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266 Cards in this Set
- Front
- Back
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Levofloxacin--IV
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rapid
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IV (Adults ): Most infections--400 mg q 12 hr. Urinary tract infections--200 mg q 12 hr.Inhalational anthrax (post exposure)--400 mg q 12 hr for 60 days
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IV (Children ): Inhalational anthrax (post exposure)--10 mg/kg q 12 hr for 60 days (not to exceed 400 mg/dose); complicated urinary tract infections in children 1-17 yr--6-10 mg/kg every 8 hr for 10-21 days (not to exceed 400 mg/dose)
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PO, IV (Adults ): 250-750 mg q 24 hr; inhalational anthrax (post-exposure)--500 mg daily for 60 days
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PO, IV (Adults ): Most Infections:--CCr 20-49 ml/min--500 mg initially then 250 mg q 24 hr; CCr 10-19 ml/min--500 mg initially then 250 mg q 48 hr. Urinary tract infections:--CCr 10-19 ml/min--250 mg q 48 hr
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Lab Test Considerations: Fluoroquinolones may cause ↑ serum AST, ALT, LDH, bilirubin, and alkaline phosphatase
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○
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May also cause ↓ WBC; ↑ or ↓ serum glucose; and glucosuria, hematuria, proteinuria, and albuminuria
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Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction. Patients taking gemifloxacinwho are at greater risk for rash are those receiving gemifloxacin for >7 days, <40 yrs of age, females, and postmenopausal females receiving hormone replacement therapy
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ROUTE
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ONSET
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IM
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rapid
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IV
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rapid
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•
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Hypersensitivity to cephalosporins
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Serious hypersensitivity to penicillins
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Hyperbilirubinemic neonates (may lead to kernicterus)
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Combined severe hepatic and renal impairment (dosage reduction/increased dosing interval recommended)
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History of GI disease, especially colitis
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Pregnancy and lactation
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Probenecid decreases excretion and increases levels
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Pedi: Assess newborns for jaundice and hyperbilirubinemia; can increase bilirubinemia and should not be administered to jaundiced neonates, especially premature neonates
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Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction
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Lab Test Considerations: May cause positive results for Coombs' test
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○
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May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine
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May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, lymphocytosis, and thrombocytosis
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IM: Reconstitute IM doses with sterile water for injection, or 0.9% NaCl for injection. May be diluted with lidocaine to minimize injection discomfort
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Inject deep into a well-developed muscle mass; massage well
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IV: Monitor injection site frequently for phlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis
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○
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If aminoglycosides are administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush lines between medications
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Intermittent Infusion: Reconstitute each 250-mg vial with 2.4 ml, each 500-mg vial with 4.8 ml, each 1-g vial with 9.6 ml, and each 2-g vial with 19.2 ml of sterile water for injection, 0.9% NaCl, or D5W for a concentration of 100 mg/ml. Solution should be further diluted in 50-100 ml of 0.9% NaCl, D5W, D10W, D5/0.45% NaCl, or D5/0.9% NaCl. Solution may appear light yellow to amber. Solution is stable for 3 days at room temperature Rate: Administer over 30 min
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Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy
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Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional
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ROUTE
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ONSET
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IM
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rapid
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IV
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rapid
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Hypersensitivity to penicillins, betalactams, cephalosporins, or tazobactam (cross-sensitivity may occur)
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Renal impairment (dosage reduction or increased interval recommended if CCr <40 ml/min)
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Sodium restriction
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OB: Pregnancy and lactation (safety not established)
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IM, IV (Adults ): Most infections--3-4 g q 4-6 hr (up to 24 g/day). Complicated urinary tract infections--3-4 g q 6-8 hr. Uncomplicated urinary tract infections--1.5-2 g q 6 hr or 3-4 g q 12 hr
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IM, IV (Neonates >2 kg): Meningitis--50 mg/kg q 8 hr for the first 7 days of life, then 50 mg/kg q 6 hr
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IM, IV (Neonates <2 kg): Meningitis--50 mg/kg q 12 hr for the first 7 days of life, then 50 mg/kg q 8 hr
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IM, IV (Adults ): CCr 20-40 ml/min--3-4 g q 8 hr; CCr <20 ml/min--3- 4 g q 12 hr
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IV (Adults ): 3.375-4.5 g q 6 hr
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IV (Adults ): CCr 20-40 ml/min--2.25-3.375 g q 6 hr; CCr <20 ml/min--2.25 g q 6-8 hr
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Do not confuse Zosyn (piperacillin/tazobactam) with Zofran (ondansetron)
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IM: To constitute, add 4 ml of sterile water, bacteriostatic water, 0.9% NaCl for injection, or 0.5 or 1% lidocaine (without epinephrine) to each 2-g vial, 6 ml to each 3-g vial, and 8 ml to each 4-g vial for a concentration of 1g/2.5 ml
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IV: Reconstitute with at least 5 ml of sterile water for injection, 0.9% NaCl, or bacteriostatic water. Shake well until dissolved. Solution is stable for 24 hr at room temperature and 7 days if refrigerated
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○
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Change IV sites every 48 hr to prevent phlebitis
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Direct IV: Inject slowly, over 3-5 min, to minimize vein irritation
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Intermittent Infusion: Dilute in at least 50 ml of 0.9% NaCl, D5W, D5/0.9% NaCl, or LR Rate: Administer over 20-30 min for adults and 30 min for children
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Intermittent Infusion: Reconstitute with 5 ml of 0.9% NaCl, sterile or bacteriostatic water for injection, or D5W. Do not use LR--incompatible. Shake well until dissolved. Dilute further in at least 50 ml of diluent. Discard any unused solution after 24 hr at room temperature or 48 hr if refrigerated Rate: Administer over at least 30 min
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Advise patient to report signs of superinfection (black furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy
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Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication
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Therapeutic Effects:
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○
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Sedation
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○
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Decreased anxiety
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○
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Decreased seizures
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ROUTE
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ONSET
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PO
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15-60 min
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IM
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30-60 min
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IV
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15-30 min
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Hypersensitivity
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Cross-sensitivity with other benzodiazepines may exist
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Comatose patients or those with pre-existing CNS depression
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Uncontrolled severe pain
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Narrow-angle glaucoma
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Severe hypotension
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OB: Use in pregnancy and lactation may cause CNS depression, flaccidity, feeding difficulties, hypothermia, and respiratory problems in the neonate
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Severe hepatic/renal/pulmonary impairment
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Myasthenia gravis
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History of suicide attempt or drug abuse
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Geri: Lower doses recommended for geriatric or debilitated patients
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Pedi: Use cautiously in children under 12 yr. In ↑ doses, benzyl alcohol in injection may cause potentially fatal "gasping syndrome" in neonates
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Hypnotic use should be short-term
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Additive CNS depression with other CNS depressants including alcohol, antihistamines , antidepressants , opioid analgesics , and other sedative/hypnotics including other benzodiazepines
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Concomitant use of kava, valerian or, chamomile can increase CNS depression
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IV (Adults (not to exceed 2 mg) Anxiety
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Status Epilepticus:
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Lab Test Considerations: Patients on high-dose therapy should receive routine evaluation of renal, hepatic, and hematologic function
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Severe pain
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Pulmonary edema
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Pain associated with
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ROUTE
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ONSET
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PO
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unknown
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PO-ER, SR
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unknown
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IM
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10-30 min
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Subcut
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20 min
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Rect
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unknown
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IV
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rapid
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Epidural
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6-30 min
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IT
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rapid (min)
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Hypersensitivity
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Some products contain tartrazine, bisulfites, or alcohol and should be avoided in patients with known hypersensitivity
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Head trauma
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Increased intracranial pressure
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Severe renal, hepatic, or pulmonary disease
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Hypothyroidism
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Adrenal insufficiency
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History of substance abuse
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Geri: Geriatric or debilitated patients (dosage reduction suggested)
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Undiagnosed abdominal pain
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Prostatic hypertrophy
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Patients undergoing procedures that rapidly decrease pain (cordotomy, radiation); long-acting agents should be discontinued 24 hr before and replaced with short-acting agents
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OB: Pregnancy or lactation (avoid chronic use; has been used during labor but may cause respiratory depression in the newborn)
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Pedi: Children <18 yr (epidural liposomal injection only-not recommended)
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Neonates and infants <3 mo (more susceptible to respiratory depression)
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Neonates (oral solution contains sodium benzoate which can cause potentially fatal gasping syndrome)
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Use with extreme cautionin patients receiving MAO inhibitors within 14 days prior (may result in unpredictable, severe reactions--↓ initial dose of morphine to 25% of usual dose)
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↑ CNS depression with alcohol, sedative/hypnotics, clomipramine , barbiturates , tricyclic antidepressants , and antihistamines
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Administration of partial-antagonist opioid analgesics may precipitate opioid withdrawal in physically dependent patients
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Buprenorphine , nalbuphine , butorphanol , or pentazocine may ↓ analgesia
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May ↑ the anticoagulant effect of warfarin
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Cimetidine ↓ metabolism and may ↑ effects
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Epidural test dose of lidocaine/epinephrine may alter release of liposomal injection
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Concomitant use of kava, valerian or chamomile can ↑ CNS depression
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High Alert: Do not confuse morphine with hydromorphone or meperidine--errors have resulted in death. Other errors associated with morphine include overdose and infusion pump miscalculations. Consider patients' previous analgesic use and current requirements, but clarify doses that greatly exceed normal range. Have second practitioner independently check original order, dose calculations and infusion pump settingsPedi: Use only preservative-free formulations in neonates, and for epidural and intrathecal routes in all patients. Medication errors with opioid analgesics are common in the pediatric population and include misinterpretation or miscalculation of dosages and use of inappropriate measuring devices
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Instruct patient how and when to ask for pain medication
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High Alert: Instruct family not to administer PCA doses to the sleeping patient. Overmedication, sedation, and respiratory depression can result
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May cause drowsiness or dizziness. Caution patient to call for assistance when ambulating or smoking and to avoid driving or other activities requiring alertness until response to medication is known
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ondansetron
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ondansetron
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Prevention of nausea and vomiting
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ROUTE
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ONSET
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PO, IV
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rapid
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IM
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rapid
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Hypersensitivity
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Orally disintegrating tablets contain aspartame and should not be used in patients with phenylketonuria
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Liver impairment (daily dose not to exceed 8 mg)
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Abdominal surgery (may mask ileus)
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OB: Pedi: Pregnancy, lactation, or children <3 yr (safety not established)
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May be affected by drugs altering the activity of liver enzymes
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PO, IM, IV (Adults ): Not to exceed 8 mg/day
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promethazine
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promethazine
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Alters the effects of dopamine in the CNS
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ROUTE
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ONSET
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PO, IM
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20 min
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Rectal
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20 min
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IV
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3-5 min
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Hypersensitivity
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Comatose patients
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Prostatic hypertrophy
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Bladder neck obstruction
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Some products contain alcohol or bisulfites and should be avoided in patients with known intolerance
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Narrow-angle glaucoma
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Pedi: Children <2 yr (may cause fatal respiratory depression)
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Hypertension
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Sleep apnea
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Epilepsy
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Underlying bone marrow depression
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Geri: Appears on Beers list. Geriatric patients are sensitive to anticholinergic effects and have increased risk for side effects
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Pedi: Use lowest effective dose, avoid concurrent respiratory depressants
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OB: Pregnancy (has been used safely during labor; avoid chronic use during pregnancy)
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Lactation: safety not established; may cause drowsiness in infant
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Additive CNS depression with other CNS depressants, including alcohol, other antihistamines , opioid analgesics , and other sedative/hypnotics
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Additive anticholinergic effects with otherdrugs possessing anticholinergic properties, including other antihistamines , antidepressants , atropine , haloperidol , other phenothiazines, quinidine , and disopyramide
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Concurrent use with MAO inhibitors may result in increased sedation and anticholinergic side effects
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Monitor blood pressure, pulse, and respiratory rate frequently in patients receiving IV doses
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Assess patient for level of sedation after administration. Risk of sedation and respiratory depression are increased when administered concurrently with other drugs that cause CNS depression
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Monitor patient for onset of extrapyramidal side effects (akathisia--restlessness; dystonia--muscle spasms and twisting motions; pseudoparkinsonism--mask-like face, rigidity, tremors, drooling, shuffling gait, dysphagia). Notify physician or other health care professional if these symptoms occur
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Geri:Assess for adverse anticholinergic effects (delirium, acute confusion, dizziness, dry mouth, blurred vision, urinary retention, constipation, tachycardia)
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Allergy: Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically throughout course of therapy
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Antiemetic: Assess patient for nausea and vomiting before and after administration
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Lab Test Considerations: May cause false-positive or false-negative pregnancy test results
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CBC should be evaluated periodically during chronic therapy; blood dyscrasias may occur
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May cause increased serum glucose
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May cause false-negative results in skin tests using allergen extracts. Promethazine should be discontinued 72 hr before the test
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When administering promethazine concurrently with opioid analgesics, supervise ambulation closely to prevent injury from increased sedation
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PO: Administer with food, water, or milk to minimize GI irritation. Tablets may be crushed and mixed with food or fluids for patients with difficulty swallowing
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IM: Administer deep into well-developed muscle. Subcut administration may cause tissue necrosis
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Direct IV: Doses should not exceed a concentration of 25 mg/ml. Slight yellow color does not alter potency. Do not use if precipitate is present Rate: Administer each 25 mg slowly, over at least 1 min. Rapid administration may produce a transient fall in
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Acts at many levels of the CNS to produce generalized CNS depression
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Effects may be mediated by GABA, an inhibitory neurotransmitter
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Therapeutic Effects:
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○
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Short-term sedation
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○
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Postoperative amnesia
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ROUTE
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ONSET
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IN
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5 min
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IM
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15 min
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IV
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1.5-5 min
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•
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Hypersensitivity
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Cross-sensitivity with other benzodiazepines may occur
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•
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Shock
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Comatose patients or those with pre-existing CNS depression
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Uncontrolled severe pain
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Products containing benzyl alcohol should not be used in neonates
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Pregnancy
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Acute narrow-angle glaucoma
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Pulmonary disease
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CHF
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•
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Renal impairment
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Severe hepatic impairment
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Obese pediatric patients (calculate dose on the basis of ideal body weight)
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Geriatric or debilitated patients (especially patients >70 yr) more susceptible to cardiorespiratory depressant effects; dosage reduction required
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Lactation (safety not established)
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↑ CNS depression with alcohol, antihistamines , opioid analgesics , and other sedative/hypnotics (↓ midazolam dose by 30-50% if used concurrently)
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↑ risk of hypotension with antihypertensives , opioid analgesics, acute ingestion of alcohol, or nitrates
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Midazolam is metabolized by the cytochrome P450 3A4 enzyme system; drugs that induce or inhibit this system may be expected to alter the effects of midazolam
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Carbamazepine , phenytoin , rifampin , rifabutin , and phenobarbital ↓ levels of midazolam
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The following agents ↓ midazolam metabolism and may ↑ its effects: erythromycin , cimetidine , ranitidine , diltiazem , verapamil , fluconazole , itraconazole , and ketoconazole
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Concomitant use of kava, valerian, or chamomile can ↑ CNS depression
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Long term use of St. John's wort may significantly decrease serum concentrations of oral midazolam
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Grapefruit juice ↓ metabolism and may ↑ effects of midazolam
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Assess level of sedation and level of consciousness throughout and for 2-6 hr following administration
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Monitor blood pressure, pulse, and respiration continuously during IV administration. Oxygen and resuscitative equipment should be immediately available
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Toxicity and Overdose: If overdose occurs, monitor pulse, respiration, and blood pressure continuously. Maintain patent airway and assist ventilation as needed. If hypotension occurs, treatment includes IV fluids, repositioning, and vasopressors
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○
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The effects of midazolam can be reversed with flumazenil (Romazicon)
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labetalol
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labetalol
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•
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Management of hypertension
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•
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Blocks stimulation of beta1 (myocardial)- and beta2 (pulmonary, vascular, and uterine)-adrenergic receptor sites
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Also has alpha1-adrenergic blocking activity, which may result in more orthostatic hypotension
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Therapeutic Effects:
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○
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Decreased blood pressure
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ROUTE
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ONSET
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PO
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20 min-2 hr
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IV
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2-5 min
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•
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Uncompensated CHF
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Pulmonary edema
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•
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Cardiogenic shock
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•
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Bradycardia or heart block
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•
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Renal impairment
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•
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Hepatic impairment
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•
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Geriatric patients (increased sensitivity to beta blockers; initial dosage reduction recommended)
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Pulmonary disease (including asthma)
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Diabetes mellitus (may mask signs of hypoglycemia)
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Thyrotoxicosis (may mask symptoms)
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Patients with a history of severe allergic reactions (intensity of reactions may be increased)
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Pregnancy, lactation, or children (safety not established; may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression)
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General anesthesia , IV, and verapamil may cause additive myocardial depression
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•
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Additive bradycardia may occur with digoxin
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•
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Additive hypotension may occur with other antihypertensives , acute ingestion of alcohol , or nitrates
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Concurrent thyroid administration may decrease effectiveness
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May alter the effectiveness of insulin or oral hypoglycemic agents (dosage adjustments may be necessary)
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•
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May decrease the effectiveness of adrenergic bronchodilators and theophylline
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•
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May decrease the beneficial beta cardiovascular effects of dopamine or dobutamine
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Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension)
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•
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Effects may be increased by propranolol or cimetidine
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•
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Concurrent NSAIDs may decrease antihypertensive action
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•
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PO (Adults ): 100 mg twice daily initially, may be increased by 100 mg twice daily q 2-3 days as needed (usual range 400-800 mg/day in 2-3 divided doses; doses up to 1.2-2.4 g/day have been used)
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•
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IV (Adults ): 20 mg (0.25 mg/kg) initially, additional doses of 40-80 mg may be given q 10 min as needed (not to exceed 300 mg total dose)or 2 mg/min infusion (range 50-300 mg total dose required)
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ketorolac
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ketorolac†
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ROUTE
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ONSET
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PO
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unknown
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IM, IV
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10 min
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•
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Hypersensitivity
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•
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Cross-sensitivity with other NSAIDs may exist
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•
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OB: Labor, delivery or lactation
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•
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Pre- or perioperative use
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•
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Known alcohol intolerance (injection only)
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•
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Peri-operative pain from coronary artery bypass graft (CABG) surgery
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•
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Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use)
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•
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History of GI bleeding
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|
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•
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Renal impairment (dosage reduction may be required)
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•
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Geri: Appears on Beers list. Geriatric patients have increased risk of GI bleeding
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|
|
•
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OB: Pedi: Pregnancy and children (use not recommended during 2nd half of pregnancy)
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|
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•
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Concurrent use with aspirin may ↓ effectiveness
|
|
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•
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↑ adverse GI effects with aspirin , other NSAIDs , potassium supplements , corticosteroids , or alcohol
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|
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•
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Chronic use with acetaminophen may ↑ risk of adverse renal reactions
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•
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May ↓ effectiveness of diuretics or antihypertensives
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|
•
|
May ↑ serum lithium levels and ↑ risk of toxicity
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|
|
•
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↑ risk of toxicity from methotrexate
|
|
|
•
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↑ risk of bleeding with cefotetan , cefoperazone , valproic acid , clopidogrel , ticlopidine , tirofiban , eptifibatide , thrombolytic agents , or anticoagulants
|
|
|
•
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↑ risk of adverse hematologic reactions with antineoplastics or radiation therapy
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|
|
•
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May ↑ risk of nephrotoxicity from cyclosporine
|
|
|
•
|
Probenecid ↑ ketorolac blood levels and the risk of adverse reactions (concurrent use should be avoided)
|
|
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•
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↑ bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng
|
|
|
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Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria
|
|
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•
|
Direct IV: Administer undiluted Rate: Administer over at least 15 sec
|
