How to Use This Book

The Nurse’s Drug Handbook gives you what today’s nurses and nursing students need: accurate, concise, and reliable drug facts. This book emphasizes the vital information you need to know before, during, and after drug administration. The information is presented in an easy-to-understand language and organized alphabetically, so you can quickly find what you need.

What’s Special

In addition to the drug information you will find in each entry (see “Drug Entries” for details), the Nurse’s Drug Handbook boasts these special features:

The design makes it easy to find the most need-to-know drug information, such as indications, dosages, dosage adjustments, drug administration, contraindications, and warnings.
Introductory material reviews essential general information you need to know to administer drugs safely and effectively, including an overview of pharmacology and the principles of drug administration. In addition, the five steps of the nursing process are explained and related specifically to drug therapy.
Highly useful illustrations throughout the text help you visualize selected mechanisms of action by showing how drugs work at the cellular, tissue, and organ levels. In addition, the inside front cover features a table listing all the drugs whose mechanisms of action are illustrated, as well as other drugs with the same mechanisms of action.
No-nonsense writing style speaks in everyday language and uses the terms and abbreviations you typically encounter in your practice and your studies.
Up-to-date drug information includes the latest FDA-approved drugs marked with a special “NEW” icon to alert the reader of its recent approval, new and revised indications and dosages, latest drug administration instructions, updated contraindications, new drug interactions, newly reported adverse reactions, latest childbearing considerations, and changes in the nursing considerations and patient teachings to reflect new information.
Dosage adjustment, headlined in color, alerts you to expected dosage changes for a patient with a specific condition or disorder, such as advanced age or renal impairment or concurrent drug therapy that may require an increase or decrease in dosage because of a potential interaction.
Adverse drug reactions that are life-threatening are bolded and in color for quick identification.
Warning, displayed in color, calls attention to important facts that you need to know before, during, and after drug administration. For example, in the beclomethasone entry, this feature informs you that when gradually switching patient from oral corticosteroid to inhaled beclomethasone, you should watch for signs of life-threatening adrenal insufficiency, such as fatigue, hypotension, lassitude, nausea, vomiting, and weakness during the transition period and when exposed to infection, surgery, trauma, or other stressors.
Easy-to-use tables showing route, onset, peak, duration, and half-life of the drug (see page xi for more details), and other tables in the appendices provide a time-saving way to track and check information. Many of the appendices will give you an overview of the most important facts for important drug groups, including insulin preparations, interferons, pediatric immunizations and vitamins, as well as selected allergen oral extracts, antihistamines, antihypertensive combinations, combination antivirals, obstetrical drugs, ophthalmics, and topical drugs. You’ll also find that several appendices provide handy instructions for calculating drug dosages and I.V. flow rates, common weights and measures used in drug administration, and syringe–drug compatibility. In addition, two of the appendices will help you gain an understanding of the FDA’s emergency authorization uses during times of a major health crisis as well as important guidelines to follow for safe opioid use.

Drug Entries

The Nurse’s Drug Handbook clearly and concisely presents all the vital facts on the drugs that you’ll typically administer. To help you find the information you need quickly, drug entries are organized alphabetically by generic drug name—from abacavir sulfate to zonisamide. For ease of use, every drug entry follows a consistent format.

GENERIC AND TRADE NAMES

First, each entry identifies the drug’s main generic name, in color, as well as alternate generic names. (For drugs prescribed by trade name, you can quickly check the comprehensive index, which refers you to the appropriate generic name and page.)

Next, the entry lists the most common U.S. trade names for each drug. It also includes common trade names available only in Canada, marked “(CAN).”

CLASS AND SCHEDULE

Each entry lists the drug’s pharmacologic and therapeutic classes. With this information, you can compare drugs in the same pharmacologic class but in different therapeutic classes, and vice versa.

Where appropriate, the entry also includes the drug’s controlled substance schedule. (For details, see Controlled substance schedules, page xi.)

INDICATIONS AND DOSAGES

This section lists FDA-approved therapeutic indications. For each indication, you’ll find the applicable drug form or route, age group (adults, adolescents, or children), and dosage, including amount per dose, timing, and duration when known and appropriate.

Drug Administration

This section provides you with what you need to know on how to safely administer the drug. The section clearly lists instructions for each route of administration that is possible and includes P.O., I.V., I.M., subcutaneous, inhaled, intranasal, topical, transdermal, or vaginal. The section under I.V. ends with a list of incompatibilities as indicated by the manufacturer.

ROUTE, ONSET, PEAK, DURATION, AND HALF-LIFE

Quick-reference tables show the drug’s onset, peak, and duration (when known) for each administration route. The onset of action is the time a drug takes to be absorbed, reach a therapeutic blood level, and elicit an initial therapeutic response. The peak therapeutic effect occurs when a drug reaches its highest blood concentration, and the greatest amount of drug reaches the site of action to produce the maximum therapeutic response. The duration of action is the amount of time the drug remains at a blood level that produces a therapeutic response. The drug’s half-life (when known) determines the time it takes for half of the drug to be eliminated from the body.

Controlled substance schedules
The Controlled Substances Act of 1970 mandated that certain prescription drugs be categorized in schedules based on their potential for abuse. The greater their potential for abuse, the greater the restrictions on their prescription. The controlled substance schedules range from I to V, signifying highest to lowest abuse potential. I High potential for abuse No accepted medical use exists for schedule I drugs, which include heroin and lysergic acid diethylamide (LSD). II High potential for abuse Use may lead to severe physical or psychological dependence. Examples include amphetamine, dextroamphetamine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone. No renewals are permitted. III Some potential for abuse Use may lead to low-to-moderate physical dependence or high psychological dependence. Examples include buprenorphine and opioid analgesics that contain no more than 90 mg of codeine per dosage unit. Up to five renewals are permitted within 6 months. IV Low potential for abuse Use may lead to limited physical or psychological dependence. Examples include alprazolam, clonazepam, clorazepate, diazepam, lorazepam, midazolam, temazepam, tramadol, and trizolam. Up to five renewals are allowed within 6 months. V Subject to state and local regulation Abuse potential is low. Examples include antidiarrheal drugs that contain atropine diphenosylate, ezogabine and pregabalin or cough medicines with less than 200 mg codeine/100 ml. Partial refills cannot occur more than 6 months after the issue date. When a partial fill occurs, it’s treated in the same manner and with the same rules as a refill of the drug.

Controlled substance schedules

The Controlled Substances Act of 1970 mandated that certain prescription drugs be categorized in schedules based on their potential for abuse. The greater their potential for abuse, the greater the restrictions on their prescription. The controlled substance schedules range from I to V, signifying highest to lowest abuse potential.

I High potential for abuse

No accepted medical use exists for schedule I drugs, which include heroin and lysergic acid diethylamide (LSD).

II High potential for abuse

Use may lead to severe physical or psychological dependence. Examples include amphetamine, dextroamphetamine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, and oxymorphone. No renewals are permitted.

III Some potential for abuse

Use may lead to low-to-moderate physical dependence or high psychological dependence. Examples include buprenorphine and opioid analgesics that contain no more than 90 mg of codeine per dosage unit. Up to five renewals are permitted within 6 months.

IV Low potential for abuse

Use may lead to limited physical or psychological dependence. Examples include alprazolam, clonazepam, clorazepate, diazepam, lorazepam, midazolam, temazepam, tramadol, and trizolam. Up to five renewals are allowed within 6 months.

V Subject to state and local regulation

Abuse potential is low. Examples include antidiarrheal drugs that contain atropine diphenosylate, ezogabine and pregabalin or cough medicines with less than 200 mg codeine/100 ml. Partial refills cannot occur more than 6 months after the issue date. When a partial fill occurs, it’s treated in the same manner and with the same rules as a refill of the drug.

Every prescription for a controlled substance must include issue date; name and address of the patient; name, address, and DEA registration number of practitioner; drug name; strength of drug; dosage form; quantity prescribed; directions for use; refills (if authorized); and manual signature of the prescriber. Some states, such as New York, mandate the prescription for a controlled substance (schedules II–V) must be issued electronically to the pharmacy.

MECHANISM OF ACTION

This section concisely describes how a drug achieves its therapeutic effects at cellular, tissue, and organ levels, when known. Illustrations of selected mechanisms of action lend exceptional clarity to sometimes complex processes.

CONTRAINDICATIONS

An alphabetical list details the conditions and disorders that preclude administration of the drug.

INTERACTIONS

This section includes drugs, foods, and activities (such as alcohol use and smoking) that can cause important, problematic, or life-threatening interactions with the topic drug. For each interacting drug, food, or activity, you’ll learn the effects of the interaction.

ADVERSE REACTIONS

Organized by body system, this section lists common, serious, and life-threatening adverse reactions. Life-threatening adverse reactions are bolded and in color for easy identification.

CHILDBEARING CONSIDERATIONS

All FDA-approved prescription drugs can no longer use the lettering system to categorize drugs based on their potential to cause fetal harm such as A, B, C, D, or X. Instead, a more comprehensive text is now required in the packaging label to explain the risks. Labeling of over-the-counter drugs will remain unchanged and is not affected by the FDA-mandated change.

The Childbearing Consideration section provides information using the new guidelines. This section is subdivided into four categories, with the first three categories consisting of pregnancy risks, labor and delivery risks, and lactation risks, if present, to the fetus or newborn and the fourth category indicating any reproductive risks the drug may pose.

NURSING CONSIDERATIONS

Warnings, general precautions, and key information that you must know before, during, and after drug administration are detailed in this section. Examples include cautions certain populations require and types of monitoring needed.

Patient-teaching information is also included here. You’ll find important guidelines for patients, such as how and when to take each prescribed drug, how to spot and manage adverse reactions, which cautions to observe, when to call the prescriber, and more. To save your time, however, this section doesn’t repeat basic patient-teaching points. (For a summary of those, see Federal guidelines for drug disposal, page xii, and Teaching your patient about drug therapy, page xiii.)

In short, the Nurse’s Drug Handbook is designed expressly to give you more of what you need. It puts vital drug information at your fingertips and helps you always stay current in this critical part of your practice or studies.

Teaching your patient about drug therapy
Your teaching about drug therapy will vary with your patient’s needs and your practice setting. To guide your teaching, each drug entry provides key information that you must teach your patient about that drug. For all patients, however, you also should: Teach the generic and trade name for each prescribed drug that they’ll take after discharge—even if they took the drug before admission. Clearly explain why each drug was prescribed, how it works, and what it’s supposed to do. To help your patient understand the drug’s therapeutic effects, relate its action to their disorder or condition. Review the drug form, dosage, and route with the patient. Tell them whether the drug is an aerosol, tablet, spray, suppository, or other form, and explain how to take it correctly. Also, tell them how often to take the drug and for what length of time, if known. Emphasize that they should take the drug exactly as prescribed. Describe the drug’s appearance and explain that scored tablets can be broken in half for safe, accurate dosing. Warn the patient not to break unscored tablets because doing so may alter the drug dosage. If your patient has trouble swallowing capsules, tell them to inquire if the capsule can be opened and sprinkled on food or mixed in a beverage; some can and some cannot. If the capsule should not be opened, have patient ask about being switched to a liquid form, if available. Also, warn them not to crush or chew enteric-coated, delayed-release (D.R.), extended-release (E.R.), sustained-release (S.R.), or similar drug forms. Teach the patient about common adverse reactions that may occur. Advise them to notify the prescriber at once if a dangerous adverse reaction, such as rash or syncope, occurs. Warn them not to suddenly stop taking a drug if they’re bothered by unpleasant adverse reactions, such as diarrhea or nausea. Instead, encourage them to discuss the reactions with their prescriber, who may adjust the dosage or substitute a drug that causes fewer adverse reactions. Tell patient that if a drug is known to cause adverse reactions (such as dizziness and drowsiness) that can impair the patient’s ability to perform activities that require alertness, help them develop a dosing schedule that minimizes these adverse reactions. Inform the patient as to which adverse reactions resolve with time. Teach the patient how to store the drug properly. Let them know if the drug is sensitive to light or temperature and how to protect it from these elements. Instruct the patient to store the drug in its original container, if possible, with the drug’s name and dosage clearly printed on the label. Inform the patient which devices to use—and which to avoid—for drug storage or administration. For example, warn them not to take liquid cyclosporine with a plastic cup or utensils. Teach the patient what to do if they miss a dose. Generally, they should take a once-daily drug as soon as they remember—provided it’s not close to the end of the 24 hours when the next dose is due. Warn them never to double the dose to make up for a missed dose. If they have questions or concerns about missed doses, tell them to contact their prescriber. Provide information specific to the prescribed drug. For example, if a patient takes a diuretic to manage heart failure, instruct them to weigh themselves daily at the same time of day, using the same scale, and wearing the same amount of clothing. Or, if the patient takes digoxin or an antihypertensive drug, teach them how to measure their pulse and blood pressure and how to record the measurements. Then, instruct them to bring the diary to their regular appointments so the prescriber can monitor their response to the drug. Advise the patient to refill prescriptions promptly unless they no longer are prescribed the drug. Also instruct them to discard expired drugs because they may become ineffective or even dangerous over time. For example, outdated tetracycline may cause life-threatening Fanconi’s syndrome. Warn the patient to always keep all drugs out of the reach of children.

Teaching your patient about drug therapy

Your teaching about drug therapy will vary with your patient’s needs and your practice setting. To guide your teaching, each drug entry provides key information that you must teach your patient about that drug. For all patients, however, you also should:

Teach the generic and trade name for each prescribed drug that they’ll take after discharge—even if they took the drug before admission.
Clearly explain why each drug was prescribed, how it works, and what it’s supposed to do. To help your patient understand the drug’s therapeutic effects, relate its action to their disorder or condition.
Review the drug form, dosage, and route with the patient. Tell them whether the drug is an aerosol, tablet, spray, suppository, or other form, and explain how to take it correctly. Also, tell them how often to take the drug and for what length of time, if known. Emphasize that they should take the drug exactly as prescribed.
Describe the drug’s appearance and explain that scored tablets can be broken in half for safe, accurate dosing. Warn the patient not to break unscored tablets because doing so may alter the drug dosage. If your patient has trouble swallowing capsules, tell them to inquire if the capsule can be opened and sprinkled on food or mixed in a beverage; some can and some cannot. If the capsule should not be opened, have patient ask about being switched to a liquid form, if available. Also, warn them not to crush or chew enteric-coated, delayed-release (D.R.), extended-release (E.R.), sustained-release (S.R.), or similar drug forms.
Teach the patient about common adverse reactions that may occur. Advise them to notify the prescriber at once if a dangerous adverse reaction, such as rash or syncope, occurs.
Warn them not to suddenly stop taking a drug if they’re bothered by unpleasant adverse reactions, such as diarrhea or nausea. Instead, encourage them to discuss the reactions with their prescriber, who may adjust the dosage or substitute a drug that causes fewer adverse reactions.
Tell patient that if a drug is known to cause adverse reactions (such as dizziness and drowsiness) that can impair the patient’s ability to perform activities that require alertness, help them develop a dosing schedule that minimizes these adverse reactions.
Inform the patient as to which adverse reactions resolve with time.
Teach the patient how to store the drug properly. Let them know if the drug is sensitive to light or temperature and how to protect it from these elements.
Instruct the patient to store the drug in its original container, if possible, with the drug’s name and dosage clearly printed on the label.
Inform the patient which devices to use—and which to avoid—for drug storage or administration. For example, warn them not to take liquid cyclosporine with a plastic cup or utensils.
Teach the patient what to do if they miss a dose. Generally, they should take a once-daily drug as soon as they remember—provided it’s not close to the end of the 24 hours when the next dose is due. Warn them never to double the dose to make up for a missed dose. If they have questions or concerns about missed doses, tell them to contact their prescriber.
Provide information specific to the prescribed drug. For example, if a patient takes a diuretic to manage heart failure, instruct them to weigh themselves daily at the same time of day, using the same scale, and wearing the same amount of clothing. Or, if the patient takes digoxin or an antihypertensive drug, teach them how to measure their pulse and blood pressure and how to record the measurements. Then, instruct them to bring the diary to their regular appointments so the prescriber can monitor their response to the drug.
Advise the patient to refill prescriptions promptly unless they no longer are prescribed the drug. Also instruct them to discard expired drugs because they may become ineffective or even dangerous over time. For example, outdated tetracycline may cause life-threatening Fanconi’s syndrome.
Warn the patient to always keep all drugs out of the reach of children.

Federal guidelines for drug disposal
Give patients these important instructions for properly disposing of their unwanted prescription drugs: Consider mixing discarded prescription drugs with a substance like coffee grounds or used cat litter and putting them in impermeable, nondescript containers, such as empty cans or sealable bags. Flush prescription drugs down the toilet only if the label or accompanying patient information specifically tells you to do so. See if your community has a pharmaceutical take-back program that allows citizens to bring unused drugs to a central location for proper disposal.

Federal guidelines for drug disposal

Give patients these important instructions for properly disposing of their unwanted prescription drugs:

Consider mixing discarded prescription drugs with a substance like coffee grounds or used cat litter and putting them in impermeable, nondescript containers, such as empty cans or sealable bags.
Flush prescription drugs down the toilet only if the label or accompanying patient information specifically tells you to do so.
See if your community has a pharmaceutical take-back program that allows citizens to bring unused drugs to a central location for proper disposal.

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Front Matter