Nursing2024 Drug Handbook

How to use Nursing2024 Drug Handbook ® vii

within this section indicates the need for a special dosage adjustment for certain patients, such as older adults or those with renal or hepatic impairment. In some cases, a dosage adjustment may apply to all patient populations for all of the indications listed; this is marked accordingly. Administration Here, readers will find guidelines for safely administering drugs by all applicable routes, including PO, IV, IM, subcut, ophthalmic, in- halational, topical, rectal, vaginal, transdermal, and buccal. A special screened background highlights IV administration guidelines (includ- ing specific instructions on how to reconstitute, mix, and store IVmedications) and the major potential IV incompatibilities. Action This section succinctly describes the mechanism of action–that is, how the drug provides its therapeutic effect. For example, although all antihypertensives lower BP, they don’t all do so by the same process. Also included, in table form, are the onset, peak (described in terms of effect or peak blood level), and duration of drug action for each route of administration, if data are available or applicable. Values listed are for patients with normal kidney function unless otherwise specified. The drug’s half-life is also provided when known. Adverse reactions In this section, adverse reactions that are known to occur at a frequency of 1% or greater are list- ed according to body system. Life-threatening reactions appear in bold italic type. Interactions Within this section, readers can find each drug’s confirmed, clinically significant interac- tions (additive effects, potentiated effects, and antagonistic effects) with other drugs, herbs, foods, beverages, and lifestyle behaviors (such as alcohol use, sun exposure, or smoking). Interactions with a rapid onset are highlighted in color; interactions with a delayed onset are in bold type. Drug interactions are listed under the drug that’s adversely affected. For example, because magnesium trisilicate, an antacid ingredient, interacts with tetracycline to decrease tetracy- cline’s absorption, this interaction is listed under tetracycline. To check on the possible effects of

potential interactions and adverse effects, implement necessary care measures, and pro- vide appropriate patient teaching. Entries are arranged alphabetically, with the generic drug name prominently displayed–along with its “tall man” lettering (if applicable), pronuncia- tion, corresponding brand (or trade) names, therapeutic class, and pharmacologic class–on a shaded background for quick and easy iden- tification. Banners or symbols to identify drugs that warrant a special safety alert, designate biosimilar drugs, or indicate drugs that appear in the color photoguide are also included in this highlighted area. Specific information for each drug is then systematically organized under the headings below. Special icons and logos may be used throughout, as warranted, to point out the drug’s safety concerns. For example, a clinical alert logo ( t ) provides important advice about life-threatening effects associated with the drug or its administration; a boxed warning ( BoxedWarning ) represents a specific warning issued by the FDA. A special icon ( ) indicates oral drug forms that shouldn’t be crushed or chewed. (See Anatomy of a monograph , on the inside book cover, for a visual guide to the various symbols that may appear within a drug entry.) Available forms This section lists the preparations available for each drug (for example, tablets, capsules, solutions for injection) and specifies available dosage forms and strengths. Dosage strengths specifically available in Canada are designated with a maple leaf ( ). Preparations that may be obtained over the counter, without a pre- scription, are marked with an open diamond (◊). Liquid formulations that contain alcohol are indicated with an asterisk (*). Capsules or tablets that shouldn’t be crushed are marked with a “Do Not Crush” symbol ( ). Indications & dosages General dosage information for adults and children is found in this section. Dosage instruc- tions reflect current trends in therapeutics and can’t be considered absolute or universal. For individual patients, dosage instructions must be considered in light of the patient’s condition. Indications and dosages that aren’t approved by the FDA are followed by a closed diamond ( ♦ ). It should be noted that only highly evi- dence-based off-label uses are included in this edition. An Adjust-a-dose logo appearing