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How should the NSAID (COX-2 inhibitor) celecoxib (Celebrex) be given?
- Give 2 hr before or after magnesium- or aluminum-based antacids.
- Monitor for initial and continued therapeutic effects.
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How should the opioid antagonist drug naloxone (Narcan) be given?
- Give IM, IV, or subcutaneous.
- Titrate doses carefully.
- Monitor vital signs.
- Be aware that the drug might increase pain by reducing opioid effects and precipitate acute withdrawal for a patient who is opioid-dependent.
- Prepare to give every 2 to 3 min until reversal of undesirable effects.
- Prepare to begin administration again as the effects of opioids might persist beyond the effects of the reversal agent.
- Observe for nausea, vomiting, tachycardia, and diaphoresis (indications of opioid reversal).
- Give naloxone (Narcan) to reverse effects.
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How should the NSAIDs (COX-1 and COX-2 inhibitors) aspirin/acetylsalicylic acid (Aspirin) and ibuprofen (Advil, Motrin) be given?
- Make sure a patient swallows enteric-coated or sustained-release forms whole and does not crush or chew them.
- Discontinue 1 week before scheduled surgery.
- Monitor for initial and continued therapeutic effects.
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How should the opioid agonist-antagonist drugs butorphanol (Stadol) and pentazocine (Talwin) be given?
- Give butorphanol IM, IV, or intranasally, and pentazocine orally.
- Measure baseline vital signs before administration, and monitor throughout therapy. Do not give the drug if the respirations are slower than 12/min.
- Have naloxone (Narcan) and resuscitation equipment available.
- For intranasal administration, give one spray, and repeat every 60 to 90 min as needed.
- For preoperative IM administration, give 60 to 90 min before surgery.
- Monitor therapeutic effects.
- Do not discontinue the drug abruptly.
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How should the glucocorticoid drug prednisone (Deltasone) be given?
- Give orally, IV, IM, subcutaneous, topically, intranasally, or by inhalation, depending on the indication.
- For long-term use (10 days or more), take in the morning using alternate-day dosing.
- Taper the dose slowly when symptoms are controlled to establish the lowest possible oral dose.
- For short-term oral use, give the largest dose on the first day with progressively smaller doses during the next eight days.
- Give supplemental doses as needed in times of stress.
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How should the opioid agonist drugs morphine and meperidine (Demerol) be given?
- Measure baseline vital signs before administration, and monitor throughout therapy.
- Give orally, IM, IV, subcutaneous, rectally, or epidurally.
- Make sure a patient swallows sustained-release forms whole and does not crush or chew them.
- Administer IV opioids slowly and with recommended dilution over 4 to 5 min; have naloxone (Narcan) and resuscitation equipment available.
- Monitor PCA use and pump settings carefully.
- Give to patients with cancer on a fixed, around-the-clock dosing schedule, not PRN.
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How should the centrally acting nonopioid drug tramadol (Ultram) be given?
- Tell patient that it takes 1 hr for the analgesic effect to begin.
- Make sure a patient swallows the extended-release form whole and does not crush or chew it.
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How should the uricosuric drug allopurinol (Zyloprim) be given?
- Give orally or intravenously.
- Monitor uric acid levels (initially, every 1 to 2 weeks to establish the appropriate dosage).
- Obtain baseline CBC and test liver and kidney function before therapy, and monitor periodically thereafter.
- Allow crushing tablets and mixing them with food or fluid.
- Give intravenously using recommended dilution, and infuse over 30 to 60 min.
- Make sure a patient drinks at least 3 L of fluid per day.
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How should the drug acetaminophen (Tylenol) be given?
- Give orally or rectally every 6 hr.
- Maximum daily dose is 3 g a day for an adult patient.
- Use manufacturer's age-adjusted doses for an infant or child patient.
- The drug is available in more than 600 over-the-counter (OTC) and prescription preparations.
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