Week One- Medication Administration

GENERIC: Acetaminophen TRADE: Tylenol

INDICATION: Antipyretic: reduces fever by acting directly on the hypothalamic heat-regulating center;
Analgesic
SAFE DOSE (ADULT): PO: 325-650 mg every 4-6 hours or 1 gram 3-4 times daily or 1300 mg every 8 hrs.
(not to exceed 4grams/24hrs)
(PEDIATRICS): Weight-based dosing: 10-15 mg /kg/dose, dose frequency, and daily maximums are
also age and weight dependent
• Fixed dosing: 6-12 years: 325-650 mg PO q4-6hr; not to exceed 1.625 g/day for not more
than 5 days unless directed by healthcare provider
CONTRAINDICATIONS: Hepatic disease/renal disease; chronic alcohol use/abuse, malnutrition, previous
hypersensitivity; products containing alcohol, aspartame, saccharin, sugar, or tartrazine (FDC yellow dye #5)
should be avoided in pts who have hypersensitivity or intolerance to these compounds.
SIDE EFFECTS: Angioedema, Disorientation, Dizziness, Pruritic maculopapular rash, Rash,
Hyperammonemia, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Urticaria
Gastrointestinal hemorrhage, Laryngeal edema, Agranulocytosis, Leukopenia, Neutropenia, Pancytopenia
Thrombocytopenia, Thrombocytopenic purpura, Hepatotoxicity, Liver failure
Nephrotoxicity, Pneumonitis, Anaphylactoid

NURSING CONSIDERATIONS: Do not exceed the recommended dosage. Consult provider if need for
children <3 yrs.; if needed for longer than ten days; if continued fever, severe or recurrent pain occurs. Avoid
using multiple preparations containing acetaminophen. Carefully check ALL OTC products. Give with food if
GI upset, discontinue drug if a hypersensitivity reaction occurs.
Assessment: assess pain, temperature, renal and liver function
Administration: When calculating the maximum daily dose, consider all sources of acetaminophen, including
OTC, and routes of administration not to exceed the maximum recommended daily dosing

Labs/Diagnostic testing: liver enzymes if risk factors for impaired liver function. GFR if renal impairment.
Pt education: Do not exceed recommended dose; do not take as a preventive anti-inflammatory. Check ALL
OTC medications to make sure they do not also contain the medication to avoid overdosing.
ANTIDOTE: N-acetylcysteine should be available
OB CLASS: B
SAFETY WITH BREAST FEEDING: Drug is excreted in milk; in general, breastfeeding is generally
acceptable.

GENERIC: regular insulin (Sub Q) TRADE: Humulin R

INDICATION: Hyperglycemia
SAFE DOSE (ADULT): 0.2 unit/kg/day- 10 units/day
(PEDIATRICS): 0.2 unit/kg/day- 1.5 unit/kg/day
CONTRAINDICATIONS: Hypoglycemia
SIDE EFFECTS: Hypoglycemia, hypokalemia
NURSING CONSIDERATIONS: onset 30-60 minutes; peak 2-4 hours, duration 5-8 hours
Assessment: assess for hypoglycemia (shaky & sweaty) time of insulin peak
Assess for hyperglycemia (polyuria, polydipsia) at time of insulin duration
Administration: give just prior to a meal for adults and after a meal for children (if does is based on carb grams
consumed); alternate injection sites based on rotation schedule
Labs/Diagnostic testing: pre-administration glucose
Pt education: administration and sub-q administration information; monitor for signs of hypoglycemia (shaky,
sweaty)
ANTIDOTE: Glucagon, sweetened fruit juice, hard candy
OB CLASS: B
SAFETY WITH BREAST FEEDING: Transferred into milk, no adverse reactions reported for breastfed
infants, consider health benefits of breast feeding and therapy

GENERIC: NPH (Sub Q) TRADE: Humulin N

INDICATION: Hyperglycemia
SAFE DOSE (ADULT): 0.2 unit/kg/day- 10 units/day
(PEDIATRICS): 0.2 unit/kg/day- 1.5 unit/kg/day
CONTRAINDICATIONS: Hypoglycemia
SIDE EFFECTS: Hypoglycemia, hypokalemia
NURSING CONSIDERATIONS: onset 1-2 hours; peak 4-12 hours, duration 14-24 hours
Assessment: assess for hypoglycemia (shaky & sweaty) at time of insulin peak
Assess for hyperglycemia (polyuria, polydipsia) at time of insulin duration
Administration: give just prior to a meal for adults and after a meal for children (if does is based on carb grams
consumed); alternate injection sites based on rotation schedule
Labs/Diagnostic testing: pre-administration glucose
Pt education: administration and sub-q administration information; monitor for signs of hypoglycemia (shaky,
sweaty)
ANTIDOTE: Glucagon, sweetened fruit juice, hard candy
OB CLASS: B
SAFETY WITH BREAST FEEDING: Transferred into milk, no adverse reactions reported for breastfed
infants, consider health benefits of breast feeding and therapy
GENERIC: magnesium sulfate (OB use- IV) TRADE: MgSO4
INDICATION: Hypomagnesium, toxemia of pregnancy- prevention of seizures associated with pre-eclampsia,
and control of seizures with eclampsia, preterm labor
SAFE DOSE (OB): Loading dose: 4-6 g IV over 20 minutes; maintenance: 2-4 g/hr IV for 12-24 hours as
tolerated after contractions cease
CONTRAINDICATIONS: hypermagnesemia, more than 5-7 days for preterm labor, continuous use in active
labor, within 2 hrs. of delivery
SIDE EFFECTS: Circulatory collapse, Respiratory paralysis, Hypothermia, Pulmonary edema, Depressed
reflexes, Hypotension, Flushing, Drowsiness, Depressed cardiac function, Diaphoresis, Hypocalcemia,
Hypophosphatemia, Hyperkalemia, Visual changes
NURSING CONSIDERATIONS:
Assessment- Monitor mom BP, HR, RR, neuro status (LOC, strength, DTR) minimum every hour (every 15
minutes when starting x2) more often if changing status; external fetal monitoring continuous; I&O every hour;
assess newborn RR and BP if mom received magnesium prior to delivery
Administration- high alert medication; max loading dose 4gm
Labs/diagnostics- magnesium and calcium levels, renal function
Patient education: report shortness of breath or weakness, call nurse before getting out of bed
monitor BP, HR, RR, neurologic status including DTR, magnesium levels, renal function, baby’s BP and RR
ANTIDOTE: Calcium gluconate
OB CLASS: D
SAFETY WITH BREAST FEEDING: Safe

GENERIC: vancomycin (IV) TRADE:

INDICATION: C-diff, Staphylococcal enterocolitis, severe infections
SAFE DOSE (ADULT): 1-2g
(PEDIATRICS): 10-40 mg/kg/day
CONTRAINDICATIONS: Hypersensitivity
SIDE EFFECTS: phlebitis, bitter taste, rash on face and upper body (redmans syndrome); ototoxicity and
nephrotoxicity
NURSING CONSIDERATIONS:
Assessment: I&O, temperature, hearing
Administration: obtain culture prior to initiation; administer over minimum of one hour not to exceed
10mg/min; irritating to tissue- secure IV;
Lab/diagnostics: renal function; trough and peak with third dose
Patient education: report dizziness, hearing problems (such as ringing in the ears, hearing loss), easy
bruising/bleeding, signs of kidney problems (such as change in the amount of urine). Get medical help right
away if you notice any symptoms of a serious allergic reaction, including: fever that doesn't go away, new or
worsening lymph node swelling, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness,
trouble breathing
ANTIDOTE: Supportive care
OB CLASS: C
SAFETY WITH BREAST FEEDING: Excreted in human milk, use caution, decide to discontinue nursing or
drug
GENERIC: cefotaxime TRADE: Claforan
INDICATION: severe infection
SAFE DOSE (ADULT): 2-12g/day divided q4-12 hours not to exceed 2 g /dose
(PEDIATRICS): <12 years or <50 kg: 50-200 mg/kg/day IV/IM divided q6-8hr
>12 years or >50 kg: 1-2 g IV/IM q8hr
CONTRAINDICATIONS: hypersensitivity, history of colitis
SIDE EFFECTS: colitis, diarrhea, eosinophilia, nausea/vomiting, pruritis, neutropenia, cause C. Diff and/or
yeast infections
NURSING CONSIDERATIONS:
Assessment: injection site, I&O,
Administration: change sites to avoid inflammation
Lab/diagnostics: renal function
Patient education: report any swelling, redness, or pain at injection site; report easy bruising/bleeding, unusual
tiredness, uncontrollable movements, mental/mood changes (such as confusion), seizures, signs of kidney
problems (such as change in the amount of urine), signs of liver problems (such as nausea/vomiting that doesn't
stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine)
ANTIDOTE: Supportive care
OB CLASS: B
SAFETY WITH BREAST FEEDING: Excreted in human milk, use caution