Medications

Front 1

Ambien drug classification

Back 1

Sch IV controlled substance

Front 2

Ambien Generic Name

Back 2

Zolpidem Tartrate

Front 3

Ambien forms available

Back 3

5mg and 10mg strength tablets orally

Front 4

Ambien General use

Back 4

ST treatment of insomnia

Front 5

Ambien Interactions
Imipramine

Back 5

Imipramine in combination with Ambien produced no pharmacokinetic interaction other than a 20% decrease in peak levels of Imipramine, but there was an additive effect of decreased alertness

Front 6

Ambien Interactions
Chlorpormazine

Back 6

Chlorpormazine in combination with Ambien produced no pharamacokinetic interaction, but there was decreased alertness and psychomotor performance.

Front 7

Ambien Interactions
Alcohol

Back 7

An effect on coordination of sensory processes and movement (psychomotor performance) between alcohol and Ambien was demonstrated.

Front 8

Ambien Interactions
Fluoxetine

Back 8

When multiple doses of zolpidem and fluoxetine at steady-state concentrations were evaluated in healthy females, the only significant change was a 17% increase in the zolpidem half-life. There was no evidence of an additive effect in psychomotor performance.

Front 9

Ambien Interactions
Flumazenil

Back 9

Zolpidem’s sedative/hypnotic effect was reversed by flumazenil; however, no significant alterations in zolpidem pharmacokinetics were found

Front 10

Ambien Interactions
CNS-active drugs

Back 10

Any drug with CNS-depressant effects could potentially enhance the CNS-depressant effects of zolpidem.

Front 11

Ambien nursing consideration 1

Back 11

Because persons with a history of addiction to, or abuse of, drugs or alcohol are at increased risk of habituation and dependence, they should be under careful surveillance when receiving zolpidem or any other hypnotic.

Front 12

Ambien nursing consideration 2

Back 12

Because some of the important adverse effects of Ambien appear to be dose related, it is important to use the smallest possible effective dose, especially in the elderly.

Front 13

Ambien nursing consideration 3

Back 13

Precautions should be observed if Ambien is prescribed to patients with compromised respiratory function, since sedative/hypnotics have the capacity to depress respiratory drive.

Front 14

Ambien nursing consideration 4

Back 14

Ambien should be used with caution in patients with sleep apnea syndrome or myasthenia gravis.

Front 15

Ambien nursing consideration 5

Back 15

Safety and effectiveness of zolpidem have not been established in pediatric patients.

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Ambien nursing consideration 7

Back 16

Ambien should be administered with caution to patients exhibiting signs or symptoms of depression. The least amount of drug that is feasible should be prescribed for the patient at any one time.

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Ambien nursing consideration 8

Back 17

Caution is advisable in using Ambien in patients with diseases or conditions that could affect metabolusm or hemodynamic reponses.

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Ambien nursing consideration 9

Back 18

Any drug with CNS-depressant effects could potentially enhance the CNS-depressant effects of Ambien.

Front 19

Ambien Family/Patient Teaching

Back 19

Ambien belongs to a group of medicines known as “sedatives" or "hypnotics." You should not use these medicines for long periods without talking with your doctor about the risks and benefits of prolonged use.

Front 20

Ambien Family/Patient Teaching

Back 20

Side Effects:
drowsiness
dizziness
lightheadedness
difficulty with coordination

Front 21

Ambien Family/Patient Teaching

Back 21

When you first start taking Ambien or any other sleep medicine until you know whether the medicine will still have some carryover effect in you the next day, use extreme care while doing anything that requires complete alertness, such as driving a car, operating machinery, or piloting an aircraft.

Front 22

Ambien Family/Patient Teaching

Back 22

NEVER drink alcohol while you are being treated with Ambien or any sleep medicine. Alcohol can increase the side effects of Ambien or any other sleep medicine.

Front 23

Ambien Family/Patient Teaching

Back 23

Do not take any other medicines without asking your doctor first. This includes medicines you can buy without a prescription. Some medicines can cause drowsiness and are best avoided while taking Ambien.

Front 24

Ambien Family/Patient Teaching

Back 24

Always take the exact dose of Ambien prescribed by your doctor. Never change your dose without talking to your doctor first.

Front 25

Ambien Family/Patient Teaching

Back 25

Never use Ambien or any other sleep medicine for longer than directed by your doctor.

Front 26

Ambien Family/Patient Teaching

Back 26

If you develop an allergic reaction such as a rash, hives, shortness of breath, or swelling of your tongue or throat when using Ambien or any other sleep medicine, discontinue Ambien or other sleep medicine immediately and contact your doctor.

Front 27

Ambien Family/Patient Teaching

Back 27

If you notice any unusual and/or disturbing thoughts or behavior during treatment with Ambien or any other sleep medicine, contact your doctor.

Front 28

Ambien Family/Patient Teaching

Back 28

Tell your doctor about any medicines you may be taking, including medicines you may buy without a prescription. You should also tell your doctor if you drink alcohol. DO NOT use alcohol while taking Ambien or any other sleep medicine.

Front 29

Ambien Family/Patient Teaching

Back 29

Do not take Ambien unless you are able to get a full night’s sleep before you must be active again. For example, Ambien should not be taken on an overnight airplane flight of less than 7 to 8 hours since ”traveler’s amnesia“ may occur.

Front 30

Ambien Family/Patient Teaching

Back 30

Do not increase the prescribed dose of Ambien or any other sleep medicine unless instructed by your doctor.

Front 31

Ambien Patient/Family Teaching

Back 31

Be aware that you may have more sleeping problems the first night or two after stopping Ambien or any other sleep medicine.

Front 32

Ambien Patient/Family Teaching

Back 32

Be sure to tell your doctor if you are pregnant, if you are planning to become pregnant, or if you become pregnant while taking Ambien.

Front 33

Ambien Patient/Family Teaching

Back 33

As with all prescription medicines, never share Ambien or any other sleep medicine with anyone else. Always store Ambien or any other sleep medicine in the original container out of reach of children.

Front 34

Ambien Patient/Family Teaching

Back 34

Ambien works very quickly. You should only take Ambien right before going to bed and are ready to go to sleep.

Front 35

Demerol Classification

Back 35

Narcotic Analgesic
Demerol is a Schedule II controlled substance with an abuse liability similar to morphine.

Front 36

Demerol Generic name

Back 36

Meperidine hydrochloride

Front 37

Demerol Forms available

Back 37

Injectable (intramuscularly or subcutaneously), or oral (syrup, tablet)

Front 38

Demerol General Use

Back 38

For the relief of moderate to severe pain

Parenteral form only for preoperative medication, obstetrical analgesia, and support of anesthesia

Front 39

Demerol Contraindications

Back 39

Meperidine is contraindicated in patients who are receiving monoamine oxidase (MAO) inhibitors or those who have recently received such agents. Doses of meperidine given to treat disease have occasionally precipitated unpredictable, severe, and occasionally fatal reactions in patients who have received such agents within 14 days.
Meperidine and barbiturates are chemically incompatible.

Front 40

Demerol Interactions

Back 40

Demerol should be used with caution and consideration should be given to starting with a reduced dosage in patients who are concurrently receiving other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, other tranquilizers, and alcohol. Drug-drug interactions may result in respiratory depression, hypotension, profound sedation, or coma if these drugs are taken in combination with the usual doses of Demerol .
Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, butorphanol, and buprenorphine) should be administered with caution to a patient who has received or is receiving a course of therapy with a pure opioid agonist analgesic such as meperidine. In this situation, mixed agonist/antagonist analgesics may reduce the analgesic effect of medperidine and/or may precipitate withdrawal symptoms in these patients.

Front 41

Demerol Nursing Considerations

Back 41

If necessary, meperidine may be given intravenously, but the injection should be given very slowly, preferably in the form of a diluted solution. Rapid intravenous injection of narcotic analgesics, including meperidine, increases the incidence of adverse reactions; severe respiratory depression, apnea, hypotension, peripheral circulatory collapse, and cardiac arrest have occurred. Meperidine should not be administered intravenously unless a narcotic antagonist and the facilities for assisted or controlled respiration are immediately available. When meperidine is given parenterally, especially intravenously, the patient should be lying down.

Front 42

Demerol Nursing Considerations

Back 42

The respiratory depressant effects of meperidine and its capacity to elevate cerebrospinal fluid pressure may be increased in the presence of head injury, other intracranial lesions, or a preexisting increase in intracranial pressure. Furthermore, narcotics produce adverse reactions which may obscure the clinical course of patients with head injuries. In such patients, meperidine must be used with extreme caution and only if its use is deemed essential.

Front 43

Demerol Nursing Considerations

Back 43

Meperidine should be used with extreme caution in patients having an acute asthmatic attack, patients with chronic obstructive pulmonary disease or cor pulmonale, patients having a substantially decreased respiratory reserve, and patients with preexisting respiratory depression, hypoxia, or hypercapnia. In such patients, even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea.

Front 44

Demerol Nursing Considerations

Back 44

The administration of meperidine may result in severe hypotension in the postoperative patient or any individual whose ability to maintain blood pressure has been compromised by a depleted blood volume or the administration of drugs such as the phenothiazines or certain anesthetics.

Front 45

Demerol Nursing Considerations

Back 45

Meperidine may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. The patient should be cautioned accordingly.

Front 46

Demerol Nursing Considerations

Back 46

Meperidine, like other narcotics, may produce temporary blackouts in ambulatory patients when they suddenly stand up.

Front 47

Demerol Nursing Considerations

Back 47

Meperidine should not be used in pregnant women prior to the labor period, unless in the judgment of the physician the potential benefits outweigh the possible hazards.

Front 48

Demerol Nursing Considerations

Back 48

Meperidine crosses the placental barrier and can produce depression of respiration and psychophysiologic functions in the newborn.

Front 49

Demerol Nursing Considerations

Back 49

Meperidine appears in the milk of nursing mothers receiving the drug.

Front 50

Demerol Nursing Considerations

Back 50

Meperidine should be used with caution in patients with atrial flutter and other supraventricular tachycardias because of a possible vagolytic action which may produce a significant increase in the ventricular response rate.

Front 51

Demerol Nursing Considerations

Back 51

Meperidine may aggravate preexisting convulsions in patients with convulsive disorders.

Front 52

Demerol Nursing Considerations

Back 52

The administration of meperidine or other narcotics may obscure the diagnosis of clinical course in patients with acute abdominal conditions.

Front 53

Demerol Nursing Considerations

Back 53

If used regularly, this drug should not be abruptly discontinued or the patient may experience opiod withdrawal symptoms.

Front 54

Demerol Nursing Considerations

Back 54

Meperidine should be used with caution in patients with alcoholism and other drug dependencies due to the increased frequency of narcotic tolerance, dependence, and the risk of addiction observed in these patients. Abuse of meperidine in combination with other CNS depressant drugs can result in serious risk to the patient.

Front 55

Demerol Patient/Family Teaching

Back 55

Patients should be aware that Demerol tablets contain meperidine, which is a morphine-like substance.

Front 56

Demerol Patient/Family Teaching

Back 56

Patients should be advised to report pain and adverse experiences occurring during use of the drug.

Front 57

Demerol Patient/Family Teaching

Back 57

Patients should be advised that Demerol may impair mental and/or physical ability required for the performance of potentially hazardous tasks (driving, operating heavy machinery).

Front 58

Demerol Patient/Family Teaching

Back 58

Patients should not combine Demerol with alcohol or other CNS depressants (sleep aids, tranquilizers) except by the orders of the prescribing physician.

Front 59

Demerol Patient/Family Teaching

Back 59

Women who are pregnant or are planning to become pregnant should consult their physician regarding the effects of using this drug during pregnancy.

Front 60

Demerol Patient/Family Teaching

Back 60

Patients should be advised that Demerol is a highly addictive drug. It should never be given to anyone other than the individual for whom it was prescribed.

Front 61

Demerol Patient/Family Teaching

Back 61

Patients should be advised that Demerol use may need to be tapered off rather than discontinued due to the risk of withdrawal symptoms.

Front 62

Demerol Patient/Family Teaching

Back 62

This drug should be kept in a secure place out of the reach of children. When it is no longer needed, the unused tablets should be destroyed by flushing down a toilet.

Front 63

Flagyl Drug classification

Back 63

Flagyl is an antibacterial agent

Front 64

Flagyl generic name

Back 64

Metronidazole

Front 65

Flagyl forms

Back 65

tablets and injectable

Front 66

Flagyl General use

Back 66

Flagyl should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.

Front 67

Flagyl Contraindications

Back 67

Flagyl is contraindicated in patients with a prior history of hypersensitivity to metronidazole or other nitroimidazole derivatives.
In patients with trichomoniasis (an STD), Flagyl is contraindicated during the first trimester of pregnancy.

Front 68

Flagyl Interactions

Back 68

Alcoholic beverages should not be consumed during Flagyl therapy and for at least one day afterward because abdominal cramps, nausea, vomiting, headaches, and flushing may occur.

Front 69

Flagyl Interactions

Back 69

Psychotic reactions have been reported in alcoholic patients who are using metronidazole and disulfiram concurrently. Metronidazole should not be given to patients who have taken disulfiram within the last two weeks.

Front 70

Flagyl Interactions

Back 70

The simultaneous administration of drugs that decrease microsomal liver enzyme activity, such as cimetidine, may prolong the half-life and decrease plasma clearance of Flagyl.

Front 71

Flagyl Interactions

Back 71

In patients stabilized on relatively high doses of lithium, short-term Flagyl therapy has been associated with elevation of serum lithium, and in a few cases, signs of lithium toxicity.

Front 72

Flagyl Interactions

Back 72

Metronidazole has been reported to enhance the anticoagulant effect of oral coumarin anticoagulants, resulting in a prolongation of the time needed for blood clot formation. This possible drug interaction should be considered when Flagyl is prescribed for patients on this type of anticoagulant therapy.

Front 73

Flagyl Nursing Considerations

Back 73

Convulsive seizures and nerve malfunction, the latter characterized mainly by numbness or any abnormal sensation of an extremity, have been reported in patients treated with Flagyl. The appearance of abnormal neurologic signs demands the prompt discontinuation of Flagyl therapy. Flagyl should be administered with caution to patients with central nervous system diseases.

Front 74

Flagyl Nursing Considerations

Back 74

The dosage regimen should be individualized. Some patients may tolerate one treatment regimen (one-day treatment vs. seven-day course of treatment) better than the other.

Front 75

Flagyl Nursing Considerations

Back 75

The dose of Flagyl should not be specifically reduced in anuric patients since accumulated metabolites may be rapidly removed by dialysis.

Front 76

Flagyl Nursing Considerations

Back 76

Pregnant patients should not be treated during the first trimester. In pregnant patients in whom alternative treatment has been inadequate, the one-day course of therapy should not be used, as it results in higher serum levels which can reach the fetal circulation.

Front 77

Flagyl Nursing Considerations

Back 77

When repeat courses of the drug are required, it is recommended that an interval of four to six weeks elapse between courses and that the presence of the trichomonad be reconfirmed by appropriate laboratory measures. Total and differential leukocyte counts should be made before and after re-treatment

Front 78

Flagyl Nursing Considerations

Back 78

Patients with severe hepatic disease metabolize Flagyl slowly, with resultant accumulation of metronidazole and its metabolites in the plasma. Accordingly, for such patients, doses below those usually recommended should be administered cautiously. Close monitoring of plasma metronidazole levels and toxicity is recommended.

Front 79

Flagyl Nursing Considerations

Back 79

Metronidazole has shown evidence of cancerous activity and impairment of fertility in a number of studies involving oral administration in mice and rats.

Front 80

Flagyl Patient/Family Teaching

Back 80

Alcoholic beverages should be avoided while taking Flagyl and for at least one day afterward.

Front 81

Flagyl Patient/Family Teaching

Back 81

Patients should be counseled that antibacterial drugs including Flagyl should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold).

Front 82

Flagyl Patient/Family Teaching

Back 82

When Flagyl is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Flagyl or other antibacterial drugs in the future.

Front 83

Glucophage Drug Classification

Back 83

Oral Antihyperglycemic

Front 84

Glucophage Generic Name

Back 84

Metformin Hydrochloride

Front 85

Glucophage Forms Available

Back 85

Tablets and extended-release tablets(Glucophage® XR)

Front 86

Glucophage Gen use

Back 86

Used in the management of type 2 diabetes

Front 87

Glucophage Contraindications

Back 87

Renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels ≥ 1.5 mg/dL [males], ≥ 1.4 mg/dL [females] or abnormal creatinine clearance) which may also result from conditions such as shock, heart attack, and bodywide illness with toxicity due to invasion of the bloodstream by virulent bacteria coming from a local area of infection.

Front 88

Glucophage Contraindications

Back 88

Known hypersensitivity to metformin hydrochloride.

Front 89

Glucophage Contraindications

Back 89

Acute or chronic metabolic acid buildup in the body, including high blood glucose with ketones in the urine and blood (diabetic ketoacidosis), with or without coma. Diabetic increase of ketone bodies and acidity in the blood (ketoacidosis) should be treated with insulin.

Front 90

Glucophage Contraindications

Back 90

Intravascular contrast studies with iodinated materials can lead to acute alteration of renal (kidney) function and have been associated with lactic acidosis (an abnormal increase in the acidity of the body's fluids) in patients receiving metformin

Front 91

Glucophage contraindications

Back 91

Glucophage and Glucophage XR should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because use of such products may result in acute alteration of renal function.

Front 92

Glucophage Interactions
Furosemide

Back 92

Furosemide:
A single-dose, metformin-furosemide drug interaction study in healthy subjects demonstrated that pharmacokinetic parameters of both compounds were affected by coadministration.

Front 93

Glucophage Interactions
Nifedipine

Back 93

Nifedipine
A single-dose, metformin-nifedipine drug interaction study in normal healthy volunteers demonstrated that coadministration of nifedipine increased plasma metformin Cmax and AUC by 20% and 9%, respectively, and increased the amount excreted in the urine. Tmax and half-life were unaffected. Nifedipine appears to enhance the absorption of metformin. Metformin had minimal effects on nifedipine

Front 94

Glucophage Interactions
Cationic drugs

Back 94

that are eliminated by renal tubular secretion theoretically have the potential for interaction with metformin by competing for common renal tubular transport systems.

Front 95

Glucophage Interactions
Other

Back 95

Certain drugs tend to produce hyperglycemia (high blood sugar) and may lead to loss of glycemic control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. When such drugs are administered to a patient receiving Glucophage or Glucophage XR, the patient should be closely observed for loss of blood glucose control. When such drugs are withdrawn from a patient receiving Glucophage or Glucophage XR, the patient should be observed closely for hypoglycemia.

Front 96

Glucophage Interactions
High protein-bound drugs

Back 96

Metformin is negligibly bound to plasma proteins and is, therefore, less likely to interact with highly protein-bound drugs such as salicylates, sulfonamides, chloramphenicol, and probenecid, as compared to the sulfonylureas, which are extensively bound to serum proteins.

Front 97

Glucophage Nursing considerations

Back 97

Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation during treatment with Glucophage or Glucophage XR; when it occurs, it is fatal in approximately 50% of cases.

Front 98

Glucophage Nursing considerations

Back 98

Metformin is known to be substantially excreted by the kidney, and the risk of metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. Thus, patients with serum creatinine levels above the upper limit of normal for their age should not receive Glucophage or Glucophage XR. In patients with advanced age, Glucophage and Glucophage XR should be carefully titrated to establish the minimum dose for adequate glycemic effect, because aging is associated with reduced renal function. In elderly patients, particularly those ≥ 80 years of age, renal function should be monitored regularly and, generally, Glucophage and Glucophage XR should not be titrated to the maximum dose

Front 99

Glucophage Nursing considerations

Back 99

Before initiation of Glucophage or Glucophage XR therapy and at least annually thereafter, renal function should be assessed and verified as normal. In patients in whom development of renal dysfunction is anticipated, renal function should be assessed more frequently and Glucophage or Glucophage XR discontinued if evidence of renal impairment is present.

Front 100

Glucophage Nursing considerations

Back 100

Concomitant medication(s) that may affect renal function or result in significant hemodynamic change or may interfere with the disposition of metformin, such as cationic drugs that are eliminated by renal tubular secretion, and should be used with caution.

Front 101

Glucophage Nursing considerations

Back 101

Intravascular contrast studies with iodinated materials can lead to acute alteration of renal function and have been associated with lactic acidosis (see beginning of section) in patients receiving metformin (see Contraindications). Therefore, in patients in whom any such study is planned, Glucophage or Glucophage XR should be temporarily discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been re-evaluated and found to be normal.

Front 102

Glucophage Nursing considerations

Back 102

Shock, from whatever cause, acute congestive heart failure, heart attack and other conditions characterized by hypoxemia have been associated with lactic acidosis and may also cause a higher than normal blood level of urea or other nitrogen containing compounds in the blood. When such events occur in patients on Glucophage or Glucophage XR therapy, the drug should be promptly discontinued.

Front 103

Glucophage Nursing considerations

Back 103

Glucophage or Glucophage XR therapy should be temporarily suspended for any surgical procedure (except minor procedures not associated with restricted intake of food and fluids) and should not be restarted until the patient’s oral intake has resumed and renal function has been evaluated as normal.

Front 104

Glucophage Nursing considerations

Back 104

Patients should be warned against excessive alcohol intake, acute or chronic, while receiving Glucophage or Glucophage XR.

Front 105

Glucophage Nursing considerations

Back 105

Glucophage and Glucophage XR should generally be avoided in patients with clinical or laboratory evidence of hepatic disease.

Front 106

Gllucophage Nursing Considerations

Back 106

Measurement of hematologic parameters on an annual basis is advised in patients on Glucophage or Glucophage XR and any apparent abnormalities should be appropriately investigated and managed.

Front 107

Glucophage Patient/Family Teaching

Back 107

Patients should be informed of the potential risks and benefits of Glucophage or Glucophage XR and of alternative modes of therapy.

Front 108

Glucophage Patient/Family Teaching

Back 108

They should also be informed about the importance of adherence to dietary instructions, of a regular exercise program, and of regular testing of blood glucose, glycosylated hemoglobin, renal function, and hematologic parameters.

Front 109

Glucophage Patient/Family Teaching

Back 109

The risks of lactic acidosis, its symptoms, and conditions that predispose to its development should be explained to patients. Patients should be advised to discontinue Glucophage or Glucophage XR immediately and to promptly notify their health practitioner if unexplained overbreathing, muscle pain, vague feelings of discomfort, unusual sleepiness or other nonspecific symptoms occur. Once a patient is stabilized on any dose level of Glucophage or Glucophage XR, gastrointestinal symptoms in the stomach and/or large and small intestines, which are common during initiation of metformin therapy, are unlikely to be drug related. Later occurrence of gastrointestinal symptoms could be due to lactic acidosis or other serious disease.

Front 110

Glucophage Patient/Family Teaching

Back 110

Patients should be counselled against excessive alcohol intake, either acute or chronic, while receiving Glucophage or Glucophage XR.

Front 111

Glucophage Patient/Family Teaching

Back 111

Glucophage or Glucophage XR alone does not usually cause low blood sugar (hypoglycemia), although it may occur when Glucophage or Glucophage XR is used in conjunction with oral sulfonylureas and insulin. When initiating combination therapy, the risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members.

Front 112

Glucophage Patient/Family Teaching

Back 112

Patients should be informed that Glucophage XR must be swallowed whole and not crushed or chewed, and that the inactive ingredients may occasionally be eliminated in the feces as a soft mass that may resemble the original tablet.

Front 113

Insulin (R) Classification

Back 113

Antidiabetic agent

Front 114

Insulin (R) generic name

Back 114

Insulin (Human Recombinant)

Front 115

Insulin (R) Forms:

Back 115

All types of insulin must be injected because, if taken by mouth, insulin is destroyed in the stomach.

Front 116

Insulin (R) Gen use

Back 116

Insulin is prescribed for the treatment of type 1 and type 2 diabetes mellitus.

Front 117

Insulin (R) Contraindications

Back 117

Hypersensitivity to any component of the formulation

Front 118

Insulin (R) Interactions

Back 118

Interacts with other drugs that lower blood glucose such as oral hypoglycemics, salicylates like aspirin, sulfa antibiotics, and certain antidepressants.

Front 119

Insulin (R) Interactions

Back 119

Small amounts of alcohol taken with meals do not usually cause a problem; however, larger amounts of alcohol taken for a long time or in one sitting without food can increase the effect of insulin to lower the blood sugar level. This can keep the blood sugar low for a longer period of time than normal

Front 120

Insulin (R) Interactions

Back 120

Drugs which DECREASE hypoglycemic effect of insulin: Contraceptives (oral), corticosteroids, dextrothyroxine, diltiazem, dobutamine, epinephrine, niacin, smoking, thiazide diuretics, thyroid hormone

Front 121

Insulin (R) Interactions

Back 121

Drugs which INCREASE hypoglycemic effect of insulin: Alcohol, alpha-blockers, anabolic steroids, beta-blockers (see "Note" below, clofibrate, guanethidine, MAO inhibitors, pentamidine, phenylbutazone, salicylates, sulfinpyrazone, tetracyclines. Note: Nonselective beta-blockers may delay recovery from hypoglycemic episodes and mask signs/symptoms of hypoglycemia. Cardioselective agents may be alternatives.

Front 122

Insulin (R) Interactions

Back 122

Insulin increases the risk of hypoglycemia associated with oral hypoglycemic agents (including sulfonylureas, metformin, pioglitazone, rosiglitazone, and troglitazone

Front 123

Insulin (R) Interactions

Back 123

Herb/Nutraceutical: Use caution with chromium, garlic, gymnema (may increase hypoglycemia).

Front 124

Insulin (R) Interactions

Back 124

Ethanol: Caution with ethanol (may increase hypoglycemia).

Front 125

Insulin (R) Interactions

Back 125

Food: Insulin shifts potassium from extracellular to intracellular space. Decreases potassium serum concentration

Front 126

Insulin (R) Nursing Considerations

Back 126

The presence of other medical problems may affect the dose of insulin the patient needs.

Front 127

Insulin (R) Nursing Considerations

Back 127

Determine if patient has ever had any reactions to insulin, especially in the skin area where you injected the insulin, or patient is allergic to any other substances, such as foods, preservatives, or dyes.

Front 128

Insulin (R) Nursing Considerations

Back 128

Some older people may have vision problems or other medical problems that make it harder for them to measure and inject the medicine. Special training and equipment may be needed.

Front 129

Insulin (R) Nursing Considerations

Back 129

Children are especially sensitive to the effects of insulin before puberty (the time when sexual changes occur). Therefore, low blood sugar may be especially likely to occur.

Front 130

Insulin (R) Patient/Family Teaching

Back 130

Insulin is a hormone produced by the pancreas, a large gland that lies near the stomach. This hormone is necessary for the body's correct use of food, especially sugar. Diabetes occurs when the pancreas does not make enough insulin to meet your body's needs.

Front 131

Insulin (R) Patient/Family Teaching

Back 131

To control your diabetes, your doctor has prescribed injections of insulin to keep your blood glucose at a nearly normal level. Proper control of your diabetes, you can lead an active, healthy, and useful life if you eat a balanced diet daily, exercise regularly, and take your insulin injections as prescribed.

Front 132

Insulin (R) Patient/Family Teaching

Back 132

Test your blood and/or your urine regularly for glucose. If your blood tests consistently show above- or below-normal glucose levels or your urine tests consistently show the presence of glucose, your diabetes is not properly controlled and you must let your doctor know.

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Insulin (R) Patient/Family Teaching

Back 133

Always keep an extra supply of insulin as well as a spare syring and needle on hand. Always wear diabetic identification so that appropriate treatment can be given if complications occur away from home.

Front 134

Insulin (R) Patient/Family Teaching

Back 134

Humulin R can be identified as follows: Humulin R is a clear and colorless liquid with a water-like appearance and consistency. Do not use if it appears cloudy, thickened, or slightly colored or if solid particles are visible.

Front 135

Insulin (R) Patient/Family Teaching

Back 135

Doses of insulin are measured in units. U-100 insulin contains 100 units/ml (1 ml = 1 cc). With Insulin , it is important to use a syringe that is marked for U-100 insulin preparations. Failure to use the proper syringe can lead to a mistake in dosage, causing serious problems for you, such as a blood glucose level that is too low or too high.

Front 136

Insulin (R) Patient/Family Teaching

Back 136

Disposable syringes and needles should be used only once and then discarded. NEEDLES AND SYRINGES MUST NOT BE SHARED. Reusable syringes and needles must be sterilized before each injection.Follow the package directions supplied with your syringe

Front 137

Insulin (R) Patient/Family Teaching

Back 137

Preparing the Dose:
Wash your hands.
Inspect the insulin. It should look clear and colorless. Do not use if it appears cloudy, thickened, or slightly colored or if solid particles are visible.
If using a new bottle, flip off the plastic protective cap, but do not remove the stopper. When using a new bottle, wipe the top of the bottle with an alcohol swab.
If you are mixing insulins, refer to the instructions for mixing that follow.
Draw air into the syringe equal to your insulin dose. Put the needle through rubber top of the insulin bottle and inject the air into the bottle.
Turn the bottle and syringe upside down. Hold the bottle and syringe firmly in 1 hand and shake gently.
Making sure the tip of the needle is in the insulin, withdraw the correct dose of insulin into the syringe.
Before removing the needle from the bottle, check your syringe for air bubbles which reduce the amount of insulin in it. If bubbles are present, hold the syringe straight up and tap its side until the bubbles float to the top. Push them out with the plunger and withdraw the correct dose.
Remove the needle from the bottle and lay the syringe down so that the needle does not touch anything.

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Insulin (R) Patient/Family Teaching

Back 138

Injection
Cleanse the skin with alcohol where the injection is to be made. Stabilize the skin by spreading it or pinching up a large area. Insert the needle as instructed by your doctor. Push the plunger in as far as it will go. Pull the needle out and apply gentle pressure over the injection site for several seconds. Do not rub the area. To avoid tissue damage, give the next injection at a site at least 1/2" from the previous site.

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Insulin (R) Patient/Family Teaching

Back 139

Storage
Insulin should be stored in a refrigerator but not in the freezer. If refrigeration is not possible, the bottle of insulin that you are currently using can be kept unrefrigerated as long as it is kept cool as possible (below 86°F [30°]) and away from heat and light. Do not use insulin if it has been frozen. Do not use a bottle of insulin after the expiration date on the label.

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Insulin (R) Patient/Family Teaching

Back 140

Other medicines
Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.

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Insulin (R) Patient/Family Teaching

Back 141

Tobacco
If you have been smoking for a long time and suddenly stop, your dosage of insulin may need to be reduced. If you decide to quit, tell your doctor first.

Front 142

Insulin (R) Patient/Family Teaching

Back 142

Travel
During traveling, keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones, keep your meal times as close as possible to your usual meal times.

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Insulin (R) Patient/Family Teaching

Back 143

On sick days
When you become sick with a cold, fever, or the flu, you need to take your usual insulin dose, even if you feel too ill to eat. This is especially true if you have nausea, vomiting, or diarrhea. Infection usually increases your need for insulin. Call your doctor for specific instructions.
Continue taking your insulin and try to stay on your regular meal plan. However, if you have trouble eating solid food, drink fruit juices, nondiet soft drinks, or clear soups, or eat small amounts of bland foods. A dietitian or your doctor can give you a list of foods and the amounts to use for sick days.
Test your blood sugar level at least every 4 hours while you are awake and check your urine for ketones. If ketones are present, call your doctor at once. If you have severe or prolonged vomiting, check with your doctor. Even when you start feeling better, let your doctor know how you are doing

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Insulin (R) Patient/Family Teaching

Back 144

In case of emergency
Wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and lists all of your medicines.
Keep an extra supply of insulin and syringes with needles on hand in case high blood sugar occurs.
Keep some kind of quick-acting sugar handy to treat low blood sugar.
Have a glucagon kit available in case severe low blood sugar occurs. Check and replace any expired kits regularly.

Front 145

Zoloft Classification

Back 145

Antidepressant

Front 146

Zoloft generic name

Back 146

sertraline hydrochloride

Front 147

zoloft forms available

Back 147

Tablets and Oral Concentrate

Front 148

zoloft general use

Back 148

Zoloft (sertraline hydrochloride) is indicated for the treatment of major depressive disorder in adults.

Front 149

zoloft contraindications

Back 149

Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) is contraindicated.
Concomitant use in patients taking pimozide is contraindicated.
The concomitant use of Zoloft and alcohol is not recommended.
Zoloft oral concentrate is contraindicated with ANTABUSE (disulfiram) due to the alcohol content of the concentrate.
Zoloft is contraindicated in patients with a hypersensitivity to sertraline or any of the inactive ingredients in Zoloft.

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Zoloft interactions

Back 150

The administration of Zoloft (sertraline hydrochloride) to a patient taking another drug which is tightly bound to protein (e.g., warfarin, digitoxin) may cause a shift in plasma concentrations potentially resulting in an adverse effect. Conversely, adverse effects may result from displacement of protein bound Zoloft by other tightly bound drugs.

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Zoloft interactions

Back 151

Avoid drinking alcohol, which can increase some of the side effects of sertraline.

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Zoloft interactions

Back 152

Do not take the liquid form of sertraline if you are taking disulfiram (Antabuse). Liquid sertraline may contain alcohol and you could have a severe reaction to the disulfiram.

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Zoloft interactions

Back 153

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, other medication for depression or anxiety). They can add to sleepiness caused by sertraline.

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Zoloft interactions

Back 154

Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with sertraline may cause you to bruise or bleed easily.

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Zoloft interactions

Back 155

Before taking sertraline, tell your doctor if you are using any of the following medicines:
tramadol (Ultram, Ultram ER, Ultracet);
digitoxin (Crystodigin);
phenytoin (Dilantin), valproate (Depacon, Depakene);
lithium (Lithobid, Eskalith);
a blood thinner such as warfarin (Coumadin);
any other antidepressants such as amitriptyline (Elavil), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor), or paroxetine (Paxil);
almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or
heart rhythm medication such as flecainide (Tambocor), propafenone (Rhythmol), and others
vitamins, minerals, herbal products, and drugs prescribed by other doctors
If you are using any of these drugs, you may not be able to use sertraline, or you may need dosage adjustments or special tests during treatment.

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Zoloft Nursing Considerations

Back 156

Zoloft should not be used in combination with an MAOI, or within 14 days of discontinuing treatment with an MAOI. Similarly, at least 14 days should be allowed after stopping Zoloft before starting an MAOI.

Front 157

Zoloft Nursing Considerations

Back 157

Caution is advisable in using Zoloft in patients with diseases or conditions that could affect metabolism or hemodynamic responses.

Front 158

Zoloft Nursing Considerations

Back 158

At this time it is recommended that plasma lithium levels be monitored following initiation of Zoloft therapy with appropriate adjustments to the lithium dose.

Front 159

Zoloft Nursing Considerations

Back 159

At this time it is recommended that plasma phenytoin concentrations be monitored following initiation of Zoloft therapy with appropriate adjustments to the phenytoin dose, particularly in patients with multiple underlying medical conditions and/or those receiving multiple concomitant medications.

Front 160

Zoloft Nursing Considerations

Back 160

The risk of using Zoloft in combination with other CNS active drugs has not been systematically evaluated. Consequently, caution is advised if the concomitant administration of Zoloft and such drugs is required.

Front 161

Zoloft Nursing Considerations

Back 161

Of all the antidepressants, only fluoxetine (Prozac®) has been FDA approved to treat pediatric depression.

Front 162

Zoloft Patient/Family Teaching

Back 162

Antidepressants are used to treat depression and other illnesses. Depression and other illnesses can lead to suicide. Whenever an antidepressant is started or its dose is changed, pay close attention to the patient.

Front 163

Zoloft Patient/Family Teaching

Back 163

Never let your patient stop taking an antidepressant without first talking to his or her healthcare provider. Stopping an antidepressant suddenly can cause other symptoms.

Front 164

Zoloft Patient/Family Teaching

Back 164

Contact patient's healthcare provider right away if your he or she exhibits any of the following signs for the first time, or if they seem worse, or worry you:
Thoughts about suicide or dying
Attempts to commit suicide
New or worse depression
New or worse anxiety
Feeling very agitated or restless
Panic attacks
Difficulty sleeping
New or worse irritability
Acting agressively, being angry, or violent
Acting on dangerous impulses
An extreme increase in activity and talking
Other unusual changes in behavior or mood

Front 165

Lasix Drug Classification

Back 165

Diuretic

Front 166

Lasix Generic Name

Back 166

Furosemide

Front 167

Lasix Forms Avail

Back 167

tablets

Front 168

Lasix Gen use

Back 168

Lasix treats fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome. Lasix is also used to treat high blood pressure (hypertension).

Front 169

Lasix Contraindications

Back 169

LASIX is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide

Front 170

Lasix Interactions

Back 170

If you take sucralfate (Carafate), take it at least 2 hours before or after you take Lasix.

Front 171

Lasix Interactions

Back 171

LASIX may increase the ototoxic potential of aminoglycoside antibiotics, especially in the presence of impaired renal function. Except in life-threatening situations, avoid this combination. LASIX should not be used concomitantly with ethacrynic acid because of the possibility of ototoxicity. Patients receiving high doses of salicylates concomitantly with LASIX, as in rheumatic disease, may experience salicylate toxicity at lower doses because of competitive renal excretory sites.

Front 172

Lasix Interactions

Back 172

LASIX has a tendency to antagonize the skeletal muscle relaxing effect of tubocurarine and may potentiate the action of succinylcholine

Front 173

Lasix Interactions

Back 173

Lithium generally should not be given with diuretics because they reduce lithium’s renal clearance and add a high risk of lithium toxicity.

Front 174

Lasix Interactions

Back 174

LASIX may add to or potentiate the therapeutic effect of other antihypertensive drugs (drugs reducing high blood pressure). Potentiation occurs with ganglionic or peripheral adrenergic blocking drugs.

Front 175

Lasix Interactions

Back 175

LASIX may decrease arterial responsiveness to norepinephrine. However, norepinephrine may still be used effectively.

Front 176

Lasix Interactions

Back 176

The combination of furosemide and acetylsalicylic acid (aspirin) temporarily reduced creatinine clearance in patients with chronic renal insufficiency. There are case reports of patients who developed increased BUN, serum creatinine and serum potassium levels, and weight gain when furosemide was used in conjunction with NSAIDs (non-steroidal anti-inflammatory drugs).

Front 177

Lasix Interactions

Back 177

Literature reports indicate that coadministration of indomethacin may reduce the natriuretic and antihypertensive effects of LASIX (furosemide) in some patients by inhibiting progstaglandin synthesis. Indomethacin may also affect plasma renin levels, aldosterone excretion, and renin profile evaluation.

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Lasix Nursing Considerations

Back 178

In patients with hepatic cirrhosis and ascites, LASIX therapy is best initiated in the hospital. In hepatic coma and in states of electrolyte depletion, therapy should not be instituted until the basic condition is improved. Sudden alterations of fluid and electrolyte balance in patients with cirrhosis may precipitate hepatic coma; therefore, strict observation is necessary during the period of diuresis. Supplemental potassium chloride and, if required, an aldosterone antagonist are helpful in preventing hypokalemia (low blood potassium) and metabolic alkalosis (a dangerous decrease in the normal acidity of the blood). If increasing azotemia (a higher than normal blood level of urea or other nitrogen containing compounds in the blood) and oliguria (less urination than normal) occur during treatment of severe progressive renal disease, LASIX should be discontinued.

Front 179

Lasix Nursing Considerations

Back 179

Patients receiving both indomethacin and LASIX should be observed closely to determine if the desired diuretic and/or antihypertensive effect of LASIX is achieved.

Front 180

Lasix Nursing Considerations

Back 180

Reports indicate that LASIX ototoxicity is associated with rapid injection, severe renal impairment, doses exceeding several times the usual recommended dose, or concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs. If the physician elects to use high dose parenteral therapy, controlled intravenous infusion is advisable (for adults, an infusion rate not exceeding 4 mg LASIX per minute has been used).

Front 181

Lasix Patient/Family Teaching

Back 181

Patients receiving LASIX should be advised that they may experience symptoms from excessive fluid and/or electrolyte losses. The drop in blood pressure that sometimes occurs can usually be managed by getting up slowly. Potassium supplements and/or dietary measures may be needed to control or avoid hypokalemia.

Front 182

Lasix Patient/Family Teaching

Back 182

Patients with diabetes should be told that furosemide may increase blood glucose levels and thereby affect urine glucose tests. The skin of some patients may be more sensitive to the effects of sunlight while taking furosemide. Patients with abnormally high blood pressure patients should avoid medications that may increase blood pressure, including over-the-counter products for appetite suppression and cold symptoms.

Front 183

Phenergan Class

Back 183

Antihistamine

Front 184

Phenergan Generic Name

Back 184

Promethazine HCI

Front 185

Phenergan Forms

Back 185

Tablets and Suppositories

Front 186

Phenergan Gen use

Back 186

Antihistamines are the basic treatment of allergic illnesses.
In addition to its antihistaminic action, it provides clinically useful sedative and anti-nausea/vomiting effects.

Front 187

Phenergan Contraindications

Back 187

Phenergan tablets and suppositories are contraindicated for use in pediatric patients less than two years of age.

Front 188

Phenergan Contraindications

Back 188

Phenergan Tablets and Suppositories are contraindicated in comatose states, and in individuals known to be hypersensitive or to have had an idiosyncratic reaction to promethazine or to other phenothiazines.

Front 189

Phenergan Contraindications

Back 189

Antihistamines are contraindicated for use in the treatment of lower respiratory tract symptoms including asthma.

Front 190

Phenergan Interactions

Back 190

Phenergan Tablets and Suppositories may increase, prolong, or intensify the sedative action of other central-nervous-system depressants, such as alcohol, sedatives/hypnotics (including barbiturates), narcotics, narcotic analgesics, general anesthetics, tricyclic antidepressants, and tranquilizers; therefore, such agents should be avoided or administered in reduced dosage to patients receiving promethazine HCl.

Front 191

Phenergan Interactions

Back 191

Because of the potential for Phenergan to reverse epinephrine's vasopressor effect causing constriction of blood vessels, epinephrine should NOT be used to treat low blood pressure (hypotension) associated with Phenergan Tablets and Suppositories overdose.

Front 192

Phenergan Interactions

Back 192

Concomitant use of other agents with anticholinergic properties (inhibiting the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle such as that, for example, in the bladder) should be undertaken with caution.

Front 193

Phenergan Interactions

Back 193

Drug interactions, including an increased incidence of effects on or involving neural pathways situated independent of the pyramidal tracts (extrapyramidal) , have been reported when some MAOI and phenothiazines are used concurrently.

Front 194

Phenergan Interactions

Back 194

Diagnostic pregnancy tests based on immunological reactions between HCG (a human hormone made by chorionic cells in the fetal part of the placenta) and anti-HCG may result in false-negative or false-positive interpretations.

Front 195

Phenergan Interactions

Back 195

An increase in blood glucose has been reported in patients receiving promethazine HCl.

Front 196

Phenergan Nursing Considerations

Back 196

When given concomitantly with Phenergan Tablets and Suppositories, the dose of barbiturates should be reduced by at least one-half, and the dose of narcotics should be reduced by one-quarter to one-half. Dosage must be individualized. Excessive amounts of promethazine HCl relative to a narcotic may lead to restlessness and movement hyperactivity in the patient with pain; these symptoms usually disappear with adequate control of the pain.

Front 197

Phenergan Nursing Considerations

Back 197

Phenergan should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression.

Front 198

Phenergan Nursing Considerations

Back 198

Caution should be exercised when administering phenergan tablets and suppositories to pediatric patients two years of age and older because of the potential for fatal respiratory despression.

Front 199

Phenergan Nursing Considerations

Back 199

Phenergan Tablets and Suppositories may lower seizure threshold

Front 200

Phenergan Nursing Considerations

Back 200

Phenergan Tablets and Suppositories should be used with caution in patients with bone-marrow depression

Front 201

Phenergan Patient/Family Teaching

Back 201

Phenergan Tablets and Suppositories may cause marked drowsiness or impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as driving a vehicle or operating machinery. The use of alcohol or other central-nervous-system depressants such as sedatives/hypnotics (including barbiturates), narcotics, narcotic analgesics, general anesthetics, tricyclic antidepressants, and tranquilizers, may enhance impairment. Pediatric patients should be supervised to avoid potential harm in bike riding or in other hazardous activities.

Front 202

Phenergan Patient/Family Teaching

Back 202

Patients should be advised to report any involuntary muscle movements.

Front 203

Phenergan Patient/Family Teaching

Back 203

Avoid prolonged exposure to the sun.

Front 204

Cardizem Drug Classification

Back 204

Calcium Channel Blocker

Front 205

Cardizem Generic Name

Back 205

Diltiazem hydrochloride

Front 206

Cardizem Forms Avail

Back 206

Tablets and injectible, capsules, suspension, topical gel, PLO

Front 207

Cardizem Gen Use

Back 207

Calcium ion cellular influx inhibitor (slow channel blocker or calcium antagonist). It works by relaxing the muscles of your heart and blood vessels.

Front 208

Cardizem Contraindications

Back 208

Diltiazem is contraindicated in (1) patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker, (2) patients with second- or third-degree Atrioventricular Block (AV block) except in the presence of a functioning ventricular pacemaker, (3) patients with hypotension (less than 90 mm Hg systolic), (4) patients who have demonstrated hypersensitivity to the drug, and (5) patients with heart attack and lung congestion documented by x-ray on admission.

Front 209

Cardizem Interactions

Back 209

Due to the potential for additive effects, caution and careful dose adjustment (titration) are warranted in patients receiving diltiazem concomitantly with other agents known to affect cardiac contractility and/or conduction.

Front 210

Cardizem Interactions

Back 210

There may be additive effects in prolonging AV conduction when using beta-blockers or digitalis concurrently with diltiazem.

Front 211

Cardizem Interactions

Back 211

Controlled and uncontrolled domestic studies suggest that concurrent use of diltiazem and beta-blockers is usually well tolerated, but available data are not sufficient to predict the effects of concurrent treatment in patients with left ventricular dysfunction (an indicator of ventricular systolic function) or cardiac conduction abnormalities (the electrical conduction that controls the heart rate).

Front 212

Cardizem Interactions

Back 212

Patients currently receiving diltiazem therapy should be carefully monitored for a change in pharmacological effect when initiating and discontinuing therapy with cimetidine. An adjustment in the diltiazem dose may be warranted.

Front 213

Cardizem Interactions

Back 213

Since there have been conflicting results regarding the effect of digoxin levels, it is recommended that digoxin levels be monitored when initiating, adjusting, and discontinuing diltiazem therapy to avoid possible over- or under- dosage administration (digitalization).

Front 214

Cardizem Interactions

Back 214

The depression of cardiac contractility, conductivity, and automaticity as well as the vascular dilation associated with anesthetics may be enhanced by calcium channel channel blockers. When used concurrently, anesthetics and calcium blockers should be standardized/titrated carefully.

Front 215

Cardizem Interactions

Back 215

A pharmacokinetic interaction between diltiazem and cyclosporine has been observed during studies involving renal and cardiac transplant patients. If these agents are to be administered concurrently, cyclosporine concentrations should be monitored, especially when diltiazem therapy is initiated, adjusted, or discontinued.

Front 216

Cardizem Interactions

Back 216

Concurrent administration of diltiazem with carbamazepine has been reported to result in elevated serum levels of carbamazepine (40% to 72% increase), resulting in toxicity in some cases. Patients receiving these drugs concurrently should be monitored for a potential drug interaction.

Front 217

Cardizem Interactions

Back 217

Diltiazem plasma levels were not significantly affected by lovastatin or pravastatin.

Front 218

Cardizem Interactions

Back 218

Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels.

Front 219

Cardizem Potential nursing considerations

Back 219

Prolongs AV node (an electrical relay station between the atria (the upper) and the ventricles (the lower chambers of the heart)) refractory periods without significantly prolonging sinus node recovery time, except in patients with sick sinus syndrome. This effect may rarely result in abnormally slow heart rates.

Front 220

Cardizem Potential nursing considerations

Back 220

Worsening of congestive heart failure has been reported in patients with preexisting impairment of ventricular function.

Front 221

Cardizem Potential nursing considerations

Back 221

Decreases in blood pressure associated with diltiazem therapy may occasionally result in symptomatic hypotension (low blood pressure).

Front 222

Cardizem Potential nursing considerations

Back 222

Mild elevations of transaminases with and without concurrent elevation in alkaline phosphatase and bilirubin have been observed in clinical studies. Such elevations were usually transient and frequently resolved even with continued diltiazem treatment. In rare instances, significant elevations in enzymes such as alkaline phosphatase and other phenomena consistent with acute hepatic injury have been noted. These reactions tended to occur early after therapy initiation (1 to 8 weeks) and have been reversible upon discontinuation of drug therapy.

Front 223

Cardizem Potential nursing considerations

Back 223

Coadministration of diltiazem with rifampin or any known CYP 3A4 inducer should be avoided when possible, and alternative therapy considered.

Front 224

Cardizem Patient/Family Teaching

Back 224

Do not use this medication if you have certain heart conditions such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker), low blood pressure, or if you have recently had a heart attack.

Front 225

Cardizem Patient/Family Teaching

Back 225

Before taking Cardizem, tell your doctor if you are allergic to any drugs, or if you have kidney disease, liver disease, or congestive heart failure.

Front 226

Cardizem Patient/Family Teaching:

Back 226

Diltiazem can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Do not stop taking this medication without first talking to your doctor. If you stop taking Diltiazem suddenly, your condition may become worse.

Front 227

Cardizem Patient/Family Teaching:

Back 227

Diltiazem may be only part of a complete program of treatment that also includes diet, exercise, and other medications. Follow your diet, medication, and exercise routines very closely.

Front 228

Cardizem Patient/Family Teaching:

Back 228

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms

Front 229

Lovenox Class

Back 229

anticoagulant (blood thinner)

Front 230

Lovenox Generic Name

Back 230

enoxaparin sodium injection

Front 231

Lovenox Forms

Back 231

Injectable

Front 232

Lovenox Gen Use

Back 232

prevent blood clot formation

Front 233

Lovenox Contraindications

Back 233

Lovenox Injection is contraindicated in patients with active major bleeding, in patients with thrombocytopenia associated with a positive lab test for anti-platelet antibody in the presence of enoxaparin sodium, or in patients with hypersensitivity to enoxaparin sodium. Patients with known hypersensitivity to heparin or pork products should not be treated with Lovenox Injection or any of its constituents.

Front 234

Lovenox Interactions

Back 234

Lovenox is also used with aspirin to prevent complications of certain types of angina and heart attacks, and with warfarin (Coumadin) to treat deep vein thrombosis (a type of blood clot).

Front 235

Lovenox Interactions

Back 235

Unless really needed, agents which may enhance the risk of hemorrhage should be discontinued prior to initiation of Lovenox Injection therapy. These agents include medications such as: anticoagulants, platelet inhibitors including acetylsalicylic acid (aspirin), sali-cylates, non-steroidal anti-inflammatory drugs (including ketorolac tromethamine), dipyridamole, or sulfinpyrazone. If co-administration is essential, conduct close clinical and laboratory monitoring.

Front 236

Lovenox Nursing Considerations

Back 236

Lovenox injection is not intended for intramuscular administration. Lovenox injection cannot be used interchangeably (unit for unit) with heparin or other low molecular weight heparins as they differ in manufacturing process, molecular weight distribution, anti-Xa and anti-IIa activities, units, and dosage. Each of these medicines has its own instructions for use.

Front 237

Lovenox Nursing Considerations

Back 237

Lovenox injection should be used with extreme caution in patients with a history of heparin-induced thrombocytopenia (a decrease in the number of platelets in circulatory blood).

Front 238

Lovenox Nursing Considerations

Back 238

Lovenox injection should not be mixed with other injections or infusions.

Front 239

Lovenox Nursing Considerations

Back 239

Cases of epidural or spinal hematomas have been reported with the associated use of Lovenox Injection and spinal/epidural anesthesia or spinal puncture resulting in long-term or permanent paralysis. The risk of these events is higher with the use of post-operative indwelling epidural catheters or by the concurrent use of additional drugs affecting hemorrhage such as NSAIDs (non-steroidal anti-inflammatory drugs).

Front 240

Lovenox Nursing Considerations

Back 240

Major hemorrhages including retroperitoneal and intercranial bleeding have been reported. Some of these cases have been fatal.

Front 241

Lovenox Nursing Considerations

Back 241

Bleeding can occur at any site during therapy with Lovenox Injection. An unexplained fall in hematocrit or blood pressure should lead to a search for a bleeding site.

Front 242

Lovenox Nursing Considerations

Back 242

Lovenox Injection, like other anticoagulants, should be used with extreme caution in conditions with increased risk of hemorrhage or in patients treated concurrently with platelet inhibitors.

Front 243

Lovenox Nursing Considerations

Back 243

Because benzyl alcohol may cross the placenta, Lovenox multiple-dose vials, preserved with benzyl alcohol, should be used with caution in pregnant women and only if clearly needed.

Front 244

Lovenox Nursing Considerations

Back 244

Low weight patients (women < 45 kg) and low weight men (< 57 kg) should be observed carefully for signs and symptoms of bleeding.

Front 245

Lovenox Nursing Considerations

Back 245

Periodic complete blood counts, including platelet count, and stool occult blood tests are recommended during the course of treatment with Lovenox Injection.

Front 246

Lovenox Nursing Considerations

Back 246

All patients receiving anticoagulants such as enoxaparin, including pregnant women, are at risk for bleeding.

Front 247

Lovenox Nursing Considerations

Back 247

Caution should be exercised when Lovenox Injection is administered to nursing women. It is not known whether this drug is excreted in human milk.

Front 248

Lovenox Nursing Considerations

Back 248

Geriatric patients with low body weight (<45 kg) and those predisposed to decreased renal function should be closely monitored.

Front 249

Lovenox Nursing Considerations

Back 249

Safety and effectiveness of Lovenox Injection in pediatric patients have not been established

Front 250

Lovenox Patient/Family Teaching

Back 250

There is a risk of bleeding in the spinal or epidural space, possibly resulting in paralysis, when Lovenox is used along with spinal or epidural anesthesia or spinal puncture. This risk may be increased by the use of indwelling epidural catheters or by the concomitant use of drugs that affect blood clotting.

Front 251

Lovenox Patient/Family Teaching

Back 251

Do not inject this medication intramuscularly (into the muscle) or intravenously (into the vein).

Front 252

Lovenox Patient/Family Teaching

Back 252

Do not take aspirin, ibuprofen (Motrin, Advil, Nuprin, and others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, and others), indomethacin (Indocin), or any other nonsteroidal anti-inflammatory medication without first talking to your doctor. These medicines may lead to bleeding when taken with Lovenox. Ask your pharmacist or doctor before taking any prescription or over-the-counter medication during treatment with Lovenox.

Front 253

Protonix Class

Back 253

proton pump inhibitor (decreases the amount of acid produced in the stomach)

Front 254

Protonix Generic Name

Back 254

Pantoprazole

Front 255

Protonix Forms

Back 255

Injectable and tablets

Front 256

Lovenox Nursing Considerations

Back 256

Bleeding can occur at any site during therapy with Lovenox Injection. An unexplained fall in hematocrit or blood pressure should lead to a search for a bleeding site.

Front 257

Lovenox Nursing Considerations

Back 257

Lovenox Injection, like other anticoagulants, should be used with extreme caution in conditions with increased risk of hemorrhage or in patients treated concurrently with platelet inhibitors.

Front 258

Lovenox Nursing Considerations

Back 258

Because benzyl alcohol may cross the placenta, Lovenox multiple-dose vials, preserved with benzyl alcohol, should be used with caution in pregnant women and only if clearly needed.

Front 259

Lovenox Nursing Considerations

Back 259

Low weight patients (women < 45 kg) and low weight men (< 57 kg) should be observed carefully for signs and symptoms of bleeding.

Front 260

Lovenox Nursing Considerations

Back 260

Periodic complete blood counts, including platelet count, and stool occult blood tests are recommended during the course of treatment with Lovenox Injection.

Front 261

Lovenox Nursing Considerations

Back 261

All patients receiving anticoagulants such as enoxaparin, including pregnant women, are at risk for bleeding.

Front 262

Lovenox Nursing Considerations

Back 262

Caution should be exercised when Lovenox Injection is administered to nursing women. It is not known whether this drug is excreted in human milk.

Front 263

Lovenox Nursing Considerations

Back 263

Geriatric patients with low body weight (<45 kg) and those predisposed to decreased renal function should be closely monitored.

Front 264

Lovenox Nursing Considerations

Back 264

Safety and effectiveness of Lovenox Injection in pediatric patients have not been established

Front 265

Lovenox Patient/Family Teaching

Back 265

There is a risk of bleeding in the spinal or epidural space, possibly resulting in paralysis, when Lovenox is used along with spinal or epidural anesthesia or spinal puncture. This risk may be increased by the use of indwelling epidural catheters or by the concomitant use of drugs that affect blood clotting.

Front 266

Lovenox Patient/Family Teaching

Back 266

Do not inject this medication intramuscularly (into the muscle) or intravenously (into the vein).

Front 267

Lovenox Patient/Family Teaching

Back 267

Do not take aspirin, ibuprofen (Motrin, Advil, Nuprin, and others), ketoprofen (Orudis KT, Orudis, Oruvail), naproxen (Aleve, Naprosyn, Anaprox, and others), indomethacin (Indocin), or any other nonsteroidal anti-inflammatory medication without first talking to your doctor. These medicines may lead to bleeding when taken with Lovenox. Ask your pharmacist or doctor before taking any prescription or over-the-counter medication during treatment with Lovenox.

Front 268

Protonix Class

Back 268

proton pump inhibitor (decreases the amount of acid produced in the stomach)

Front 269

Protonix Generic Name

Back 269

Pantoprazole

Front 270

Protonix Forms

Back 270

Injectable and tablets

Front 271

Protonix Gen use

Back 271

Protonix is used for the short-term treatment (7 to 10 days) of erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid

Front 272

Protonix Contraindications

Back 272

Protonix is not recommended for use in CHILDREN; safety and effectiveness have not been confirmed.
Do not use if you are allergic to any ingredient in Protonix

Front 273

Protonix Interactions

Back 273

Tell your health care provider if you are taking any other medicines, especially any of the following:
(1) Clarithromycin or voriconazole because side effects and toxic effects associated with Protonix may be increased
(2) Digoxin or methotrexate because the actions and side effects of these medicines may be increased
(3) HIV protease inhibitors (eg, ritonavir) because their effectiveness may be decreased by Protonix
There have been postmarketing reports of increased INR (International normalized ratio) and clotting time in patients receiving proton pump inhibitors, including pantoprazole, and warfarin concurrently. Increases in INR and clotting time time may lead to abnormal bleeding and even death.

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Protonix Nursing Considerations

Back 274

Protonix may affect the results of certain lab tests (eg, false positive urine screen for THC/marijuana). Make sure laboratory personnel and your doctors know you use Protonix . An alternative confirmatory method should be considered to verify positive results.
Protonix should not be taken within 4 hours of imidazoles (eg, ketoconazole).
Patients treated with proton pump inhibitors and warfarin concurrently should be monitored for increases in INR and prothrombin time.
Because of profound and long lasting inhibition of gastric acid secretion, pantoprazole may interfere with absorption of drugs where gastric pH is an important determinant of their bioavailability.

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Protonix Pat/Fam Teaching

Back 275

Protonix may cause dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Protonix . Using Protonix alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks.
Do not reuse needles, syringes, or other materials. Dispose of properly after use.
If you miss a dose of Protonix , contact your doctor for further instruction.
Protonix should not be taken within 4 hours of imidazoles (eg, ketoconazole).
If Protonix contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it.
Protonix is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Protonix at home, carefully follow the injection procedures taught to you by your health care provider.
Patients should be cautioned that "Protonix Delayed-Release Tablets" should not be split, crushed or chewed. The tablets should be swallowed whole, with or without food in the stomach. Concurrent administration of antacids does not affect the absorption of pantoprazole.

Front 276

Haldol Drug Class

Back 276

Tranquilizers

Front 277

Haldol Generic Name

Back 277

Haloperidol

Front 278

Haldol Forms

Back 278

It is available in sesame oil in sterile form for intramuscular (IM) injection.

Front 279

Haldol Gen Use

Back 279

Used for the treatment of schizophrenic patients who require prolonged parenteral antipsychotic ( medication or another measure that is believed to be effective in the treatment of psychosis) therapy.

Front 280

Haldol Contraindications

Back 280

Contraindications, warnings, and additional information are those of HALDOL, modified only to reflect the prolonged action. HALDOL is contraindicated in severe toxic central nervous system depression or comatose states from any cause and in individuals who are hypersensitive to this drug or have Parkinson's disease.

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Haldol Interactions

Back 281

As with other antipsychotic agents, it should be noted that HALDOL may be capable of enhancing CNS depressants such as anesthetics, opiates, and alcohol.
In a study of 12 schizophrenic patients coadministered oral haloperidol and rifampin, plasma haloperidol levels were decreased by an average of 70%.
Weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN, and FBS followed by irreversible brain damage has occurred in a few patients treated with lithium plus HALDOL.

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Haldol Nursing Considerations

Back 282

Careful monitoring of clinical status is warranted when rifampin is administered or discontinued in haloperidol-treated patients.

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Haldol Nursing Considerations

Back 283

Patients receiving combined therapy of lithium and HALDOL should be monitored closely for early evidence of neurological taxicity and treatment discontinued promptly if such signs appear.

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Haldol Nursing Considerations

Back 284

Both the risk of developing tardive dyskinesia (difficulty of voluntary movements) and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase.

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Haldol Nursing Considerations

Back 285

A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status (including catatonic signs) and evidence of irregular pulse, blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmias. Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis) and kidney failure.

Front 286

Haldol Nursing Considerations

Back 286

A number of cases of bronchopneumonia, some fatal, have followed the use of antipsychotic drugs, including HALDOL (haloperidol). It has been assumed without proof that lethargy and decreased sensation of thirst due to central inhibition may lead to dehydration, hemoconcentration and reduced pulmonary ventilation (total exchange of gas). Therefore, if the above signs and symptoms appear, especially in the elderly, the physician should institute remedial therapy promptly.

Front 287

Haldol Pat/Fam Teaching

Back 287

Haloperidol decanoate may impair the mental and/or physical abilities required for the performance of hazardous tasks such as operating machinery or driving a motor vehicle. The ambulattory patient should be warned accordingly.
The use of alcohol with this drug should be avoided due to possible additive effects and hypotension (low blood pressure).

Front 288

Morphine Drug Class

Back 288

Opiate Agonists

Front 289

Morphine Generic Name

Back 289

Morphine

Front 290

Morphine Forms

Back 290

controlled-release tablets (15 mg 30 mg 60 mg 100 mg 200 mg)

Front 291

Morphine Gen use

Back 291

Used to treat moderate to severe pain

Front 292

Morphine Contraindications

Back 292

MS CONTIN is contraindicated in patients with known hypersensitivity to the drug, in patients with respiratory depression in the absence of resuscitative equipment, and in patients with acute or severe bronchial asthma.
MS CONTIN is contraindicated in any patient who has or is suspected of having a paralysis of the intestine.

Front 293

Morphine Interactions

Back 293

The concurrent use of other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, tranquilizers, and alcohol may produce additive depressant effects. Respiratory depression, low blood pressure, and profound sedation or coma may occur. When such combined therapy is contemplated, the dose of one or both agents should be reduced. Opioid analgesics, including MS CONTIN, may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.

Front 294

Morphine Nursing Considerations

Back 294

MS CONTIN may cause severe hypotension in an individual whose ability to maintain his blood pressure has already been compromised.

Front 295

Morphine Nursing Considerations

Back 295

MS CONTIN may produce a temporary lowering of blood pressure (hypotension) due usually to suddenly standing up in ambulatory patients.

Front 296

Morphine Nursing Considerations

Back 296

MS CONTIN should be used with great caution and in reduced dosage in patients who are concurrently receiving other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, other tranquilizers, and alcohol because respiratory depression, hypotension, and profound sedation or coma may result.

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Morphine Nursing Considerations

Back 297

MS CONTIN should NOT be administered to a patient who has received or is receiving a course of therapy with a pure opioid agonist analgesic. In these patients, mixed agonist/antagonist analgesics may reduce the analgesic effect or may precipitate withdrawal symptoms.

Front 298

Morphine Nursing Considerations

Back 298

Morphine can produce drug dependence and has a potential for being abused.

Front 299

Morphine Nursing Considerations

Back 299

Although extremely rare, cases of allergic reaction have been reported.

Front 300

Morphine Nursing Considerations

Back 300

Morphine produces effects which may obscure neurologic signs of further increases in pressure in patients with head injuries

Front 301

Morphine Nursing Considerations

Back 301

MS CONTIN, like all opioid analgesics, should be administered with caution to patients in circulatory shock, since widend blood vessels produced by the drug may further reduce heart output and blood pressure.

Front 302

Morphine Nursing Considerations

Back 302

Use of MS CONTIN has not been evaluated systematically in children

Front 303

Morphine Fam/Pat Teaching

Back 303

Appropriate pain management requires changes in the dose to maintain best pain control. Patients should be advised of the need to contact their physician if pain control is inadequate, but not to change the dose of MS CONTIN without consulting their physician.

Front 304

Morphine Fam/Pat Teaching

Back 304

Morphine may impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating machinery). Patients started on MS CONTIN or whose dose has been changed should refrain from dangerous activity until it is established that they are not adversely affected.

Front 305

Morphine Fam/Pat Teaching

Back 305

Morphine should not be taken with alcohol or other CNS depressants (sleep aids, tranquilizers) because additive effects including CNS depression may occur. A physician should be consulted if other prescription medications are currently being used or are prescribed for future use.

Front 306

Morphine Fam/Pat Teaching

Back 306

For women of childbearing potential who become or are planning to become pregnant, a physician should be consulted regarding analgesics and other drug use.

Front 307

Morphine Fam/Pat Teaching

Back 307

Upon completion of therapy, it may be appropriate to taper the morphine dose, rather than abruptly discontinue it.

Front 308

Morphine Fam/Pat Teaching

Back 308

While psychological dependence ("addiction") to morphine used in the treatment of pain is very rare, morphine is one of a class of drugs known to be abused and should be handled accordingly.

Front 309

Morphine Fam/Pat Teaching

Back 309

The MS CONTIN 100 and 200 mg Tablet strengths are for use only in opioid-tolerant patients requiring daily morphine equivalent dosages of 200 mg or more. Special care must be taken to avoid accidental ingestion or the use by individuals (including children) other than the patient for whom it was originally prescribed, as such unsupervised use may have severe, even fatal, consequences.

Front 310

Potassium Chloride Drug Class

Back 310

Oral Potassium Supplements (TPD Category IV)

Front 311

Potassium Chloride Generic Name

Back 311

Potassium Chloride

Front 312

Potassium Chloride Forms

Back 312

Extended-release tablets (also liquid available)

Front 313

Potassium Chloride Gen Use

Back 313

Potassium Chloride is used for treating or preventing low potassium blood levels when the amount of potassium in the diet is inadequate.

Front 314

Potassium Chloride Contraindications

Back 314

Potassium supplements are contraindicated in patients with hyperkalemia, since a further increase in serum potassium concentration in such patients can produce heart attack. Hyperkalemia may complicate any of the following conditions: kidney failure, diabetic acidosis, acute dehydration, heat cramps, extensive tissue breakdown as in severe burns, adrenal insufficiency, or the administration of a potassium-sparing diuretic.

Front 315

Potassium Chloride Contraindications

Back 315

Extended and controlled release formulations of potassium chloride have produced esophageal erosion in certain cardiac patients with esophageal compression due to an enlarged left heart atrium. Potassium supplementation, when indicated in such patients, should be given as a liquid preparation/an immediate release liquid preparation.

Front 316

Potassium Chloride Contraindications

Back 316

All solid oral dosage forms of potassium chloride are contraindicated in any patient in whom there is structural, pathological (e.g., diabetic gastroparesis where a muscle of the stomach is paralyzed) or pharmacologic (use of anticholinergic agents (inhibits the transmission of nerve impulses) or other agents with anticholinergic properties (inhibiting the transmission of parasympathetic nerve impulses and thereby reduce spasms of smooth muscle) at sufficient doses to exert anticholinergic effects) cause for arrest or delay in tablet or capsule-passage through the intestines; an oral liquid preparation should be used when indicated in these patients.

Front 317

Potassium Chloride Contraindications

Back 317

Safety and effectiveness in pediatric patients have not been established.

Front 318

Potassium Chloride Interactions

Back 318

Hypokalemia (low blood potassium) should not be treated by the concurrent administration of potassium salts and a potassium-sparing diuretic (e.g., spironolactone, triamterene, or amiloride), since the simultaneous administration of these agents can produce severe hyperkalemia.

Front 319

Potassium Chloride Interactions

Back 319

Angiotensin (act as vasoconstrictors to narrow blood vessels) converting enzyme (ACE) inhibitors (e.g., captopril, enalapril) will produce some potassium retention by inhibiting aldosterone p(regulates balance of salt and water in the body) production. Potassium supplements should be given to patients receiving ACE inhibitors only with close monitoring.

Front 320

Potassium Chloride Interactions

Back 320

Before using this drug, tell your doctor if you are taking any of the following drugs: ACE inhibitor, a beta-blocker such as acebutolol, a diuretic, a steriod, an NSAID (non-steriodal anti-inflammatory drug). If you are using any of these drugs, you may not be able to use potassium chloride, or you may need dosage adjustments or special tests during treatment.

Front 321

Potassium Chloride Nursing Considerations

Back 321

Potassium supplements should be given to patients receiving ACE inhibitors only with close monitoring.

Front 322

Potassium Chloride Nursing Considerations

Back 322

In patients with impaired mechanisms for excreting potassium, the administration of potassium salts can produce hyperkalemia and heart attack. Requires particularly careful monitoring of the serum potassium concentration and appropriate dosage adjustments.

Front 323

Potassium Chloride Nursing Considerations

Back 323

Solid oral dosage forms of potassium chloride can produce ulcerative and/or narrow lesions of the intestines.

Front 324

Potassium Chloride Nursing Considerations

Back 324

According to reports, enteric coated preparations of potassium chloride are associated with an increased frequency of small bowel lesions.

Front 325

Potassium Chloride Nursing Considerations

Back 325

Hypokalemia in patients with metabolic acidosis should be treated with an alkalinizing potassium salt such as potassium bicarbonate, potassium citrate, potassium acetate, or potassium gluconate.

Front 326

Potassium Chloride Nursing Considerations

Back 326

The treatment of potassium depletion, particularly in the presence of heart disease, renal disease, or acidosis, requires careful attention to acid-base balance and appropriate monitoring of serum electrolytes, the electrocardiogram, and the clinical status of the patient.

Front 327

Potassium Chloride Nursing Considerations

Back 327

Regular serum potassium determinations are recommended, especially in patients with renal insufficiency or diabetic nephropathy (kidney disease associated with long-standing diabetes). When blood is drawn for analysis of plasma potassium it is important to recognize that artifactual elevations can occur after improper puncture of a vein (blood draw) technique or as a result of test-tube (lab) destruction of red blood cells of the sample.

Front 328

Potassium Chloride Nursing Considerations

Back 328

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Front 329

Potassium Chloride Pat/Fam Teaching

Back 329

Take Potassium chloride with meals and with a full glass of water or some other liquid.

Front 330

Potassium Chloride Pat/Fam Teaching

Back 330

Do not use a salt substitute while taking potassium chloride without first talking to your doctor. Salt substitutes may contain potassium. You may get too much potassium and experience side effects if you use these products.

Front 331

Potassium Chloride Pat/Fam Teaching

Back 331

Take this medicine following the frequency and amount prescribed by the physician. This is especially important if the patient is also taking diuretics and/or digitalis preparations.

Front 332

Potassium Chloride Pat/Fam Teaching

Back 332

Tell your doctor if you have difficulty swallowing Potassium chloride. You may sprinkle the contents of the capsule onto a spoonful of soft food. Capsules and tablets should not be crushed, chewed, or sucked.

Front 333

Potassium Chloride Pat/Fam Teaching

Back 333

--If you miss a dose...
If it is within 2 hours of the scheduled time, take it as soon as you remember. If you do not remember until later, skip the dose you missed and go back to your regular schedule. Do not take 2 doses at once.

Front 334

Potassium Chloride Pat/Fam Teaching

Back 334

Check with the physician at once if tarry stools or other evidence of gastrointestinal bleeding is noticed.

Front 335

Potassium Chloride Pat/Fam Teaching

Back 335

Store at room temperature in a tightly closed container.

Front 336

Vicodin Drug Class

Back 336

Opiod Analgesic and antitussive, and is a Schedule III controlled substance

Front 337

Vicodin Generic Name

Back 337

acetaminophen and hydrocodone bitartrate

Front 338

Vicodin Forms

Back 338

Hydrocodone bitartrate and acetaminophen is supplied in tablet form for oral administration

Front 339

Vicodin Gen Use

Back 339

Pain reliever; the combination of acetaminophen and hydrocodone is used to relieve moderate to severe pain.

Front 340

Vicodin Contraindications

Back 340

Do not use this medication if you are allergic to acetaminophen or hydrocodone, or other narcotic pain relievers such as fentanyl (Actiq, Duragesic), hydromorphone (Dilaudid, Palladone), methadone (Methadose, Dolophine), morphine (Kadian, MS Contin, Oramorph, and others), oxycodone (Oxycontin), and oxymorphone (Opana).

Front 341

Vicodin Contraindications

Back 341

Before using Vicodin, tell your doctor if you are allergic to any drugs, or if you have: asthma, COPD, sleep apnea, other breathing disorders, liver disease, kidney disease, underactive thyroid, a history of head injury or brain tumor, epilepsy or other seizure disorders, low blood pressure, gallbladder disease, Addison's disease, enlarged prostate, mental illnesss, or a history of drug or alcohol addiction. If you have any of these conditions, you may not be able to use Vicodin, or you may need a dosage adjustment or special tests during treatment.

Front 342

Vicodin Interactions

Back 342

Patients receiving other narcotic analgesics, antihistamines, antipsychotics, antianxiety agents, or other central nervous system depressants (including alcohol) concurrently with VICODIN Tablets may exhibit an additive central nervous system depression. When combined therapy is contemplated, the dose of one or both agents should be reduced.

Front 343

Vicodin Interactions

Back 343

The use of MAO inhibitors or tricyclic antidepressants with hydrocodone preparations may increase the effect of either the antidepressant or hydrocodone.

Front 344

Vicodin Nursing Considerations

Back 344

Do not give this medicine to anyone younger than 18 years old.
Older adults may be more sensitive to the effects of this medicine.
This medication may be harmful to an unborn baby, and could cause addiction or withdrawal symptoms in a newborn.

Front 345

Vicodin Nursing Considerations

Back 345

At high doses or in sensitive patients, hydrocodone may produce dose-related respiratory depression by acting directly on the brain stem respiratory center. Hydrocodone also affects the center that controls respiratory rhythm, and may produce irregular and periodic breathing.

Front 346

Vicodin Nursing Considerations

Back 346

The respiratory depressant effects of narcotics and their capacity to elevate cerebrospinal fluid pressure may be exaggerated in the presence of head injury, other intracranial lesions or a preexisting increase in intracranial pressure.

Front 347

Vicodin Nursing Considerations

Back 347

The administration of narcotics may obscure the diagnosis or clinical course of patients with acute abdominal conditions.

Front 348

Vicodin Nursing Considerations

Back 348

Opioid agonists have the potential for being abused and are sought by abusers and addicts.

Front 349

Vicodin Pat/Fam Teaching

Back 349

Do not take Vicodin with alcohol, other central nervous system depressants, other narcotic pain medications, sedatives, tranquilizers, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result.

Front 350

Vicodin Pat/Fam Teaching

Back 350

Do not take this medication without first talking to your doctor if you drink more than three alcoholic beverages per day or if you have had alcoholic liver disease (cirrhosis). You may not be able to take medication that contains acetaminophen.

Front 351

Vicodin Pat/Fam Teaching

Back 351

Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. Vicodin should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

Front 352

Vicodin Pat/Fam Teaching

Back 352

Keep track of how many tablets have been used from each new bottle of this medicine. Hydrocodone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

Front 353

Vicodin Pat/Fam Teaching

Back 353

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Front 354

Vicodin Pat/Fam Teaching

Back 354

Never take more Vicodin than is prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Front 355

Vicodin Pat/Fam Teaching

Back 355

Since Vicodin is sometimes used as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

Front 356

Vicodin Pat/Fam Teaching

Back 356

You may have withdrawal symptoms when you stop using this medication after using it over a long period of time. Do not stop using Vicodin suddenly without first talking to your doctor. You may need to use less and less before you stop the medication completely.

Front 357

Vicodin Pat/Fam Teaching

Back 357

Do not use this medication without telling your doctor if you are breast-feeding a baby.