Medication

(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment

Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment
Nursing Considerations

furosemide/Lasix
Loop diuretic

BP: Is it too low? <90/60

K+: Is it below normal? If so, do not give the
med.call PCP

PO: Tabs may be crushed

IM: Needle according to pt size, syringe 3ml
IVP: Undiluted
Give 20mg or less per minute

Tinnitus (ringing in the ears); Hypokalemia,

Hypotension
BP
How is pts output?
Assess for S/S hypokalemia: Postural hypotension,
malaise, fatigue, tachycardia, leg cramps, weakness
Rise slowly due to postural hypotension risk

Patient teaching
WILL YOU GIVE THIS
DRUG?
Medication (generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment

Notes about
administration:

Yes

No

digoxin/Lanoxin

Cardiac glycoside; inotropic, antidysrhythmic

Apical heart rate for 1 minute; hold if < 60

Dig level: Is it within therapeutic range?
If it is above therapeutic range.hold med
and call PCP
If it is below therapeutic range.why? Is it
a newly started
med that hasnt had time for the blood level
to become
therapeutic yet?

PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?
Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I give
it?
Subcutaneous
Side Effects
Post-assessment
Nursing Considerations

PO: May crush tabs; Do not break, crush, or chew

capsules
NO IM ROUTE
IVP: Undiluted OR 1ml of med in 4ml of NS
Give over >5 minutes

Bradycardia
Blurred vision, yellow-green halos
Continue to monitor for HR <60
May crush tabs
Do not break, crush, or chew capsules
Administer 1 hour away from antacids
Never stop drug abruptly
How to assess heart rate
Call PCP if any blurred vision or yellow-green halos
Do not take antacid at the same time

Yes

No

enoxaparin/Lovenox
Anticoagulant; antithrombotic

If the platelet count falls below 100,000/mm 3,

LOVENOX should be discontinued.
Not available PO
Never give this drug IM!

Administer in the love handles area- do not massage

area

Thrombocytopenia, hemmorrhage
Bleeding: gums, petechiae, ecchymosis, black tarry
stools, hematuria; notify PCP
Do not aspirate; rotate sites; do not expel bubble from
pre-filled syringe before administration; do not

Patient teaching

WILL YOU GIVE THIS

DRUG?
Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment
Nursing Considerations
Patient teaching

WILL YOU GIVE THIS

DRUG?
Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?

massage area after injection

To use soft-bristle toothbrush to avoid bleeding gums;
to use electric razor
To report any signs of bleeding: gums, under skin,
urine, stools
To avoid OTC products containing aspirin unless
approved by prescriber

Yes

No

pantoprazole/Protonix
Proton pump inhibitor blocks the final step of acid
production

Bowel sounds (done with AM assessment)

PO: Do not break, crush, or chew
NO IM ROUTE
IVP: Reconstitute with 10ml of NS and push over 2
minutes
IVPB: Dilute with 80ml or more of NS and give over 15
minutes

Headache, diarrhea, abdominal pain; hyperglycemia

Bowel sounds every 8 hours
Assess for absence of epigastric pain (desired effect)
Report severe diarrhea, tarry stools, abd pain
Avoid alcohol, salicylates, NSAIDS (may cause GI
irritation)
Continue to take this med even though you feel better

Yes

No

piperacillin-tazobactam/Zosyn
Antiinfective, broad spectrum

Pre-assessment

Notes about
administration:
PO
IM: Size needle/syringe
size
IVPB: Do I need to
dilute it?
How fast do I give
it?
Side Effects
Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Assess for allergies to penicillin; Obtain specimen for

culture and sensitivity tests before giving first dose.
Therapy may begin while awaiting results.
Not available PO
Not available for IM injection
IVPB: Reconstitute each gram with 5 mL of diluent,
such as sterile or bacteriostatic water for injection,
normal saline solution for injection
Further dilute to 50 to 150 mL before infusion.
Infuse over at least 30 minutes
pseudomembranous colitis ;leukopenia, neutropenia,
thrombocytopenia; phlebitis at I.V. site.
Monitor patient for diarrhea and initiate therapeutic
measures as needed. Drug may need to be stopped.
Monitor for anaphylaxis: wheezing, laryngeal edema,
rash, itching; discontinue product, have emergency
equipment nearby
Tell patient to report adverse reactions promptly
Tell patient to alert a health care professional about
discomfort at the I.V. site.
To report sore throat, fever, fatigue (superinfection);
CNS effects (anxiety, depression, hallucinations,
seizures); pseudomembranous colitis: fever, diarrhea
with blood, pus, mucous
To wear or carry emergency ID if allergic to penicillins
To notify nurse of diarrhea

Yes

No

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO

IM: Size needle/syringe

size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

metoprolol/Toprol XL;
Lopressor
Antihypertensive, antianginal ; Selective betaadrenergic blocker

BP: Hold if BP < 90/60 or as instructed by PCP

Apical HR: Hold if <50
PO: Do not break, crush, or chew extended release tabs
Administer regular release tab after meals, at bedtime;
tab may be crushed or swallowed whole; take at same
time each day
Not given IM
IV: undiluted
Give over 1 min 3 doses at 2 to 5-min intervals; start
PO 15 min after last IV dose

Bradycardia
BP and heart rate q 4 hrs
In diabetic patients, monitor glucose level closely
because drug masks common signs and symptoms of
hypoglycemia.
Administer with meal
To take immediately after meals; to take medication at
bedtime to prevent effect of orthostatic hypotension
Not to discontinue product abruptly; to taper over 2
wk; may cause precipitate angina

Yes

No

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size

IVP: Do I need to dilute

it?
How fast do I give
it?
IVPB:
Side Effects
Post-assessment

Nursing Considerations
Patient teaching

methylprednisolone/DepoMedrol;Solu-Medrol
Corticosteroid, synthetic

PO: With food or milk to decrease GI symptoms

IM: Needle according to pt size, syringe 3ml
inj deep in large muscle mass; rotate sites; avoid
deltoid; use 21G needle; after shaking suspension
IVP: After diluting with diluent provided; agitate slowly;
give 500 mg/1 min
IVPB: Dilute further in D5W, NS, D5NS; haze may form,
give over 15-60 min; large dose (500 mg) should be
given over 30-60 min

May increase blood glucose and cholesterol levels

Assess for change in B/P, pulse, tachycardia, sweating,
rigidity, altered consciousness
Assess mental status: depression, anxiety, irritability
GI complaints: nausea, vomiting, anorexia, constipation
Monitor patient for cushingoid effects, including moon
face, buffalo hump, central obesity, thinning hair,
hypertension, and increased susceptibility to infection.
monitor glucose level for elevation and need for
treatment
Avoid SUBCUT administration; may damage tissue
To avoid driving, other hazardous activities until
stabilized on product
To avoid alcohol, other CNS depressants that will
enhance sedating properties of this product
Tell patient not to stop drug abruptly or without
prescriber's consent.

Instruct patient to take oral form of drug with milk or

food.
Teach patient signs and symptoms of early adrenal
insufficiency: fatigue, muscle weakness, joint pain,
fever, anorexia, nausea, shortness of breath, dizziness,
and fainting.
Warn patient on long-term therapy about cushingoid
effects (moon face, buffalo hump) and the need to
notify prescriber about sudden weight gain or swelling.
WILL YOU GIVE THIS
DRUG?

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment

Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment

Yes

No

docusate sodium/Colace
Laxative, emollient; stool softener

Before giving drug, determine whether patient has

adequate fluid intake
Assess bowel movements
PO: Administer with a full glass of water if possible
Not given IM
Not given IVP or IVPB

Mild abdominal cramping, diarrhea.

Bowel movements

Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO

Administer oral preparations with a full glass of water

(unless on fluid restrictions) and encourage pt to
increase fluid intake
Teach patient about dietary sources of fiber, including
bran and other cereals, fresh fruit, and vegetables.
Instruct patient to use drug only occasionally and not
for longer than 1 week without prescriber's knowledge.
Tell patient to stop drug and notify prescriber if severe
cramping occurs.
Notify patient that it may take from 1 to 3 days to
soften stools.

Yes

No

potassium chloride/KDur; Klor

Con; Slow K
Electrolyte, mineral replacement

Potassium level
Do not break, crush, or chew ext rel tabs, caps or
enteric products

IM: Size needle/syringe

size
IVP:
IVPB:
Do I need to
dilute it?
How fast do I
give it?
Side Effects
Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Medication
(generic/Brand)
Functional
Classification

Administer with or after meals;

Dissolve effervescent tabs, powder in 8 oz cold water
or juice
Caps with full glass of liquid
NEVER GIVEN IM
NEVER GIVEN IVP
Through large-bore needle to decrease vein
inflammation; check for extravasation; in large vein
Dilute potassium chloride in a suitable I.V. solution of
less than 80 mEq/L,
Infuse 10 mEq/hr; in severe hypokalemia, rate may be
40 mEq/hr
Arrhythmias, heart block, cardiac arrest,
Assess for S/S hyperkalemia
If burning occurs during infusion, decrease rate.
Fatal outcomes are possible if concentrated
potassium is administered by I.V. push.
Tell patient to take with or after meals with full glass of
water or fruit juice to lessen GI distress.
Teach patient signs and symptoms of hyperkalemia,
and tell patient to notify prescriber if they occur.
Tell patient to report discomfort at I.V. insertion site.
Warn patient not to use salt substitutes concurrently,
except with prescriber's permission.
Tell patient not to be concerned if wax matrix (cover of
capsule) appears in stool because the drug has already
been absorbed.

Yes

No

ondansetron/Zofran
Antiemetic

Why is THIS pt getting

this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I
give it?
IVPB:
Side Effects
Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Monitor liver function test results. Don't exceed 8 mg in

patients with hepatic impairment.
PO: Oral disintegrating tab: do not push through foil;
gently remove, immediately place on tongue to
dissolve; swallow with saliva
IM: 4mg undiluted can given
IVP: May give undiluted
Administer over 2-5 minutes
IVPB: Dilute drug in 50 mL of D5W injection or normal
saline solution for injection
Infuse over 15 minutes.
arrhythmias, hypoxia
Resolution of nausea
Open blister just before use by peeling backing off and
not by pushing through foil blister, taking it with liquid
isn't required.
Teach patient to place ODTs on tongue, allow to
dissolve, then swallow with saliva.
Alert: Caution patient to contact his health care
provider immediately if he experiences signs and
symptoms of abnormal heart rate or rhythm, such as
palpitations, dyspnea, or dizziness.
For patient taking ODTs, tell him to
To report diarrhea, constipation, rash, changes in
respirations, or discomfort at insertion site
Headache requiring analgesic is common

Yes

No

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment

Notes about
administration:
PO

IM: Size needle/syringe

size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment
Nursing Considerations

Patient teaching

morphine sulfate/MS
Contin
Opioid analgesic

Pain: location, type, character; give dose before pain

becomes severe
B/P, pulse, respirations (character, depth, rate) HOLD
MED IF RESPIRATORY RATE <12
Give morphine sulfate without regard to food.
Oral capsules may be carefully opened and the entire
contents poured into cool, soft foods, such as water,
orange juice, applesauce, or pudding; patient should
consume mixture immediately.
Black Box Warning: Don't crush, break, or allow patient
to chew
extended-release forms.
Give after diluting with 5 ml sterile water or NS
Give 15 mg/4-5 min;

RESPIRATORY DEPRESSION, hypotension; pruritus,

dizziness
Pain assessment; respiratory assessment
Assess bowel status; constipation common, use
stimulant laxative if needed
I&O ratio; check for decreasing output; may indicate
urinary retention
CNS changes: dizziness, drowsiness, hallucinations,
euphoria, LOC, pupil reaction
To change position slowly; orthostatic hypotension may
occur
To report any symptoms of CNS changes, allergic
reactions

That physical dependency may result from long-term

use
To avoid use of alcohol, CNS depressants
That withdrawal symptoms may occur: nausea,
vomiting, cramps, fever, faintness, anorexia
WILL YOU GIVE THIS
DRUG?

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO

IM: Size needle/syringe

size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects

Yes

No

acetaminophen/Tylenol
Nonopioid analgesic, antipyretic

For fever and pain: type of pain, location, intensity,

duration
PO: Crushed or whole, do not crush EXT REL product;
chewable tabs may be chewed; give with full glass of
water
Give drug without regard for food.
Not given IM
May administer without further dilution.
Give over 15 minutes.

Chronic poisoning: rapid, weak pulse; dyspnea; cold,

clammy extremities; report immediately to prescriber
Hepatotoxicity: dark urine; clay-colored stools;
yellowing of skin, sclera; itching; abdominal pain; fever;
diarrhea if patient is on long-term therapy
Allergic reactions: rash, urticaria; if these occur,
product may have to be discontinued

Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment

Notes about
administration:
PO
IM: Size needle/syringe
size
IVPB: Do I need to
dilute it?
How fast do I give
it?

Assess for absence of pain using pain scoring; fever

Alert: Many OTC and prescription products contain
acetaminophen; be aware of this when calculating total
daily dose.
To recognize signs of chronic overdose: bleeding,
bruising, malaise, fever, sore throat
Not to exceed recommended dosage; acute poisoning
with liver damage may result

Yes

No

vancomycin
hydrochloride/Vancomycin
Antiinfective

Obtain specimen for culture and sensitivity tests before

giving.
Look at any peak and trough data..See data below
this chart

Not given IM
Reconstitute 500-mg vial with 10 mL or 1-g vial with 20
mL sterile water for injection to provide a solution
containing 50 mg/mL.
For infusion, further dilute 500 mg in 100 mL or 1 g in
200 mL normal saline solution for injection or D5W, and
infuse over 60 minutes; if dose is greater than 1 g,
infuse over 90 minutes.

Side Effects
Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Pseudomembranous colitis; anaphylaxis

Therapeutic response: absence of fever, sore throat;
negative culture
Hearing loss, ringing, roaring in ears; product should be
discontinued;
Assess for red-man syndrome occurs: decreased B/P,
flushing of neck, face- if this occurs slow infusion and if
no improvement, STOP infusion antihistamine may be
needed
To report sore throat, fever, fatigue; could indicate
superinfection
That product must be taken in equal intervals around
the clock to maintain blood levels

Yes

No

Vancomycin trough concentrations below 10 g/mL are associated with inadequate therapy and
an increased risk of developing bacterial resistance.
Vancomycin trough concentrations above the therapeutic range may increase the risk of
nephrotoxicity.
Vancomycin peak concentrations above the therapeutic range may be associated with an
increased the risk of nephrotoxicity, although peak concentrations do not correlate well with
toxicity. Most doctors want to know the trough blood level so you may not see peak levels tested
very often.
How and when blood is drawn for a peak and trough:
Do not draw specimens until steady state is achieved (ie, before fourth dose)
Draw trough specimen immediately before (30 min) next dose
Draw peak specimen 1-2 hours after completion of intravenous dosage (not routinely tested)

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting

warfarin/Coumadin
Anticoagulant

this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?

PT and INR determinations are essential for proper

control. Recommended INR range is usually 2 to 3.
PO:
IM: Not given IM
IVP: Reconstitute with 2.7 ml sterile water for inj (2
mg/ml); do not use sol that is discolored or that has
particulates
Give over 1-2 min into peripheral vein (Not used very
often)

How fast do I give

it?
Side Effects

Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Bleeding gums, petechiae, ecchymosis, black tarry

stools, hematuria; fatal hemorrhage can occur
Withhold drug and call prescriber at once in the event
of fever or rash (signs of severe adverse reactions).
Continuously monitor for S/S of side effects
Avoid all IM inj that may cause bleeding
Effect can be neutralized by oral or parenteral vitamin
K.
To avoid OTC preparations that may cause serious
product interactions unless directed by prescriber
To carry emergency ID identifying product taken
About the importance of compliance
To report any signs of bleeding: gums, under skin,
urine, stools; to use soft-bristle toothbrush to avoid
bleeding gums; to use electric razor
To avoid hazardous activities (football, hockey, skiing),
dangerous work
About the importance of avoiding unusual changes in
vitamin intake, diet, or lifestyle
To inform all health care providers of anticoagulant
intake

Yes

No

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size
IVP or Continuous
infusion
Subcutaneous
Side Effects
Post-assessment

Nursing Considerations

Patient teaching
WILL YOU GIVE THIS
DRUG?

Insulin/many types
Anti-diabetic

Blood glucose
PO: Not given PO
IM: Not given IM
IVP or Continuous infusion: You will learn more about
this later
Subcutaneous: See nursing considerations below; give
within 15 min before or 20 min after starting a meal
Hypoglycemia
Observe for S/S:
Hypoglycemia: sweating, weakness, dizziness, chills,
confusion, headache, nausea, rapid weak pulse,
fatigue, tachycardia, memory lapses, slurred speech,
staggering gait, anxiety, tremors, hunger
Hyperglycemia: acetone breath; polyuria; fatigue;
polydipsia; flushed, dry skin; lethargy
Press, don't rub, site after injection. Rotate injection
sites to avoid overuse of one area. Diabetic patients
may achieve better control if injection site is rotated
within same anatomic region.
S/S of hypoglycemia and hyperglycemia
LOTS more that you will learn later!

Yes

No

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment

Nursing Considerations

Patient teaching
WILL YOU GIVE THIS
DRUG?

ceftriaxzone/Rocephin
Broad-spectrum antibiotic (cephalosporin)

Sensitivity to penicillins; S/S of problems with kidney

function (Bun and Creat; I & O)

May be further diluted with 50-100 ml NS, D5W,

D10W; shake; run over 1/2-1 hr

Seizures; pseudomembranous colitis, nephrotoxicity

Anaphylaxis: rash, urticaria, pruritus, chills, fever,
joint pain, angioedema; may occur a few days after
therapy begins
If large doses are given, therapy is prolonged, or
patient is at high risk, monitor patient for signs and
symptoms of superinfection.
To report persistent diarrhea

Yes

No

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:
PO
IM: Size needle/syringe
size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects

Post-assessment

promethazine/Phenergan
Antihistamine, H1-receptor antagonist, antiemetic

Reason for this med being given

PO: With meals for GI symptoms; absorption may
slightly decrease
IM: Inj deep in large muscle; rotate site
IVP: After diluting each 25-50 mg/9 ml of NaCl for inj;
give 25 mg/2 min

Neuroleptic malignant syndrome: fever, confusion,

diaphoresis, rigid muscles, elevated CPK,
encephalopathy; discontinue product, notify prescriber
I&O ratio; be alert for urinary retention

Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

Medication
(generic/Brand)
Functional
Classification
Why is THIS pt getting
this drug?
Is dosage correct ?
Pre-assessment
Notes about
administration:

Avoid use with other CNS depressants ; give PO with

meals to decrease GI upset.
Check for extravasation: burning, pain, swelling at IV
site; can cause tissue necrosis
Do not use if precipitate is present
Rapid administration may cause transient decrease in
B/P
That product may cause photosensitivity; to avoid
prolonged exposure to sunlight
To notify prescriber of confusion, sedation,
hypotension, jaundice, fever
To avoid driving, other hazardous activity if drowsy
To avoid concurrent use of alcohol or other CNS
depressants
That product may reduce sweating; that there is a risk
of heat stroke
How to use frequent sips of water, gum to decrease dry
mouth

Yes

No

levothyroxine/Synthroid
Thyroid hormones

PO: Give drug at same time each day on an empty

PO

IM: Size needle/syringe

size
IVP: Do I need to dilute
it?
How fast do I give
it?
Side Effects
Post-assessment
Nursing Considerations

Patient teaching

WILL YOU GIVE THIS

DRUG?

stomach, preferably 1/2 to 1 hour before breakfast.

If necessary, crush tablet and suspend it in small
amount of formula
IVP: IV after diluting with provided diluent 500 mcg/5
ml, 200 mcg/2 ml; shake; give through Y-tube or 3-way
stopcock; give 100 mcg/1 min; do not add to
continuous IV infusion
Arrythmias, cardiac arrest
Patients taking anticoagulants may need their dosage
modified and require careful monitoring of coagulation
status.
Teach patient the importance of compliance. Tell him
to take drug at same time each day, preferably 1/2 to 1
hour before breakfast, to maintain constant hormone
levels and help prevent insomnia.
Make sure patient understands that replacement
therapy is usually for life. The drug should never be
stopped unless directed by prescriber.
Tell patient to report unusual bleeding and bruising.

Yes

No