Opioid (Narcotics)

Morphine

Maximizing therapeutic effects: assess pain thoroughly before and during therapy and titrate the dose until the desired pain-relieving effect is achieved.

Cardiac Glycosides

Digoxin

Maximizing therapeutic effects: achieve rapid onset of therapeutic effects with a loading dose “digitalization”

Minimizing adverse effects: monitor serum digoxin levels, assess for bradycardia (take apical pulse for 1 minute before giving drug), monitor and correct electrolyte imbalances, and assess for non-cardiac signs of digoxin toxicity.

Nitrates

Maximizing therapeutic effects: Keep tablets out of sunlight (keep in dark bottle), keep moisture out, keep away from heat.  Give tablet every 5 minutes-up to 3 in 15 minutes.

Minimizing adverse effects: Keep patient lying down during an attack

Life Span alert: heparin is the anticoagulant that can be used during pregnancy

Maximizing therapeutic effects: monitor APTT for therapeutic range, adjust until therapeutic range achieved

Life Span alert: Warfarin is not for use in pregnancy because it causes fetal defects.

Maximizing therapeutic effects: Monitor PT for therapeutic range: adjust dosage until therapeutic range is attained, interacts with many medications and foods with Vitamin K, monitor therapeutic levels if on other medications and variations of vitamin K intake.

Minimizing adverse effects: monitor for signs of bleeding

Lipid lowering medications

Statin drugs

Life Span alert: pregnancy category X.

Maximizing therapeutic effects:  education on the importance of taking medication as prescribed

Minimizing adverse effects: monitor lever enzyme levels for at least first year of therapy

Mucolytics

Minimizing adverse effects:

keep suctioning equipment close by

Bronchodilators - Albuterol

Maximizing therapeutic effects:  ensure correct use of inhalation device

Minimizing adverse effects:  do not use more than prescribed

Anti-inflammatory agents-inhaled glucocorticoids

(AeroBid)

Maximizing therapeutic effects: take the medication daily, despite the absence of symptoms

Minimizing adverse effects:  use a spacer device

Hydrochlorothiazide HTCZ- Thiazide Diuretics

Minimizing adverse effects:

monitor blood pressure, weight, intake and output, and serum electrolyte levels during therapy with this drug.

Loop diuretics -

Furosemide (lasix)

Life Span alert: Older adults are more sensitive to effects of rapid fluid loss.

Minimizing adverse effects: Administer IV push slowly, and monitor blood pressure, edema, breath sounds, weight, intake and output, and serum electrolyte levels while therapy continues.

Potassium Sparring Diuretics

Aldactone

Life span alert:

older adults are especially at risk for hyperkalemia

Magnesium Hydroxide

Milk of Magnesia

Maximizing therapeutic effects:

follow administration with a glass of water

Histamine 2 - receptor antagonists

Maximizing therapeutic effects:

give at least 2 hours apart from antacids

Thyroid Medications

Maximizing therapeutic effects: monitor drug response carefully at the start of therapy; administer oral drug as a single daily dose before breakfast.

Minimizing adverse effects: monitor cardiac response, as increased basal metabolic rate may exacerbate angina pectoris.

Regular Insulin

Minimizing adverse effects: use the same type and brand of syringe to avoid dosage errors; rotate injection sites to prevent tissue damage; have second nurse check dose; read labels carefully.

Glucose elavating Agents

Maximizing therapeutic effects: Provide supplemental carbohydrates as soon as possible after drug injection to restore lever glycogen and prevent secondary hypoglycemia.

Minimizing adverse effects:  teach the patient and family members preparation and administration techniques for glucagons before an emergency arises.

Glucocorticoids

Maximizing therapeutic effects:

administer prednisone according to established schedule (preferably one that follows the normal diurnal pattern of cortisol secretion-given in the morning); increase the dosage in times of stress to prevent drug-induced adrenal insufficiency.

Benzodiazepines

Minimizing adverse effects:

assess for suicidal tendencies, however usually low risk for abuse

SSRI -- Zoloft

Maximizing therapeutic effects: encourage patient to continue medicine, even though immediate response does not occur, and continue medication well after an improvement is experienced.

Phenytoin  - Dilantin

Maximizing therapeutic effects:  monitor for therapeutic blood level

Minimizing adverse effects: change dose in slow increments, monitor blood levels often, if IV-given slow

PCN

Maximizing therapeutic effects: oral preparations should be given on an empty stomach.  Culture and sensitivity tests are done before administration.

Minimizing adverse effects: monitor intake and output because it may be the first sign of kidney dysfunction.  Blood levels may become toxic if the kidneys cannot excrete penicillin.

Vancomycin

Life span alert:  Elderly patients may need concentration monitoring because of a higher risk of toxicity and drug accumulation secondary to age-related decreases in renal function.

Maximizing therapeutic effects:  obtain culture and sensitivity tests are done before administration

Minimizing adverse effects: administer over 60 minutes

Aminoglycosides - Gentamicin

Maximizing therapeutic effects: administer at least 2 hours before or after extended infusions of penicillins

Minimizing adverse effects: monitor peak and trough levels throughout therapy.

Tetracyclines

Maximizing therapeutic effects: administer at evenly spaced intervals on an empty stomach.

Minimizing adverse effects:  give frequent small meals and increase mouth care when GI distress is present

Ciprofloxacin - Cipro

Maximizing therapeutic effects: complete the full course of antibiotic therapy.

Minimizing adverse effects: provide small, frequent meals for GI distress

Acyclovir

Maximizing therapeutic effects: administer the drug at regular intervals.

Minimizing adverse effects: ensure hydration to avoid nephrotoxicity