Table Of ContentCommon abbreviations
The abbreviations below are commonly used by nurses.Not all ofthem,however,
are acceptable.Those in red marked with a Clinical Alert logo 2were identified
as contributing to medication errors in the National Patient Safety Goals ofthe
Joint Commission and by the Institute for Safe Medication Practices.To avoid mis-
takes and to ensure Joint Commission compliancy,spell out the entire term.
2@ at cm centimeter
ABG arterial blood gas CMV cytomegalovirus
a.c. before meals CNS central nervous system
ACE angiotensin-converting COPD chronic obstructive
enzyme pulmonary disease
ACLS advanced cardiac life CR controlled release
support CV cardiovascular
ACTH adrenocorticotropic CVA cerebrovascular accident
hormone CYP cytochrome
2AD right ear DW dextrose 5% in water
5
ADH antidiuretic hormone DIC disseminated intravascular
ADLs activities ofdaily living coagulation
AICD automatic implantable 2D/C discharge,discontinue
cardiac defibrillator dl deciliter
AIDS acquired immunodeficiency DNA deoxyribonucleic acid
syndrome ECG electrocardiogram
ALP alkaline phosphatase EEG electroencephalogram
ALT alanine aminotransferase EENT eyes,ears,nose,and throat
APTT activated partial thrombo- F Fahrenheit
plastin time FDA Food and Drug Adminis-
2AS left ear tration
AST aspartate aminotransferase g gram
2AU each ear G gauge
AV atrioventricular GABA gamma-aminobutyric acid
B beta GFR glomerular filtration rate
1 1
B beta GI gastrointestinal
2 2
BCLS basic cardiac life support GnRH gonadotropin-releasing
b.i.d. twice daily hormone
BSA body surface area gr grain
2B.T. bedtime gtt drops
BUN blood urea nitrogen G6PD glucose-6-phosphate
c- with dehydrogenase
C Celsius GU genitourinary
cAMP cyclic 3’,5’adenosine H histamine
1 1
monophosphate H histamine
2 2
CBC complete blood count HCL hydrochloride
2cc cubic centimeter HCT hematocrit
CI cardiac index HDL high-density lipoprotein
CK creatine kinase Hg mercury
2Clinical alert. Do not use.
Hgb hemoglobin 2O.D. right eye
HIT heparin-induced thrombo- 2OJ orange juice
cytopenia 2O.S. left eye
HIV human immunodeficiency OTC over the counter
virus 2O.U. each eye
HMG-CoA 3-hydroxy-3-methylglutaryl oz ounce
coenzyme A p.c. after meals
HR heart rate PCA patient-controlled
2h.s. at bedtime analgesia
2H.S. half-strength per through,by
2I.J. injection P.O. by mouth
I.M. intramuscular P.R. by rectum
2I.N. intranasal p.r.n. as needed
INR International Normalized PT prothrombin time
Ratio PTT partial thromboplastin
IPPB intermittent positive- time
pressure breathing PVC premature ventricular
2IU international unit contraction
I.V. intravenous q every
K potassium 2Q.D. every day
kg kilogram 2q.h.s. at bedtime
KVO keep vein open q.i.d. four times daily
L liter 2Q.O.D. every other day
LD lactate dehydrogenase RBC red blood cell
LDL low-density lipoprotein RDA recommended dietary
LMW low-molecular-weight allowance
m meter RNA ribonucleic acid
m2 square meters RSV respiratory syncytial virus
2μg microgram SA sinoatrial
MAO monoamine oxidase 2S.C. subcutaneous
mcg microgram SI International System of
MDI metered-dose inhaler Units
mEq milliequivalent SIADH syndrome ofinappropriate
mg milligram antidiuretic hormone
2MgSO magnesium sulfate secretion
4
ml milliliter S.L. sublingual
mm millimeter 2S.Q. subcutaneous
mm3 cubic millimeters SSRI selective serotonin reuptake
mm Hg millimeters ofmercury inhibitor
mmol millimole T triiodothyronine
3
2MS morphine sulfate T thyroxine
4
2MSO morphine sulfate TCA tricyclic antidepressant
4
Na sodium t.i.d. three times daily
NA not applicable 2T.I.W. three times a week
NaCl sodium chloride tRNA transfer ribonucleic acid
ng nanogram tsp teaspoon
NG nasogastric 2U unit
N.P.O. nothing by mouth USP United States Pharmacopeia
NSAID nonsteroidal anti-inflam- VMA vanillylmandelic acid
matory drug WBC white blood cell
2Clinical alert. Do not use.
McGraw-Hill
NURSE’S
DRUG
Handbook
Notice
Medicine is an ever-changing science.As new research and clinical experience
broaden our knowledge,changes in treatment and drug therapy are required.
The authors and the publisher ofthis work have checked with sources believed
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ever,in view ofthe possibility ofhuman error or changes in medical sciences,
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encouraged to confirm the information contained herein with other sources.
For example and in particular,readers are advised to check the product infor-
mation sheet included in the package ofeach drug they plan to administer to
be certain that the information contained in this work is accurate and that
changes have not been made in the recommended dose or in the contraindi-
cations for administration.This recommendation is ofparticular importance
in connection with new or infrequently used drugs.
McGraw-Hill
NURSE’S
DRUG
Handbook
S E V E N T H E D I T I O N
Patricia Dwyer Schull
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Contents
Common abbreviations Inside front cover
Foreword vii
About the author viii
Advisors ix
Contributors and reviewers x
Preface and user’s guide xii
Part 1
Drug monographs A to Z 3
Safe drug administration (between pages 106 and 107)
Drug compatibilities S-2
Conversions and calculations S-6
Medication Reconciliation S-7
Guidelines for timely administration
ofscheduled drugs S-8
Drug names that look or sound alike S-11
Identifying injection sites S-14
Tall Man letters S-16
Tablets and capsules notto crush S-17
Monitoring blood levels S-20
Effects ofdialysis on drug therapy S-22
Anaphylaxis:Treatment guidelines S-25
Adult cardiac arrest:Treatment guidelines S-26
Pediatric cardiac arrest:Treatment guidelines S-27
Acute coronary syndrome:Treatment guidelines S-28
Preventing and treating extravasation S-30
Guidelines for handling,preparing,and
administering hazardous drugs S-31
Managing poisonings and overdoses S-34
Part 2
Drug classes 1331
Vitamins and minerals 1379
Herbs and supplements 1390
v
vi Contents
Part 3
Appendices
Appendix A.Common anesthetic drugs 1406
Appendix B.Common combination drug products 1418
Appendix C.Adult immunization schedule by age group 1423
Appendix D.Childhood immunization schedule
by age group 1424
Appendix E.Adolescent immunization schedule
by age group 1425
Appendix F.Normal laboratory values for blood tests 1426
Appendix G.Drug infusion rates 1429
Appendix H.Identifying life-threatening adverse reactions 1434
Appendix I.Potentially inappropriate drugs
for elderly patients 1441
Appendix J.Hazardous drugs 1445
Appendix K.Drugs that prolong the QT interval 1447
Appendix L.Most commonly used drugs in
nursing specialties 1449
Appendix M.Top 200 most commonly prescribed drugs 1451
Appendix N.Current drug shortages 1454
Selected references 1456
Index 1459
Foreword
E
rrors can and do occur at all phases ofthe medication delivery process,but more than
60% ofthem occur during drug administration,which is primarily the responsibility of
nurses.That means nurses are the last line ofdefense against patient harm,and have a
real opportunity to make medication delivery significantly safer.
To prevent errors,nurses must follow current and sanctioned safety guidelines,including
the five rights ofmedication administration.But today nurses are doing more than that.
They are spearheading efforts to prevent errors by improving the medication manage-
ment process,using safety practices associated with fewer medication errors.These safety
practices include questioning a patient’s medication orders,clarifying unclear orders,rec-
onciling patient medications from admission to discharge,and avoiding interruptions
during administration.
Despite the implementation ofthese error-reduction strategies,protecting patients from
medication errors continues to be a formidable task and a daily challenge.Nurses must
stay on guard,especially as high-risk drugs appear on the market and are often pre-
scribed for the sickest patients.And many newly approved drugs are being marketed
directly to consumers.
To meet these challenges and protect patients,nurses need to use their skills and their
smarts,and they need a clear nursing drug guide that focuses on patient safety from
cover to cover.Since the first edition,the McGraw-Hill Nurse’s Drug Handbookhas
done just that.
This handbook promotes safety by providing detailed administration guidelines and
vital information for each drug,including adverse reactions,patient monitoring with a
special emphasis on elderly and pediatric patients,patient education,clinical alerts,and
Food and Drug Administration Boxed Warnings.Plus,the hallmark ofthe handbook,
the special section called “Safe Drug Administration”(now 36 pages),is packed with
invaluable information,such as drug compatibilities,drug names that look or sound
alike,Tall Man letters,conversions and calculations,and much more.
In this seventh edition,the “Safe Drug Administration”section has a new feature,Guide-
lines for Timely Medication Administration,which addresses the most common violation
ofthe five rights,the wrong time.This new feature provides the most current and authori-
tative guidelines for definingthe right time for drug administration based on the nature of
each prescribed drug and the relevant patient and clinical considerations.Because national
regulations now require medication reconciliation to reduce errors and ensure patients
understand their medications at discharge,the “Safe Drug Administration”section now
also includes an updated algorithm on the steps nurses can take to reconcile patient med-
ications.
Called the safest drug handbook for nurses by its users,this guide will help you meet the
ongoing challenge ofavoiding medication errors in today’s complex clinical environ-
ment.With its emphasis on safe,effective drug administration in both the A-to-Z drug
monographs and the full-color “Safe Drug Administration”section,the McGraw-Hill
Nurse’s Drug Handbookstands alone in the crowded,look alike,sound alike world of
drug guides for nurses.
Peggy Kalowes,RN,PhD,CNS,FAHA
Director,Nursing Research and Evidence Based Practice
Long Beach Memorial and Miller Children’s Hospital
Long Beach,CA
vii
