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By: L. Stan, MD
Deputy Director, Kaiser Permanente School of Medicine
Vag: Instruct patient not to use vaginal gel concurrently with other vaginal agents medications you cant take while breastfeeding actonel 35mg with mastercard. If these agents must be used concurrently medications 377 discount actonel 35 mg without prescription, administer at least 6 hr before or after vaginal gel. Small, white globules may appear as a vaginal discharge possibly due to gel accumulation, even several days after use. Has inhibitory effect on the chemoreceptor trigger zone in the medulla, resulting in antiemetic properties. Therapeutic Effects: Relief of symptoms of histamine excess usually seen in allergic conditions. Distribution: Widely distributed; crosses the bloodbrain barrier and the placenta. Neuroleptic malignant syndrome can occur when used concurrently with antipsychotics. Additive anticholinergic effects with other drugs possessing anticholinergic properties, including other antihistamines, antidepressants, atropine, haloperidol, other phenothiazines, quinidine, and disopyramide. Potential Nursing Diagnoses Deficient fluid volume (Indications) Risk for injury (Side Effects) Availability (generic available) Tablets: 12. In combination with: codeine, dextromethorphan, and/or phenylephrine in a variety of cough and cold preparations. Tablets may be crushed and mixed with food or fluids for patients with difficulty swallowing. Subcut or inadvertent intra-arterial administration may cause severe tissue necrosis. 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). Geri: Assess for adverse anticholinergic effects (delirium, acute confusion, dizziness, dry mouth, blurred vision, urinary retention, constipation, tachycardia). Allergy: Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically throughout course of therapy. Antiemetic: Assess patient for nausea and vomiting before and after administration. Lab Test Considerations: May cause false-positive or false-negative pregnancy test results. Y-Site Compatibility: alemtuzumab, alfentanil, amifostine, amikacin, amsacrine, anidulafungin, ascorbic acid, atropine, benztropine, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, caspofungin, ceftaroline, ciprofloxacin, cisatracurium, cisplatin, cladribine, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxorubicin, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, gemcitabine, gentamicin, glycopyrrolate, granisetron, hydromorphone, ifosfamide, insulin, irinotecan, isoproterenol, ketamine, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitoxantrone, morphine, mycophenolate, nalbuphine, naloxone, nitroglycerin, norepi- P Canadian drug name. Y-Site Incompatibility: acyclovir, aldesleukin, allopurinol, aminophylline, amphotericin B cholesteryl, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, azathioprine, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, clindamycin, dantrolene, dexamethasone, diazepam, diazoxide, doxorubicin liposome, ertapenem, fluorouracil, folic acid, foscarnet, furosemide, ganciclovir, heparin, indomethacin, ketorolac, methylprednisolone, nafcillin, nitroprusside, oxacillin, pantoprazole, penicillin G, pentobarbital, phenobarbital, phenytoin, piperacillin/tazobactam, sodium bicarbonate, streptokinase, trimethoprim/sulfamethoxazole. Maintenance of balanced anesthesia when used with other agents in children 2 mo and adults. Pedi: Caution caregivers to use only the measuring device accompanying the liquid medication and not to use household measuring devices. Instruct patient to notify health care professional if sore throat, fever, jaundice, or uncontrolled movements are noted. Maintenance- 20% less than the usual adult infusion dose; rapid/repeated bolus dosing should be avoided. Propofol should be used only by individuals experienced in endotracheal intubation, and equipment for this procedure should be readily available. Assess level of sedation and level of consciousness throughout and following administration. Abrupt discontinuation may cause rapid awakening with anxiety, agitation, and resistance to mechanical ventilation. Monitor for propofol infusion syndrome (severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal failure).
Instruct patient using powder for inhalation never to exhale into diskus device and always to hold device in a level horizontal position medications i can take while pregnant buy 35mg actonel with mastercard. A rapid-acting inhaled beta-adrenergic bronchodilator should be used for relief of acute asthma attacks medicinenetcom medications order genuine actonel online. Advise patients on chronic therapy not to use additional salmeterol to prevent exercise-induced bronchospasm. Patients using salmeterol for prevention of exercise-induced bronchospasm should not use additional doses of salmeterol for 12 hr after prophylactic administration. Advise patient to notify health care professional immediately if difficulty in breathing persists after use of salmeterol, if condition worsens, if more inhalations of rapid-acting bronchodilator than usual are needed to relieve an acute attack, or if using 4 or more inhalations of a rapid-acting bronchodilator for 2 or more consecutive days or more than 1 canister in an 8-wk period. Salmeterol is often used with inhaled corticosteroids and is not a substitute for corticosteroids or adrenergic bronchodilators. Advise patients using inhalation or systemic corticosteroids to consult health care professional before stopping or reducing therapy. Emphasize the importance of regular follow-up exams to determine progress during therapy. Evaluation/Desired Outcomes Prevention of bronchospasm or reduction of fre- quency of acute asthma attacks in patients with chronic asthma. Interactions Drug-Drug: Lithium or corticosteroids may potentiate myeloproliferative effects of sargramostim (concurrent use should be undertaken cautiously). Therapeutic Effects: Accelerated recovery of bone marrow after autologous bone marrow transplantation, resulting in decreased risk of infection and other complications. Capillary leak syndrome (swelling of feet or lower legs, sudden weight Canadian drug name. Does not recur with first dose of each course but may occur with first dose of more than 1 course. Usually mild and dose-related and resolves with discontinuation or administration of antipyretics. Assess for arthralgias and myalgias, usually in lower extremities, which tend to occur when granulocyte counts are returning to normal. Monitor renal and hepatic function before and biweekly throughout therapy in patients with renal or hepatic dysfunction. After bone marrow transplantation or failure of engraftment: Administer over 2 hr. Y-Site Compatibility: amikacin, aminocaproic Potential Nursing Diagnoses Risk for infection (Indications) acid, aminophylline, aztreonam, bleomycin, butorphanol, calcium gluconate, carboplatin, carmustine, cefazolin, cefepime, cefotaxime, cefotetan, ceftriaxone, cefuroxime, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, dexamethasone sodium phosphate, diphenhydramine, dopamine, doxorubicin hydrochloride, doxycycline, droperidol, etoposide, famotidine, fentanyl, floxuridine, fluconazole, fluorouracil, furosemide, gentamicin, granisetron, heparin, idarubicin, ifosfamide, immune globulin, levofloxacin, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methotrexate, metoclopramide, metronidazole, mitoxantrone, pentostatin, piperacillin/tazobactam, potassium chloride, prochlorperazine, promethazine, ranitidine, rituximab, sodium acetate, teniposide, trastuzumab, trimethoprim/sulfamethoxazole, vinblastine, vincristine, zidovudine. Y-Site Incompatibility: acyclovir, ampicillin, ampicillin/sulbactam, chlorpromazine, ganciclovir, haloperidol, hydrocortisone, hydromorphone, hydroxyzine, imipenem/cilastatin, lorazepam, methylprednisolone sodium succinate, mitomycin, morphine, nalbuphine, nesiritide, ondansetron, sodium bicarbonate, tobramycin. Refrigerate but do not freeze powder, reconstituted solution, or diluted solution. Reconstitute with 1 mL of sterile water without preservatives injected toward side of vial. Concentration: If final concentration is 10 mcg/mL, add 1 mg human albumin per 1 mL of 0. Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to the back) during therapy. If pancreatitis occurs, discontinue saxagliptin and monitor serum and urine amylase, amylase/creatinine clearance ratio, electrolytes, serum calcium, glucose, and lipase. Potential Nursing Diagnoses Imbalanced nutrition: more than body requirements (Indications) Noncompliance (Patient/Family Teaching) Blood levels. Contraindications/Precautions Contraindicated in: Type 1 diabetes; Diabetic ke- Implementation Patients stabilized on a diabetic regimen who are ex- S posed to stress, fever, trauma, infection, or surgery may require administration of insulin.
If skin lesions are present treatment zone guiseley discount 35 mg actonel otc, inform patient that le- currently administered tamoxifen symptoms narcissistic personality disorder purchase 35mg actonel with amex. Mayqthe anticoagulant effect of war- sions may temporarily increase in size and number and may have increased erythema. Instruct patient to notify health care professional promptly if pain or swelling of legs, shortness of breath, weakness, sleepiness, confusion, nausea, vomiting, weight gain, dizziness, headache, loss of appetite, or blurred vision occurs. Patient should also report menstrual irregularities, vaginal bleeding, pelvic pain or pressure. Advise patient to use a nonhormonal method of contraception during and for 1 mo after the therapy. Interactions Drug-Drug: Cimetidine mayqblood levels and the Evaluation/Desired Outcomes Decrease in the size or spread of breast cancer. Action Decreases contractions in smooth muscle of the prostatic capsule by preferentially binding to alpha1-adrenergic receptors. Therapeutic Effects: Decreased symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia). Observe patient closely during this period and take precautions to prevent injury. Monitor intake and output ratios and daily weight, and assess for edema daily, especially at beginning of therapy. Rectal exams prior to and periodically throughout therapy to assess prostate size are recommended. Metabolism and Excretion: Extensively metabolized by the liver; 10% excreted unchanged in urine. Contraindications/Precautions Contraindicated in: Hypersensitivity; Significant Indications Management of moderate to severe pain. Diabetic pain associated with diabetic peripheral neuropathy in patients requiring around-the-clock opioid analgesia for an extended time. Metabolism and Excretion: Undergoes extensive first-pass hepatic metabolism (97%); metabolites have no analgesic activity; metabolized drug is 99% renally excreted. Route/Dosage When switching from immediate-release to extended-release product, the same total daily dose can be used. If pain control is not achieved within first hour of first dose, additional dose may be given. Implementation Initial immediate-release dose of 50 mg, 75 mg, or Availability Immediate-release tablets: 50 mg, 75 mg, 100 mg. Second dose may be administered as soon as 1 hr after first dose if adequate pain relief is not obtained with first dose. Monitor for respiratory depression especially during initial dosing and with patients at increased risk. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. Most patients who receive tapentadol for pain do not develop psychological dependence. Abuse or misuse of extended-release preparations by crushing, chewing, snorting, or injecting dissolved product will result in uncontrolled delivery of tapentatol and can result in overdose and death. Patient/Family Teaching Instruct patient on how and when to ask for and take pain medication and to take tapentadol as directed; do not adjust dose without consulting health care professional. Do not stop abruptly; may cause withdrawal symptoms (anxiety, sweating, insomina, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, hallucinations). Advise patient to read the Medication Guide prior to taking tapentadol and with each Rx refill, in case of changes. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed; may be dangerous. Stop taking tapentadol and notify health care professional immediately if seizures occur.
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