NAME OF THE

DRUG

MECHANISM
OF ACTION

INDICATION

CONTRAINDICATI
ON

SIDE EFFECTS

NURSING
RESPONSIBILITI
ES

GENERIC NAME:
Cefoxitin sodium
BRAND NAME:

Bactericidal:

Inhibits
synthesis of
bacterial cell
wall, causing cell
death.

Mefoxin
CLASSIFICATIO
N:
Antibiotic
Cephalosporin
(second
generation)
DOSAGE:
Adults:
1-2 g/day IM or IV
once a day or in
equal divided
doses bid. Do not
exceed 4 g/day.
Gonorrhea:
Single 250
mg IM dose.
Meningitis:
1-2 g IM or
IV once a
day or in
equal
divided
doses bid
for 4-14
days.

Lower
respiratory
tract
infections,
including
pneumonia
and lung
abscess,
caused by
Streptococcus
pneumoniae,
other
streptococci
(excluding
enterococci,
e.g.,
Enterococcus
faecalis
[formerly
Streptococcus
faecalis]),
Staphylococcu
s aureus
(including
penicillinaseproducing
strains),
Escherichia
coli, Klebsiella
species,
Haemophilus
influenzae,
and
Bacteroides
species.
Urinary tract

Contraindicated
with allergy to
cephalosporins
or penicillins.
Use cautiously
with renal
failure,
lactation,
pregnancy.

CNS:
Headache,
dizziness,
lethargy,
paresthesias.
GI: Nausea,
vomiting,
diarrhea,
anorexia,
abdominal
pain,
flatulence,
pseudomembr
anous colitis,
hepatotoxicity.
GU:
Nephrotoxicity
Hematologic:
Bone marrow
depression
decreased
WBC count,
decrease
platelets, and
decrease Hct.
Hypersensitivit
y: Ranging
from rash to
fever to
anaphylaxis,
serum
sickness
reaction.
Local: Pain,
abscess at
injection site,

Assessment
History:
Hepatic and
renal
impairment,
lactation,
pregnancy.
Physical: Skin
status, LFTs,
renal function
test, culture of
affected area,
sensitivity
tests.
Interventions
Culture
infection site,
and arrange
for sensitivity
tests before
and during
therapy if
expected
response is not
seen.
Reconstitution
drug varies by
size of
package; see
manufacturer
s directions for
details.
Reconstitute
drug for IM use

Longer
therapy
may be
required.
Do not
exceed 4
g/day.
Perioperativ
e
prophylaxis:
Give 1 g of
IV 30 120
min before
surgery.

Pediatric Patients:
50- 75 mg/kg/day
IV or IM in divided
doses every 12
hr. Do not exceed
2 g/day.
Meningitis: 100
mg/kg/day IV or
IM in divided
doses every 12 hr
for 7- 14 days. Do
not exceed 4
g/day. Loading
dose of 100
mg/kg may be
used.

ROUTE:

infections
caused by
Escherichia
coli, Klebsiella
species,
Proteus
mirabilis,
Morganella
morganii,
Proteus
vulgaris and
Providencia
species
(including P.
rettgeri ).
Intraabdominal
infections,
including
peritonitis and
intraabdominal
abscess,
caused by
Escherichia
coli, Klebsiella
species,
Bacteroides
species
including
Bacteroides
fragilis, and
Clostridium
species.
Gynecological
infections,

phlebitis,
inflammation
at IV site.
Other:
Superinfection
s, disulfiramlike reaction
with alcohol.

with sterile
water or
bacteriostatic
water for
injection;
divide doses of
2 g and
administer at
two different
sites by deep
IM injection.
Discontinue if
hypersensitivit
y reaction
occurs.
Evaluate
patient for
Clostridium
difficile
infection if
diarrhea
occurs.

Teaching points
Avoid alcohol
while taking
this drug and
for 3 days
after because
severe
reactions often
occur.
You may
experience
these side

Parenteral (IM
and IV)

including
endometritis,
pelvic
cellulitis, and
pelvic
inflammatory
disease
caused by
Escherichia
coli, Neisseria
gonorrhoeae
(including
penicillinaseproducing
strains),
Bacteroides
species
including B.
fragilis,
Clostridium
species,
Peptococcus
niger,
Peptostreptoco
ccus species,
and
Streptococcus
agalactiae.
Cefoxitin for
Injection, USP,
like
cephalosporins
, has no
activity
against
Chlamydia
trachomatis.

effects:
stomach
upset,
diarrhea.
Report severe
diarrhea,
difficulty
breathing,
unusual
tiredness or
fatigue, pain at
injection site.

Therefore,
when Cefoxitin
for Injection,
USP is used in
the treatment
of patients
with pelvic
inflammatory
disease and C.
trachomatis is
one of the
suspected
pathogens,
appropriate
antichlamydial
coverage
should be
added.
Septicemia
caused by
Streptococcus
pneumoniae,
Staphylococcu
s aureus
(including
penicillinaseproducing
strains),
Escherichia
coli, Klebsiella
species, and
Bacteroides
species
including B.
fragilis.

Bone and joint

infections
caused by
Staphylococcu
s aureus
(including
penicillinaseproducing
strains).
Skin and skin
structure
infections
caused by
Staphylococcu
s aureus
(including
penicillinaseproducing
strains),
Staphylococcu
s epidermidis,
Streptococcus
pyogenes and
other
streptococci
(excluding
enterococci
e.g.,
Enterococcus
faecalis
[formerly
Streptococcus
faecalis]),
Escherichia
coli, Proteus
mirabilis,

Klebsiella
species,
Bacteroides
species
including B.
fragilis,
Clostridium
species,
Peptococcus
niger, and
Peptostreptoco
ccus species.

NAME OF THE
DRUG

MECHANISM
OF ACTION

INDICATION

CONTRAINDICATI
ON

SIDE EFFECTS

NURSING
RESPONSIBILITI
ES

GENERIC NAME:
Cefuroxime
BRAND NAME:
Ceftin, Kefurox,
Zinacef, Zinacef
ADD-Vantage,
Zinacef TwistVial
CLASSIFICATION:
Antibiotic
Cephalosporin
(second
generation)
DOSAGE:
Oral
Adults and
patients 12 yr and
older:
250 mg bid. For
severe infections,
may be increased
to 500 mg bid.
Treat for up to 10
days.
Uncomplicat
ed UTIs: 250
mg bid. Treat
for up to 10
days.
Uncomplicat

Bactericidal:
Inhibits
synthesis of
bacterial cell
wall, causing
cell death.

Oral (Cefuroxime

axetil)
Pharyngitis,
tonsillitis
caused by
Streptococus

pyogenes.
Otitis media
caused by
Streptococcus
pneumonia, S.
pyogenes,
Haemophilus
influenza,
Moraxella
catarrhalis
Acute bacterial
maxillary
sinusitis
caused by S.
pneumonia, H.
influenza
Lower
respiratory
infections
caused by S.
pneumonia,
Haemophilus
parainfluenzae
, H. influenza
UTIs caused by
Escherichia
coli, Klebstella
pneumoniae
Uncomplicated
gonorrhea

Contraindicated
with allergy to
cephalosporins
or penicillins.
Use cautiously
with renal
failure,
lactation,
pregnancy.

CNS:
Headache,
dizziness,
lethargy,
paresthesias.
GI: Nausea,
vomiting,
diarrhea,
anorexia,
abdominal
pain,
flatulence,
pseudomembr
anous colitis,
hepatotoxicity.
GU:
Nephrotoxicity
Hematologic:
Bone marrow
depression
decreased
WBC count,
decrease
platelets, and
decrease Hct.
Hypersensitivit
y: Ranging
from rash to
fever to
anaphylaxis,
serum
sickness
reaction.
Local: Pain,
abscess at
injection site,

Assessment
History:
Hepatic and
renal
impairment,
lactation,
pregnancy.
Physical: Skin
status, LFTs,
renal function
test, culture of
affected area,
sensitivity
tests.
Interventions
Culture
infection site,
and arrange
for sensitivity
tests before
and during
therapy if
expected
response is not
seen.
Give oral drug
with food to
decrease GI
upset and
enhance
absorption.
Give oral
tablets to
children who

ed
gonorrhea:
1000 mg
once as a
single dose.
Pediatric patients
younger than 12 yr
125 mg bid.
Acute otitis
media: 3 mo12 yr: 250
mg PO bid
for 10 days
in children
who can
swallow
tablets
whole. Or, 30
mg/kg/day
(maximum, 1
g/day) in two
divided
doses for 10
days (oral
solution).
Pharyngitis
or tonsillitis:
3 mo- 12 yr:
125 mg PO
every 12 hr
for 10 days
in children
who can
swallow
tablets

(urethral and
endocervical)
Skin an skin
structure
infections,
including
impetigo
caused by
Streptoccocus
aureus, S.
pyogenes
Treatment of
early Lyme
disease

Parenteral
(cefuroxime
sodium)
Lower
respiratory
infections
caused by S.
pneumonia, S.
aureus, E. coli,
Klebsiella
pneumoniae,
H. influenza, S.
pyogenes
Dermatologic
infections
caused by S.
aureus, S.
pyogenes, E
coli, K,
pneumonia,
Enterobacter

phlebitis,
inflammation
at IV site.
Other:
Superinfection
s, disulfiramlike reaction
with alcohol.

can swallow
tablets;
crushing the
drug results in
a bitter,
unpleasant
taste. Use
solution for
children who
cannot
swallow
tablets.
Have vitamin K
available in
case
hypoprothrom
binemia
occurs.
Discontinue if
hypersensitivit
y reaction
occurs.
Evaluate
patient for
Clostridium
difficile
infection if
diarrhea
occurs.

Teaching points
Oral drug
Take full
course of
therapy even if

whole. Or, 20
mg/kg/day
(maximum,
500 mg/day)
in two
divided
doses for 10
days (oral
solution).
Acute
sinusitis: 3
mo- 12 yr:
250 mg PO
bid for 10
days in
children who
can swallow
tablets
whole. Or, 30
mg/kg/day
(maximum, 1
g/day) in two
divided
doses for 10
days (oral
solution).
Impetigo: 3
mo- 12 yr:
250
mg/kg/day
PO
(maximum, 1
g/day) in two
divided
doses for 10
days (oral

UTIs caused by
E. coli, K.
pneumonia
Uncomplicated
and
disseminated
gonorrhea
caused by N.
gonorrhoeae
Septicimia
caused by S.
pneumonia, S.
aureus, E. coli,
K pneumonia,
H. influenza
Meningitis
caused by S.
pneumonia, S.
aureus, N.
meningitides
Bone and joint
infections due
to S. aureus
Perioperative
prophylaxis
Treatment of
acute bacterial
maxillary
sinusitis in
patients 3 mo12 yr

you are feeling

better.
This drug is
specific for this
infection and
should not be
used to selftreat other
problems.
Swallow
tablets whole;
do not crush
them. Take the
drug with food.
Store solution
in the
refrigerator.
Shake well
before each
use.
You may
experience
these side
effects:
Stomach upset
or diarrhea.
Report severe
diarrhea with
blood, pus or
mucus; rash
difficulty of
breathing;
unusual
tiredness,
fatigue;
unusual

suspension).
Parenteral
Adults
50 mg- 1.5 mg IM
or IV every 8 hr,
depending on
severity of
infection, for 5- 10
days.
Uncomplicat
ed
gonorrhea:
1.5 g IM (at
two different
sites) with 1
g of oral
probenecid.
Perioperative
prophylaxis:
1.5 g IV 3060 min prior
to initial
incision;
then 750 mg
IV or IM
every 8 hr
for 24 hr
after surgery.
Pediatric patients
older than 3 mo
50- 100 mg/kg/day
IM or IV in divided
doses every 6- 8
hr.

bleeding or
bruising;
unusual
itching or
irritation.
Parenteral drug
Avoid alcohol
while taking
this drug and
for 3 days
after because
severe
reactions often
occur.
You may
experience
these side
effects:
stomach
upset,
diarrhea.
Report severe
diarrhea,
difficulty
breathing,
unusual
tiredness or
fatigue, pain at
injection site.

Pediatric patients
with impaired renal
function
Adjust adult
dosage for renal
impairment by
weight or age of
child.
ROUTE:
Oral and
Parenteral (IM and
IV)

NAME OF THE
DRUG

MECHANISM
OF ACTION

INDICATION

CONTRAINDICATI
ON

SIDE EFFECTS

NURSING
RESPONSIBILITI
ES

GENERIC NAME:
Diazepam
BRAND NAME:
ApoDiazepam(CAN),
Diastat, AcuDial,
Diazemuls CAN),
Diazepam,
Intensol, Valium
CLASSIFICATION:
Antiepileptic
Anxiolytic
Benzodiazepine
Skeletal muscle
relaxant (centrally
acting)
DOSAGE:
Individual dosage;
increase dosage
cautiously to avoid
adverse effects.
Adults
Oral
Anxiety
disorders,
skeletal muscle

Exact
mechanis,s of
action not
understood;
acts mainly at
the limbic
system and
reticular
formation; may
act in spinal
cord and at
supraspinal
sites to
produce
skeletal muscle
relaxation;
potentiates the
efeectsof
GABA, an
inhibitory
neurotransmitt
er; anxiolytic
effects occur at
doses well
below these
necessary to
cause sedation,
ataxia; has
little effect on
cortical
function.

Managemen of
anxiety
disorders or
for short term
relief of
symptoms of
anxiety.
Acute alcohol
withdrawal:
may be useful
to
symptomatic
relief of acute
agitation,
tremor,
delirium
tremens,
hallucinosis.
Muscle
relaxant:
Adjunct for
relief of reflex
skeletal
muscle spasm
due to local
pathology or
secondary to
trauma:
spasticity
caused by
upper
motoneuron
disorders,
athetosis, stiff
man
syndrome.

Contraindicated
with
hypersensitivity
to
benzodiazepine
s; psychoses;
acute narrow
angle
glaucoma,
shock, coma,
acute alcohol
intoxication;
pregnancy;
lactation.
Use cautiously
with elderly or
debilitated
patients;
impaired liver
or renal
function; and in
patients with
history of
substance
abuse.

CNS: Transient
mild
drowsiness
initially
sedation,
depression,
lethargy,
apathy,
fatigue, lightheadedness,
confusion,
crying,
delirium,
headache,
slurred
speech,
dysarthria,
stupor,
rigidity,
tremor,
dystonia,
vertigo,
euphoria,
nervousness,
difficulty in
concentration,
vivid dreams,
psychomotor
retardation,
extrapyramida
l symptoms,
mild
paradoxical
excitatory
reactions
during first 2

Assessment
History:
Hypersensitivit
y to
benzodiazipine
s; psychoses,
acute narrowangle,
glaucoma,
shock, coma,
acute alcoholic
intoxication;
elderly or
debilitated
ptients;
impaired liver
or renal
function;
pregnancy,
lactation.
Physical:
Weight; skin
color, lesions;
orientation,
affect,
reflexes,
sensory nerve
function,
ophthalmologi
c examination;
P, BP; R,
adventitious
sounds; bowel
sounds,
normal output,
liver

spasm, seizure
disorders: 2- 10
mg PO bid- qid.
Alcohol
withdrawal: 0
mg PO tid- qid
first 24 hr,
reduce to 5 mg
tid- qid, as
needed.

Rectal
0.2 mg/kg; treat no
more than one
episode every 5
days. May give a
second dose in 412 hr.
Parenteral
Usual dose is 2- 20
mg IM or IV. Larger
doses may be
required for some
indications
(tetanus). Injection
may be repeated
in 1 hr.
Anxiety: 2- 10
mg IM or IV;
repeat in 3-4 hr
if necessary.
Alcohol
withdrawal: 10
mg IM or IV
initially, then 5-

Parenteral:
treatment of
tetanus
Antiepileptic:
Adjunct in
status
epilepticus
and severe
recurrent
convulsive
seizures
(parenteral);
adjunct in
seizure
disorders
(oral)
Preoperative
(parenteral):
relief of
anxiety and
tension and to
lessen recall in
patients rior to
surgical
procedure,
cardioversion,
and
endoscopic
procedure.
Rectal:
management
of slected,
refractory
patients with
epilepsy who
require

wk of
treatment,
visual and
auditory,
nystagmus,
depressed
hearing, nasal
congestion.
CV:
bradycardia,
tachycardia,
CV collapse,
hypertension
and
hypotension,
palpitations,
edema.
GI:
constipation,di
arrhea, dry
mouth,
salivation,
nausea,
anorexia,
vomiting,
difficulty in
swallowing,
gastric
disorders,
elevations of
blood
enzymes- LDH,
alkaline
phosphatase,
AST, ALT,
hepatic

evaluation;
normal output;
LFTs, renal
function tests,
CBC
Interventions
Change from
IV therapy to
oral therapy as
soon as
possible.
Do not use
small veins for
IV injection.
Reduce dose
of opioid
anlgesics with
IV diazepam;
dose should be
reduced by at
least one- third
or eliminated.
Carefully
monitor P, BP,
respiration
during IV
administration.
Monitor EEG in
patients
treated for
status
epilepticus;
seizures may
recur after

10 mg in 3-4 hr
if necessary.
Endoscopic
procedures: 10
mg or less, up
to 20 mg IV just
before
procedure or 510 mg IM 30
min prior to
procedure.
Reduce or omit
dosage of
opioids.
Muscle spasm:
5- 10 mg IM or
IV initially then
5- 10 mg in 3-4
hr if necessary.
Status
epilepticus: 510 mg ,
preferably by
slow IV. May
repeat every 510 min up to
total dose of 30
mg. if
necessary,
repeat therapy
in 2-4 hr; other
drugs are
preferable for
long- term
control.
Preoperative:

intermittent
use to control
bouts of
increased
seizure activity
Unlabeled use:
Treatment of
night terrors.

impairment,
jaundice.
GU:
incontinence,
urinary
retention,
changes in
libido,
menstrual
irregularities.
Hematologic:
decrease Hct,
blood
dyscrasias.
Other:
Phlebitis and
thrombus at IV
injection sites,
hiccups, fever,
diaphoresis,
paresthesias,
muscular
distirbances,
gyne
comastia,
pain, burninh
and redness
after IM
injection.

initial control,
presumably
because of
short durations
of drug effect.
Monitor liver
and and renal
function, CBC
during longterm therapy.

Teaching points:
Take this drug
exactly as
prescribed. Do
not stop taking
this rug
without
consulting
your health
care provider.
Caregiver
should learn to
assess
seizures,
administer
rectal form,
and monitor
patient.
It is advisable
to wear a
medical alert
ID indicating
your diagnosis
and treatment.

10 mg IM.
Cardioversion:
5- 15 mg IV 510 min before
procedure.

Pediatric Patients
Oral
Older than 6 mos:
1-2.5 mg PO tidqid initially.
Gradually increase
as needed and
tolerated. Can be
given rectally if
needed.
Rectal
Younger than 2 yr:
Not recommended.
2-5 yr: 0.5 mg/kg
6- 11 yr: 0.3 mg/kg
Older than 12 yr:
0.2 mg/kg; may
give a second dose
in 4-12 hr.
Parenteral
Maximum dose of
0.25 mg/kg IV
administration
over 3 min; may
repeat after 15- 30
min. if no relief of
symptoms after
three doses,

Report severe
dizziness,
weakness,
drowsiness
that persists,
rash or skin
lesions,
palpitations,
swelling of the
ankles, visual
or hearing
disturbances,
difficulty
voiding.

adjunctive therapy
is recommended.
Tetanus (older
than 1 mo): 1-2
mg IM or IV
slowly every 3-4
hr as necessary.
Tetanus (5 yr
and older): 510 mg IV every
3-4 hr.
Status
epilepticus
(older than 1
mo- younger
than 5 yr): 0.20.5 mg slowly
IV every 2-5
min up to a
maximum of 5
mg.
Status
epilepticus: (5
yr and older): 1
mg IV every 2-5
min up to a
maximum of 10
mg; repeat in 24 hr if
necessary.
Geriatric patients
or patients with
debilitating
disease
2- 2.5 mg PO daily-

bid or 2-5 mg
parenteral initially;
reduce rectal dose.
Gradually increase
as needed and
tolerated; use
cautiously.
ROUTE:
Oral, recta and
parenteral (IM and
IV)

NAME OF THE
DRUG

MECHANISM
OF ACTION

INDICATION

CONTRAINDICATI
ON

SIDE EFFECTS

NURSING
RESPONSIBILITI
ES

GENERIC NAME:
Diclofenac
BRAND NAME:
Cambia, Cataflam,
Voltaren-XR,
Zipsor, Zorvolex,
Voltaren

Inhibits
prostaglandin
synthetase to
cause
antipyretic and
antiinflammatory
effects; the
exact
mechanism is
unknown.

CLASSIFICATION:
Analgesic
(nonopioid)
Anti- inflammatory
Antipyretic
NSAID

DOSAGE:

Adults
Oral
Pain including
dysmenorrhea:
50 mg tid PO;
initial dose of
200 mg may
help some
patients
(Cataflam)
Osteoarthritis:
100- 150
mg/day PO in
divided doses;
50 mg bid tid

Acute or long

term
treatment of
mild to
moderate
pain, including
dysmenorrhea.
Rheumatoid

arthritis
Acute
treatment of
migraine
headache with
or without
aura.
Osteoarthritis
Ankylosing
spondylitis
Treatment of
actibic
keratosis on
conjunction
with sun
avoidance
(topical only)
Topical
treatment of
acute pain due
to minor
strains,
sprains,
contusions
(Flector)
Treatment of
mild to
moderate

Contraindicated
with allergy to
NSAIDs,
significant renal
impairment,
pregnancy,
lactation.
Use cautiously
with impaired
hearing,
allergies,
hapatic, CV, GI
conditions, and
in elderly
patients.

CNS:
Headache,
dizziness,
somnolence,
insomnia,
fatigue,
tiredness,
tinnitus,
ophthalmic
effects.
Dermatologic:
Rash, pruritus,
sweating, dry
mucous
membranes,
stomatitis.
GI: Nausea,
dyspepsia, GI
pain, diarrhea,
vomiting,
constipation,
flatulence, GI
bleed
GU: Dysuria,
renal
impairment.
Hematologic:
Bleeding,
platelet
inhibition with
higher doses.
Other:
Peripheral
edema,
anaphylactoid
reactions to

Assessment
History: Renal
impairment;
impaired
hearing;
allergies;
hepatic, CV
and GI
conditions;
lactation,
pregnancy.
Physical: Skin
color and
lesions,
orientation,
reflexes,
ophthalmologi
c and
audiometric
evaluation,
peripheral
sensation; P,
BP; edema; R,
adventitious
breath sounds;
liver
evaluation;
CBC, clotting
times, renal
function tests,
LFTs; serum
electrolytes,
stool guaiac.
Interventions

PO (Cataflam).
Rheumatoid
arthritis: 150200 mg/day PO
in divided
doses; 50 mg
bid/tid PO
(Cataflam).
Ankylosing
spondylitis:
100- 125
mg/day PO.
Gives as 25 mg
qid, with an
extra 25 mg
dose at
bedtime; 25 mg
qid PO with an
additional 25
mg at bedtime
if needed.
Acute migraine:
50 mg packet
mixed on 30- 60
ml water as
single dose at
onset of
headache.
Treatment of
mild to
moderate pain:
25 mg liquidfilled capsule
PO qid (Zipsor)
or 18 or 35 mg
PO

acute pain in
adults.
Ophthalmic:
Post operative
inflammation
from cataract
extraction.

fatal
anaphylactic
shock.

Administer
drug with food
or after meals
if GI upset
occurs. Ensure
that patient
does not cut,
crush, or chew
ER or DR
tablets. Mix
packets for
oral
suspension in
30- 60 ml
water.
Ensure that
the correct
topical gel is
being used for
indication
being treated;
gels are not
interchangeabl
e.
Arrange for
periodic
ophthalmologi
c examination
during long
term therapy.
Monitor renal
function in
order patients.

Teaching points:

tid(Zorvolex).
Neither are
interchangeable
with other
forms of
diclofenac.
Topical
Actinic
keratosis: Cover
lesion with gel
and smooth into
skin; do not
cover with
dressings or
cosmetics.
Osteoarthritis:
Upper
extremities,
apply gel (2g)
to affected area
qid; lower
extremities,
apply gel (4g)
to affected area
qid (Voltaren).
Transdermal patch
1 patch applied to
most painful area
bid. Use lowest
effective dose for
shortest time; do
not apply to
damaged or

Take drug with

food or meals
if GI upset
occurs. Do not
cut, crush or
chew delayed
release or
extendedrelease
tablets.
Apply topical
gel as
indicated,
avoid sun
exposure and
sun lamps.
Apply
transdermal
patch to intact
skin. Remove
old patch
before
applying new
one.
Mix packets for
oral solution in
30 to 60 ml
water. Take at
first sign of
migraine.
Take only the
prescribed
dosage.
Report sore
throat, fever,
rash, itching,

broken skin
(Flector).
Ophthalmic
1 drop to affected
eye qid starting 24
after surgery for 2
wk.
ROUTE:
Oral, topical and
ophthalmic

weight gain,
swelling in
ankles or
fingers,
changes in
vision; black,
tarry stools.

NAME OF THE
DRUG

MECHANISM
OF ACTION

INDICATION

CONTRAINDICATI
ON

SIDE EFFECTS

NURSING
RESPONSIBILITI
ES

GENERIC NAME:
Digoxin
BRAND NAME:
Lanoxin, Lanoxin
pediatric
CLASSIFICATION:
Cardiac glycoside
DOSAGE:
Patient response is
quite variable.
Evaluate patient
carefully to
determine the
appropriate dose.
Adults
Loading dose, 0.25
mg/day IV or PO
for patients
younger than 70 yr
with good renal
function; 0.125
mg/day for
patients older than
70 yr or with
impaired renal
function; or 0.0625
mg/day for
patients with
marked renal

Increases
intracellular
calcium and
allows more
calcium to
enter
myocardial cell
during
depolarization
via a sodiumpotassium
pump
mechanism;
this increases
force of
contraction,
increases renal
perfusion,
decreases
heart rate, and
decreases AV
node
conduction
velocity.

Treatment of
mild to
moderate
heart failure.
Control of
ventricular
response rate
in patients
with chronic
atrial
fibrillation.

Contraindicated
with allergy to
cardiac
glycosides,
ventricular
tachycardia,
ventricular
fibrillation,
heart block, sick
sinus syndrome,
IHSS, acute MI,

renal
insufficiency
and electrolyte
abnormalities.
Use cautiously
with pregnancy
and lactation.

CNS:
Headache,
weakness,
drowsiness,
visual
disturbances,
mental status
change.
CV:
Arrhythmias
GI: GI upset,
anorexia.

Assessment
History: allergy
to cardiac
glycosides,
ventricular
tachycardia,
ventricular
fibrillation,
heart block,
sick sinus
syndrome,
IHSS, acute MI,
renal
insufficiency.
Physical:
Weight
orientation,
affect,
reflexes,
vision; P;BP;
baseline ecg,
cardiac
auscultation
bowel sounds,
renal function
tests.
Interventions
Check dosage
and
preparation
carefully.
Avoid IM
injections,
which may be

impairment.
Maintenance dose,
0.125- 0.5 mg/day
PO.
Pediatric patients
Maintenance dose,
25%- 35% of
loading dose in
divided daily
doses. Usually
0.125- 0.5 mg/day
PO; 20%- 30% for
premature infants.
ROUTE:
Oral and
parenteral (IV)

very painful
Follow diluting
instructions
carefully and
use diluted
solution
properly.
Avoid giving
with meals,
taking this
drug with food
will delay
absorption and
alter drug
pharmacokinet
ics.
Have
emergency
equipment
ready.

Teaching points:
Do mot stop
taking this
drug without
notifying your
healthcare
provider.
Take pulse at
the same time
each day and
record it in a
calendar.
Weigh yourself
every other

day with the

same clothing
and at the
same time.
Record.
Do not start
taking
prescriptions;
OTC products
or herbal
supplements
without talking
to your health
care provider.
Wear or carry
a medical alert
bag tag stating
that you are
on this drug.
Have regular
medical check
up, which may
include blood
tests, to
evaluate the
effects and
dosage of the
drug.