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357 Cards in this Set

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Ambien drug classification
Sch IV controlled substance
Ambien Generic Name
Zolpidem Tartrate
Ambien forms available
5mg and 10mg strength tablets orally
Ambien General use
ST treatment of insomnia
Ambien Interactions
Imipramine
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
Ambien Interactions
Chlorpormazine
Chlorpormazine in combination with Ambien produced no pharamacokinetic interaction, but there was decreased alertness and psychomotor performance.
Ambien Interactions
Alcohol
An effect on coordination of sensory processes and movement (psychomotor performance) between alcohol and Ambien was demonstrated.
Ambien Interactions
Fluoxetine
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.
Ambien Interactions
Flumazenil
Zolpidem’s sedative/hypnotic effect was reversed by flumazenil; however, no significant alterations in zolpidem pharmacokinetics were found
Ambien Interactions
CNS-active drugs
Any drug with CNS-depressant effects could potentially enhance the CNS-depressant effects of zolpidem.
Ambien nursing consideration 1
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.
Ambien nursing consideration 2
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.
Ambien nursing consideration 3
Precautions should be observed if Ambien is prescribed to patients with compromised respiratory function, since sedative/hypnotics have the capacity to depress respiratory drive.
Ambien nursing consideration 4
Ambien should be used with caution in patients with sleep apnea syndrome or myasthenia gravis.
Ambien nursing consideration 5
Safety and effectiveness of zolpidem have not been established in pediatric patients.
Ambien nursing consideration 7
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.
Ambien nursing consideration 8
Caution is advisable in using Ambien in patients with diseases or conditions that could affect metabolusm or hemodynamic reponses.
Ambien nursing consideration 9
Any drug with CNS-depressant effects could potentially enhance the CNS-depressant effects of Ambien.
Ambien Family/Patient Teaching
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.
Ambien Family/Patient Teaching
Side Effects:
drowsiness
dizziness
lightheadedness
difficulty with coordination
Ambien Family/Patient Teaching
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.
Ambien Family/Patient Teaching
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.
Ambien Family/Patient Teaching
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.
Ambien Family/Patient Teaching
Always take the exact dose of Ambien prescribed by your doctor. Never change your dose without talking to your doctor first.
Ambien Family/Patient Teaching
Never use Ambien or any other sleep medicine for longer than directed by your doctor.
Ambien Family/Patient Teaching
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.
Ambien Family/Patient Teaching
If you notice any unusual and/or disturbing thoughts or behavior during treatment with Ambien or any other sleep medicine, contact your doctor.
Ambien Family/Patient Teaching
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.
Ambien Family/Patient Teaching
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.
Ambien Family/Patient Teaching
Do not increase the prescribed dose of Ambien or any other sleep medicine unless instructed by your doctor.
Ambien Patient/Family Teaching
Be aware that you may have more sleeping problems the first night or two after stopping Ambien or any other sleep medicine.
Ambien Patient/Family Teaching
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.
Ambien Patient/Family Teaching
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.
Ambien Patient/Family Teaching
Ambien works very quickly. You should only take Ambien right before going to bed and are ready to go to sleep.
Demerol Classification
Narcotic Analgesic
Demerol is a Schedule II controlled substance with an abuse liability similar to morphine.
Demerol Generic name
Meperidine hydrochloride
Demerol Forms available
Injectable (intramuscularly or subcutaneously), or oral (syrup, tablet)
Demerol General Use
For the relief of moderate to severe pain

Parenteral form only for preoperative medication, obstetrical analgesia, and support of anesthesia
Demerol Contraindications
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.
Demerol Interactions
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.
Demerol Nursing Considerations
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.
Demerol Nursing Considerations
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.
Demerol Nursing Considerations
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.
Demerol Nursing Considerations
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.
Demerol Nursing Considerations
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.
Demerol Nursing Considerations
Meperidine, like other narcotics, may produce temporary blackouts in ambulatory patients when they suddenly stand up.
Demerol Nursing Considerations
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.
Demerol Nursing Considerations
Meperidine crosses the placental barrier and can produce depression of respiration and psychophysiologic functions in the newborn.
Demerol Nursing Considerations
Meperidine appears in the milk of nursing mothers receiving the drug.
Demerol Nursing Considerations
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.
Demerol Nursing Considerations
Meperidine may aggravate preexisting convulsions in patients with convulsive disorders.
Demerol Nursing Considerations
The administration of meperidine or other narcotics may obscure the diagnosis of clinical course in patients with acute abdominal conditions.
Demerol Nursing Considerations
If used regularly, this drug should not be abruptly discontinued or the patient may experience opiod withdrawal symptoms.
Demerol Nursing Considerations
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.
Demerol Patient/Family Teaching
Patients should be aware that Demerol tablets contain meperidine, which is a morphine-like substance.
Demerol Patient/Family Teaching
Patients should be advised to report pain and adverse experiences occurring during use of the drug.
Demerol Patient/Family Teaching
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).
Demerol Patient/Family Teaching
Patients should not combine Demerol with alcohol or other CNS depressants (sleep aids, tranquilizers) except by the orders of the prescribing physician.
Demerol Patient/Family Teaching
Women who are pregnant or are planning to become pregnant should consult their physician regarding the effects of using this drug during pregnancy.
Demerol Patient/Family Teaching
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.
Demerol Patient/Family Teaching
Patients should be advised that Demerol use may need to be tapered off rather than discontinued due to the risk of withdrawal symptoms.
Demerol Patient/Family Teaching
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.
Flagyl Drug classification
Flagyl is an antibacterial agent
Flagyl generic name
Metronidazole
Flagyl forms
tablets and injectable
Flagyl General use
Flagyl should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
Flagyl Contraindications
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.
Flagyl Interactions
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.
Flagyl Interactions
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.
Flagyl Interactions
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.
Flagyl Interactions
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.
Flagyl Interactions
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.
Flagyl Nursing Considerations
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.
Flagyl Nursing Considerations
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.
Flagyl Nursing Considerations
The dose of Flagyl should not be specifically reduced in anuric patients since accumulated metabolites may be rapidly removed by dialysis.
Flagyl Nursing Considerations
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.
Flagyl Nursing Considerations
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
Flagyl Nursing Considerations
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.
Flagyl Nursing Considerations
Metronidazole has shown evidence of cancerous activity and impairment of fertility in a number of studies involving oral administration in mice and rats.
Flagyl Patient/Family Teaching
Alcoholic beverages should be avoided while taking Flagyl and for at least one day afterward.
Flagyl Patient/Family Teaching
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).
Flagyl Patient/Family Teaching
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.
Glucophage Drug Classification
Oral Antihyperglycemic
Glucophage Generic Name
Metformin Hydrochloride
Glucophage Forms Available
Tablets and extended-release tablets(Glucophage® XR)
Glucophage Gen use
Used in the management of type 2 diabetes
Glucophage Contraindications
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.
Glucophage Contraindications
Known hypersensitivity to metformin hydrochloride.
Glucophage Contraindications
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.
Glucophage Contraindications
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
Glucophage contraindications
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.
Glucophage Interactions
Furosemide
Furosemide:
A single-dose, metformin-furosemide drug interaction study in healthy subjects demonstrated that pharmacokinetic parameters of both compounds were affected by coadministration.
Glucophage Interactions
Nifedipine
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
Glucophage Interactions
Cationic drugs
that are eliminated by renal tubular secretion theoretically have the potential for interaction with metformin by competing for common renal tubular transport systems.
Glucophage Interactions
Other
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.
Glucophage Interactions
High protein-bound drugs
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.
Glucophage Nursing considerations
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.
Glucophage Nursing considerations
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
Glucophage Nursing considerations
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.
Glucophage Nursing considerations
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.
Glucophage Nursing considerations
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.
Glucophage Nursing considerations
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.
Glucophage Nursing considerations
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.
Glucophage Nursing considerations
Patients should be warned against excessive alcohol intake, acute or chronic, while receiving Glucophage or Glucophage XR.
Glucophage Nursing considerations
Glucophage and Glucophage XR should generally be avoided in patients with clinical or laboratory evidence of hepatic disease.
Gllucophage Nursing Considerations
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.
Glucophage Patient/Family Teaching
Patients should be informed of the potential risks and benefits of Glucophage or Glucophage XR and of alternative modes of therapy.
Glucophage Patient/Family Teaching
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.
Glucophage Patient/Family Teaching
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.
Glucophage Patient/Family Teaching
Patients should be counselled against excessive alcohol intake, either acute or chronic, while receiving Glucophage or Glucophage XR.
Glucophage Patient/Family Teaching
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.
Glucophage Patient/Family Teaching
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.
Insulin (R) Classification
Antidiabetic agent
Insulin (R) generic name
Insulin (Human Recombinant)
Insulin (R) Forms:
All types of insulin must be injected because, if taken by mouth, insulin is destroyed in the stomach.
Insulin (R) Gen use
Insulin is prescribed for the treatment of type 1 and type 2 diabetes mellitus.
Insulin (R) Contraindications
Hypersensitivity to any component of the formulation
Insulin (R) Interactions
Interacts with other drugs that lower blood glucose such as oral hypoglycemics, salicylates like aspirin, sulfa antibiotics, and certain antidepressants.
Insulin (R) Interactions
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
Insulin (R) Interactions
Drugs which DECREASE hypoglycemic effect of insulin: Contraceptives (oral), corticosteroids, dextrothyroxine, diltiazem, dobutamine, epinephrine, niacin, smoking, thiazide diuretics, thyroid hormone
Insulin (R) Interactions
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.
Insulin (R) Interactions
Insulin increases the risk of hypoglycemia associated with oral hypoglycemic agents (including sulfonylureas, metformin, pioglitazone, rosiglitazone, and troglitazone
Insulin (R) Interactions
Herb/Nutraceutical: Use caution with chromium, garlic, gymnema (may increase hypoglycemia).
Insulin (R) Interactions
Ethanol: Caution with ethanol (may increase hypoglycemia).
Insulin (R) Interactions
Food: Insulin shifts potassium from extracellular to intracellular space. Decreases potassium serum concentration
Insulin (R) Nursing Considerations
The presence of other medical problems may affect the dose of insulin the patient needs.
Insulin (R) Nursing Considerations
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.
Insulin (R) Nursing Considerations
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.
Insulin (R) Nursing Considerations
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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.
Insulin (R) Patient/Family Teaching
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
Insulin (R) Patient/Family Teaching
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.
Zoloft Classification
Antidepressant
Zoloft generic name
sertraline hydrochloride
zoloft forms available
Tablets and Oral Concentrate
zoloft general use
Zoloft (sertraline hydrochloride) is indicated for the treatment of major depressive disorder in adults.
zoloft contraindications
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.
Zoloft interactions
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.
Zoloft interactions
Avoid drinking alcohol, which can increase some of the side effects of sertraline.
Zoloft interactions
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.
Zoloft interactions
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.
Zoloft interactions
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.
Zoloft interactions
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.
Zoloft Nursing Considerations
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.
Zoloft Nursing Considerations
Caution is advisable in using Zoloft in patients with diseases or conditions that could affect metabolism or hemodynamic responses.
Zoloft Nursing Considerations
At this time it is recommended that plasma lithium levels be monitored following initiation of Zoloft therapy with appropriate adjustments to the lithium dose.
Zoloft Nursing Considerations
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.
Zoloft Nursing Considerations
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.
Zoloft Nursing Considerations
Of all the antidepressants, only fluoxetine (Prozac®) has been FDA approved to treat pediatric depression.
Zoloft Patient/Family Teaching
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.
Zoloft Patient/Family Teaching
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.
Zoloft Patient/Family Teaching
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
Lasix Drug Classification
Diuretic
Lasix Generic Name
Furosemide
Lasix Forms Avail
tablets
Lasix Gen use
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).
Lasix Contraindications
LASIX is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide
Lasix Interactions
If you take sucralfate (Carafate), take it at least 2 hours before or after you take Lasix.
Lasix Interactions
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.
Lasix Interactions
LASIX has a tendency to antagonize the skeletal muscle relaxing effect of tubocurarine and may potentiate the action of succinylcholine
Lasix Interactions
Lithium generally should not be given with diuretics because they reduce lithium’s renal clearance and add a high risk of lithium toxicity.
Lasix Interactions
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.
Lasix Interactions
LASIX may decrease arterial responsiveness to norepinephrine. However, norepinephrine may still be used effectively.
Lasix Interactions
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).
Lasix Interactions
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.
Lasix Nursing Considerations
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.
Lasix Nursing Considerations
Patients receiving both indomethacin and LASIX should be observed closely to determine if the desired diuretic and/or antihypertensive effect of LASIX is achieved.
Lasix Nursing Considerations
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).
Lasix Patient/Family Teaching
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.
Lasix Patient/Family Teaching
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.
Phenergan Class
Antihistamine
Phenergan Generic Name
Promethazine HCI
Phenergan Forms
Tablets and Suppositories
Phenergan Gen use
Antihistamines are the basic treatment of allergic illnesses.
In addition to its antihistaminic action, it provides clinically useful sedative and anti-nausea/vomiting effects.
Phenergan Contraindications
Phenergan tablets and suppositories are contraindicated for use in pediatric patients less than two years of age.
Phenergan Contraindications
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.
Phenergan Contraindications
Antihistamines are contraindicated for use in the treatment of lower respiratory tract symptoms including asthma.
Phenergan Interactions
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.
Phenergan Interactions
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.
Phenergan Interactions
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.
Phenergan Interactions
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.
Phenergan Interactions
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.
Phenergan Interactions
An increase in blood glucose has been reported in patients receiving promethazine HCl.
Phenergan Nursing Considerations
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.
Phenergan Nursing Considerations
Phenergan should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression.
Phenergan Nursing Considerations
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.
Phenergan Nursing Considerations
Phenergan Tablets and Suppositories may lower seizure threshold
Phenergan Nursing Considerations
Phenergan Tablets and Suppositories should be used with caution in patients with bone-marrow depression
Phenergan Patient/Family Teaching
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.
Phenergan Patient/Family Teaching
Patients should be advised to report any involuntary muscle movements.
Phenergan Patient/Family Teaching
Avoid prolonged exposure to the sun.
Cardizem Drug Classification
Calcium Channel Blocker
Cardizem Generic Name
Diltiazem hydrochloride
Cardizem Forms Avail
Tablets and injectible, capsules, suspension, topical gel, PLO
Cardizem Gen Use
Calcium ion cellular influx inhibitor (slow channel blocker or calcium antagonist). It works by relaxing the muscles of your heart and blood vessels.
Cardizem Contraindications
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.
Cardizem Interactions
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.
Cardizem Interactions
There may be additive effects in prolonging AV conduction when using beta-blockers or digitalis concurrently with diltiazem.
Cardizem Interactions
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).
Cardizem Interactions
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.
Cardizem Interactions
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).
Cardizem Interactions
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.
Cardizem Interactions
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.
Cardizem Interactions
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.
Cardizem Interactions
Diltiazem plasma levels were not significantly affected by lovastatin or pravastatin.
Cardizem Interactions
Coadministration of rifampin with diltiazem lowered the diltiazem plasma concentrations to undetectable levels.
Cardizem Potential nursing considerations
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.
Cardizem Potential nursing considerations
Worsening of congestive heart failure has been reported in patients with preexisting impairment of ventricular function.
Cardizem Potential nursing considerations
Decreases in blood pressure associated with diltiazem therapy may occasionally result in symptomatic hypotension (low blood pressure).
Cardizem Potential nursing considerations
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.
Cardizem Potential nursing considerations
Coadministration of diltiazem with rifampin or any known CYP 3A4 inducer should be avoided when possible, and alternative therapy considered.
Cardizem Patient/Family Teaching
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.
Cardizem Patient/Family Teaching
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.
Cardizem Patient/Family Teaching:
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.
Cardizem Patient/Family Teaching:
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.
Cardizem Patient/Family Teaching:
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
Lovenox Class
anticoagulant (blood thinner)
Lovenox Generic Name
enoxaparin sodium injection
Lovenox Forms
Injectable
Lovenox Gen Use
prevent blood clot formation
Lovenox Contraindications
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.
Lovenox Interactions
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).
Lovenox Interactions
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.
Lovenox Nursing Considerations
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.
Lovenox Nursing Considerations
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).
Lovenox Nursing Considerations
Lovenox injection should not be mixed with other injections or infusions.
Lovenox Nursing Considerations
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).
Lovenox Nursing Considerations
Major hemorrhages including retroperitoneal and intercranial bleeding have been reported. Some of these cases have been fatal.
Lovenox Nursing Considerations
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.
Lovenox Nursing Considerations
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.
Lovenox Nursing Considerations
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.
Lovenox Nursing Considerations
Low weight patients (women < 45 kg) and low weight men (< 57 kg) should be observed carefully for signs and symptoms of bleeding.
Lovenox Nursing Considerations
Periodic complete blood counts, including platelet count, and stool occult blood tests are recommended during the course of treatment with Lovenox Injection.
Lovenox Nursing Considerations
All patients receiving anticoagulants such as enoxaparin, including pregnant women, are at risk for bleeding.
Lovenox Nursing Considerations
Caution should be exercised when Lovenox Injection is administered to nursing women. It is not known whether this drug is excreted in human milk.
Lovenox Nursing Considerations
Geriatric patients with low body weight (<45 kg) and those predisposed to decreased renal function should be closely monitored.
Lovenox Nursing Considerations
Safety and effectiveness of Lovenox Injection in pediatric patients have not been established
Lovenox Patient/Family Teaching
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.
Lovenox Patient/Family Teaching
Do not inject this medication intramuscularly (into the muscle) or intravenously (into the vein).
Lovenox Patient/Family Teaching
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.
Protonix Class
proton pump inhibitor (decreases the amount of acid produced in the stomach)
Protonix Generic Name
Pantoprazole
Protonix Forms
Injectable and tablets
Lovenox Nursing Considerations
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.
Lovenox Nursing Considerations
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.
Lovenox Nursing Considerations
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.
Lovenox Nursing Considerations
Low weight patients (women < 45 kg) and low weight men (< 57 kg) should be observed carefully for signs and symptoms of bleeding.
Lovenox Nursing Considerations
Periodic complete blood counts, including platelet count, and stool occult blood tests are recommended during the course of treatment with Lovenox Injection.
Lovenox Nursing Considerations
All patients receiving anticoagulants such as enoxaparin, including pregnant women, are at risk for bleeding.
Lovenox Nursing Considerations
Caution should be exercised when Lovenox Injection is administered to nursing women. It is not known whether this drug is excreted in human milk.
Lovenox Nursing Considerations
Geriatric patients with low body weight (<45 kg) and those predisposed to decreased renal function should be closely monitored.
Lovenox Nursing Considerations
Safety and effectiveness of Lovenox Injection in pediatric patients have not been established
Lovenox Patient/Family Teaching
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.
Lovenox Patient/Family Teaching
Do not inject this medication intramuscularly (into the muscle) or intravenously (into the vein).
Lovenox Patient/Family Teaching
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.
Protonix Class
proton pump inhibitor (decreases the amount of acid produced in the stomach)
Protonix Generic Name
Pantoprazole
Protonix Forms
Injectable and tablets
Protonix Gen use
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
Protonix Contraindications
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
Protonix Interactions
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.
Protonix Nursing Considerations
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.
Protonix Pat/Fam Teaching
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.
Haldol Drug Class
Tranquilizers
Haldol Generic Name
Haloperidol
Haldol Forms
It is available in sesame oil in sterile form for intramuscular (IM) injection.
Haldol Gen Use
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.
Haldol Contraindications
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.
Haldol Interactions
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.
Haldol Nursing Considerations
Careful monitoring of clinical status is warranted when rifampin is administered or discontinued in haloperidol-treated patients.
Haldol Nursing Considerations
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.
Haldol Nursing Considerations
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.
Haldol Nursing Considerations
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.
Haldol Nursing Considerations
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.
Haldol Pat/Fam Teaching
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).
Morphine Drug Class
Opiate Agonists
Morphine Generic Name
Morphine
Morphine Forms
controlled-release tablets (15 mg 30 mg 60 mg 100 mg 200 mg)
Morphine Gen use
Used to treat moderate to severe pain
Morphine Contraindications
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.
Morphine Interactions
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.
Morphine Nursing Considerations
MS CONTIN may cause severe hypotension in an individual whose ability to maintain his blood pressure has already been compromised.
Morphine Nursing Considerations
MS CONTIN may produce a temporary lowering of blood pressure (hypotension) due usually to suddenly standing up in ambulatory patients.
Morphine Nursing Considerations
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.
Morphine Nursing Considerations
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.
Morphine Nursing Considerations
Morphine can produce drug dependence and has a potential for being abused.
Morphine Nursing Considerations
Although extremely rare, cases of allergic reaction have been reported.
Morphine Nursing Considerations
Morphine produces effects which may obscure neurologic signs of further increases in pressure in patients with head injuries
Morphine Nursing Considerations
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.
Morphine Nursing Considerations
Use of MS CONTIN has not been evaluated systematically in children
Morphine Fam/Pat Teaching
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.
Morphine Fam/Pat Teaching
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.
Morphine Fam/Pat Teaching
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.
Morphine Fam/Pat Teaching
For women of childbearing potential who become or are planning to become pregnant, a physician should be consulted regarding analgesics and other drug use.
Morphine Fam/Pat Teaching
Upon completion of therapy, it may be appropriate to taper the morphine dose, rather than abruptly discontinue it.
Morphine Fam/Pat Teaching
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.
Morphine Fam/Pat Teaching
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.
Potassium Chloride Drug Class
Oral Potassium Supplements (TPD Category IV)
Potassium Chloride Generic Name
Potassium Chloride
Potassium Chloride Forms
Extended-release tablets (also liquid available)
Potassium Chloride Gen Use
Potassium Chloride is used for treating or preventing low potassium blood levels when the amount of potassium in the diet is inadequate.
Potassium Chloride Contraindications
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.
Potassium Chloride Contraindications
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.
Potassium Chloride Contraindications
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.
Potassium Chloride Contraindications
Safety and effectiveness in pediatric patients have not been established.
Potassium Chloride Interactions
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.
Potassium Chloride Interactions
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.
Potassium Chloride Interactions
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.
Potassium Chloride Nursing Considerations
Potassium supplements should be given to patients receiving ACE inhibitors only with close monitoring.
Potassium Chloride Nursing Considerations
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.
Potassium Chloride Nursing Considerations
Solid oral dosage forms of potassium chloride can produce ulcerative and/or narrow lesions of the intestines.
Potassium Chloride Nursing Considerations
According to reports, enteric coated preparations of potassium chloride are associated with an increased frequency of small bowel lesions.
Potassium Chloride Nursing Considerations
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.
Potassium Chloride Nursing Considerations
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.
Potassium Chloride Nursing Considerations
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.
Potassium Chloride Nursing Considerations
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.
Potassium Chloride Pat/Fam Teaching
Take Potassium chloride with meals and with a full glass of water or some other liquid.
Potassium Chloride Pat/Fam Teaching
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.
Potassium Chloride Pat/Fam Teaching
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.
Potassium Chloride Pat/Fam Teaching
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.
Potassium Chloride Pat/Fam Teaching
--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.
Potassium Chloride Pat/Fam Teaching
Check with the physician at once if tarry stools or other evidence of gastrointestinal bleeding is noticed.
Potassium Chloride Pat/Fam Teaching
Store at room temperature in a tightly closed container.
Vicodin Drug Class
Opiod Analgesic and antitussive, and is a Schedule III controlled substance
Vicodin Generic Name
acetaminophen and hydrocodone bitartrate
Vicodin Forms
Hydrocodone bitartrate and acetaminophen is supplied in tablet form for oral administration
Vicodin Gen Use
Pain reliever; the combination of acetaminophen and hydrocodone is used to relieve moderate to severe pain.
Vicodin Contraindications
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).
Vicodin Contraindications
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.
Vicodin Interactions
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.
Vicodin Interactions
The use of MAO inhibitors or tricyclic antidepressants with hydrocodone preparations may increase the effect of either the antidepressant or hydrocodone.
Vicodin Nursing Considerations
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.
Vicodin Nursing Considerations
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.
Vicodin Nursing Considerations
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.
Vicodin Nursing Considerations
The administration of narcotics may obscure the diagnosis or clinical course of patients with acute abdominal conditions.
Vicodin Nursing Considerations
Opioid agonists have the potential for being abused and are sought by abusers and addicts.
Vicodin Pat/Fam Teaching
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.
Vicodin Pat/Fam Teaching
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.
Vicodin Pat/Fam Teaching
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.
Vicodin Pat/Fam Teaching
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.
Vicodin Pat/Fam Teaching
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.
Vicodin Pat/Fam Teaching
Never take more Vicodin than is prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.
Vicodin Pat/Fam Teaching
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.
Vicodin Pat/Fam Teaching
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.
Vicodin Pat/Fam Teaching
Do not use this medication without telling your doctor if you are breast-feeding a baby.