omeprazole
Losec (CAN), Prilosec, Zegerid
Nursing Considerations
• Give omeprazole before meals, preferably
in the morning for once-daily dosing. If
needed, also give an antacid, as prescribed.
• If needed, open capsule and sprinkle
enteric-coated granules on applesauce or
yogurt or mix with water or acidic fruit
juice, such as apple or cranberry juice.
Give immediately.
• To give drug via NG tube, mix granules in
acidic juice because enteric coating dissolves
in alkaline pH.
• Because drug can interfere with absorption
of vitamin B12, monitor patient for
macrocytic anemia.
• Be aware that long-term use of omeprazole
may increase the risk of gastric carcinoma.
PATIENT TEACHING
• Tell patient to take drug before eating—
usually before breakfast—and to swallow
delayed-release capsules or tablets whole.
If needed, patient may sprinkle contents of
capsule onto 1 tablespoon of applesauce
and swallow immediately without chewing
pellets. Tell him to follow with a glass of
cool water and not to keep any leftover
mixture.
• If patient takes the oral suspension, tell
him to empty package into a small cup
containing 2 tablespoons of water (no
other beverage should be used), stir the
mixture well, drink it immediately, refill
the cup with water, and drink again.
• Encourage patient to avoid alcohol, aspirin
products, ibuprofen, and foods that may
increase gastric secretions during therapy.
Tell him to notify all prescribers about
prescription drug use.
• Advise patient to notify prescriber immediately
about abdominal pain or diarrhea.
• Urge female patient of childbearing age to
use effective contraception during therapy
and to inform prescriber immediately if
she is or suspects she may be pregnant.
Tuesday, March 15, 2011
Nursing Consideration Patient Teaching - Naproxen Aleve Anaprox Comfort Pac with Naproxen EC-Naprosyn Leader Naproxen Sodium Midol Extended Relief Nap
naproxen
Apo-Naproxen (CAN), EC-Naprosyn,
Naprosyn, Naprosyn-E (CAN), Naxen
(CAN), Novo-Naprox (CAN), Nu-Naprox
(CAN)
naproxen sodium
Aleve, Anaprox, Anaprox DS, Apo-
Napro-Na (CAN), Naprelan, Naprosyn-
SR (CAN), Novo-Naprox Sodium (CAN)
Nursing Considerations
• Use naproxen with extreme caution in
patients with a history of ulcer disease or
GI bleeding because NSAIDs such as
naproxen increase risk of GI bleeding and
ulceration. Expect to use naproxen for the
shortest time possible in these patients.
• Serious GI tract ulceration, bleeding, and
perforation may occur without warning
symptoms. Elderly patients are at greater
risk. To minimize risk, give drug with
food. If GI distress occurs, withhold drug
and notify prescriber immediately.
• Use naproxen cautiously in patients with
hypertension, and monitor blood pressure
closely. Drug may cause hypertension or
worsen it. Because of naproxen’s sodium
content, watch for fluid retention.
• Rehydrate a dehydrated patient before giving
drug. If patient has renal disease, monitor
renal function closely during therapy.
• Naproxen isn’t recommended for patients
with advanced renal disease.
WARNING Monitor patient closely for
thrombotic events, including MI and
stroke, because NSAIDs increase the risk,
especially if used in higher doses than recommended
or for extended periods of
time.
•Monitor patient—especially if elderly or
receiving long-term naproxen therapy—
for less common but serious adverse GI
reactions, including anorexia, constipation,
diverticulitis, dysphagia, esophagitis,
gastritis, gastroenteritis, gastroesophageal
reflux disease, hemorrhoids, hiatal hernia,
melena, stomatitis, and vomiting.
•Monitor liver function test results because,
in rare cases, elevations may progress to
severe hepatic reactions, including fatal
hepatitis, liver necrosis, and hepatic failure.
•Monitor BUN and serum creatinine levels
in elderly patients, patients taking diuretics
or ACE inhibitors, and patients with
heart failure, impaired renal function, or
hepatic dysfunction; naproxen may cause
renal failure.
•Monitor CBC for decreased hemoglobin
and hematocrit because drug may worsen
anemia.
WARNING If patient has bone marrow suppression
or is receiving treatment with an
antineoplastic drug, monitor laboratory
results (including WBC count), and watch
for evidence of infection because antiinflammatory
and antipyretic actions of
naproxen may mask signs and symptoms,
such as fever and pain.
• Assess patient’s skin regularly for signs of
rash or other hypersensitivity reaction
because naproxen is an NSAID and may
cause serious skin reactions without warning,
even in patients with no history of
NSAID sensivitity. At first sign of reaction,
stop drug and notify prescriber.
• Assess drug effectiveness in ankylosing
spondylitis, as evidenced by decreased
night pain, morning stiffness, and pain at
rest; in osteoarthritis: decreased joint pain
or tenderness and increased mobility,
range of motion, and ability to perform
daily activities; in rheumatoid arthritis:
increased mobility and decreased joint
swelling and morning stiffness; in acute
gouty arthritis: decreased heat, pain,
swelling, and tenderness in affected joints.
• Tell prescriber if patient complains of
vision changes; patient may need ophthalmic
exam.
PATIENT TEACHING
• Caution patient not to exceed recommended
dosage, take for longer than
directed, or take for more than 10 days
without consulting prescriber because
serious adverse reactions may occur.
• Tell patient to swallow delayed-release tab-
lets whole and not to break, crush, or
chew them.
• Advise patient to take drug with food to
reduce GI distress.
• Tell patient to take drug with a full glass of
water and to remain upright for 15 to
30 minutes after taking it to prevent drug
from lodging in esophagus and causing
irritation.
• Caution patient to avoid hazardous activities
until drug’s CNS effects are known.
• Urge patient to keep scheduled appointments
with prescriber to monitor progress.
• Tell pregnant patient to avoid taking
naproxen-containing products late in
pregnancy.
• Explain that naproxen may increase risk of
serious adverse cardiovascular reactions;
urge patient to seek immediate medical
attention if signs or symptoms arise, such
as chest pain, shortness of breath, weakness,
and slurring of speech.
• Inform patient that naproxen may increase
risk of serious adverse GI reactions; stress
the importance of seeking immediate
medical attention for such signs and
symptoms as epigastric or abdominal
pain, indigestion, black or tarry stools, or
vomiting blood or material that looks like
coffee grounds.
• Alert patient to rare but serious skin reactions.
Urge her to seek immediate medical
attention for rash, blisters, itching, fever,
or other indications of hypersensitivity.
• Advise patient to consult prescriber before
taking naproxen-containing OTC products
if he has asthma, ulcers, bleeding problems,
high blood pressure, heart or kidney
disease, a need for diuretic therapy, serious
adverse effects from previous use of fever
reducers or pain relievers, or persistent
stomach problems, such as heartburn,
upset stomach, or stomach pain.
Apo-Naproxen (CAN), EC-Naprosyn,
Naprosyn, Naprosyn-E (CAN), Naxen
(CAN), Novo-Naprox (CAN), Nu-Naprox
(CAN)
naproxen sodium
Aleve, Anaprox, Anaprox DS, Apo-
Napro-Na (CAN), Naprelan, Naprosyn-
SR (CAN), Novo-Naprox Sodium (CAN)
Nursing Considerations
• Use naproxen with extreme caution in
patients with a history of ulcer disease or
GI bleeding because NSAIDs such as
naproxen increase risk of GI bleeding and
ulceration. Expect to use naproxen for the
shortest time possible in these patients.
• Serious GI tract ulceration, bleeding, and
perforation may occur without warning
symptoms. Elderly patients are at greater
risk. To minimize risk, give drug with
food. If GI distress occurs, withhold drug
and notify prescriber immediately.
• Use naproxen cautiously in patients with
hypertension, and monitor blood pressure
closely. Drug may cause hypertension or
worsen it. Because of naproxen’s sodium
content, watch for fluid retention.
• Rehydrate a dehydrated patient before giving
drug. If patient has renal disease, monitor
renal function closely during therapy.
• Naproxen isn’t recommended for patients
with advanced renal disease.
WARNING Monitor patient closely for
thrombotic events, including MI and
stroke, because NSAIDs increase the risk,
especially if used in higher doses than recommended
or for extended periods of
time.
•Monitor patient—especially if elderly or
receiving long-term naproxen therapy—
for less common but serious adverse GI
reactions, including anorexia, constipation,
diverticulitis, dysphagia, esophagitis,
gastritis, gastroenteritis, gastroesophageal
reflux disease, hemorrhoids, hiatal hernia,
melena, stomatitis, and vomiting.
•Monitor liver function test results because,
in rare cases, elevations may progress to
severe hepatic reactions, including fatal
hepatitis, liver necrosis, and hepatic failure.
•Monitor BUN and serum creatinine levels
in elderly patients, patients taking diuretics
or ACE inhibitors, and patients with
heart failure, impaired renal function, or
hepatic dysfunction; naproxen may cause
renal failure.
•Monitor CBC for decreased hemoglobin
and hematocrit because drug may worsen
anemia.
WARNING If patient has bone marrow suppression
or is receiving treatment with an
antineoplastic drug, monitor laboratory
results (including WBC count), and watch
for evidence of infection because antiinflammatory
and antipyretic actions of
naproxen may mask signs and symptoms,
such as fever and pain.
• Assess patient’s skin regularly for signs of
rash or other hypersensitivity reaction
because naproxen is an NSAID and may
cause serious skin reactions without warning,
even in patients with no history of
NSAID sensivitity. At first sign of reaction,
stop drug and notify prescriber.
• Assess drug effectiveness in ankylosing
spondylitis, as evidenced by decreased
night pain, morning stiffness, and pain at
rest; in osteoarthritis: decreased joint pain
or tenderness and increased mobility,
range of motion, and ability to perform
daily activities; in rheumatoid arthritis:
increased mobility and decreased joint
swelling and morning stiffness; in acute
gouty arthritis: decreased heat, pain,
swelling, and tenderness in affected joints.
• Tell prescriber if patient complains of
vision changes; patient may need ophthalmic
exam.
PATIENT TEACHING
• Caution patient not to exceed recommended
dosage, take for longer than
directed, or take for more than 10 days
without consulting prescriber because
serious adverse reactions may occur.
• Tell patient to swallow delayed-release tab-
lets whole and not to break, crush, or
chew them.
• Advise patient to take drug with food to
reduce GI distress.
• Tell patient to take drug with a full glass of
water and to remain upright for 15 to
30 minutes after taking it to prevent drug
from lodging in esophagus and causing
irritation.
• Caution patient to avoid hazardous activities
until drug’s CNS effects are known.
• Urge patient to keep scheduled appointments
with prescriber to monitor progress.
• Tell pregnant patient to avoid taking
naproxen-containing products late in
pregnancy.
• Explain that naproxen may increase risk of
serious adverse cardiovascular reactions;
urge patient to seek immediate medical
attention if signs or symptoms arise, such
as chest pain, shortness of breath, weakness,
and slurring of speech.
• Inform patient that naproxen may increase
risk of serious adverse GI reactions; stress
the importance of seeking immediate
medical attention for such signs and
symptoms as epigastric or abdominal
pain, indigestion, black or tarry stools, or
vomiting blood or material that looks like
coffee grounds.
• Alert patient to rare but serious skin reactions.
Urge her to seek immediate medical
attention for rash, blisters, itching, fever,
or other indications of hypersensitivity.
• Advise patient to consult prescriber before
taking naproxen-containing OTC products
if he has asthma, ulcers, bleeding problems,
high blood pressure, heart or kidney
disease, a need for diuretic therapy, serious
adverse effects from previous use of fever
reducers or pain relievers, or persistent
stomach problems, such as heartburn,
upset stomach, or stomach pain.
Nursing Consideration Patient Teaching - Morphine Avinza Kadian MS Contin MSIR Oramorph SR Roxanol
morphine sulfate
Astramorph PF, Avinza, DepoDur,
Duramorph, Epimorph (CAN), Kadian,
M-Eslon (CAN), Morphine Extra-Forte
(CAN), Morphine Forte (CAN), Morphine
H.P. (CAN), Morphitec (CAN), MS Contin,
MSIR, MS/L, MS/L Concentrate, MS/S,
OMS Concentrate, Oramorph SR,
Rescudose, RMS Uniserts, Roxanol,
Roxanol 100, Roxanol UD, Statex (CAN)
Nursing Considerations
• Use cautiously in patients about to undergo
surgery of the biliary tract and patients
with acute pancreatitis secondary to biliary
tract disease because morphine may
cause spasm of the sphincter of Oddi.
• Store morphine at room temperature.
• Before giving morphine, make sure opioid
antagonist and equipment for oxygen
delivery and respiration are available.
• Before therapy, assess patient’s drug use,
including all prescription and OTC drugs.
• Expect prescriber to start patient who has
never received opioids on immediaterelease
form and then switch to E.R. form
if therapy must last longer than a few days.
• Keep in mind that when morphine is
given by epidural route, dosage must be
individualized according to patient’s age,
body mass, physical status, previous experience
with opioids, risk factors for respiratory
depression, and drugs to be coadministered
before or during surgery.
• Give oral form with food or milk to minimize
adverse GI reactions, if needed.
Solution can be mixed with fruit juice to
improve taste.
• If needed, open E.R. capsules and sprinkle
contents on applesauce (at room temperature
or cooler) just before giving to
patient. Make sure patient doesn’t chew or
crush capsules or dissolve capsule’s pellets
in his mouth.
• Be aware that E.R. forms of morphine
aren’t interchangeable.
• Discard injection solution that is discolored
or darker than pale yellow or that
contains precipitates that don’t dissolve
with shaking.
WARNING Don’t use highly concentrated
solutions (such as 10 to 25 mg/ml) for single-
dose I.V., I.M., or subcutaneous
administration. These solutions are
intended for use in continuous, controlled
microinfusion devices.
• For direct I.V. injection, dilute appropriate
dose with 4 to 5 ml of sterile water for
injection. Inject 2.5 to 15 mg directly into
tubing of free-flowing I.V. solution over 4
to 5 minutes. Rapid I.V. injection may
increase adverse reactions.
• For continuous I.V. infusion, dilute drug
in D5W and administer with infusioncontrol
device. Adjust dose and rate based
on patient response, as prescribed.
• Avoid I.M. route for long-term therapy
because of injection site irritation.
• During subcutaneous injection, take care
to avoid injecting drug intradermally.
• For intrathecal injection, expect prescriber
to give no more than 2 ml of 0.5-mg/ml
solution or 1 ml of 1-mg/ml solution.
Expect intrathecal dosage to be about onetenth
of epidural dosage.
• If rectal suppository is too soft to insert,
refrigerate for 30 minutes or run wrapped
suppository under cold tap water.
WARNING Monitor respiratory and cardio-
vascular status carefully and frequently
during morphine therapy. Be alert for respiratory
depression and hypotension.
•Monitor patient with seizure disorder for
increased seizure activity because morphine
may worsen the disorder.
•Monitor patient for excessive or persistent
sedation; dosage may need to be adjusted.
• If patient is receiving a continuous morphine
infusion, watch for and notify prescriber
about new neurologic signs or
symptoms. Inflammatory masses (such as
granulomas) have caused serious neurologic
reactions, including paralysis.
• Expect morphine to cause physical and
psychological dependence; watch for drug
tolerance and withdrawal, such as body
aches, diaphoresis, diarrhea, fever, piloerection,
rhinorrhea, sneezing, and yawning.
• If tolerance to morphine develops, expect
prescriber to increase dosage.
•Morphine may have a prolonged duration
and cumulative effect in patients with
impaired hepatic or renal function. It also
may prolong labor by reducing strength,
duration, and frequency of uterine contractions.
•When discontinuing morphine in patients
receiving more than 30 mg daily, expect
prescriber to reduce daily dose by about
one-half for 2 days and then by 25% every
2 days thereafter until total dose reaches
initial amount recommended for patients
who haven’t received opioids (15 to 30 mg
daily). This regimen minimizes the risk of
withdrawal symptoms.
PATIENT TEACHING
• Instruct patient to take morphine exactly
as prescribed and not to change dosage
without consulting prescriber.
• Explain that patient may take tablets or
capsules with food or milk to relieve GI
distress and may mix oral solution with
juice to improve taste.
• Urge patient not to break, chew, or crush
E.R. capsules and tablets to avoid rapid
release and, possibly, toxicity.
• For patient who has difficulty swallowing,
suggest that he open E.R. capsules and
sprinkle contents on food or liquids. Urge
him to take drug immediately and not let
capsule contents dissolve in his mouth.
• Instruct patient to moisten rectal suppository
before inserting it.
• Urge patient to avoid alcohol and other
CNS depressants during therapy.
• Advise patient to avoid potentially hazardous
activities during morphine therapy.
• Tell patient to change positions slowly to
minimize the orthostatic hypotension.
• Instruct patient to notify prescriber about
worsening or breakthrough pain.
• Explain that morphine may be habitforming.
Urge him to notify prescriber if
he experiences anxiety, decreased appetite,
excessive tearing, irritability, muscle aches
or twitching, rapid heart rate, or yawning.
• Advise female patient to notify prescriber
if she becomes pregnant. Regular morphine
use during pregnancy may cause
physical dependence in fetus and withdrawal
in neonate.
Astramorph PF, Avinza, DepoDur,
Duramorph, Epimorph (CAN), Kadian,
M-Eslon (CAN), Morphine Extra-Forte
(CAN), Morphine Forte (CAN), Morphine
H.P. (CAN), Morphitec (CAN), MS Contin,
MSIR, MS/L, MS/L Concentrate, MS/S,
OMS Concentrate, Oramorph SR,
Rescudose, RMS Uniserts, Roxanol,
Roxanol 100, Roxanol UD, Statex (CAN)
Nursing Considerations
• Use cautiously in patients about to undergo
surgery of the biliary tract and patients
with acute pancreatitis secondary to biliary
tract disease because morphine may
cause spasm of the sphincter of Oddi.
• Store morphine at room temperature.
• Before giving morphine, make sure opioid
antagonist and equipment for oxygen
delivery and respiration are available.
• Before therapy, assess patient’s drug use,
including all prescription and OTC drugs.
• Expect prescriber to start patient who has
never received opioids on immediaterelease
form and then switch to E.R. form
if therapy must last longer than a few days.
• Keep in mind that when morphine is
given by epidural route, dosage must be
individualized according to patient’s age,
body mass, physical status, previous experience
with opioids, risk factors for respiratory
depression, and drugs to be coadministered
before or during surgery.
• Give oral form with food or milk to minimize
adverse GI reactions, if needed.
Solution can be mixed with fruit juice to
improve taste.
• If needed, open E.R. capsules and sprinkle
contents on applesauce (at room temperature
or cooler) just before giving to
patient. Make sure patient doesn’t chew or
crush capsules or dissolve capsule’s pellets
in his mouth.
• Be aware that E.R. forms of morphine
aren’t interchangeable.
• Discard injection solution that is discolored
or darker than pale yellow or that
contains precipitates that don’t dissolve
with shaking.
WARNING Don’t use highly concentrated
solutions (such as 10 to 25 mg/ml) for single-
dose I.V., I.M., or subcutaneous
administration. These solutions are
intended for use in continuous, controlled
microinfusion devices.
• For direct I.V. injection, dilute appropriate
dose with 4 to 5 ml of sterile water for
injection. Inject 2.5 to 15 mg directly into
tubing of free-flowing I.V. solution over 4
to 5 minutes. Rapid I.V. injection may
increase adverse reactions.
• For continuous I.V. infusion, dilute drug
in D5W and administer with infusioncontrol
device. Adjust dose and rate based
on patient response, as prescribed.
• Avoid I.M. route for long-term therapy
because of injection site irritation.
• During subcutaneous injection, take care
to avoid injecting drug intradermally.
• For intrathecal injection, expect prescriber
to give no more than 2 ml of 0.5-mg/ml
solution or 1 ml of 1-mg/ml solution.
Expect intrathecal dosage to be about onetenth
of epidural dosage.
• If rectal suppository is too soft to insert,
refrigerate for 30 minutes or run wrapped
suppository under cold tap water.
WARNING Monitor respiratory and cardio-
vascular status carefully and frequently
during morphine therapy. Be alert for respiratory
depression and hypotension.
•Monitor patient with seizure disorder for
increased seizure activity because morphine
may worsen the disorder.
•Monitor patient for excessive or persistent
sedation; dosage may need to be adjusted.
• If patient is receiving a continuous morphine
infusion, watch for and notify prescriber
about new neurologic signs or
symptoms. Inflammatory masses (such as
granulomas) have caused serious neurologic
reactions, including paralysis.
• Expect morphine to cause physical and
psychological dependence; watch for drug
tolerance and withdrawal, such as body
aches, diaphoresis, diarrhea, fever, piloerection,
rhinorrhea, sneezing, and yawning.
• If tolerance to morphine develops, expect
prescriber to increase dosage.
•Morphine may have a prolonged duration
and cumulative effect in patients with
impaired hepatic or renal function. It also
may prolong labor by reducing strength,
duration, and frequency of uterine contractions.
•When discontinuing morphine in patients
receiving more than 30 mg daily, expect
prescriber to reduce daily dose by about
one-half for 2 days and then by 25% every
2 days thereafter until total dose reaches
initial amount recommended for patients
who haven’t received opioids (15 to 30 mg
daily). This regimen minimizes the risk of
withdrawal symptoms.
PATIENT TEACHING
• Instruct patient to take morphine exactly
as prescribed and not to change dosage
without consulting prescriber.
• Explain that patient may take tablets or
capsules with food or milk to relieve GI
distress and may mix oral solution with
juice to improve taste.
• Urge patient not to break, chew, or crush
E.R. capsules and tablets to avoid rapid
release and, possibly, toxicity.
• For patient who has difficulty swallowing,
suggest that he open E.R. capsules and
sprinkle contents on food or liquids. Urge
him to take drug immediately and not let
capsule contents dissolve in his mouth.
• Instruct patient to moisten rectal suppository
before inserting it.
• Urge patient to avoid alcohol and other
CNS depressants during therapy.
• Advise patient to avoid potentially hazardous
activities during morphine therapy.
• Tell patient to change positions slowly to
minimize the orthostatic hypotension.
• Instruct patient to notify prescriber about
worsening or breakthrough pain.
• Explain that morphine may be habitforming.
Urge him to notify prescriber if
he experiences anxiety, decreased appetite,
excessive tearing, irritability, muscle aches
or twitching, rapid heart rate, or yawning.
• Advise female patient to notify prescriber
if she becomes pregnant. Regular morphine
use during pregnancy may cause
physical dependence in fetus and withdrawal
in neonate.
Nursing Consideration Patient Teaching - Metoprolol Lopressor Metoprolol Succinate ER Toprol-XL Metoprolol Tartrate
metoprolol
succinate
Toprol-XL
metoprolol tartrate
Apo-Metoprolol (CAN), Betaloc (CAN),
Betaloc Durules (CAN), Lopresor (CAN),
Lopresor SR (CAN), Lopressor,
Novometoprol (CAN)
Nursing Considerations
• Use metoprolol with extreme caution in
patients with bronchospastic disease who
don’t respond to or can’t tolerate other
antihypertensives. Expect to give smaller
doses more often to avoid the higher plasma
levels in longer dosage intervals.
• Use cautiously in patients with hypertension
or angina who have congestive heart
failure because beta blockers such as
metoprolol can further depress myocardial
contractility, worsening heart failure.
• For patient with acute MI who can’t tolerate
initial dosage or who delays treatment,
start with maintenance dosage, as prescribed
and tolerated.
• Before starting therapy for heart failure,
expect to give a diuretic, an ACE inhibitor,
and digoxin to stabilize patient.
• If patient has pheochromocytoma, alpha
blocker therapy should start first, followed
by metoprolol to prevent paradoxical
increase in blood pressure from attenuation
of beta-mediated vasodilation in
skeletal muscle.
• Be aware that metoprolol dosage for heart
failure is highly individualized.Monitor
patient for evidence of worsening heart
failure during dosage increases. If heart
failure worsens, expect to increase diuretic
dosage and possibly decrease metoprolol
dosage or temporarily discontinue drug, as
prescribed.Metoprolol dosage shouldn’t
be increased until worsening heart failure
has been stabilized.
• If patient with heart failure develops
symptomatic bradycardia, expect to
decrease the metoprolol dosage.
WARNING If dosage exceeds 400 mg daily,
monitor patient for bronchospasm and
dyspnea because metoprolol competitively
blocks beta2-adrenergic receptors in
bronchial and vascular smooth muscles.
WARNING When substituting metoprolol for
clonidine, expect to gradually reduce
clonidine and increase metoprolol dosage
over several days. Given together, these
drugs have additive hypotensive effects.
• Patients who take metoprolol may be at
risk for AV block. If AV block results from
depressed AV node conduction, prepare to
give appropriate drug, as ordered, or assist
with insertion of temporary pacemaker.
• Check for signs of poor glucose control in
patient with diabetes mellitus. Metoprolol
may interfere with therapeutic effects of
insulin and oral antidiabetic drugs. It also
may mask evidence of hypoglycemia, such
as palpitations, tachycardia, and tremor.
•Monitor patient with peripheral vascular
disease for evidence of arterial insufficiency
(pain, pallor, and coldness in affected
extremity) Metoprolol can precipitate or
aggravate peripheral vascular disease.
WARNING Expect to taper dosage over 1 to
2 weeks when drug is discontinued; stopping
abruptly can cause myocardial
ischemia, MI, ventricular arrhythmias, or
severe hypertension, especially in patients
with cardiac disease. Abrupt withdrawal
also may cause thyroid storm in a patient
with hyperthyroidism or thyrotoxicosis.
PATIENT TEACHING
• Instruct patient to take metoprolol with
food at the same time each day—once
daily for E.R. tablets. Explain that he may
halve tablets but not chew or crush them.
• Advise patient to notify prescriber if pulse
rate falls below 60 beats/minute or is significantly
lower than usual.
• Urge diabetic patient to check blood glucose
level often during therapy.
• Caution patient not to stop drug abruptly.
succinate
Toprol-XL
metoprolol tartrate
Apo-Metoprolol (CAN), Betaloc (CAN),
Betaloc Durules (CAN), Lopresor (CAN),
Lopresor SR (CAN), Lopressor,
Novometoprol (CAN)
Nursing Considerations
• Use metoprolol with extreme caution in
patients with bronchospastic disease who
don’t respond to or can’t tolerate other
antihypertensives. Expect to give smaller
doses more often to avoid the higher plasma
levels in longer dosage intervals.
• Use cautiously in patients with hypertension
or angina who have congestive heart
failure because beta blockers such as
metoprolol can further depress myocardial
contractility, worsening heart failure.
• For patient with acute MI who can’t tolerate
initial dosage or who delays treatment,
start with maintenance dosage, as prescribed
and tolerated.
• Before starting therapy for heart failure,
expect to give a diuretic, an ACE inhibitor,
and digoxin to stabilize patient.
• If patient has pheochromocytoma, alpha
blocker therapy should start first, followed
by metoprolol to prevent paradoxical
increase in blood pressure from attenuation
of beta-mediated vasodilation in
skeletal muscle.
• Be aware that metoprolol dosage for heart
failure is highly individualized.Monitor
patient for evidence of worsening heart
failure during dosage increases. If heart
failure worsens, expect to increase diuretic
dosage and possibly decrease metoprolol
dosage or temporarily discontinue drug, as
prescribed.Metoprolol dosage shouldn’t
be increased until worsening heart failure
has been stabilized.
• If patient with heart failure develops
symptomatic bradycardia, expect to
decrease the metoprolol dosage.
WARNING If dosage exceeds 400 mg daily,
monitor patient for bronchospasm and
dyspnea because metoprolol competitively
blocks beta2-adrenergic receptors in
bronchial and vascular smooth muscles.
WARNING When substituting metoprolol for
clonidine, expect to gradually reduce
clonidine and increase metoprolol dosage
over several days. Given together, these
drugs have additive hypotensive effects.
• Patients who take metoprolol may be at
risk for AV block. If AV block results from
depressed AV node conduction, prepare to
give appropriate drug, as ordered, or assist
with insertion of temporary pacemaker.
• Check for signs of poor glucose control in
patient with diabetes mellitus. Metoprolol
may interfere with therapeutic effects of
insulin and oral antidiabetic drugs. It also
may mask evidence of hypoglycemia, such
as palpitations, tachycardia, and tremor.
•Monitor patient with peripheral vascular
disease for evidence of arterial insufficiency
(pain, pallor, and coldness in affected
extremity) Metoprolol can precipitate or
aggravate peripheral vascular disease.
WARNING Expect to taper dosage over 1 to
2 weeks when drug is discontinued; stopping
abruptly can cause myocardial
ischemia, MI, ventricular arrhythmias, or
severe hypertension, especially in patients
with cardiac disease. Abrupt withdrawal
also may cause thyroid storm in a patient
with hyperthyroidism or thyrotoxicosis.
PATIENT TEACHING
• Instruct patient to take metoprolol with
food at the same time each day—once
daily for E.R. tablets. Explain that he may
halve tablets but not chew or crush them.
• Advise patient to notify prescriber if pulse
rate falls below 60 beats/minute or is significantly
lower than usual.
• Urge diabetic patient to check blood glucose
level often during therapy.
• Caution patient not to stop drug abruptly.
Nursing Consideration Patient Teaching - Methocarbamol Robaxin
methocarbamol
Carbacot, Robaxin, Robaxin 750, Skelex
Nursing Considerations
• If needed, crush methocarbamol tablets
and mix with water for administration by
NG tube.
• Give I.V. form directly through infusion
line at 3 ml/min. To prepare solution, add
10 ml to no more than 250 ml D5W or
normal saline solution. Infuse at no more
than 300 mg (3 ml)/ min to avoid hypotension
and seizures.
• Keep patient recumbent during I.V.
administration and for at least 15 minutes
afterward. Then have him rise slowly.
•Monitor I.V. site regularly for signs of
phlebitis.
• Inject I.M. form deep into large muscle,
such as the gluteus. Give no more than
5 ml/dose every 8 hours. One dose is usually
adequate.
• Don’t give methocarbamol by subcutaneous
route.
• Keep epinephrine, antihistamines, and
corticosteroids available in case patient
experiences anaphylactic reaction.
• Be aware that the parenteral dosage form
shouldn’t be used in patients with renal
dysfunction because the polyethylene glycol
300 vehicle is nephrotoxic.
PATIENT TEACHING
• Tell patient to take drug exactly as prescribed.
• Advise patient to take drug with food or
milk to avoid nausea.
• Inform patient that urine may turn green,
black, or brown until mehtocarbamol is
discontinued.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient to avoid alcohol and other
CNS depressants during therapy.
Carbacot, Robaxin, Robaxin 750, Skelex
Nursing Considerations
• If needed, crush methocarbamol tablets
and mix with water for administration by
NG tube.
• Give I.V. form directly through infusion
line at 3 ml/min. To prepare solution, add
10 ml to no more than 250 ml D5W or
normal saline solution. Infuse at no more
than 300 mg (3 ml)/ min to avoid hypotension
and seizures.
• Keep patient recumbent during I.V.
administration and for at least 15 minutes
afterward. Then have him rise slowly.
•Monitor I.V. site regularly for signs of
phlebitis.
• Inject I.M. form deep into large muscle,
such as the gluteus. Give no more than
5 ml/dose every 8 hours. One dose is usually
adequate.
• Don’t give methocarbamol by subcutaneous
route.
• Keep epinephrine, antihistamines, and
corticosteroids available in case patient
experiences anaphylactic reaction.
• Be aware that the parenteral dosage form
shouldn’t be used in patients with renal
dysfunction because the polyethylene glycol
300 vehicle is nephrotoxic.
PATIENT TEACHING
• Tell patient to take drug exactly as prescribed.
• Advise patient to take drug with food or
milk to avoid nausea.
• Inform patient that urine may turn green,
black, or brown until mehtocarbamol is
discontinued.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient to avoid alcohol and other
CNS depressants during therapy.
Nursing Consideration Patient Teaching - Methadone Diskets Dolophine Methadose
methadone
hydrochloride
Dolophine, Methadose
Nursing Considerations
• Before giving methadone, make sure opioid
antagonist and equipment for administering
oxygen and controlling respiration
are nearby.
• Before therapy begins, assess patient’s current
drug use, including all prescription
and OTC drugs.
WARNING Give drug cautiously to patients
at risk for a prolonged QT interval, such as
those with cardiac hypertrophy, hypokalemia,
or hypomagnesemia; those with a
history of cardiac conduction abnormalities;
and those taking diuretics or medications
that affect cardiac conduction.
• Dilute oral concentrate with water or
another liquid to volume of at least 30 ml,
but preferably to 90 ml or more, before
administration. Dissolve dispersible tablets
in water or another liquid before giving.
•Monitor patient for expected excessive
drowsiness, unsteadiness, or confusion
during first 3 to 5 days of therapy, and
notify prescriber if effects continue to
worsen or persist beyond this time.
WARNING Monitor respiratory and circulatory
status carefully and often during
methadone therapy because respiratory
depression, circulatory depression, respiratory
arrest, shock, hypotension, and cardiac
arrest are risks. Monitor children
often for respiratory depression and paradoxical
CNS excitation because of their
increased sensitivity to drug. Assess
patient for excessive or persistent sedation;
dosage may need to be adjusted.
•Watch for drug tolerance, especially in
patients with a history of chronic drug
abuse, because methadone can cause physical
and psychological dependence.
•Monitor patient for pain because maintenance
dosage doesn’t provide pain relief;
patients with tolerance to opiate agonists,
including those with chronic cancer pain,
may require a higher dosage.
•Monitor patients who are pregnant or
who have liver or renal impairment for
increased adverse effects from methadone
because drug may have a prolonged duration
and cumulative effect in these
patients. Methadone may prolong labor by
reducing strength, duration, and frequency
of uterine contractions, so expect dosage
to be tapered before third trimester of
pregnancy. Breast-feeding mothers on
maintenance therapy put their infants at
risk of withdrawal symptoms if they
abruptly stop breast-feeding or discontinue
methadone therapy.Methadone also
accumulates in CNS tissue, increasing the
risk of seizures in infants.
• Check plasma amylase and lipase levels in
patients who develop biliary tract spasms
because levels may increase up to 15 times
normal. Notify prescriber immediately of
any significant or sustained increase.
•Monitor patients who have head injuries
or other conditions that may increase
intracranial pressure (ICP) because
methadone may further increase ICP.
• Assess patient for withdrawal symptoms
and tolerance to therapy because physiologic
dependence can occur with longterm
methadone use. Avoid abrupt discontinuation
because withdrawal symptoms
will occur within 3 to 4 days after last
dose.
•Monitor patients, especially the elderly, for
cardiac arrhythmias, hypotension,
hypovolemia, orthostatic hypotension, and
vasovagal syncope because methadone
may produce cholinergic effects in patients
with cardiac disease, resulting in bradycardia
and peripheral vasodilation; dosage
decrease may be indicated.
•Monitor patients with prostatic hypertrophy,
urethral stricture, or renal disease for
urine retention and oliguria because
methadone can increase tension of detrusor
muscle.
• Be prepared to treat patient’s symptoms of
anxiety, and be aware that anxiety may be
confused with symptoms of opioid absti-
nence and that methadone doesn’t have
antianxiety effects.
PATIENT TEACHING
• Instruct patient taking oral concentrate
form of methadone to dilute it with water
or another liquid to a volume of at least 30
ml and preferably to 90 ml or more before
administration.
• Instruct patient to dissolve dispersible
tablets in water or other liquid before
administration.
• Advise patient to notify prescriber of all
other drugs he’s currently taking and to
avoid alcohol and other depressants, such
as sleeping pills and tranquilizers, because
they may increase drug’s CNS depressant
effects.
• Instruct patient to take drug only as prescribed
and not to change dosage without
prescriber approval. Inform patient that
abrupt cessation of methadone therapy
can precipitate withdrawal symptoms.
Urge him to notify prescriber if he develops
any concerns over therapy.
• Urge patient to notify prescriber if he
experiences palpitations, dizziness, lightheadedness,
or syncope, which may be
caused by methadone-induced arrhythmias.
• Instruct patient to avoid potentially hazardous
activities or those that require
mental alertness because methadone therapy
may cause drowsiness or sleepiness.
• Teach patient to change positions slowly to
minimize the effects of orthostatic hypotension.
• Instruct patient to notify prescriber of
worsening or breakthrough pain because
dosage may need to be adjusted.
• Inform parents that a child on methadone
maintenance therapy may become unusually
excited or restless; advise them to
notify prescriber of changes in child’s
behavior.
• Instruct female patient to notify prescriber
immediately if she becomes pregnant during
methadone therapy because drug may
cause physical dependence in fetus and
withdrawal symptoms in neonate.
• Caution patient who is breast-feeding not
to stop doing so abruptly and not to stop
taking methadone without prescriber’s
approval because infant may experience
withdrawal symptoms.
hydrochloride
Dolophine, Methadose
Nursing Considerations
• Before giving methadone, make sure opioid
antagonist and equipment for administering
oxygen and controlling respiration
are nearby.
• Before therapy begins, assess patient’s current
drug use, including all prescription
and OTC drugs.
WARNING Give drug cautiously to patients
at risk for a prolonged QT interval, such as
those with cardiac hypertrophy, hypokalemia,
or hypomagnesemia; those with a
history of cardiac conduction abnormalities;
and those taking diuretics or medications
that affect cardiac conduction.
• Dilute oral concentrate with water or
another liquid to volume of at least 30 ml,
but preferably to 90 ml or more, before
administration. Dissolve dispersible tablets
in water or another liquid before giving.
•Monitor patient for expected excessive
drowsiness, unsteadiness, or confusion
during first 3 to 5 days of therapy, and
notify prescriber if effects continue to
worsen or persist beyond this time.
WARNING Monitor respiratory and circulatory
status carefully and often during
methadone therapy because respiratory
depression, circulatory depression, respiratory
arrest, shock, hypotension, and cardiac
arrest are risks. Monitor children
often for respiratory depression and paradoxical
CNS excitation because of their
increased sensitivity to drug. Assess
patient for excessive or persistent sedation;
dosage may need to be adjusted.
•Watch for drug tolerance, especially in
patients with a history of chronic drug
abuse, because methadone can cause physical
and psychological dependence.
•Monitor patient for pain because maintenance
dosage doesn’t provide pain relief;
patients with tolerance to opiate agonists,
including those with chronic cancer pain,
may require a higher dosage.
•Monitor patients who are pregnant or
who have liver or renal impairment for
increased adverse effects from methadone
because drug may have a prolonged duration
and cumulative effect in these
patients. Methadone may prolong labor by
reducing strength, duration, and frequency
of uterine contractions, so expect dosage
to be tapered before third trimester of
pregnancy. Breast-feeding mothers on
maintenance therapy put their infants at
risk of withdrawal symptoms if they
abruptly stop breast-feeding or discontinue
methadone therapy.Methadone also
accumulates in CNS tissue, increasing the
risk of seizures in infants.
• Check plasma amylase and lipase levels in
patients who develop biliary tract spasms
because levels may increase up to 15 times
normal. Notify prescriber immediately of
any significant or sustained increase.
•Monitor patients who have head injuries
or other conditions that may increase
intracranial pressure (ICP) because
methadone may further increase ICP.
• Assess patient for withdrawal symptoms
and tolerance to therapy because physiologic
dependence can occur with longterm
methadone use. Avoid abrupt discontinuation
because withdrawal symptoms
will occur within 3 to 4 days after last
dose.
•Monitor patients, especially the elderly, for
cardiac arrhythmias, hypotension,
hypovolemia, orthostatic hypotension, and
vasovagal syncope because methadone
may produce cholinergic effects in patients
with cardiac disease, resulting in bradycardia
and peripheral vasodilation; dosage
decrease may be indicated.
•Monitor patients with prostatic hypertrophy,
urethral stricture, or renal disease for
urine retention and oliguria because
methadone can increase tension of detrusor
muscle.
• Be prepared to treat patient’s symptoms of
anxiety, and be aware that anxiety may be
confused with symptoms of opioid absti-
nence and that methadone doesn’t have
antianxiety effects.
PATIENT TEACHING
• Instruct patient taking oral concentrate
form of methadone to dilute it with water
or another liquid to a volume of at least 30
ml and preferably to 90 ml or more before
administration.
• Instruct patient to dissolve dispersible
tablets in water or other liquid before
administration.
• Advise patient to notify prescriber of all
other drugs he’s currently taking and to
avoid alcohol and other depressants, such
as sleeping pills and tranquilizers, because
they may increase drug’s CNS depressant
effects.
• Instruct patient to take drug only as prescribed
and not to change dosage without
prescriber approval. Inform patient that
abrupt cessation of methadone therapy
can precipitate withdrawal symptoms.
Urge him to notify prescriber if he develops
any concerns over therapy.
• Urge patient to notify prescriber if he
experiences palpitations, dizziness, lightheadedness,
or syncope, which may be
caused by methadone-induced arrhythmias.
• Instruct patient to avoid potentially hazardous
activities or those that require
mental alertness because methadone therapy
may cause drowsiness or sleepiness.
• Teach patient to change positions slowly to
minimize the effects of orthostatic hypotension.
• Instruct patient to notify prescriber of
worsening or breakthrough pain because
dosage may need to be adjusted.
• Inform parents that a child on methadone
maintenance therapy may become unusually
excited or restless; advise them to
notify prescriber of changes in child’s
behavior.
• Instruct female patient to notify prescriber
immediately if she becomes pregnant during
methadone therapy because drug may
cause physical dependence in fetus and
withdrawal symptoms in neonate.
• Caution patient who is breast-feeding not
to stop doing so abruptly and not to stop
taking methadone without prescriber’s
approval because infant may experience
withdrawal symptoms.
Nursing Consideration Patient Teaching - Metformin Fortamet Glucophage Glucophage XR Glumetza, Riomet
metformin
hydrochloride
Fortamet, Gen-Metformin (CAN),
Glucophage, Glucophage XR,
Glumetza, Glycon (CAN), Novo-
Metformin (CAN), Riomet
Nursing Considerations
• Give metformin tablets with food, which
decreases and slightly delays absorption,
thus reducing risk of adverse GI reactions.
Give E.R. tablets with evening meal; don’t
break or crush them.
• Expect prescriber to alter dosage if patient
has a condition that decreases or delays
gastric emptying, such as diarrhea, gastroparesis,
GI obstruction, ileus, or vomiting.
• Expect to assess BUN and serum creatinine
level before and during long-term
therapy in those at increased risk for lactic
acidosis.
•Monitor patient’s hepatic function, as
ordered, because impaired hepatic function
may significantly reduce the liver’s
ability to clear lactate, predisposing the
patient to lactic acidosis.
•Monitor patient’s blood glucose level to
evaluate drug effectiveness. Assess for
hyperglycemia and the need for insulin
during times of increased stress, such as
infection and surgery.
•Withhold drug, as ordered, if patient
becomes dehydrated or develops hypoxemia
or sepsis because these conditions
increase the risk of lactic acidosis.
• Iodinated contrast media used in radiographic
studies increases risk of renal
failure and lactic acidosis during metformin
therapy. Expect to withhold drug
for 48 hours before and after testing.
PATIENT TEACHING
• Instruct patient to take metformin tablet
at breakfast if taking drug once a day or at
breakfast and dinner if taking drug twice a
day. Instruct him to take E.R. tablets once
daily with evening meal and to swallow
them whole without crushing or chewing.
• Direct patient to take drug exactly as prescribed
and not to change the dosage or
frequency unless instructed.
• Stress importance of following prescribed
diet, exercising regularly, controlling
weight, and checking blood glucose level.
• Teach patient how to measure blood glucose
level and recognize hyperglycemia
and hypoglycemia. Urge him to notify prescriber
of abnormal blood glucose level.
• Caution patient to avoid alcohol, which
can increase the risk of hypoglycemia.
• Instruct patient to report early signs of lactic
acidosis, including drowsiness, hyperventilation,
malaise, and muscle pain.
• Advise patient to expect laboratory testing
of glycosylated hemoglobin every
3 months until blood glucose is controlled.
hydrochloride
Fortamet, Gen-Metformin (CAN),
Glucophage, Glucophage XR,
Glumetza, Glycon (CAN), Novo-
Metformin (CAN), Riomet
Nursing Considerations
• Give metformin tablets with food, which
decreases and slightly delays absorption,
thus reducing risk of adverse GI reactions.
Give E.R. tablets with evening meal; don’t
break or crush them.
• Expect prescriber to alter dosage if patient
has a condition that decreases or delays
gastric emptying, such as diarrhea, gastroparesis,
GI obstruction, ileus, or vomiting.
• Expect to assess BUN and serum creatinine
level before and during long-term
therapy in those at increased risk for lactic
acidosis.
•Monitor patient’s hepatic function, as
ordered, because impaired hepatic function
may significantly reduce the liver’s
ability to clear lactate, predisposing the
patient to lactic acidosis.
•Monitor patient’s blood glucose level to
evaluate drug effectiveness. Assess for
hyperglycemia and the need for insulin
during times of increased stress, such as
infection and surgery.
•Withhold drug, as ordered, if patient
becomes dehydrated or develops hypoxemia
or sepsis because these conditions
increase the risk of lactic acidosis.
• Iodinated contrast media used in radiographic
studies increases risk of renal
failure and lactic acidosis during metformin
therapy. Expect to withhold drug
for 48 hours before and after testing.
PATIENT TEACHING
• Instruct patient to take metformin tablet
at breakfast if taking drug once a day or at
breakfast and dinner if taking drug twice a
day. Instruct him to take E.R. tablets once
daily with evening meal and to swallow
them whole without crushing or chewing.
• Direct patient to take drug exactly as prescribed
and not to change the dosage or
frequency unless instructed.
• Stress importance of following prescribed
diet, exercising regularly, controlling
weight, and checking blood glucose level.
• Teach patient how to measure blood glucose
level and recognize hyperglycemia
and hypoglycemia. Urge him to notify prescriber
of abnormal blood glucose level.
• Caution patient to avoid alcohol, which
can increase the risk of hypoglycemia.
• Instruct patient to report early signs of lactic
acidosis, including drowsiness, hyperventilation,
malaise, and muscle pain.
• Advise patient to expect laboratory testing
of glycosylated hemoglobin every
3 months until blood glucose is controlled.
Nursing Consideration Patient Teaching - Lyrica pregabalin
pregabalin
Lyrica
Nursing Considerations
• Pregabalin therapy should be stopped
gradually over at least 1 week to decrease
risk of seizure activity and avoid unpleasant
symptoms such as diarrhea, headache,
insomnia, and nausea.
• If patient has evidence of hypersensitivity
(red skin, urticaria, rash, dyspnea, facial
swelling, wheezing), stop drug at once,
notify prescriber, and give supportive care.
•Monitor patient closely for adverse reactions.
Notify prescriber if significant
adverse reactions persist.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
•Warn against stopping pregabalin abruptly.
• Urge patient to avoid hazardous activities
until she knows how drug affects her.
• Instruct patient to notify prescriber if she
has changes in vision or unexplained muscle
pain, tenderness, or weakness, especially
if these muscle symptoms are accompanied
by malaise or fever.
• Alert patient that drug may cause edema
and weight gain.
• If patient also takes a thiazolidinedione
antidiabetic, tell her these effects may be
intensified. If significant, tell patient to
notify prescriber.
• Inform male patient who plans to father a
child that drug could impair his fertility.
• Instruct diabetic patients to inspect their
skin while taking pregabalin.
• Urge caregivers to watch patient closely for
evidence of suicidal tendencies, especially
when therapy starts or dosage changes and
to report concerns at once to prescriber.
• Urge woman who becomes pregnant while
taking pregabalin for seizures to enroll in
the North American antiepileptic drug
pregnancy registry by calling 1-888-233-
2334. Explain that the registry is collecting
information about the safety of antiepileptic
drugs during pregnancy
Lyrica
Nursing Considerations
• Pregabalin therapy should be stopped
gradually over at least 1 week to decrease
risk of seizure activity and avoid unpleasant
symptoms such as diarrhea, headache,
insomnia, and nausea.
• If patient has evidence of hypersensitivity
(red skin, urticaria, rash, dyspnea, facial
swelling, wheezing), stop drug at once,
notify prescriber, and give supportive care.
•Monitor patient closely for adverse reactions.
Notify prescriber if significant
adverse reactions persist.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
•Warn against stopping pregabalin abruptly.
• Urge patient to avoid hazardous activities
until she knows how drug affects her.
• Instruct patient to notify prescriber if she
has changes in vision or unexplained muscle
pain, tenderness, or weakness, especially
if these muscle symptoms are accompanied
by malaise or fever.
• Alert patient that drug may cause edema
and weight gain.
• If patient also takes a thiazolidinedione
antidiabetic, tell her these effects may be
intensified. If significant, tell patient to
notify prescriber.
• Inform male patient who plans to father a
child that drug could impair his fertility.
• Instruct diabetic patients to inspect their
skin while taking pregabalin.
• Urge caregivers to watch patient closely for
evidence of suicidal tendencies, especially
when therapy starts or dosage changes and
to report concerns at once to prescriber.
• Urge woman who becomes pregnant while
taking pregabalin for seizures to enroll in
the North American antiepileptic drug
pregnancy registry by calling 1-888-233-
2334. Explain that the registry is collecting
information about the safety of antiepileptic
drugs during pregnancy
Nursing Consideration Patient Teaching - Lisinopril Prinivil Zestril
lisinopril
Prinivil, Zestril
Nursing Considerations
• Use lisinopril cautiously in patients with
fluid volume deficit, heart failure, impaired
renal function, or sodium depletion.
• To prepare pediatric suspension, add
10 ml purified water to a polyethylene
terephthalate (PET) bottle containing ten
20-mg tablets and shake for at least
1 minute. Add 30 ml of Bicitra diluent and
160 ml of Ora-Sweet SF to concentrate in
PET bottle and shake gently for several
seconds. Refrigerate up to 4 weeks. Shake
suspension before each use.
•Monitor blood pressure often, especially
early in treatment. If excessive hypotension
develops, expect to withhold drug
for several days.
WARNING If angioedema affects face, glottis,
larynx, limbs, lips, mucous mem-
branes, or tongue, notify prescriber immediately
and expect to stop lisinopril and
start appropriate therapy at once. If airway
obstruction threatens, promptly give 0.3 to
0.5 ml of epinephrine 1:1,000 solution
subcutaneously, as prescribed.
•Monitor patient for anaphylaxis, especially
patient being dialyzed with high-flux
membranes and treated with an ACE
inhibitor such as lisinopril. If anaphylaxis
occurs, stop dialysis immediately and treat
aggressively (antihistamines are ineffective
in this situation), as ordered. Anaphylaxis
has also occurred with some patients
undergoing low-density lipoprotein
apheresis with dextran sulfate absorption.
• Notify prescriber if patient has persistent,
nonproductive cough, a common adverse
effect of ACE inhibitors such as lisinopril.
•Monitor for dehydration, which can lead
to hypotension. Be aware that diarrhea
and vomiting can cause dehydration.
•Monitor patient for hepatic dysfunction
because lisinopril, an ACE inhibitor, may
rarely cause a syndrome that starts with
cholestatic jaundice or hepatitis and progresses
to fulminant hepatic necrosis. If
patient develops jaundice or a marked elevation
in liver enzyme levels, withhold
drug and notify prescriber.
• If patient takes insulin or an oral antidiabetic,
monitor blood glucose level closely
because risk of hypoglycemia increases,
especially during first month of therapy.
PATIENT TEACHING
• Explain that lisinopril helps to control but
doesn’t cure hypertension and that patient
may need lifelong therapy.
• Advise patient to take lisinopril at the
same time every day.
• Emphasize need to take drug as ordered,
even if patient feels well; caution her not
to stop drug without consulting prescriber.
• Instruct patient to report dizziness, especially
during first few days of therapy.
• Inform patient that persistent, nonproductive
cough may develop during lisinopril
therapy. Urge her to notify prescriber
immediately if cough becomes difficult to
tolerate.
• Advise patient to drink adequate fluid and
avoid excessive sweating, which can lead to
dehydration and hypotension.Make sure
she understands that diarrhea and vomiting
also can cause hypotension.
• Caution patient not to use salt substitutes
that contain potassium.
• Instruct patient to report signs of infection,
such as fever and sore throat, which
may indicate neutropenia.
• Advise patient to change position slowly to
minimize orthostatic hypotension.
• If patient has diabetes and takes insulin or
an oral antidiabetic, urge her to monitor
her blood glucose level closely and watch
for symptoms of hypoglycemia.
• Caution female patient to notify prescriber
immediately if she is or could be pregnant.
Prinivil, Zestril
Nursing Considerations
• Use lisinopril cautiously in patients with
fluid volume deficit, heart failure, impaired
renal function, or sodium depletion.
• To prepare pediatric suspension, add
10 ml purified water to a polyethylene
terephthalate (PET) bottle containing ten
20-mg tablets and shake for at least
1 minute. Add 30 ml of Bicitra diluent and
160 ml of Ora-Sweet SF to concentrate in
PET bottle and shake gently for several
seconds. Refrigerate up to 4 weeks. Shake
suspension before each use.
•Monitor blood pressure often, especially
early in treatment. If excessive hypotension
develops, expect to withhold drug
for several days.
WARNING If angioedema affects face, glottis,
larynx, limbs, lips, mucous mem-
branes, or tongue, notify prescriber immediately
and expect to stop lisinopril and
start appropriate therapy at once. If airway
obstruction threatens, promptly give 0.3 to
0.5 ml of epinephrine 1:1,000 solution
subcutaneously, as prescribed.
•Monitor patient for anaphylaxis, especially
patient being dialyzed with high-flux
membranes and treated with an ACE
inhibitor such as lisinopril. If anaphylaxis
occurs, stop dialysis immediately and treat
aggressively (antihistamines are ineffective
in this situation), as ordered. Anaphylaxis
has also occurred with some patients
undergoing low-density lipoprotein
apheresis with dextran sulfate absorption.
• Notify prescriber if patient has persistent,
nonproductive cough, a common adverse
effect of ACE inhibitors such as lisinopril.
•Monitor for dehydration, which can lead
to hypotension. Be aware that diarrhea
and vomiting can cause dehydration.
•Monitor patient for hepatic dysfunction
because lisinopril, an ACE inhibitor, may
rarely cause a syndrome that starts with
cholestatic jaundice or hepatitis and progresses
to fulminant hepatic necrosis. If
patient develops jaundice or a marked elevation
in liver enzyme levels, withhold
drug and notify prescriber.
• If patient takes insulin or an oral antidiabetic,
monitor blood glucose level closely
because risk of hypoglycemia increases,
especially during first month of therapy.
PATIENT TEACHING
• Explain that lisinopril helps to control but
doesn’t cure hypertension and that patient
may need lifelong therapy.
• Advise patient to take lisinopril at the
same time every day.
• Emphasize need to take drug as ordered,
even if patient feels well; caution her not
to stop drug without consulting prescriber.
• Instruct patient to report dizziness, especially
during first few days of therapy.
• Inform patient that persistent, nonproductive
cough may develop during lisinopril
therapy. Urge her to notify prescriber
immediately if cough becomes difficult to
tolerate.
• Advise patient to drink adequate fluid and
avoid excessive sweating, which can lead to
dehydration and hypotension.Make sure
she understands that diarrhea and vomiting
also can cause hypotension.
• Caution patient not to use salt substitutes
that contain potassium.
• Instruct patient to report signs of infection,
such as fever and sore throat, which
may indicate neutropenia.
• Advise patient to change position slowly to
minimize orthostatic hypotension.
• If patient has diabetes and takes insulin or
an oral antidiabetic, urge her to monitor
her blood glucose level closely and watch
for symptoms of hypoglycemia.
• Caution female patient to notify prescriber
immediately if she is or could be pregnant.
Nursing Consideration Patient Teaching - Lipitor atorvastatin
atorvastatin calcium
Lipitor
Nursing Considerations
• Atorvastatin is used in patients with
homozygous familial hypercholesterolemia
as an adjunct to other lipid-lowering treatments
or alone only if other treatments
aren’t available.
• Atorvastatin may be used with colestipol
or cholestyramine for additive antihyperlipidemic
effects.
• Expect atorvastatin to be used in patients
without obvious coronary artery disease
(CAD) but with multiple risk factors (such
as age 55 or over, smoker, history of
hypertension or low HDL level, or family
history of early CAD). Drug is used to
reduce risk of MI, angina, and adverse
effects of revascularization procedures.
• Also expect drug to be used in patients
with type 2 diabetes who have no obvious
CAD but multiple risk factors, such as
retinopathy, albuminuria, smoking, or
hypertension. Drug is used in these
patients to reduce risk of MI and stroke.
• Expect liver function tests to be performed
before atorvastatin therapy starts, after
6 and 12 weeks, with each dosage increase,
and every 6 months thereafter.
• Expect to measure lipid levels 2 to 4 weeks
after therapy starts, to adjust dosage as
directed, and to repeat periodically until
lipid levels are within desired range.
PATIENT TEACHING
• Stress that atorvastatin is an adjunct to—
not a substitute for—low-cholesterol diet.
• Tell patient to take drug at the same time
each day to maintain its effects.
• Instruct patient to take a missed dose as
soon as possible. If it’s almost time for his
next dose, he should skip the missed dose.
Tell him not to double the dose.
• Instruct patient to consult prescriber
before taking OTC niacin because of
increased risk of rhabdomyolysis.
• Advise patient to notify prescriber immediately
if he develops unexplained muscle
pain, tenderness, or weakness, especially if
accompanied by fatigue or fever.
• Be aware that atorvastatin is expensive.
Reinforce the benefits of therapy, and urge
patient to comply if possible.
Lipitor
Nursing Considerations
• Atorvastatin is used in patients with
homozygous familial hypercholesterolemia
as an adjunct to other lipid-lowering treatments
or alone only if other treatments
aren’t available.
• Atorvastatin may be used with colestipol
or cholestyramine for additive antihyperlipidemic
effects.
• Expect atorvastatin to be used in patients
without obvious coronary artery disease
(CAD) but with multiple risk factors (such
as age 55 or over, smoker, history of
hypertension or low HDL level, or family
history of early CAD). Drug is used to
reduce risk of MI, angina, and adverse
effects of revascularization procedures.
• Also expect drug to be used in patients
with type 2 diabetes who have no obvious
CAD but multiple risk factors, such as
retinopathy, albuminuria, smoking, or
hypertension. Drug is used in these
patients to reduce risk of MI and stroke.
• Expect liver function tests to be performed
before atorvastatin therapy starts, after
6 and 12 weeks, with each dosage increase,
and every 6 months thereafter.
• Expect to measure lipid levels 2 to 4 weeks
after therapy starts, to adjust dosage as
directed, and to repeat periodically until
lipid levels are within desired range.
PATIENT TEACHING
• Stress that atorvastatin is an adjunct to—
not a substitute for—low-cholesterol diet.
• Tell patient to take drug at the same time
each day to maintain its effects.
• Instruct patient to take a missed dose as
soon as possible. If it’s almost time for his
next dose, he should skip the missed dose.
Tell him not to double the dose.
• Instruct patient to consult prescriber
before taking OTC niacin because of
increased risk of rhabdomyolysis.
• Advise patient to notify prescriber immediately
if he develops unexplained muscle
pain, tenderness, or weakness, especially if
accompanied by fatigue or fever.
• Be aware that atorvastatin is expensive.
Reinforce the benefits of therapy, and urge
patient to comply if possible.
Nursing Consideration Patient Teaching - Lexapro escitalopram
escitalopram
oxalate
Lexapro
Nursing Considerations
• Use escitalopram cautiously in patients
with history of mania or seizures, patients
with severe renal impairment, and those
with diseases or conditions that produce
altered metabolism or hemodynamic
responses.
•Monitor patient—especially elderly
patient—for hypoosmolarity of serum and
urine and for hyponatremia (headache,
trouble contentrating, impaired memory,
weakness, unsteadiness) because they may
may indicate escitalopram-induced syndrome
of inappropriate ADH secretion.
•Watch for signs of misuse or abuse, such
as development of tolerance, increasing
dosage without approval, and drug-seeking
behavior; drug’s potential for physical
and psychological dependence is
unknown.
•Monitor patient for bleeding, especially if
patient is also taking aspirin, an NSAID, or
an anticoagulant. Bleeding can range from
ecchymoses, hemtomas, epitaxis and
petechiae to life-threatening hemorrhages.
• Expect prescriber to reassess patient periodically
to determine the continued need
for therapy and evaluate dosage.
• If patient (particularly a child or an adolescent)
takes escitalopram for depression,
watch closely for suicidal tendencies, especially
when therapy starts or dosage
changes, because depression may worsen
temporarily.
• If escitalopram will be stopped, expect to
taper dosage to avoid serious adverse reactions.
PATIENT TEACHING
• Inform patient that alcohol use isn’t recommended
during escitalopram therapy
because it may decrease his ability to think
clearly and perform motor skills.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient that drug shouldn’t be
taken with citalopram hydrobromide
because of potentially additive effects.
• Tell patient that improvement may not be
noticed for 1 to 4 weeks after therapy
begins. Emphasize the importance of continuing
therapy as prescribed.
• If patient (particularly a child or an adolescent)
takes drug for depression, urge
caregivers to watch closely for suicidal tendencies,
especially when therapy starts or
dosage changes.
•Warn patient not to stop taking drug
abruptly. Explain that gradual tapering
helps to avoid withdrawal symptoms.
• Urge patient to inform prescriber of any
OTC drugs he takes because of potential
for interactions.
• Review signs and symptoms of hyponatremia,
and instruct patient to report them
to prescriber.
•Warn patient that escitalopram increases
bleeding risk if taken with aspirin, an
NSAID, or an anticoagulants and that
bleeding events could range from mild to
severe. Tell patient to seek emergency care
for serious or prolonged bleeding.
oxalate
Lexapro
Nursing Considerations
• Use escitalopram cautiously in patients
with history of mania or seizures, patients
with severe renal impairment, and those
with diseases or conditions that produce
altered metabolism or hemodynamic
responses.
•Monitor patient—especially elderly
patient—for hypoosmolarity of serum and
urine and for hyponatremia (headache,
trouble contentrating, impaired memory,
weakness, unsteadiness) because they may
may indicate escitalopram-induced syndrome
of inappropriate ADH secretion.
•Watch for signs of misuse or abuse, such
as development of tolerance, increasing
dosage without approval, and drug-seeking
behavior; drug’s potential for physical
and psychological dependence is
unknown.
•Monitor patient for bleeding, especially if
patient is also taking aspirin, an NSAID, or
an anticoagulant. Bleeding can range from
ecchymoses, hemtomas, epitaxis and
petechiae to life-threatening hemorrhages.
• Expect prescriber to reassess patient periodically
to determine the continued need
for therapy and evaluate dosage.
• If patient (particularly a child or an adolescent)
takes escitalopram for depression,
watch closely for suicidal tendencies, especially
when therapy starts or dosage
changes, because depression may worsen
temporarily.
• If escitalopram will be stopped, expect to
taper dosage to avoid serious adverse reactions.
PATIENT TEACHING
• Inform patient that alcohol use isn’t recommended
during escitalopram therapy
because it may decrease his ability to think
clearly and perform motor skills.
• Advise patient to avoid hazardous activities
until drug’s CNS effects are known.
• Instruct patient that drug shouldn’t be
taken with citalopram hydrobromide
because of potentially additive effects.
• Tell patient that improvement may not be
noticed for 1 to 4 weeks after therapy
begins. Emphasize the importance of continuing
therapy as prescribed.
• If patient (particularly a child or an adolescent)
takes drug for depression, urge
caregivers to watch closely for suicidal tendencies,
especially when therapy starts or
dosage changes.
•Warn patient not to stop taking drug
abruptly. Explain that gradual tapering
helps to avoid withdrawal symptoms.
• Urge patient to inform prescriber of any
OTC drugs he takes because of potential
for interactions.
• Review signs and symptoms of hyponatremia,
and instruct patient to report them
to prescriber.
•Warn patient that escitalopram increases
bleeding risk if taken with aspirin, an
NSAID, or an anticoagulants and that
bleeding events could range from mild to
severe. Tell patient to seek emergency care
for serious or prolonged bleeding.
Nursing Consideration Patient Teaching - Klonopin Klonopin Wafer clonazepam
clonazepam
Apo-Clonazepam (CAN), Clonapam
(CAN), Gen-Clonazepam (CAN), Klonopin,
Rivotril (CAN)
Nursing Considerations
• Use clonazepam cautiously in patients
with renal failure, mixed seizure disorder
(because drug can increase the risk of generalized
tonic-clonic seizures), or respiratory
disease and troublesome secretions
(because clonazepam increases salivation)
and in elderly patients (because they’re
more sensitive to drug’s CNS effects).
•Monitor blood drug level, CBC, and liver
function test results during long-term or
high-dose therapy, as ordered.
WARNING Don’t stop drug abruptly; expect
to taper dosage gradually to avoid withdrawal
symptoms and seizures.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
• Tell patient to take drug exactly as prescribed.
Explain that stopping abruptly
can cause seizures and withdrawal symptoms.
• Advise patient to avoid alcohol and sleepinducing
drugs during therapy. Instruct
him to consult prescriber before taking
any OTC drugs.
• Urge patient to carry medical identification
of his seizure disorder and drug therapy.
•Warn patient about possible drowsiness.
• Instruct patient to report severe dizziness,
persistent drowsiness, palpitations, difficulty
urinating, seizure activity, and other
disruptive adverse reactions.
• Suggest that parents monitor child’s performance
in school because clonazepam
can cause drowsiness or inattentiveness.
• Urge caregivers to watch patient closely for
evidence of suicidal tendencies, especially
when therapy starts or dosage changes,
and to report concerns to prescriber
immediately.
• Urge female patient who becomes pregnant
while taking clonazepam to enroll in
the Antiepileptic Drug Pregnancy Registry
by calling 1-888-233-2334. Explain that
the registry is studying the safety of
antiepileptic drugs during pregnancy.
Apo-Clonazepam (CAN), Clonapam
(CAN), Gen-Clonazepam (CAN), Klonopin,
Rivotril (CAN)
Nursing Considerations
• Use clonazepam cautiously in patients
with renal failure, mixed seizure disorder
(because drug can increase the risk of generalized
tonic-clonic seizures), or respiratory
disease and troublesome secretions
(because clonazepam increases salivation)
and in elderly patients (because they’re
more sensitive to drug’s CNS effects).
•Monitor blood drug level, CBC, and liver
function test results during long-term or
high-dose therapy, as ordered.
WARNING Don’t stop drug abruptly; expect
to taper dosage gradually to avoid withdrawal
symptoms and seizures.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
• Tell patient to take drug exactly as prescribed.
Explain that stopping abruptly
can cause seizures and withdrawal symptoms.
• Advise patient to avoid alcohol and sleepinducing
drugs during therapy. Instruct
him to consult prescriber before taking
any OTC drugs.
• Urge patient to carry medical identification
of his seizure disorder and drug therapy.
•Warn patient about possible drowsiness.
• Instruct patient to report severe dizziness,
persistent drowsiness, palpitations, difficulty
urinating, seizure activity, and other
disruptive adverse reactions.
• Suggest that parents monitor child’s performance
in school because clonazepam
can cause drowsiness or inattentiveness.
• Urge caregivers to watch patient closely for
evidence of suicidal tendencies, especially
when therapy starts or dosage changes,
and to report concerns to prescriber
immediately.
• Urge female patient who becomes pregnant
while taking clonazepam to enroll in
the Antiepileptic Drug Pregnancy Registry
by calling 1-888-233-2334. Explain that
the registry is studying the safety of
antiepileptic drugs during pregnancy.
Nursing Consideration Patient Teaching - Hydrochlorothiazide Aquazide H HydroDIURIL Microzide
hydrochlorothiazide
Esidrix, Hydro-chlor, Hydro-D,
HydroDIURIL, Microzide, Neo-Codema
(CAN), Novo-Hydrazide (CAN), Oretic,
Urozide (CAN)
Nursing Considerations
• Give hydrochlorothiazide in the morning
and early evening to avoid nocturia.
•Monitor fluid intake and output, daily
weight, blood pressure, and serum levels
of electrolytes, especially potassium.
• Assess for evidence of hypokalemia, such
as muscle spasms and weakness.
•Monitor BUN and serum creatinine levels.
• Check blood glucose level often, as
ordered, in diabetic patients, and expect to
increase antidiabetic dosage, as needed.
• If patient has gouty arthritis, expect
increased risk of gout attacks during therapy.
PATIENT TEACHING
• Advise patient to take hydrochlorothiazide
morning and early evening to avoid awakening
during the night to urinate.
• Instruct patient to take drug with food or
milk if adverse GI reactions occur.
• Tell patient to weigh herself at the same
time each day wearing the same amount
of clothing and to notify prescriber if she
gains more than 2 lb (0.9 kg) per day or
5 lb (2.3 kg) per week.
• Instruct patient to eat a diet high in potassium-
rich food, including citrus fruits,
bananas, tomatoes, and dates.
• Advise patient to change position slowly
to minimize effects of orthostatic
hypotension.
• Urge patient to report decreased urination,
muscle cramps and weakness, and
unusual bleeding or bruising.
Esidrix, Hydro-chlor, Hydro-D,
HydroDIURIL, Microzide, Neo-Codema
(CAN), Novo-Hydrazide (CAN), Oretic,
Urozide (CAN)
Nursing Considerations
• Give hydrochlorothiazide in the morning
and early evening to avoid nocturia.
•Monitor fluid intake and output, daily
weight, blood pressure, and serum levels
of electrolytes, especially potassium.
• Assess for evidence of hypokalemia, such
as muscle spasms and weakness.
•Monitor BUN and serum creatinine levels.
• Check blood glucose level often, as
ordered, in diabetic patients, and expect to
increase antidiabetic dosage, as needed.
• If patient has gouty arthritis, expect
increased risk of gout attacks during therapy.
PATIENT TEACHING
• Advise patient to take hydrochlorothiazide
morning and early evening to avoid awakening
during the night to urinate.
• Instruct patient to take drug with food or
milk if adverse GI reactions occur.
• Tell patient to weigh herself at the same
time each day wearing the same amount
of clothing and to notify prescriber if she
gains more than 2 lb (0.9 kg) per day or
5 lb (2.3 kg) per week.
• Instruct patient to eat a diet high in potassium-
rich food, including citrus fruits,
bananas, tomatoes, and dates.
• Advise patient to change position slowly
to minimize effects of orthostatic
hypotension.
• Urge patient to report decreased urination,
muscle cramps and weakness, and
unusual bleeding or bruising.
Nursing Consideration Patient Teaching - Gabapentin Gabarone Neurontin
gabapentin
Neurontin
Nursing Considerations
• As needed, open gabapentin capsules and
mix contents with water, fruit juice, applesauce,
or pudding before administration.
• Administer initial dose at bedtime to minimize
adverse reactions, especially ataxia,
dizziness, fatigue, and somnolence.
• Give drug at least 2 hours after an antacid.
• Don’t exceed 12 hours between doses on a
3-times-a-day schedule.
• Be aware that routine monitoring of blood
gabapentin level isn’t needed.
WARNING To discontinue drug or switch to
an a different anticonvulsant, expect to
change gradually over at least 1 week, as
prescribed, to avoid loss of seizure control.
•Monitor renal function test results, and
expect to adjust dosage, if needed.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
• If patient has trouble swallowing gabapentin
capsules, advise him to open them and
sprinkle contents in juice or on soft food
immediately before use.
• Instruct patient not to take drug within
2 hours after taking an antacid.
• Urge patient to take a missed dose as soon
as he remembers. If the next dose is in less
than 2 hours, tell him to wait 1 to 2 hours
before taking it and then resume his regular
schedule. Caution against doubling the
dose.
• Caution patient not to stop drug abruptly.
• Inform patient about possible ataxia,
dizziness, drowsiness, and nystagmus.
Advise him to avoid hazardous activities
until drug’s CNS effects are known.
• To prevent complications from adverse
oral reactions (such as gingivitis), encourage
patient to use good oral hygiene and
to seek routine dental care.
• Explain that adverse effects usually are
mild to moderate and decline with time.
• Urge patient to keep follow-up appointments
with prescriber to check progress.
• Urge caregivers to watch closely for evidence
of suicidal tendencies, especially
when therapy starts or dosage changes,
and to report concerns immediately.
• Urge woman who becomes pregnant while
taking gabapentin to enroll in the North
American antiepileptic drug pregnancy
registry by calling 1-888-233-2334.
Explain that this registry is collecting
information about the safety of antiepileptic
drugs during pregnancy.
Neurontin
Nursing Considerations
• As needed, open gabapentin capsules and
mix contents with water, fruit juice, applesauce,
or pudding before administration.
• Administer initial dose at bedtime to minimize
adverse reactions, especially ataxia,
dizziness, fatigue, and somnolence.
• Give drug at least 2 hours after an antacid.
• Don’t exceed 12 hours between doses on a
3-times-a-day schedule.
• Be aware that routine monitoring of blood
gabapentin level isn’t needed.
WARNING To discontinue drug or switch to
an a different anticonvulsant, expect to
change gradually over at least 1 week, as
prescribed, to avoid loss of seizure control.
•Monitor renal function test results, and
expect to adjust dosage, if needed.
•Monitor patient closely for evidence of
suicidal thinking or behavior, especially
when therapy starts or dosage changes.
PATIENT TEACHING
• If patient has trouble swallowing gabapentin
capsules, advise him to open them and
sprinkle contents in juice or on soft food
immediately before use.
• Instruct patient not to take drug within
2 hours after taking an antacid.
• Urge patient to take a missed dose as soon
as he remembers. If the next dose is in less
than 2 hours, tell him to wait 1 to 2 hours
before taking it and then resume his regular
schedule. Caution against doubling the
dose.
• Caution patient not to stop drug abruptly.
• Inform patient about possible ataxia,
dizziness, drowsiness, and nystagmus.
Advise him to avoid hazardous activities
until drug’s CNS effects are known.
• To prevent complications from adverse
oral reactions (such as gingivitis), encourage
patient to use good oral hygiene and
to seek routine dental care.
• Explain that adverse effects usually are
mild to moderate and decline with time.
• Urge patient to keep follow-up appointments
with prescriber to check progress.
• Urge caregivers to watch closely for evidence
of suicidal tendencies, especially
when therapy starts or dosage changes,
and to report concerns immediately.
• Urge woman who becomes pregnant while
taking gabapentin to enroll in the North
American antiepileptic drug pregnancy
registry by calling 1-888-233-2334.
Explain that this registry is collecting
information about the safety of antiepileptic
drugs during pregnancy.
Nursing Consideration Patient Teaching - Flexeril Amrix Fexmid Cyclobenzaprine
cyclobenzaprine
hydrochloride
Flexeril
Nursing Considerations
• Use cyclobenzaprine cautiously in patients
with history of low seizure threshold.
• If possible, avoid giving drug to elderly
patients because of its anticholinergic
effects.
• To prevent falls, take safety precautions if
patient is confused, dizzy, or weak.
PATIENT TEACHING
• Urge patient to avoid alcohol and other
CNS depressants during therapy.
• Inform patient about possible lack of
alertness and dexterity.
• Advise patient to ask for assistance with
walking, driving, or hazardous activities if
he experiences dizziness or weakness.
hydrochloride
Flexeril
Nursing Considerations
• Use cyclobenzaprine cautiously in patients
with history of low seizure threshold.
• If possible, avoid giving drug to elderly
patients because of its anticholinergic
effects.
• To prevent falls, take safety precautions if
patient is confused, dizzy, or weak.
PATIENT TEACHING
• Urge patient to avoid alcohol and other
CNS depressants during therapy.
• Inform patient about possible lack of
alertness and dexterity.
• Advise patient to ask for assistance with
walking, driving, or hazardous activities if
he experiences dizziness or weakness.
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