Chastity ***all Med Cards Printed And Finished***

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Trade name:Flexeril, Cycloflex Generic name:cyclobenzaprine Classification:skeletal muscle relaxants (centrally acting)

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Indications:Management of acute painful musculoskeletal conditions associated with muscle spasm. Unlabeled uses:Management of fibromyalgia Route/Dosage:PO (Adults):Acute painful muscluskeletal conditions-10mg 3 times daily (range 20-40 mg/day in 2-4 divided doses);not to exceed 60 mg/day. Fibromyalgia syndrome-5-40mg at bedtime (unlabeled) Adverse Reactions/Side Effects:CNS:dizziness,drowsiness,confusion,fatigue,headache,nervousness. EENT:dry mouth,blurred vision.CV:arrhythmias. GI:constipation,dyspepsia,nausea,unpleasant taste. GU:urinary retention. Nursing Implications:assess patient for pain,muscle stiffness,and range of motion before and periodically throughout therapy. GERI:assess geriatric patients for anticholinergic effects (sedation and weakness)

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Trade name:Clonazepam Generic name: klonopin Classification/Therapeutic:anticonvulsants Pharmacologic:benzodiazepines

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Indications:Prophylaxis of petit mal,petit mal variant, akinetic, and myoclonic seizures. Management of panic disorder. Unlabeled Uses: uncontrolled leg movements during sleep.Nueralgias/Sedation Route/Dosage:PO (Adults):0.5mg 3 times daily;may increase by 0.5-1mg every third day. Total daily maintenance dose not to exceed 20mg. Panic disorder-0.125mg twice daily, increase after 3 days toward target dose of 1mg/day (some patients may require up to 4mg/day) Adverse Reactions/Side Effects:CNS:behavioral changes,drowsiness. EENT:abnormal eye movements, diplopia, nystagmus. CV:palpitations. GI:constipation,diarrhea,hepatitis. GU:dysuria,nocturia,urinary retention. Hemat:anemia,eosinophlia,leukopenia,thrombocytopenia. Neuro:ataxia,hypotonia. Misc:fever,physical dependence,psychological dependence,tolerance Nursing Implications:observe and record intensity,duration, and location of seizure activity, Assess degree and manisfestations of anxiety and mental status before and periodicall during therapy. Assess patient for drowsiness, unsteadiness,and clumsiness.These symptoms are dose-related and most severe during intial therapy;may decrease in severity or disappear with continued or long-term therapy.

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Trade Name:Dilatrate-SR,ISDN,Iso-Bid,Isonate,Isorbid,Isotrate,Sorbitrate,Sorbitrate SA Generic Name:Isosorbid Dinitrate Classification(s):Antianginal agents (nitrate) Trade Name:Imdur,ER,ISMO,Monoket Generic Name:Isosorbide Mononitrate

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Indications:Acute treatment of anginal attacks (SL,chewable dinitrate only) Long-term prophylactic management of angina pectoris (dinitrate and mononitrate) Treatment of chronic congestive heart failure (dinitrate) Route/Dosage:PO/SL,Chewable, Buccal (Adults):Acute attack of angina pectoris-2.5-5mg may be repeated every 5-10 min for 3 doses in 15-30 min. Prophylaxis of angina pectoris-2.5-10mg may be repeated every 2-3 hrs. Intial dose of chewable tablet is 5mg. PO(Adults):Prophylaxis of angina pectoris-5-20mg intially, usual maintenance dose is 10-40 every 6 hr. or 40-80mg every 8-12 hr as sustained release form/Isosorbide Mononitrate:PO(Adults):ISMO,Monoket-20mg twice daily (may start with 5mg twice daily)7 hr apart. Imdur-30-60mg once daily may increase to 120mg once daily (up to 240mg/day) Adverse Reactions/Side Effects:CNS:dizziness,headache,apprehension,weakness. CV:hypotension,tachycardia,paradoxical bradycardia,syncope. GI:abdominal pain, nausea,vomiting Misc:cross-tolerance,flushing,tolerance Nursing Implications:Assess location,duration,intensity,and precipitating factors of anginal pain. Monitor BP and pulse routinely during period of dosage adjustment

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Trade Name:Hep-Lock,Hep-Lock U/P Generic Name:Heparin Classification/Therapeutic:anticoagulants Pharmacologic:antithrombotics

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Indications:Prophylaxis and treatment of various thromboembolic disorders including:Venous thromboembolism,pulmonary emboli,atrial fibrillation with embolization, acute and chronic consumptive coagulopathies, peripheral arterial thromboembolism.Used in VERY low doses (10-100 units) to maintain patency of IV catheter (heparin flush) Route/Dosage:IV (Adults): Intermittent boluses-10,000 units followed by 5000-10,000 units every 4-6 hr. Continuous infusion-5000 units (35-70 units/kg), followed by 20,000-40,000 units infused over 24 hr. (approx. 1000 units/hr or 15-18 units/kg/hr) Prophylaxis of Thromboembolism/Subcut (Adults):5000 units every 8-12 hr (may be started 2 hr before surgery). Adverse Reactions/Side Effects:GI:drug-induced hepatitis Derm:alopecia (long-term use), rashes urticaria. Hemat:BLEEDING,anemia,thrombocytopenia. Local:pain at injection site. MS:osteoporosis (long-term use) Misc.:fever,hypersensitivity Nursing Implications:Assess patient for signs of bleeding and hemorrhage (bleeding gums;nosebleed;unusual bruising;black tarry stools;hematuria;fall in hematorcrit or blood pressure;guaiac-positive stools) Notify physician if these occur. Assess patient for evidence of additional or increased thrombosis. Symptoms will depend on area of involvement. Monitor patient for hypersensitivity reactions (chills,fever,urticaria) report signs to physician SC: observe injection sites for hematomas, ecchymosis or inflammation.

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Trade Name: Lyphocin,Vancocin, Vancoled Generic Name:Vancomycin Classification(s): Anti-infective agents (miscellaneous)

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Indications IV:treatment of potentiallly life-threatening infections when less toxic anti-infectives are contraindicated:Endocarditis/Osteomyelitis/Pneumonia/Septicemia/Soft-tissue infections in patients who have allergies to penicillin or it derivatives or when sensitivity testing demonstrates resistance to methicillin PO:treatment of pseudomembranous colitis caused by Clostridium difficile IV: part of endocarditis prophylaxis in high-risk patients who are allergic to penicillin Route/Dosage:IV (Adults):500mg (7.5mg/kg )every 6hr or 1g (15mg/kg) every 12 hr (up to 3-4g/day) Adverse Reactions/Side Effects: Mainly associated with IV adminsitration EENT: ototoxicity CV:hypotension GI:nausea,unpleasant taste, vomiting GU:nephrotoxicity Derm: rashes Hemat:eosinophilia,leukopenia Local: phlebitis MS: back and neck pain Misc: hypersensivtivity reactions including ANAPHYLAXIS,fever, chills, "red man" syndrome, superinfection Nursing Implications:Geneal info. Assess patient for infection before and during therapy , obtain specimens for culture and sensitivity before intiating therapy. First dose may be given before receiving results. Monitor IV site closely. Vancomycin is irritating to tissues and causes necrosis and severe pain with extravasation. Monitor blood pressure throughout IV infusion. Assess patient for signs fo superinfection (black, furry overgrowth on tongue; vaginal itching or discharge;loose or fou-smelling stools) Pseudomembranous Colitis: assess bowel status (bowel sounds, frequency and consistency of stools, presence of blood in stools) throughout therapy.

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Trade Name: Zithromax Generic Name: Azithromycin Classification(s): Anti-infective agents (macrolide)

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Indications:Treatment of upper respiratory tract infections, including streptococcal pharyngitis and tonsillitis,lower tract respiratory infections, including bronchitis and pneumonia, skin and skin structure infections. Non-gonococcal urethritis, cervicitis, gonorrhea and chancroid. Pelvic inflammatory disease. Prevention of disseminated Mycobacterium avium complex (MAC) infection in patients with advanced HIV infection. Unlabeled Uses: prevention of bacterial endocarditis Route/Dosage: PO (Adults) 500mg on first day then 250mg/day for 4 more days (total dose of 1.5g) Community-acquired pneumonia IV,PO (Adults) 500mg IV every 24 hr for at least 2 days then 500mg PO every 24 hr for a total of 7-10 days Pelvic Inflammatory Disease IV,PO (Adults) 500mg IV every 24 hr for 1-2 days then 250mg PO every 24 hr for a total of 7 days Endocarditis Prophylaxis PO (Adults) 500mg 1 hr before procedure Nongonocoaal Urethritis,Cervictis,Chancroid,Chalmydia PO (Adults) single 1-g dose Prevention of Disseminated MAC infection PO (Adults) 1.2g once weekly (alone or with rifabutin) Adverse Reactions/Side Effects: CNS:dizziness,drowsiness,fatigue,headache CV:ches pain, palpitations GI:PSEUDOMEMBRANOUS COLITIS ,abdominal pain, diarrhea, nausea, cholestatic jaundice,dyspepsia,flatulence, melena GU:nephritis,vaginitis Derm:photosensitivity, rashes Endo:hyperglycemia F &E: hyperkalemia Misc: ANGIODEMA Nursing Implications: Assess patient for infection (vital signs, apperance of wound, sputum, urine , and stool;WBC)at beginning of and throughout therapy. Obtain specimens for culture and sensitivity before intiating therapy.First dose may be given before receiving results. Observe for signs and symptoms of anaphylaxis (rash,pruritus,laryngeal edema,wheezing)

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Trade Name:Amoxil,Trimox,Wylmox Generic Name: amoxicillin Classification(s): Anti-infective agents (aminopenicillin)

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Indications:Treatment fo the following infections:skin/skin structure infections/Otitis media/Sinusitis/Respiratory infections/Genitourinary infections/Septicemia/Endocarditis proyphylaxis/ Management of ulcer disease caused by Helicobacter pylori Route/Dosage:PO (Adults and Children >20kg)250-500mg every 8 hr or 500-875mg every 12 hr. Helicobacter pylori infections PO(Adults):triple therapy-1000mg amoxicillin twice daily with lansoprazole 30mg twice daily and clarithromycin 500mg twice daily for 14 days or 1000mg amoxicillin twice daily with omeprazole 20mg twice daily and clarithromycin 500mg twice daily for 14 days. Dual therapy-1000mg amoxicillin three times daily with lansoprazole 30mg three times daily for 14 days. Endocarditis Prophylaxis PO (Adults):2g 1 hr before procedure Adverse Reactions/Side Effects:CNS:SEIZURES (high doses) GI:PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,vomiting Derm:rashes,urticaria Hemat:blood dyscrasias Misc:allergic reactions including ANAPHYLAXIX/SERUM SICKNESS Nuring Implications:Assess patient for infection (vital signs, apperance of wound,sputum,urine,and stool; WBC)at beginning of and throughout therapy. Observe for signs and symptoms of anaphylaxis (rash,pruritus,larygneal edema, wheezing).Monitor bowel function (diarrhea,abdominal cramping,fever, and blood stools should be reported to health care professional promptly as a sign of pseudomembranous colitis.May begin up to several weeks after cessation of therapy.

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Trade Name:Lasix Generic Name:furosemide Classification: Therapeutic:diuretics Pharmacologic:loop diurectics

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Indications:Edema due to heart failure, hepatic impairment or renal disease.Hypertension Route/Dosage:PO (Adults)20-80mg/day as a single dose intially may repeat in 6-8 hr; may increase dose by 20-40mg every 6-8 hr until desired response. Maintenance doses may be given once or twice daily (doses up to 2.5g/day have been used in patients with congestive heart failure or renal disease).Hypertension-40mg twice daily initially (when added to regimen, decrease dose or other antihypertensives by 50%); adjust further dosing based on response; Hypercalcemia-120mg/day in 1-3 doses. Hypertension PO (Adults) 40mg twice daily initiallly when added to regimen, decrease dose of other antihypertensives by 50% adjust further dosing based on response. Adverse Reactions/Side Effects:CNS: blurred vision,dizziness,headache, vertigo. EENT: hearing loss, tinnitus CV: hypotension GI:excessive urination, Derm:photosensitivity, pruritis, rash F&E: dehydration, hypocalcemia, hypochloremia, hypokalemia,hypomagnesemia,hyponatremia, hypovolemia, metabolic alkalosis Hemat:APLASTIC ANEMIA,AGRANULOCYTOSIS, hemolytic anemia,leulopenia,thrombocytopenia MS:muscle cramps Neuro:paresthesia Misc:fever,increased BUN, nephrocalcinosis Nurinsg Implications: Assess fluid status. Monitor daily weight, intake and output ratios, amount and location of edema , lung sounds ,skin turgor,and mucous membranes. Notify physician or other health care professional if thirst, dry mouth, lethargy,weakness,hypotension, or oliguria occurs. Monitor blood pressure and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension. Geri:diuretic use is associated with increased risk for falls in older adults. Assess falls risk and implement fall prevention strategies.

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Trade Name: Lopressor Generic Name:metoprolol Classification(s): Therapeutic:antianginals, antihypertensives Pharmacologic: beta blockers

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Indications:Hypertension, angina pectoris.Prevention of MI and decreased mortality in patients with recent MI. Management of stable, symptomatic (class II or III) heart failure due to ischemic, hypertensive or cardiomyopathc origin (may be used with ACE inhibitors, diuretics ann/or digoxin; Toprol XL 25mg only). Unlabeled Uses: ventricular arrhythnias/tachycardia. Migraine prophylaxis. Tremors ,aggressive behavior, drug induced akathisia , anxiety. Route/Dosage:PO (Adults):antiphyertensive/antianginal-25-100mg/day as a single dose initially or 2 divided doses; may be increased every 7 days as needed up to 450mg/day (for angina , give in divided doses). Extended release products are given once daily. MI-25-50mg (starting 15 min after last IV dose) every 6 hr for 48 hr, then 100mg twice daily for a minimum of 3 mo. Heart failure -12.5-25mg once daily can be doubled every 2 wk up to 200mg/day.Migraine prevention-50-100mg 2-4 times daily (unlabeled) Adverse Reactions/Side Effects: CNS: fatigue,weakness, anxiety, depression, dizziness, drowsiness,insomnia, memory loss, mental status changes, nervousness , nightmares EENT: blurred vision, stuffy nose Resp: bronchospasm, wheezing. CV: BRADYCARDIA,CHF,PULMONARY EDEMA, hypotension, peripheral vasoconstriction GI: constipation,diarrhea,drug induced hepatitis,dry mouth, flatulence,gastric pain,heartburn,increased liver function studies,nausea, vominting GU:erectile dysfuntion,decreased libido,urinary frequency Derm:rashes Endo:hyperglycemia, hypoglycemia MS: arthralgia, back pain, joint pain, Misc: drug induced lupus syndrome Nursing Implications: Monitor blood pressure, ECG, and pulse frequently during dose adjustment and periodically during therapy. Monitor frequency or prescription refills to determine compliance. Angina:assess frequency and characteristics of anginal attacks periodically during therapy. Monitor intake and output ratios and daily weights , assess routinely for signs and symptoms of CHF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention)

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Trade Name: Hycodan, Tussingon (U.S. antitussive formulations contain homatropine) Generic Name:hydrocodone Classification(s):Therapeutic:allergy,cold and cough, remedies (antitussive), opioid analgesics Pharmacologic:opioid agonists/nonopioid analgesic combinations

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Indications:Used mainly in combination with nonopioid analgesics (acetaminophen/aspirin/ibuprofen) in the management of moderate to severe pain. Antitussive (usually in combination products with decogestants). Route/Dosage:PO (Adults): analgesic-2.5-10mg every 3-6 hr as needed ; if using combination products, acetaminophen or aspirin dosage should not exceed 4g/day and should not exceed 5 tablets/day of ibuprofen-containing products; Antitussive-5mg every 4-6 hr as needed. Adverse Reactions/Side Effects:CNS: confusion, dizziness,sedation,euphoria,hallucinations,headache,unusual dreams. EENT: blurred vision, diplopia,miosis Resp: respiratory depression CV: hypotension, bradycardia GI: urinary retention Derm: sweating Misc: physical dependence, psychological dependence , tolerance Nursing Implications:Assess blood pressure , pulse and respirations before and periodically during administrations. If respiratory rate is <10/min assess level of sedation . Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use. Assess bowel function routinely, prevention of constipation should be instituted with increased intake of fluids and bulk, and laxatives to minimize constipating effects. Stimulant laxatives should be administered routinelly if opioid use exceeds 2-3 days unless contraindicated. Assess pain , location,type,and intensity prior to and 1 hr (peak) following administration. When titrating opioid doses, increases of 25-50% should be administered until there is either a 50% reduction in the patients pain rating on a numerical or visual analogue scale or the patient reports satifactory pain relief. A repeat dose can be safely adminsitered at the time of the peak if previous dose is ineffective and side effects are minimal.

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Trade Name: Halcion
Generic Name: triazolam
Classification(s): Therapeutic:sedative/hypnotics
Pharmacologic:benzodiazapams

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Indications:Short-term management of insomnia
Route/Dosage:125-250mcg (up to 500mcg) at bedtime
PO (Geriatric patients or debilitated patients):125mcg at bedtime initiallyl may be increased as needed
Adverse Reactions/Side Effects: CNS: abnormal thinking,behavior changes, dizziness,excessive sedation, hangover, headache, anterograde amnesia, confusion,hallucinations, sleep-driving,lethargy,mental depression, paradoxical excitation. EENT: blurred vision GI: constipation, diarrhea,nausea, vomiting
Derm: rashes Misc:physical dependence,psychological dependence, tolerance
Nursing Implications: Assess patient for urinary tract infection (fever,cloudy urine, frequency, urgency, pain and burning on urination) or other signs of infection at begining of and throughout therapy.
Monitor intake and output ratios.Fluid intake should be sufficient to maintain urine output of at least 1200-1500 ml daily.

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Trade Name:Ancef
Generic Name:cefazolin
Classification(s):Thearpeutic: anti-infectives
Pharmacologic: first-generation cephalosporins

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Indications:Treatment of the following infections caused by susceptible organisms:skin and skin structure infections (including burn wounds), pneumonia, urinary tract infections,bone and joint infections, septicemia. Not suitable for the treatment of meningitis. Perioperative prophylaxis, biliary tract infections, genital infections, bacterial endocarditis prophylaxis for dental and upper respiratory tract procedures.
Route/Dosage:IM,IV (Adults):moderate to severe infections-500mg-2g every 6-8 hr (maximum 12g/day). Mild infections with gram positive cocci-250-500mg every 8 hr. Uncomplicated urinary tract infections-1g every 12 hr. Pneumococcal pneumonia-500mg every 12 hr.
Infective endocarditis or septicemia-1-1.5g every 6 hr. Perioperative prophylaxis-1g given 30-60 min prior to incision. Additional 500 mg-1g should be given for surgeries>2 hr. 500mg-1g shoudl then be given for all surgeries every 6-8 hrs. for 24 hr. postoperatively.
Adverse Reactions/Side Effects:SEIZURES (high doses)
GI:PSEUDOMEMBRANOUS COLITIS,diarrhea, nausea, vomiting, cramps, Derm: rashes, pruritis, urticaria.
Hemat:agranulocytosis, eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia
Local: pain at IM site, phlebitis AT IV SITE
Misc: allegic reactions including ANAPHYLAXIS and SERUM SICKNESS, superinfection
Nursing Implications:Assess for infection (vital signs; apperance of wound , sputum, urine , and stool;WBC) at beginning and during therapy.
Observe patient for signs and symptoms of anaphylaxis (rash,pruritus, laryngeal edema, wheezing) Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine an anithistamine and resuscitation equipment close b in case of an anaphylactic reaction.

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Trade Name:Maalox, Mylanta
Generic Name:magnesium hydroxide/aluminum hydroxide
Classification(s):Therapeutic:antiulcer agents
Pharmacologic:antacids

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Indications:Useful in a variety of GI complaints , including:Hyperacidity, indigestion , GERD, heartburn
Route/Dosage:PO(Adults and Children>12 yr): 5-30ml or 1-2 tablets 1-3 hr after meals and at bedtime
Chewable tablets:300 mg aluminum hydroxide/150mg magnesium hydroxide Suspension:225mg aluminum hydroxide/200mg magnesium hydroxide/5ml , 500mg aluminumhydroxide/500mg magnesium hydroxide/5ml
Adverse Reactions/Side Effects:GI: aluminum salts-constipation, magnesium salts-diarrhea. F&E: magnesium salts-hypermagnesemia; aluminum salts-hypophosphatemia
Nursing Implications: Assess for heartburn and indigestion as well as location , duration, character, and precipitating factors of gastric pain.