Ativan PO pg 799
- For: Anxiety disorder, sedation
- Interact: Additive CNS depression (alcohol, antihistamine,opioid analgesics)
Tagamet PO (cimetidine) pg. 661
- *Increase risk of toxicity with Coumadin (Warfarin)*
- For: Healing and prevention of ulcers. Decrease GERD symptoms, Decrease secretion of gastric acid.
- Assess for epigastric or abdominal pain, frank/occult blood stools, emesis, gastric aspirate.
- Check CBC w/ diff for anemia, agranolocytosis.
- Administer with meals or at bedtime to prolong effect (one dose/day=hs).
Vicodine pg. 675
- Reduce moderate-severe pain.
- Assess pain level
- Don’t use with MAOI (Marplan, Parnate)
Too much Tylenol/day
Coumadin (Warfarin) pg 1295
- Prevention of thromboembolic events, blood clots, MI
- *Check PT (1.3-1.5 % of normal) & INR (2.5-3.5 recommended for therapeutic effect)*
- Heparin may effect PT, INR but Coumadin PO takes 3-5 days to reach effective level, usually begun still on Heparin.
- Contraindicated: active ulcer disease, bleeding issues
- Limit foods high in vitamin K, cranberry juice/products, IM meds, activities that could lead to bleeding, NSAIDs. Use soft toothbrush.
Foods High in Vitamin K
- Brussels Sprouts
- Non-Steroidal Anti-Inflammatory Drugs
Mylanta pg. 803
- Use: Neutralization of gastric acid w/ healing of ulcers and decrease in associated pain.
- Don’t take within 2 hrs of other meds
Nitro Paste pg 929
- Use: Relief/prevention of anginal attacks. Increase cardiac output. Reduction in BP
- *Monitor BP before and after *
- Use gloves
- Rotate location of topical site
Stadole IM pg 257
- Use: Decrease the severity of pain moderate-severe. Used in labor, sedation before surgry
- *assess pain prior to administration*
- Rotate sites of injection
Promethazine IM (Phenergan) pg. 1061
- Use: Treatment of allergic conditions, motion sickness, sedation, anti-nausea/vomiting
- Can cause CNS depression
- Monitor for EPS
- IM: Administer deep into well developed muscle. (Can cause severe tissue necrosis)
Lovenox SQ (Enoxaparin) pg. 657
- Prevention of thrombus formation
- Assess for signs of bleeding/hemorrhage
- SQ: Observe injection sites for hematomas, ecchymosis, or inflammation.
- Administer deep into subcutaneous tissue. Inject in abdomen (rotate sides, stay at least 1” away from belly button). Pinch/bunch skin with thumb and forefinger.
Meperdine IM (Demerol) pg. 820
- Used for relief of moderate-severe pain.
- Assess pain level
- Can cause seizers, CNS depression.
- Do not use with MAOIs
- Check respirations and bowel function
Hydroxyzine IM pg. 682
- Sedation, relief of anxiety, decrease nausea/vomiting, decrease allergic symptoms associated with the release of histamine.
- Do not use with pregnant women, causes CNS depression, increased fall risk.
- Assess patient for level of sedation
- *Use the Z-track, deep into well developed muscle. Do not use deltoid site, extremely painful shot.*
Heparin SQ pg. 654
- Prevention of thrombus formation. Prevent extension of existing thrombi
- Assess for uncontrolled bleeding, open wounds, hypertension
- Avoid NSAIDs
- Monitor platelet count every 2-3 days.
Assessing pain level
- Site- Where is the pain?
- Onset- When did the pain start, and was it sudden or gradual?
- Character- What is the pain like? An ache? Stabbing?
- Radiation- Does the pain radiate anywhere?
- Associations- Any other s/s associated with the pain?
- Time course - Does the pain follow any pattern?
- Exacerbating/Relievingfactors - Does anything change the pain?
- Severity- How bad is the pain?