Drug Study

Date Ordered November 7, 2010

Generic Name
Brand Name Kalium Durule

Drug Image
Classification Therapeutic: mineral and electrolyte
replacements/supplements
Ordered Dose i tab TID
Suggested Dose PO (Adults): 20–40 mEq/day in 1–2
divided doses; single dose should not
exceed 20 mEq.
Adult & elderly Prophylaxis 2 durules
daily. Hypokalemia Adjust dosage
according to serum K level. Suggested
dose: 2 durules bid or more until serum K
is restored to normal, then prophylactic
dosage.
Mode of Action Maintain acid-base balance, isotonicity,
and electrophysiologic balance of the cell.
Activator in many enzymatic reactions;
essential to transmission of nerve
impulses; contraction of cardiac, skeletal,
and smooth muscle; gastric secretion;
renal function; tissue synthesis; and
carbohydrate metabolism. Therapeutic Ef
fects: Replacement. Prevention of
deficiency.
Indication PO, IV: Treatment/prevention of potassium
depletion.
IV: Arrhythmias due to digoxin toxicity.
Hypokalemia. Prophylaxis during
treatment with diuretics
Contraindication Contraindicated in: Hyperkalemia;
Severe renal impairment; Untreated
Addison’s disease; Severe tissue trauma;
Hyperkalemic familial periodic paralysis;
Some products may contain tartrazine
(FDC yellow dye #5) or alcohol; avoid
using in patients with known
hypersensitivity or intolerance; Potassium
acetate injection contains aluminum, which
may become toxic with prolonged use to
high risk groups (renal impairment,
premature neonates).
Drug Interactions Drug-Drug: Use with potassium-sparing
diuretics or ACE inhibitors or angiotensin II
receptor antagonists may lead to
hyperkalemia. Anticholinergics may ↑ GI
mucosal lesions in patients taking wax-
matrix potassium chloride preparations.
Side-Effects/ Adverse Reactions CNS: confusion, restlessness, weakness.
CV: ARRHYTHMIAS, ECG changes.
GI: abdominal pain, diarrhea, flatulence,
nausea, vomiting; tablets, capsules only—
GI ulceration, stenotic lesions.
Local: irritation at IV site.
Neuro: paralysis, paresthesia.
Nursing Responsibilities a. Assess for signs and symptoms of
hypokalemia (weakness, fatigue, U
wave on ECG, arrhythmias,
polyuria, polydipsia) and
hyperkalemia
b. Monitor pulse, blood pressure, and
ECG periodically during IV therapy.
 c. Monitor serum potassium before
and periodically during therapy.
d. Monitor renal function, serum
bicarbonate, and pH.
e. PO: Administer with or after meals
to decrease GI irritation.
f. Report dark, tarry, or bloody stools;
weakness; unusual fatigue; or
tingling of extremities. Notify health
care professional if nausea,
vomiting, diarrhea, or stomach
discomfort persists. Dosage may
require adjustment.
g. Explain to patient purpose of the
medication and the need to take as
directed.
h. Instruct patient to avoid salt
substitutes or low-salt milk or food
unless approved by health care
professional.

Date Ordered November 7, 2010

Generic Name esomeprazole
Brand Name
Drug Image
Classification Therapeutic: antiulcer agents
Pharmacologic: proton-pump inhibitors
Ordered Dose 40mg i tab OD
Suggested Dose PO (Adults): 20 or 40 mg once daily for
up to 6 mo.
Mode of Action Binds to an enzyme on gastric parietal
cells in the presence of acidic gastric pH,
preventing the final transport of hydrogen
ions into the gastric lumen. Therapeutic
Effects: Diminished accumulation of acid
in the gastric lumen with lessened
gastroesophageal reflux. Healing of
duodenal ulcers. Decreased incidence of
gastric ulcer during continuous NSAID
therapy.
Indication GERD including: erosive esophagitis.
Hypersecretory conditions, including
Zollinger-Ellison syndrome. With
amoxicillin and clarithromycin to eradicate
Helicobacter pylori in duodenal ulcer
disease or history of duodenal ulcer
disease.
Decrease risk of gastric ulcer during
continuous NSAID therapy.
Contraindication Contraindicated in: Hypersensitivity; OB:
Lactation (not recommended).
Use Cautiously in: Severe hepatic
impairment (daily dose should not exceed
20 mg); Geri: Increased risk of hip
fractures in patients using high-doses for
>1 year; OB: Pregnancy (use
only if clearly needed); Pedi: Children <18
 yr (safety not established).
Drug Interactions Drug-Drug: May ↓ absorption and effects
of drugs where gastric pH is a determinant
of bioavailability, including digoxin,
ketoconazole, and iron salts.May ↑ risk of
bleeding with warfarin (monitor INR and
PT).
Side-Effects/ Adverse Reactions CNS: headache.
GI: abdominal pain, constipation, diarrhea,
dry mouth, flatulence, nausea.
Nursing Responsibilities a.

Date Ordered November 7, 2010

Generic Name ketoanalogues & essential amino acids
Brand Name Ketosteril

Drug Image
Classification Other Drugs Acting on the Genito-Urinary
System (MIMS)

Ordered Dose i tab TID

Suggested Dose Adult 70 kg 4-8 tab tid given if GFR is <25
 mL/min.
Mode of Action
Indication Prevention & therapy of damages due to
faulty/deficient protein metabolism in
chronic renal insufficiency.
Contraindication Hypercalcemia, disturbed amino acid
metabolism.
Drug Interactions The simultaneous administration of
medications containing calcium (eg,
acetolyte) may lead to pathological
increases of the serum calcium level or
intensification. As the uremia symptoms
improve with Ketosteril, a possible
administration of aluminium hydroxide
should be reduced. Pay attention to a
reduction of serum phosphate. In order not
to interfere with absorption, do not take
drugs together with Ketosteril that form
sparingly soluble compounds with calcium
(eg, tetracyclines).
Side-Effects/ Adverse Reactions Hypercalcemia. Monitor regularly the
serum calcium level. Ensure the sufficient
supply with calories.
Nursing Responsibilities a.
Date Ordered November 7, 2010
Generic Name Ferrous sulfate, Folic acid, Vitamin B-
complex (PPD)
Brand Name Terraferon

Drug Image
Classification Dietary/ Dietary Drugs/ Hematinics (PPD)
Vitamins & Minerals (Pre & Post
Natal) / Antianemics (MIMS)
Ordered Dose i cap OD
Suggested Dose Usual dose: 1-2 cap daily.
Severe anemia 1 cap tid. Prophylaxis 15-
30mg/day. Therapeutic 200 mg/day.
Mode of Action
Indication Prevention & treatment of Fe-
deficiency anemia due to hemorrhage,
infections, intestinal parasitism, prolonged
illness, rapid growth, menstruation.
Prevention & treatment of anemia due to
folic acid & vit B12 deficiencies. Fe
depletion secondary to post-op blood loss.
Pregnancy & lactation.
Contraindication
Drug Interactions
Side-Effects/ Adverse Reactions Heartburn, nausea, vomiting, constipation
& diarrhea.
Nursing Responsibilities a. Take on an empty stomach (Best
taken between meals. May be taken
w/ meals to reduce GI discomfort.).
b.
Date Ordered November 7, 2010
Generic Name calcium carbonate
Brand Name Caltrate Plus

Drug Image

Classification Therapeutic: mineral and electrolyte

replacements/supplements
Ordered Dose i tab OD
Suggested Dose PO (Adults): 1–2 g/day.
Mode of Action Essential for nervous, muscular, and
skeletal systems. Maintain cell membrane
and capillary permeability. Act as an
activator in the transmission of nerve
impulses and contraction of cardiac,
skeletal, and smooth muscle. Essential for
bone formation and blood coagulation.
Therapeutic Effects: Replacement of
calcium in deficiency states. Control of
 hyperphosphatemia in end-stage renal
disease without promoting aluminum
absorption (calcium acetate).
Indication PO, IV: Treatment and prevention of
hypocalcemia. PO: Adjunct in the
prevention of postmenopausal
osteoporosis. IV: Emergency treatment of
hyperkalemia and hypermagnesemia and
adjunct in cardiac arrest or calcium
channel blocking agent toxicity (calcium
chloride, calcium gluconate). Calcium
carbonate: May be used as an antacid.
Calcium acetate: Control of
hyperphosphatemia in end-stage renal
disease.
Contraindication Contraindicated in: Hypercalcemia;
Renal calculi; Ventricular fibrillation. Use
Cautiously in: Patients receiving digitalis
glycosides; Severe respiratory
insufficiency; Renal disease; Cardiac
disease.
Drug Interactions Drug-Drug: Hypercalcemia increases the
risk of digoxin toxicity. Chronic use with
antacids in renal insufficiency may lead to
milk-alkali syndrome. Ingestion by mouth
decreases the absorption of orally
administered tetracyclines,
fluoroquinolones, phenytoin, and iron salts.
Excessive amounts may decrease the
effects of calcium channel blockers.
Decreases absorption of etidronate and
risedronate (do not take within 2 hr of
 calcium supplements). May decrease the
effectiveness of atenolol. Concurrent use
with diuretics (thiazide) may result in
hypercalcemia. May decrease the ability of
sodium polystyrene sulfonate to decrease
serumpotassium.
Drug-Food: Cereals, spinach, or rhubarb
may decrease the absorption of calcium
supplements. Calcium acetate should not
be given concurrently with other calcium
supplements.
Side-Effects/ Adverse Reactions CNS: syncope (IV only), tingling.
CV: CARDIAC ARREST (IV only),
arrhythmias, bradycardia.
GI: constipation, nausea, vomiting.
GU: calculi, hypercalciuria.
Local: phlebitis (IV ONLY).
Nursing Responsibilities a. Observe patient closely for
symptoms of hypocalcemia
(paresthesia, muscle twitching,
laryngospasm, colic, cardiac
arrhythmias, Chvostek’s or
Trousseau’s sign).
b. Monitor blood pressure, pulse, and
ECD frequently. May cause
vasodilation with resulting
hypotension, bradycardia,
arrhythmias, and cardiac arrest.
c. When used as an antacid, assess
for heartburn, indigestion, and
abdominal pain. Inspect abdomen;
auscultate bowel sounds.
d. Monitor serum calcium or ionized
calcium chloride, sodium,
potassium, magnesium, albumin,
and parathyroid hormone (PTH)
concentrations before and
periodically during therapy for
treatment of hypocalcemia.
e. Monitor cardiac rate and rhythm
closely.
f. Do not administer concurrently with
foods containing large amounts of
oxalic acid (spinach, rhubarb),
phytic acid (brans, cereals), or
phosphorus (milk or dairy products).
g. Do not take within 1-2 hours of
other medications if possible.
h. Advise patient to avoid excessive
use of tobacco or beverages
containing alcohol or caffeine.
Date Ordered November 7, 2010
Generic Name losartan
Brand Name

Drug Image
Classification Therapeutic: antihypertensives
Pharmacologic: angiotensin II receptor
antagonists
Ordered Dose 100mg i tab OD
50mg i tab OD (November 7, 2010: 9AM)
Suggested Dose PO (Adults): Hypertension—50 mg once
daily initially (range 25–100 mg/day as a
single daily dose or 2 divided doses)
Prevention of stroke in patients with
hypertension and left ventricular
hypertrophy—50 mg once daily initially; or
losartan increased to 100 mg once daily
Type 2 diabetic nephropathy — 50mg
once daily; may increase to 100mg once
daily; depending on blood pressure
response
Mode of Action Blocks vasoconstrictor and aldosterone-
producing effects of angiotensin II at
receptor sites, including vascular smooth
 muscle and the adrenal glands.
Therapeutic Effects: Lowering of blood
pressure. Slowed progression of diabetic
nephropathy (irbesartan and losartan
only). Reduced cardiovascular death and
hospitalizations due to CHF in patients
with CHF (candesartan and valsartan
only). Decreased risk of cardiovascular
death in patients with left ventricular
systolic dysfunction who are post-MI
(valsartan only). Decreased risk of stroke
in patients with hypertension and left
ventricular hypertrophy (effect may be less
in black patients) (losartan only).
Indication Alone or with other agents in the
management of hypertension.
Treatment of diabetic nephropathy in
patients with type 2 diabetes and
hypertension (irbesartan and losartan
only).Management of CHF in patients who
cannot tolerate ACE inhibitors
(candesartan and valsartan only) or in
combination with an ACE inhibitor and
beta-blocker (candesartan only).
Prevention of stroke in patients with
hypertension and left ventricular
hypertrophy (losartan only). Reduction of
risk of death from cardiovascular causes in
patients with left ventricular systolic
dysfunction after MI (valsartan only)
Contraindication Contraindicated in: Hypersensitivity; OB:
Can cause injury or death of fetus;
 Lactation: Discontinue drug or provide
formula. Use Cautiously in: CHF (may
result in azotemia, oliguria, acute renal
failure, and/or death); Impaired renal
function due to primary renal disease or
CHF (may worsen renal function);
Drug Interactions Drug-Drug: Antihypertensive effect may
be blunted by NSAIDs. ↑ antihypertensive
effects with other antihypertensives and
diuretics. Telmisartan may ↑ serum digoxin
levels. Concurrent use of potassium-
sparing diuretics, potassium-containing
salt substitutes, angiotensin-converting
enzyme inhibitors, or potassium
supplements may ↑ risk of hyperkalemia.
Candesartan may ↑ serum lithium levels.
Irbesartan and losartan may ↑ effects of
amiodarone, fluoxetine, glimepiride,
glipizide, phenytoin, rosiglitazone, and
warfarin. Rifampin may ↓ effects of
losartan.
Side-Effects/ Adverse Reactions CNS: dizziness, anxiety, depression,
fatigue, headache, insomnia, weakness.
CV: hypotension, chest pain, edema,
tachycardia.
Derm: rashes.
EENT: nasal congestion, pharyngitis,
rhinitis, sinusitis.
GI: abdominal pain, diarrhea, drug-
induced hepatitis, dyspepsia, nausea,
vomiting.
GU: impaired renal function.
 F and E: hyperkalemia.
MS: arthralgia, back pain, myalgia.
Misc: ANGIOEDEMA.
Nursing Responsibilities a. Assess blood pressure (lying,
sitting, and standing) and pulse
periodically during therapy. Notify
health care professional of
significant changes.
b. Monitor frequency of prescription
refills to determine adherence.
c. Assess patient for signs of
angioedema (dyspnea, facial
swelling). May rarely cause
angoedema.
d. Monitor daily weight and assess
patient routinely for resolution of
fluid overload (peripheral edema,
rales/crackles, dyspnea, weight
gain, jugular venous distention).
e. Monitor renal function and
electrolyte levels periodically.
Serum potassium, BUN, and serum
creatinine may be ↑.
f. May be administered without regard
to meals.
g. Caution patient to avoid sudden
changes in position to decrease
orthostatic hypotension.
h. Assist patient in ambulation since it
may cause dizziness.
i. Allow patient to sit on bed and
 dangle feet before standing to
prevent orthostatic hypotension.

Date Ordered November 7, 2010

Generic Name simvastatin
Brand Name

Drug Image
Classification Therapeutic: lipid-lowering agents
Pharmacologic: HMG-CoA reductase
inhibitors
Ordered Dose 20mg i tab OD
Suggested Dose PO (Adults): 5–80mg once daily in the
evening
Mode of Action Inhibit an enzyme, 3-hydroxy-3-
methylglutaryl-coenzyme A (HMG-CoA)
reductase, which is responsible for
catalyzing an early step in the synthesis of
cholesterol. Therapeutic Effects: Lowers
total and LDL cholesterol and triglycerides.
Slightly increase HDL. Slows of the
progression of coronary atherosclerosis
with resultant decrease in CHD-related
events (all agents except rosuvastatin
have indication for ↓ events).
Indication Adjunctive management of primary
hypercholesterolemia andmixed
dyslipidemias. Simvastatin: Secondary
prevention of cardiovascular events (↓ risk
of MI, coronary revascularization, stroke,
and cardiovascular mortality) in patients
 with clinically evident CHD or those at
high-risk for CHD (history of diabetes,
peripheral arterial disease, or stroke).
Contraindication Contraindicated in: Hypersensitivity;
Active liver disease or unexplained
persistent ↑ in AST or ALT; OB, Lactation:
Pregnancy or lactation (potential for fetal
anomalies); Concurrent use of gemfibrozil
or azole antifungals; Concurrent use of
nelfinavir or ritonavir (with lovastatin or
simvastatin).
Drug Interactions Drug-Drug: Atorvastatin, lovastatin and
simvastatin may interact with CYP3A4
inhibitors. Bioavailability and effectiveness
may be ↓ by cholestyramine and
colestipol. Risk of myopathy with
atorvastatin, lovastatin, and simvastatin is
↑ with amiodarone, cyclosporine,
gemfibrozil, clofibrate, diltiazem,
veraverapamil, erythromycin,
clarithromycin, telithromycin, nefazodone,
large doses of niacin, azole antifungals,
nelfinavir, saquinavir, and ritonavir.
Atorvastatin, fluvastatin, and simvastatin
may slightly ↑ serum digoxin levels.
Atorvastatin, fluvastatin, lovastatin,
rosuvastatin, and simvastatin may ↑ risk of
bleeding with warfarin.
Drug-Natural Products: St. John’s wort
may ↓ levels and effectiveness (lovastatin
and simvastatin).
Drug-Food: Large quantities of grapefruit
juice ↑ blood levels and ↑ risk of
rhabdomyolysis. Food enhances blood
 levels of lovastatin.
Side-Effects/ Adverse Reactions CNS: dizziness, headache, insomnia,
weakness.
CV: chest pain, peripheral edema.
EENT: rhinitis;
Resp: bronchitis
GI: abdominal cramps, constipation,
diarrhea, flatus, heartburn, altered taste,
drug-induced hepatitis, dyspepsia,
elevated liver enzymes, nausea,
pancreatitis.
GU: erectile dysfunction.
Derm: rashes, pruritus.
MS: RHABDOMYOLYSIS, arthralgia,
arthritis, myalgia, myositis.
Misc: hypersensitivity reactions.
Nursing Responsibilities a. Obtain a dietary history, especially
with regard to fat consumption.
b. Monitor liver function tests,
including AST. If AST levels ↑ to 3
times normal, HMG-CoA reductase
inhibitor therapy should be reduced
or discontinued. May also cause ↑
alkaline phosphatase and bilirubin
levels.
c. If patient develops muscle
tenderness during therapy, monitor
CK levels. If CK levels are >10
times the upper limit of normal or
myopathy occurs, therapy should
be discontinued.
d. Administer fluvastatin, pravastatin,
 and simvastatin once daily in the
evening.
e. May be administered without regard
to food.
f. Avoid large amounts of grapefruit
juice during therapy; may ↑ risk of
toxicity.
g. Advise patient that this medication
should be used in conjunction with
diet restrictions (fat, cholesterol,
carbohydrates, alcohol), exercise,
and cessation of smoking.
h. Watch out for hypersensitivity
reations.
Date Ordered November 7, 2010
Generic Name amlodipine
Brand Name Norvasc

Drug Image
Classification Therapeutic: antihypertensives
Pharmacologic: calcium channel blockers
Ordered Dose 5mg i tab OD
Suggested Dose PO (Adults): 5–10 mg once daily
Mode of Action Inhibits the transport of calcium into
myocardial and vascular smooth muscle
cells, resulting in inhibition of excitation-
contraction coupling and subsequent
contraction. Therapeutic Effects:
Systemic vasodilation resulting in
decreased blood pressure. Coronary
vasodilation resulting in decreased
frequency and severity of attacks of
angina.
Indication Alone or with other agents in the
management of hypertension, angina
pectoris, and vasospastic (Prinzmetal’s)
angina.
Contraindication Contraindicated in: Hypersensitivity;
Blood pressure <90mmHg.
Drug Interactions Drug-Drug: Additive hypotension may
occur when used concurrently with
fentanyl, other antihypertensives, nitrates,
acute ingestion of alcohol, or quinidine.
Antihypertensive effects may be ↓ by
concurrent use of nonsteroidal anti-
inflammatory agents. May ↑ risk of
neurotoxicity with lithium.
 Drug-Food: Grapefruit juice ↑ serum
levels and effect
Side-Effects/ Adverse Reactions CNS: headache, dizziness, fatigue.
CV: peripheral edema, angina,
bradycardia, hypotension, palpitations.
GI: gingival hyperplasia, nausea.
Derm: flushing.
Nursing Responsibilities a. Monitor blood pressure and pulse
before therapy, during dose
titration, and periodically during
therapy. Monitor ECG periodically
during prolonged therapy.
b. Monitor intake and output ratios and
daily weight. Assess for signs of
CHF (peripheral edema,
rales/crackles, dyspnea, weight
gain, jugular venous distention).
c. May be administered without regard
to meals.
d. Advise patient to avoid large
amounts (6–8 glasses of grapefruit
juice/day) during therapy.
e. Caution patient to change positions
slowly to minimize orthostatic
hypotension.
f. Caution patient to avoid sudden
changes in position to decrease
orthostatic hypotension.
g. Assist patient in ambulation since it
may cause dizziness.
h. Allow patient to sit on bed and
dangle feet before standing to
 prevent orthostatic hypotension.

Date Ordered November 7, 2010

Generic Name citicoline
Brand Name
Drug Image
Classification Nootropics & Neurotonics
Ordered Dose 1gm q12 IVTT
Suggested Dose IV: Adult: Up to 1 g IM/IV daily.
Mode of Action Citicoline increases blood flow and
O2 consumption in the brain. It is also
involved in the biosynthesis of lecithin.
Indication Treatment for head injury, cerebrovascular
disorders, and Parkinsonism
Contraindication
Drug Interactions
Side-Effects/ Adverse Reactions
Nursing Responsibilities a. May be taken with or without food.
(Take w/ or between meals.)
b.

Date Ordered November 7, 2010

Generic Name sodium chloride
Brand Name

Drug Image
Classification Therapeutic: mineral and electrolyte
replacements/supplements
Ordered Dose 2 tabs TID
Suggested Dose PO (Adults): 1–2 g 3 times daily.
Mode of Action Sodium is a major cation in extracellular
 fluid and helps maintain water distribution,
fluid and electrolyte
balance, acid-base equilibrium, and
osmotic pressure. Chloride is the major
anion in extracellular fluid and is involved
in maintaining acid-base balance.
Solutions of NaCl resemble extracellular
fluid. Reduces corneal edema by an
osmotic effect. Therapeutic Effects: IV,
PO: Replacement in deficiency states and
maintenance of homeostasis.
Indication PO: Prevention of or management of
volume depletion due to salt restriction or
heat prostration when excessive sweating
occurs during exposures to high
temperatures.
Contraindication Contraindicated in: IV solution:
Hypertonic (3%, 5%) solutions should not
be used in patients with elevated, slightly
decreased, or normal serum sodium, Fluid
retention or hypernatremia.
Drug Interactions Drug-Drug: Excessive amounts of NaCl
may partially antagonize the effects of
antihypertensives. Use with
corticosteroids may result in excess
sodium retention.
Side-Effects/ Adverse Reactions Seen primarily during PO and IV use
CV: CHF, PULMONARY EDEMA, edema.
F and E: hypernatremia, hypervolemia,
hypokalemia.
Nursing Responsibilities a. Assess fluid balance (intake and
output, daily weight, edema, lung
sounds) throughout therapy.
b. Assess patient for symptoms of
hyponatremia (headache,
tachycardia, lassitude, dry mucous
membranes, nausea, vomiting,
muscle cramps) or hypernatremia
(edema, weight gain, hypertension,
tachycardia, fever, flushed skin,
mental irritability) throughout
therapy.
c. Monitor serum sodium, potassium,
bicarbonate, and chloride
concentrations and acid-base
balance periodically for patients
receiving prolonged therapy with
sodium chloride.
d. Monitor vital signs periodically
e. Watch out for signs and symptoms
of pulmonary edema (difficulty of
breathing, excessive sweating, skin
pallor)
Date Ordered November 7, 2010
Generic Name aspirin
Brand Name

Drug Image
Classification Therapeutic: antipyretics, nonopioid
analgesics
Pharmacologic: salicylates
Ordered Dose 80mg i tab OD (pc)
Suggested Dose PO (Adults): 50–325 mg once daily.
Mode of Action Produce analgesia and reduce
inflammation and fever by inhibiting the
production of prostaglandins. Aspirin Only
Decreases platelet aggregation.
 Therapeutic Effects: Analgesia.
Reduction of inflammation. Reduction of
fever. Aspirin. Decreased incidence of
transient ischemic attacks and MI.
Indication Inflammatory disorders including:
Rheumatoid arthritis, Osteoarthritis. Mild to
moderate pain. Fever. Aspirin:
Prophylaxis of transient ischemic attacks
and MI.
Contraindication Contraindicated in: Hypersensitivity to
aspirin, tartrazine (FDC yellow dye #5), or
other salicylates; Cross-sensitivity with
other NSAIDs may exist (less with
nonaspirin salicylates); Bleeding disorders
or thrombocytopenia (more important with
aspirin); Children or adolescents with viral
infections (may increase the risk of Reye’s
syndrome).
Drug Interactions Drug-Drug: Aspirin may ↑ the risk of
bleeding with warfarin, heparin, heparin-
like agents, thrombolytic agents,
ticlopidine, clopidogrel, abciximab,
tirofiban, or eptifibatide, although these
agents are frequently used safely in
combination and in sequence. Ibuprofen
may negate the cardioprotective anti-
platelet effects of low-dose aspirin. Aspirin
may ↑ risk of bleeding with cefoperazone,
cefotetan, and valproic acid. May ↑ activity
of penicillins, phenytoin, methotrexate,
valproic acid, oral hypoglycemic agents,
and sulfonamides. May ↓ beneficial effects
 of probenecid or sulfinpyrazone.
Corticosteroids may ↓ serum salicylate
levels. Urinary acidification ↑ reabsorption
and may ↑ serum salicylate levels.
Alkalinization of the urine or the ingestion
of large amounts of antacids ↑ excretion
and ↓ serum salicylate levels. May blunt
the therapeutic response to diuretics, and
antihypertensives. ↑ risk of GI irritation with
NSAIDs.
Drug-Natural Products:_anticoagulant
effect and bleeding risk when using aspirin
with arnica, chamomile, clove, feverfew,
garlic, ginger, ginkgo, Panax ginseng, and
others.
Drug-Food: Foods capable of acidifying
the urine may ↑ serum salicylate levels.
Side-Effects/ Adverse Reactions EENT: tinnitus.
GI: GI BLEEDING, dyspepsia, epigastric
distress, nausea, abdominal pain,
anorexia, hepatotoxicity, vomiting.
Hemat: aspirin—anemia, hemolysis,
increased bleeding time
Misc: allergic reactions including
ANAPHYLAXIS and LARYNGEAL
EDEMA.
Nursing Responsibilities a. Assess pain and limitation of
movement; note type, location, and
intensity before and at the peak
after administration.
b. Assess fever and note associated
signs (diaphoresis, tachycardia,
 malaise, chills).
c. Prolongs bleeding time for 4–7 days
and, in large doses, may cause
prolonged prothrombin time.
d. Monitor patient for the onset of
tinnitus, headache, hyperventilation,
agitation, mental confusion,
lethargy, diarrhea, and sweating. If
these symptoms appear, withhold
medication and notify physician or
other health care professional
immediately.
e. Administer after meals or with food
or an antacid to minimize gastric
irritation. Food slows but does not
alter the total amount absorbed.
f. Do not crush or chew enteric-
coated tablets. Do not take antacids
within 1–2 hr of enteric-coated
tablets. Chewable tablets may be
chewed, dissolved in liquid, or
swallowed whole.
Date Ordered November 10, 2010
Generic Name Epoetin alpha (α)
Brand Name Eprex®

Drug Image

Classification Therapeutic: antianemics

Pharmacologic: hormones
Ordered Dose 4000 ‘u’ once a week
Suggested Dose SQ, IV (Adults): 50-100 units/kg 3 times
weekly initially, then adjust dose based on
hematocrit
Mode of Action Stimulates erythropoeisis (production of
red blood cells). Therapeutic effects:
 Maintains and may elevate RBCs,
decreasing the need for transfusions.
Indication Anemia associated with chronic renal
failure. Anemia secondary to zidovudine
(AZT) therapy in HIV-infected patients.
Anemia from chemotherapy in patients
with nonmyeloid malignancies. Reduction
of need for transfusions after surgery.
Contraindication Contraindicated in: Hypersensitivity to
albumin or mammalian cell-derived
products; uncontrolled hypertension;
patients with erythropoietin
levels>200mU/ml. Use cautiously in history
of seizures; history of porphyria;
pregnancy or lactation.
Drug Interactions Drug-Drug: May increase the requirement
for heparin anticoagulation during
hemodialysis.
Side-Effects/ Adverse Reactions CNS: seizures, headache
CV: hypertension, thrombotic events such
as myocardial infarction or stroke (↑ in
hemodialysis patients or
hemoglobin≥12g/dL)
Derm: transient rashes
Endo: restored fertility, resumption of
menses
Misc: ↑ mortality and ↑ tumor growth ( with
hemoglobin≥12g/dL)
Nursing Responsibilities a. Monitor blood pressure before and
during therapy.
b. Monitor for symptoms of anemia
(fatigue, dyspnea, pallor)
c. Monitor lab tests: may cause ↑ in
 WBCs and platelets. May ↓
bleeding times
d. Monitor renal function studies and
electrolytes closely
e. Give supplemental iron as ordered
f. Institute seizure precautions
g. Do not shake vial; inactivation of
medication may occur
h. Explain rationale for concurrent iron
therapy (increased RBC production
requires iron)
i. Discuss ways of preventing self-
injury in patients at risk for seizures.
Driving and activities requiring
continuous alertness should be
avoided
j. Stress importance of compliance
with dietary restrictions,
medications. Foods high in iron and
low in potassium include liver, pork,
veal, beef, mustard and turnip
greens, peas, eggs, broccoli, kale,
blackberries, strawberries, apple
juice, watermelon, oatmeal, and
enriched bread