposure anthrax prophylaxis

Adverse effects 

• CNS: Lethargy, hallucinations, seizures
• GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black “hairy” tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis,pseudomembranous colitis, nonspecific hepatitis
• GU: Nephritis—oliguria, proteinuria, hematuria, casts, azotemia, pyuria
• Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time
• Hypersensitivity reactions: Rash, fever, wheezing, anaphylaxis (sometimes fatal)
• Other: Superinfections, sodium overload leading to CHF; potassium poisoning—hyperreflexia, coma, cardiac arrhythmias, cardiac arrest (potassium preparations)

Contraindications 

• Contraindicated with allergies to penicillins, cephalosporins, or other allergens.
• Use cautiously with renal disorders, pregnancy, lactation (may cause diarrhea or candidiasis in the infant).

Nursing considerations 

Assessment 

• History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; pregnancy; lactation
• Physical: Culture infection; skin color, lesions; R, adventitious sounds; bowel sounds: CBC, LFTs, renal function tests, serum electrolytes, Hct, urinalysis

Interventions 

• Culture infection before beginning treatment; reculture if response is not as expected.
• Continue therapy for at least 2 days after infection has disappeared, usually 7–10 days.
• Do not administer oral drug with milk, fruit juices, or soft drinks; a full glass of water is preferred; this oral penicillin is less affected by food than other penicillins.

Teaching points 

• Avoid self-treating other infections with this antibiotic because it is specific for the infection being treated. Complete the full course of drug therapy.
• You may experience these side effects: Nausea, vomiting, diarrhea, mouth sores.
• Report difficulty breathing, rashes, severe diarrhea, mouth sores, unusual bleeding or bruising.

Penicillin V (Novo-Pen) Drug Study Original source at: Nurseslabs

Generic Name :

Brand Name:

• Oral:
• Apo-K (CAN),
• Cena-K,
• Effer-K,
• Gen-K,
• Kaon-Cl,
• Kay Ciel,
• Kaylixir,
• K-Dur 10,
• K-Dur 20,
• K-Lor,
• K-Tab,
• Klor-Con,
• Klorvess,
• Klotrix,
• K-Lyte/Cl,
• Kolyum,
• K+ Care ET,
• K + 8, K + 10,
• Micro-K Extencaps,
• Potasalan, Rum-K,
• Ten K
• Injection:
• Potassium Chloride ,
• Kaon,
• K-G Elixir,
• Kolyum,
• Tri-K,
• Twin-K

Classification:

• Electrolyte
• Pregnancy Category C

Dosage & Route

Adult Dose for Hypokalemia

Parenteral:

• 40 to 100 mEq potassium chloride for injection diluted in an appropriate amount and type of solution to be intravenously infused once at a rate not to exceed 10 to 40 mEq/hour.

Oral:

• 40 to 100 mEq orally once a day given in equally divided doses using formulations which include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution or powder for dissolution mixed with an appropriate volume of water or juice.

Adult Dose for Prevention of Hypokalemia

Parenteral:

• 10 to 40 mEq potassium chloride for injection diluted in an appropriate amount and type of solution to be intravenously infused once at a rate not to exceed 40 mEq/hour.

Oral:

• 10 to 20 mEq orally once a day given in equally divided doses using formulations which include normal-release tablets or capsules, extended-release tablets or capsules, dissolvable tablets, oral solution or powder for dissolution mixed with an appropriate volume of water or juice.

Pediatric Dose for Hypokalemia

Parenteral:

• 0.5 to 1 mEq/kg/dose (maximum dose 30 mEq) potassium chloride for injection diluted in an appropriate amount and type of solution to be intravenously infused once at a rate not to exceed 0.3 to 0.5 mEq/kg/hour.

Oral:

• 2 to 5 mEq/kg/day orally in equally divided doses using age-appropriate oral dosage formulations.

Pediatric Dose for Prevention of Hypokalemia

Oral:

• 1 to 2 mEq/kg/day orally in equally divided doses using age-appropriate oral dosage formulations.

Therapeutic actions

Principal intracellular cation of most body tissues, participates in a number of physiologic processes—maintaining intracellular tonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle, maintenance of normal renal function; also plays a role in carbohydrate metabolism and various enzymatic reactions.

Indications

Prevention and correction of potassium deficiency; when associated with alkalosis, use potassium chloride; when associated with acidosis, use potassium acetate, bicarbonate, citrate, or gluconate
IV: Treatment of cardiac arrhythmias due to cardiac glycosides

Adverse effects

• Dermatologic: Rash
• GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction, GI bleeding, GI ulceration or perforation
• Hematologic: Hyperkalemia—increased serum K+, ECG changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of QTc interval)
• Local: Tissue sloughing, local necrosis, local phlebitis, and venospasm with injection

Contraindications

• Contraindicated with allergy to tartrazine, aspirin (tartrazine is found in some preparations marketed as Kaon-Cl, Klor-Con); severe renal impairment with oliguria, anuria, azotemia; untreated Addison’s disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps; GI disorders that delay passage in the GI tract.
• Use cautiously with cardiac disorders, especially if treated with digitalis, pregnancy, lactation.

Nursing considerations

Assessment

• History: Allergy to tartrazine, aspirin; severe renal impairment; untreated Addison’s disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps, GI disorders that cause delay in passage in the GI tract, cardiac disorders, lactation
• Physical: Skin color, lesions, turgor; injection sites; P, baseline ECG; bowel sounds, abdominal examination; urinary output; serum electrolytes, serum bicarbonate

Interventions

• Arrange for serial serum potassium levels before and during therapy.
• Administer liquid form to any patient with delayed GI emptying.
• Administer oral drug after meals or with food and a full glass of water to decrease GI upset.
• Caution patient not to chew or crush tablets; have patient swallow tablet whole.
• Mix or dissolve oral liquids, soluble powders, and effervescent tablets completely in 3–8 oz of cold water, juice, or other suitable beverage, and have patient drink it slowly.
• Arrange for further dilution or dose reduction if GI effects are severe.
• Agitate prepared IV solution to prevent “layering” of potassium; do not add potassium to an IV bottle in the hanging position.
• Monitor IV injection sites regularly for necrosis, tissue sloughing, phlebitis.
• Monitor cardiac rhythm carefully during IV administration.
• Caution patient that expended wax matrix capsules will be found in the stool.
• Caution patient not to use salt substitutes.

Teaching points

• Take drug after meals or with food and a full glass of water to decrease GI upset. Do not chew or crush tablets, swallow tablets whole. Mix or dissolve oral liquids, soluble powders, and effervescent tablets completely in 3–8 ounces of cold water, juice, or other suitable beverage, and drink it slowly. Take the drug as prescribed; do not take more than prescribed.
• Do not use salt substitutes.
• You may find wax matrix capsules in the stool. The wax matrix is not absorbed in the GI tract.
• Have periodic blood tests and medical evaluation.
• You may experience these side effects: Nausea, vomiting, diarrhea (taking the drugs with meals, diluting them further may help).
• Report tingling of the hands or feet, unusual tiredness or weakness, feeling of heaviness in the legs, severe nausea, vomiting, abdominal pain, black or tarry stools, pain at IV injection site.

Kalium Durule (Potassium Chloride) Drug Study Original source at: Nurseslabs

GENERIC NAME: Bupivacaine HCL

BRAND NAME: Sensorcaine, Marcaine

GENERAL CLASSIFICATION: amide type local anaesthetic

Indications of Bupivacaine

• For the production of local or regional anesthesia or analgesia for surgery, for oral surgery procedures, for diagnostic and therapeutic procedures, and for obstetrical procedures.

Contraindications of Bupivacaine

Sensorcaine (bupivacaine HCl) is contraindicated in obstetrical paracervical block anesthesia. Its use by this technique has resulted in fetal bradycardia and death.

Sensorcaine is contraindicated in patients with a known hypersensitivity to it or to any local anesthetic agent of the amide type or to other components of bupivacaine solutions.

Side-Effects of Bupivacaine

• Mild dizziness or drowsiness.
• Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; changes in hearing; chest pain; excitement; irregular heartbeat; nausea; numbness that lasts for more than a few hours; restlessness; ringing in the ears; seizures; severe dizziness or drowsiness; tremors; vomiting.

Nursing Considerations of Bupivacaine

1. When appropriate, patients should be informed in advance that they may experience temporary loss of sensation and motor activity, usually in the lower half of the body following proper administration of caudal or lumbar epidural anesthesia. Also, when appropriate, the physician should discuss other information including adverse reactions in the Sensorcaine package insert.
2. Inform the patient before using this medication, to tell his/her doctor or pharmacist of all prescription and nonprescription/herbal products he/she may use. Do not start or stop any medicine without doctor or pharmacist approval.

Bupivacaine HCl Drug Study Original source at: Nurseslabs

Pregnancy Category D

Controlled Substance C-IV

Drug classes: Benzodiazepine, Anxiolytic, Sedative-hypnotic

Therapeutic actions

Exact mechanisms are not understood; acts mainly at subcortical levels of the CNS, leaving the cortex relatively unaffected. Main sites of action may be the limbic system and reticular formation; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those needed to cause sedation and ataxia.

Indications

• Oral: Management of anxiety disorders or for short-term relief of symptoms of anxiety or anxiety associated with depression; insomnia due to anxiety of transient situational stress
• Parenteral: Preanesthetic medication in adults to produce sedation, relieve anxiety, and decrease recall of events related to surgery; treatment of status epilepticus
• Unlabeled parenteral use: Management of chemotherapy-induced nausea and vomiting, acute alcohol withdrawal

Contraindications and cautions

• Contraindicated with hypersensitivity to benzodiazepines, propylene glycol, polyethylene glycol or benzyl alcohol (parenteral lorazepam); psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy (crosses placenta; risk of congenital malformations and neonatal withdrawal syndrome); labor and delivery (“floppy infant” syndrome); lactation.
• Use cautiously with impaired hepatic or renal function.

Available forms

Injection—2, 4 mg/mL; oral solution—2 mg/mL; tablets—0.5, 1, 2 mg

Dosages

ADULTS

Oral

Usual dose is 2–6 mg/day; range 1–10 mg/day given in divided doses with largest dose hs.

• Insomnia due to transient stress: 2–4 mg given hs.

IM

0.05 mg/kg up to a maximum of 4 mg administered at least 2 hr before operative procedure.

IV

Initial dose is 2 mg total or 0.044 mg/kg, whichever is smaller. Do not exceed this dose in patients older than 50 yr. Doses as high as 0.05 mg/kg up to a total of 4 mg may be given 15–20 min before the procedure to those benefited by a greater lack of recall. Continuous infusion 0.5–1 mg/hr titrated, based on patient response.

PEDIATRIC PATIENTS

Drug should not be used in children < 12 yr.

GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC DISEASE

Initially, 1–2 mg/day in divided doses. Adjust as needed and tolerated.

Pharmacokinetics

Metabolism: Hepatic; T_1/2: 10–20 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

IV facts

Preparation: Dilute lorazepam immediately before IV use. For direct IV injection or injection into IV line, dilute with an equal volume of compatible solution (sterile water for injection, sodium chloride injection, or 5% dextrose injection); do not use if solution is discolored or contains a precipitate. Protect from light.

Infusion: Direct inject slowly, or infuse at maximum rate of 2 mg/min.

Y-site incompatibilities: Do not mix with foscarnet, ondansetron.

Adverse effects

• CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility,episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty concentrating, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment
• CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema
• Dermatologic: Urticaria, pruritus, rash, dermatitis
• EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion
• GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic dysfunction
• GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
• Hematologic: Elevations of blood enzymes: LDH, alkaline phosphatase, AST, ALT; blood dyscrasias—agranulocytosis, leukopenia
• Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia. Drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for > 4 mo

Interactions

Drug-drug

• Increased CNS depression with alcohol and other sedating medications, such as barbiturates and opioids
• Decreased effectiveness with theophyllines
• Risk of toxicity if combined with probenecid, valproate; reduce lorazepam dose by 50%

Drug-herb

• Kava kava increases the sedative effects of benzodiazepines; coma has been reported with concurrent use

Nursing considerations

CLINICAL ALERT!

Name confusion has occurred between lorazepam and alprazolam; use caution.

Assessment

• History: Hypersensitivity to benzodiazepines, propylene glycol, polyethylene glycol or benzyl alcohol; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy; lactation; impaired liver or renal function, debilitation
• Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic examination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests

Interventions

• Sublingual administration has more rapid absorption than PO, and bioavailability compares to IM use.
• Do not administer intra-arterially; arteriospasm or gangrene may result.
• Give IM injections of undiluted drug deep into muscle mass, monitor injection sites.
• Do not use solutions that are discolored or contain a precipitate. Protect drug from light, and refrigerate oral solution.
• Intensol is a concentrated solution; it is recommended it be mixed with water, juice, soda, applesauce, or pudding.
• WARNING: Keep equipment to maintain a patent airway readily available when drug is given IV.
• Refrigerate injection and oral solution (36° to 46° F).
• Reduce dose of opioid analgesics by at least half in patients who have received parenteral lorazepam.
• Keep patients who have received parenteral doses under close observation, preferably in bed, up to 3 hr. Do not permit ambulatory patients to drive following an injection.
• WARNING: Taper dosage gradually after long-term therapy, especially in patients with epilepsy.

Teaching points

• Take drug exactly as prescribed; do not stop taking drug (in long-term therapy) without consulting health care provider.
• You may experience these side effects: Drowsiness, dizziness (may be transient; avoid driving or engaging in dangerous activities); GI upset (take drug with food); nocturnal sleep disturbances for several nights after discontinuing the drug if used as a sedative and hypnotic; depression, dreams, emotional upset, crying.
• Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, palpitations, edema of the extremities; visual changes; difficulty voiding.

Sources: (1), (2), (3), (4),

Lorazepam Original source at: Nurseslabs

Generic Name:

Brand Name: Ketosteril

Classifications: Ketoanalogs; Essential amino acids

Therapeutic Actions of Ketosteril

Normalizes metabolic process, promotes recycling product exchange. Reduces ion concentration of potassium, magnesium and phosphate.

Indications of Ketosteril

• Protein energy malnutrition
• Prevention and treatment of conditions caused by modified or insufficient protein metabolism in chronic renal failure

Contraindications of Ketosteril

• Allergy and hypersensitivity to any content of this drug
• Hypercalcemia
• Disturbed amino acid metabolism
• Caution use for patietn with phenylketonuria

Dosage of Ketosteril

• Four to eight tabs TID
• 1 tab/5kg body weight/day

Adverse Reactions of Ketosteril

• Hypercalcemia may develop

Nursing Considerations of Ketosteril

• Evaluate for any contraindications
• Take drug as prescribed
• Warn the patient about possible side effects and how to recognize them
• Give with food if GI upset occurs
• Frequently assess for hypercalcemia

Ketosteril Drug Study Original source at: Nurseslabs

(oh lan‘ za peen)

Zyprexa, Zyprexa IntraMuscular, Zyprexa Zydis

Pregnancy Category C

Drug classes

• Antipsychotic
• Dopaminergic blocker

Therapeutic actions

Mechanism of action not fully understood; blocks dopamine receptors in the brain, depresses the RAS; blocks serotonin receptor sites; anticholinergic, antihistaminic (H₁), and alpha-adrenergic blocking activity may contribute to some of its therapeutic (and adverse) actions; produces fewer extrapyramidal effects than mostantipsychotics.

Indications

• Treatment of schizophrenia
• Treatment of acute mixed or manic episodes associated with bipolar 1 disorder and maintenance of bipolar 1 disorder as monotherapy, or combined with lithium or valproate
• Treatment of agitation associated with schizophrenia and bipolar 1 mania (injection)

Contraindications and cautions

• Contraindicated with allergy to olanzapine, myeloproliferative disorders, severe CNS depression, comatose states, lactation.
• Use cautiously in elderly or debilitated patients, or with CV or cerebrovascular disease, dehydration, seizure disorders, Alzheimer’s disease, prostate enlargement, narrow-angle glaucoma, history of paralytic ileus or breast cancer, pregnancy; phenylketonuria (if using orally disintegrating tablets, contain phenylalanine).

Available forms

Tablets—2.5, 5, 7.5, 10, 15, 20 mg; orally disintegrating tablets—5, 10, 15, 20 mg; powder for injection—10 mg

Dosages

ADULTS

• Schizophrenia: Initially, 5–10 mg PO daily, increase to 10 mg PO daily within several days; may be increased by 5 mg/day at 1-wk intervals to achieve desired effect. Do not exceed 20 mg/day.
• Bipolar mania: 10–15 mg/day PO; adjust at 5-mg intervals as needed, not less than q 24 hr. Maximum dose, 20 mg/day. For maintenance, 5–20 mg/day PO. The initial dose is 10 mg of olanzapine when combined with lithium or valproate.
• Agitation: 10 mg IM; range 5–10 mg IM; dose may be repeated in 2 hr if needed, safety of > 30 mg/24 hr not established.

PEDIATRIC PATIENTS

Safety and efficacy not established in patients < 18 yr.

GERIATRIC PATIENTS

5 mg IM.

DEBILITATED PATIENTS

Start with initial dose of 5 mg; 2.5 mg IM.

Pharmacokinetics

Metabolism: Hepatic; T_1/2: 30 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Feces, urine

Adverse effects

• CNS: Somnolence, dizziness, nervousness, headache, akathisia, personality disorders, tardive dyskinesia, neuroleptic malignant syndrome
• CV: Orthostatic hypotension, peripheral edema, tachycardia
• GI: Constipation, abdominal pain
• Respiratory: Cough, pharyngitis
• Other: Fever, weight gain, joint pain, development of diabetes mellitus

Interactions

Drug-drug

• Increased risk of orthostatic hypotension with antihypertensives, alcohol, benzodiazepines; avoid use of alcohol and use caution with antihypertensives
• Increased risk of seizures with anticholinergics, CNS drugs
• May decrease effectiveness of levodopa, dopamine agonists
• Decreased effectiveness with rifampin, omeprazole, carbamazepine, smoking
• Increased risk of toxicity with fluvoxamine

Nursing considerations

CLINICAL ALERT!

Name confusion has occurred between Zyprexa (olanzapine) and Zyrtec (cetirizine); use caution.

Assessment

• History: Allergy to olanzapine, myeloproliferative disorders, severe CNS depression, comatose states, history of seizure disorders, lactation; CV orcerebrovascular disease, dehydration, Alzheimer’s disease, prostate enlargement, narrow-angle glaucoma, history of paralytic ileus or breast cancer, elderly or debilitated patients, pregnancy
• Physical: T, weight; reflexes, orientation, IOP, ophthalmologic examination; P, BP, orthostatic BP, ECG; R, adventitious sounds; bowel sounds, normal output, liver evaluation; prostate palpation, normal urine output; CBC, urinalysis, LFTs, renal function tests

Interventions

• Do not dispense more than 1-wk supply at a time.
• Peel back foil on blister pack of disintegrating tablets; do not push through foil; use dry hands to remove tablet and place in mouth.
• Prepare solution for IM injection using 2.1 mL sterile water for injection. Resulting solution contains 5 mg/mL. Solution should be clear yellow. Use within 1 hr of reconstitution. Discard any unused portion.
• Monitor for the many possible drug interactions before beginning therapy.
• BLACK BOX WARNING: Monitor elderly patients for dehydration and institute remedial measures promptly; sedation and decreased sensation of thirst related to CNS effects of drug can lead to dehydration.
• Encourage patient to void before taking the drug to help decrease anticholinergic effects of urinary retention.
• Monitor for elevations of temperature and differentiate between infection and neuroleptic malignant syndrome.
• Monitor for orthostatic hypotension and provide appropriate safety measures as needed.
• Monitor patient regularly for signs and symptoms of diabetes mellitus.

Teaching points

• Take this drug exactly as prescribed; do not change dose without consulting your health care provider.
• Peel back foil on blister pack of disintegrating tablets; do not push through foil; use dry hands to remove tablet, place entire tablet in mouth.
• This drug cannot be taken during pregnancy. If you think you are pregnant or wish to become pregnant, contact your health care provider.
• You may experience these side effects: Drowsiness, dizziness, sedation, seizures (avoid driving, operating machinery, or performing tasks that require concentration); dizziness, faintness on arising (change positions slowly, use caution); increased salivation (if bothersome, contact your health care provider); constipation (consult with your health care provider for appropriate relief measures); fast heart rate (rest and take your time if this occurs).
• Report lethargy, weakness, fever, sore throat, malaise, mouth ulcers, and flulike symptoms.

Adverse effects in Italic are most common; those in Bold are life-threatening.

Olanzapine (Zyprexa) Original source at: Nurseslabs