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LPN Initial IV Push Medication List

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LPN Initial IV Push Medication List

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  1. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><AllResponses /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>255,255,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Red</insertObjectUsingColor><showResults>Yes</showResults><teamColors>Use PowerPoint Color Scheme</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>All Slides</showControlBar><defaultCorrectPointValue>0</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName></Settings> <?xml version="1.0"?><AllAnswers /> LPN Initial IV Push Medication List by Barbara Sherman, MSN, RN, RT-R January 2010

  2. Course Objectives: • To prepare LPNs for competent administration of medication via the intravenous route. • To ensure application of evidence-based practice in developing the individual practitioner’s role in administration of intravenous therapy.

  3. IV Medication Administration • The process of giving medication directly into a patient’s vein- includes giving the medication using a syringe via “the IV push method”. • Purpose to initiate a rapid systemic response to medication

  4. Rights to Drug Administration • Right patient • Right drug • Right dose • Right time • Right route of administration

  5. IV Medication Administration • Some IV push medications must be diluted before injection. • Drug delivery rate is critical in administration of IV medications. • The IV line must be flushed both before and after IV medication administration to avoid contact of incompatible solutions or medications.

  6. IV Medication Administration • The nurse must know the indications, actions, and adverse effects of the medication that is delivered.

  7. IV Medication Administration • Make sure IV fluids are compatible with the medication being administered via the IV. • After IV meds are administered, observe the patient for signs/symptoms of adverse or allergic reactions. • When using single dose ampules, use a filter needle to withdraw medication. • Wipe stoppers of medication vials with alcohol then draw up medication. • Check IV access site for patency, changes, and phlebitis prior to and after administering medication.

  8. IV Medication Administration • Possible complications include: • Infiltration (extravasation) • Tissue necrosis • Thrombophlebitis • Air embolism • Hypotension • Cardiac arrhythmia, cardiac arrest • Allergic reaction/anaphylaxis • Venous thrombosis • Pain at the IV site

  9. IV Delivery Methods • Peripheral IV (or saline lock)- lie within peripheral venous system, normally in vein in forearm or hand • Central venous access- have their tip in one of the major veins leading to the heart (the superior & inferior vena cava) • Non-tunneled catheters- ex. subclavians, cut-downs • PICC • Implanted devices & tunneled catheters

  10. IV Medication Dosage Calculations Order: Morphine sulfate 4 mg IV q3-4 hours prn chest pain Available: Morphine sulfate 10 mg per 1 ml How many mls do you administer? dose you want _________________ X number of mls it’s provided in amount you have Example: 4 mg ______ X 1 ml = 0.4 X 1 = 0.4 ml 10 mg

  11. Administering IV Medications Uses appropriate hand hygiene/gloves for prep & administration Preparing Injection Checks expiration date Compares medication with order Chooses appropriate supplies & equipment Checks label Calculates correct dose Identifies patient (barcoding) Explains procedure Asks about medication allergies Checks for compatibility of medication & IV fluid Provides information to patient about medication Selects appropriate site on IV port Cleanses site appropriately Injects at appropriate site on IV port Injects at appropriate rate Withdraws syringe appropriately from IV port Proper syringe disposal Observes patient for reaction Documents appropriately

  12. Benadryl Demerol Dilaudid Lasix Morphine Sulfate Narcan Protonix Stadol Talwin Toradol Zofran List of Medications:

  13. Benadryl – diphenhydramine hydrochloride • Class- antihistamine, antitussive, antiemetic, antivertigo agent, antidyskinetic • Action- interferes with histamine effects at histamine1-receptor sites, prevents but does not reverse histamine-mediated responses, possesses CNS depressant and anticholinergic properties • Indications- allergy symptoms caused by histamine release including anaphylaxis, seasonal & perennial allergic rhinitis & allergic dermatoses; nausea; vertigo; motion sickness; Parkinson’s disease; sedation; antipsychotic-induced dystonia • Contraindications- hypersensitivity to drug, alcohol intolerance, acute asthma attacks, MAO inhibitor use within the past 14 days, breastfeeding

  14. Benadryl, cont. Availability: • Capsules: 25 mg. 50 mg • Syrup/elixir: 12.5 mg/5 ml • Injection: 10 mg/ml, 50 mg/ml • Tablets: 25 mg, 50 mg • Chewables: 12.5 mg, 25 mg Dosage • Adults & children >12 y.o.: • 25-50 mg PO q4-6h • 10-50 mg IV or IM q2-3h (some pts may need up to 100 mg) • Don’t exceed 400 mg/day • Children 6-12 y.o.: • 12.5-25 mg PO q4-6h • 1.25 mg/kg IM or IV qid, don’t exceed 150 mg/day • Children 2-5 y.o.: • 6.25 mg PO q4-6h, don’t exceed 37.5 mg/day

  15. Benadryl, cont. • Use cautiously in severe hepatic disease, angle-closure glaucoma, seizure disorders, prostatic hypertrophy, elderly patients, pregnancy • Administration: • Administer 30 min. prior to activity for motion sickness • Give oral doses with food or milk to minimize GI effects • Check compatibility for IV use before mixing with other drugs • Inject IM dose deep into large muscle mass, rotate sites • Discontinue drug 4 days before allergy skin testing to avoid misleading results • Don’t exceed 25 mg/min during IV administration • Incompatible with allopurinol, amobarbital, amphotericin B, cefepime, dexamethasone, foscarnet, haloperidol lactate, pentobarbital, phenobarbital, phenytoin, thiopental • Adverse reactions: drowsiness, sedation, sleepiness, incoordination, dizziness, headache, seizures, confusion, tremor, nervousness, thickening of bronchial secretions, paradoxical stimulation especially in children, hypotension, palpitations, blurred vision, tinnitus, diarrhea, constipation, dry mouth, dysuria, urinary frequency or retention, photosensitivity, pain at IM injection site

  16. Benadryl, cont. • Interactions • Drug to drug: ↑CNS depression with antihistamines, opioids, sedative hypnotics; ↑anticholinergic effects with disopyramide, quinidine, tricyclic antidepressants, MAO inhibitors • Drug to diagnostics: false negative allergy tests, ↓ Hgb & platelets • Drug to herbs: ↑ CNS depression with chamomile, hops, kava, skullcap, valerian; ↑ anticholinergic effects with angel’s trumpet, jimson weed, scopolia • ↑ CNS depression in combination with alcohol

  17. Demerol- meperidine hydrochloride • Class- opioid, analgesic, adjunct to anesthesia • Action- binds to & depresses opiate receptors in spinal cord & CNS altering perception of and emotional response to pain • Indications- moderate to severe pain, pre-op sedation, analgesia during labor • Contraindications- hypersensitivity to drug or to bisulfites, MAO inhibitor use in past 14 days

  18. Demerol, cont. • Availability: • Injection- 10 mg/ml, 25 mg/ml, 50 mg/ml, 75 mg/ml, 100 mg/ml • Syrup- 50 mg/5 ml • Tablets- 50 mg, 100 mg • Dosages: Adults: 50-150 mg PO, IM, or SC q3-4h, 15-35 mg/hr as an IV cont. infusion Children: 1.1-2.2 mg/kg PO, IM, or SC q3-4h not to exceed 100 mg/dose • Use cautiously in head trauma, increased intracranial pressure, severe renal, hepatic, or pulmonary disease, hypothyroidism, adrenal insufficiency, extensive burns, alcoholism, undiagnosed abdominal pain or prostatic hyperplasia, elderly or debilitated patients, pregnant patients, labor, breastfeeding, children

  19. Demerol, cont. • Adverse reactions: confusion, sedation, dysphoria, euphoria, headache, floating feeling, hallucinations, unusual dreams, seizures, hypotension, bradycardia, cardiac arrest, shock, blurred vision, diplopia, miosis, nausea, vomiting, constipation, ileus, biliary tract spasms, urinary retention, respiratory depression, respiratory arrest, flushing, sweating, induration &/or pain at injection site, physical or psychological dependence, drug tolerance • Patient monitoring: CNS/ respiratory depression, seizures, agitation, irritability, nervousness, twitches, tremors- especially in renal or hepatic impaired patients • Reversal agent: narcan • Give slow IV push; don’t give if respirations less than 12/minute

  20. Demerol, cont. • Interactions • Drug to drug: ↑ CNS depression/respiratory depression with antihistamines, sedative hypnotics, barbiturates, cimetidine, protease inhibitor anti-retrovirals; ↑ meperidine toxicity with chlorpromazine & thioridazine, precipitation of opioid withdrawal in physically dependent patients with opioid agonist-antagonists; potentially fatal with MAO inhibitors • Drug to diagnostics: ↑ amylase & lipase • Drug to herb: ↑ CNS depression with chamomile, hops, kava, skullcap, valerian • Drug to alcohol: ↑ CNS depression

  21. Dilaudid- hydromorphone hydrochloride • Class- opioid agonist, opioid analgesic, antitussive • Action- binds to opiate receptors in spinal cord & CNS altering perception of and emotional response to painful stimuli while producing generalized CNS depression, also subdues cough reflex & decreases GI motility • Indications- moderate to severe pain • Contraindications- hypersensitivity to narcotics or bisulfites, acute or severe bronchial asthma or upper respiratory tract obstruction, premature neonates

  22. Dilaudid, cont. • Availability • Injection- 1 mg/ml, 2 mg/ml, 4 mg/ml, 10 mg/ml • Oral solution- 5 mg/5 ml • Suppository- 3 mg • Tablets- 1 mg, 2 mg, 3 mg, 4 mg, 8 mg • Doses- adults > 50 kg • 2-10 mg PO (tabs) q4-6h • 2.5-10 mg PO (oral solution) q4-6h • 1-2 mg SC, IM, or IV q4-6h, increase to 3-4 mg q4-6h for severe pain • 3 mg PR q6-8h

  23. Dilaudid, cont. • Use cautiously in increased intracranial pressure, severe renal, hepatic, or pulmonary disease, hypothyroidism, adrenal insufficiency, prostatic hypertrophy, alcoholism, concurrent use of MAO inhibitors, elderly patients, pregnant or breastfeeding patients • Administration-give IV injections slowly over 2-5 min. for each 2 mg dose, give oral form with food to avoid GI upset • Patient monitoring- with IV use monitor for respiratory depression, assess for signs of physical or psychological dependence, monitor for constipation • Adverse reactions- sedation, dizziness, bradycardia, hypotension, nystagmus, urinary retention, respiratory depression, bronchospasm, constipation, dry mouth

  24. Lasix - furosemide • Class: loop diuretic • Action- unclear, thought to inhibit sodium and chloride re-absorption from ascending loop of Henle and distal renal tubules, increases potassium excretion and plasma volume, promoting renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium • Indications- acute pulmonary edema, edema caused by heart failure, hepatic cirrhosis or renal disease, hypertension • Contraindications- hypersensitivity to drug or other sulfonamides, anuria • Use cautiously in diabetics, severe hepatic disease, elderly patients, pregnant or breastfeeding patients, neonates

  25. Lasix, cont. • Availability: • Injection- 10 mg/ml • Oral solution- 10 mg/ml, 40 mg/5 ml • Tablets- 20 mg, 40 mg, 80 mg • Dosages: adults • 40 mg IV over 1-2 min, if inadequate response within 1 hr give 80 mg IV over 1-2 min. • 20-80 mg PO qday, max. 600 mg/day PO for CHF, liver or renal failure but max. 240 mg PO qday for hypertension

  26. Lasix, cont. • Administration- if giving via IV infusion, don’t infuse more than 4 mg/min, if giving via IV injection give over 1-2 min. • Adverse reactions- dizziness, headache, vertigo, weakness, lethargy, paresthesia, drowsiness, restlessness, light headedness, hypotension, orthostatic hypotension, tachycardia, volume depletion, necrotizing angiitis, thrombophlebitis, arrhythmias, blurred vision, xanthopia, hearing loss, tinnitus, nausea, vomiting, diarrhea, constipation, dyspepsia, oral & gastric irritation, cramping, anorexia, dry mouth, acute pancreatitis, excessive & frequent urination, nocturia, glucosuria, bladder spasm, oliguria, interstitial nephritis, anemia, purpura, leukopenia, thrombocytopenia, hemolytic anemia, jaundice, hyperglycemia, hyperuricemia, dehydration, hypokalemia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis, muscle pain/cramps, photosensitivity, rash, diaphoresis, urticaria, pruritis, exfoliative dermatitis, erythema multiforme, fever, transient pain at injection site

  27. Lasix, cont. • Interactions: • Drug to drug-↑ risk of ototoxicity with aminoglycosides, ethacrynic acid, other ototoxic drugs; ↑ hypokalemia with amphotericin B, corticosteroids, corticotropin, potassium-wasting diuretics, stimulant laxatives; ↑ glycoside toxicity & fatal arrhythmias with cardiac glycosides; ↑ hypotension with antihypertensives, diuretics, nitrates; ↑ diuretic response, muscle pain & stiffness with clofibrate; ↓ hypoglycemic effect with insulin & oral hypoglycemics; diuresis inhibition with hydantoins, NSAIDS, probenicid; ↓ lithium excretion & toxicity; ↓ arterial response with norepinephrine; ↑ serum concentration of propranolol; ↑ toxicity with salicylates; ↓ naturetic & antihypertensive effects with succinylcholine; hyperglycemia with sulfonylureas; altered effects with theophylline; antagonism of effects with tubocurarine

  28. Lasix, cont. • Drug to diagnostics- transient ↑ BUN, ↓ calcium, magnesium, platelets, potassium, sodium; ↑ cholesterol, creatinine, glucose, nitrogenous compounds (uric acid) • Drug to herb- ↓ lasix efficacy with ephedra (ma huang) & ginseng; rapid potassium loss with licorice; dandelion interferes with lasix • Drug to behavior- ↑ hypotension with alcohol, ↑ photosensitivity to sun exposure • Patient monitoring- assess for drug toxicity- arrhythmias, renal dysfunction, abdominal pain, sore throat, fever, increased photosensitivity

  29. Morphine Sulfate • Class- opioid • Action- interacts with opioid receptor sites primarily in limbic system, thalamus, and spinal cord. This interaction alters neurotransmitter release, altering perception of and tolerance for pain. • Indications- moderate to severe pain • Contraindications- hypersensitivity to drug, tartrazine, bisulfites, or alcohol, acute bronchial asthma, upper airway obstruction, respiratory depression, GI obstruction, paralytic ileus

  30. Morphine, cont. • Availability: • Capsules- 15 mg, 30 mg • ER capsules- 10, 20, 30, 50, 60, 80, 90, 100, 120, & 200 mg • SR capsules- 10, 20, 30, 50, 60, 100 mg • Oral solution- 2 mg/ml, 4 mg/ml, 20 mg/ml (concentrate), 10 mg/5 ml, 20 mg/5 ml, 100 mg/5 ml • IV, IM, or SC injection- 1 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml, 10 mg/ml, 15 mg/ml, 25 mg/ml, 50 mg/ml • Tablets- 10, 15, 30, 60, 100, & 200 mg • Dosage: adults • 5-30 mg PO q4h, if sustained release give 20 mg PO qd or bid, or 200 mg PO of MS Contin • 5-20 mg/70 kg IM or SC q4h • 2-20 mg/70 kg IV slowly over 4-5 min • 10-30 mg PR q4h • Adjust dose if <50 kg, elderly, children

  31. Morphine, cont. • Administration- Give oral form with food or milk. Dilute in at least 5 ml NSS when giving IV and give 2.5-10 mg over 4-5 min. • Adverse reactions- confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, nightmares, hypotension, bradycardia, blurred vision, diplopia, miosis, nausea, vomiting, constipation, dry mouth, urinary retention, apnea, respiratory depression, respiratory arrest, flushing, itching, sweating, physical or psychological dependence, drug tolerance, seizures

  32. Morphine, cont. • Interactions: • Drug to drug:↑ CNS depression with antihistamines, barbiturates, clomipramine, sedative hypnotics, tricyclic antidepressants; ↓ analgesia with buprenorphine, butorphanol, dezocrine, nalbuphine, & pentazocine; changes in metabolism and medication effects with cimetidine; severe unpredictable reactions with MAO inhibitors; precipitation of withdrawal with mixed opioid-antagonists; ↑ anticoagulant effect with warfarin • Drug to diagnostics: increased amylase & lipase • Drug to herbs: increased CNS depression with chamomile, hops, kava, skullcap, & valerian • Drug to behaviors: increased CNS depression with alcohol

  33. Narcan-naloxone hydrochloride • Class: opioid antagonist • Indications: opioid induced respiratory depression • Adverse reactions: seizures, tremors, v. fib., hyper/hypotension, tachycardia, nausea, vomiting, pulmonary edema, withdrawal, diaphoresis • Dosage: • Adults- 0.4 - 2 mg IV, IM, or SC q2-3 min, max dose 10 mg, titrated based on response, slow IV push

  34. Protonix-pantoprazole sodium • Class- proton pump inhibitor • Action- reduces gastric acid secretion and increases gastric mucous and bicarbonate production creating a protective coating on gastric mucosa • Indications- erosive esophagitis caused by gastroesophageal reflux disease, pathologic hypersecretory conditions • Contraindications- hypersensitivity to drug

  35. Protonix, cont. • Availability: • Powder for injection (freeze dried) – 40 mg/vial • Tablets- 20 mg, 40 mg • Dosage: adults • 40 mg IV qday for 7-10 days, may give 80 mg IV q12h to max 240 mg/day • 40 mg PO qday for 8 weeks to max 240 mg PO qday, may give for up to 2 years in some cases • Use cautiously in severe hepatic disease, pregnant or breastfeeding, children

  36. Protonix, cont. • Administration- When giving IV use the in-line filter provided, dilute with 10 ml NS, further dilute in D5W, NS, or LR as directed. Give over 10 -15 min., no faster than 3 mg/min. Per City Hospital’s Pharmacy and their additional research via Lexicomp, 40 mg Protonix reconstituted in 10 ml NS can be given SIVP over 2 minutes. Don’t mix with other meds in IV. • Adverse reactions- dizziness, headache, chest pain, rhinitis, vomiting, diarrhea, abdominal pain, dyspepsia, hyperglycemia, rash, pruritis, injection site reaction

  37. Protonix, cont. • Interactions: • Drug to drug- delayed absorption of ampicillin, cyanocobalamin, digoxin, iron salts, ketoconazole; increased protonix level with clarithromycin, diazepam, flurazepam, phenytoin, & triazolam; delayed protonix absorption with sucralfate; increased bleeding with warfarin • Drug to diagnostics- increased levels of aspartate aminotransferase & glucose; false positive tetrahydrocannabinol tests

  38. Stadol-butorphanol tartrate • Class- opioid agonist-antagonist • Action- alters perception of and emotional response to pain by binding with opioid receptors in the brain causing CNS depression. Also exerts antagonistic activity at opioid receptors which reduces risk of toxicity, drug dependence, and respiratory depression • Indications- moderate to severe pain, labor pain, pre-op anesthesia • Contraindications- hypersensitivity to drug

  39. Stadol, cont. • Availability: • Injection- 1 mg/ml, 2 mg/ml • Nasal spray- 10 mg/ml • Dosage: adults • 1-4 mg IM q3-4h not to exceed 4 mg per dose • 0.5-2 mg IV q 3-4h • One spray in one nostril = 1 mg q3-4h • Dose adjustment for renal or hepatic impairment, elderly patients

  40. Stadol, cont. • Use cautiously in head injury, ventricular dysfunction, coronary insufficiency, respiratory disease, renal or hepatic dysfunction, history of drug abuse • Adverse reactions- drowsiness, sedation, dizziness, tremor, irritability, syncope, stimulation, hypertension, hypotension, palpitations, bradycardia, tachycardia, arrhythmias, blurred vision, nasal congestion or dryness, dry or sore throat, nausea, vomiting, constipation, epigastric distress, dry mouth, GI obstruction, urinary retention or hesitancy, dysuria, early menses, decreased libido, erectile dysfunction, thickened bronchial secretions, chest tightness, wheezing, urticaria, rash, diaphoresis, change in appetite, weight gain, local stinging, anaphylaxis, hypersensitivity reaction • Interactions: • Drug to drug: increased CNS depression with CNS depressants • Drug to herb: increased CNS depression with kava, St. John’s Wort, valerian • Drug to behavior: additive effects with alcohol

  41. Talwin-pentazocine lactate • Class- opioid agonist-antagonist • Action- unknown. Thought to interact with opioid receptors primarily in limbic system, thalamus, and spinal cord blocking transmission of pain impulses • Indications- moderate to severe pain, pre-op, adjunct to surgical anesthesia or labor • Contraindications- hypersensitivity to drug, acetaminophen, or oral form of narcan

  42. Talwin, cont. • Availability: • Injection: 30 mg/ml • Tablets: Talwin NX = 50 mg talwin + 0.5 mg narcan; Talacen = 25 mg talwin + 650 mf acetaminophen • Dosages: adults • 20-30 mg SC, IV, or IM q 3-4h not to exceed 60 mg/dose SC or IM or 30 mg/dose IV. Max. daily dose = 360 mg, IV doses given slow IV push at 5 mg/min. SC route can cause tissue damage. • 1-2 tabs PO q3-4h, max 12 tabs/day

  43. Talwin, cont. • Use cautiously in head trauma, ICP, respiratory conditions, adrenal insufficiency, seizure disorder, acute CNS manifestations, hepatic impairment, AMI, alcohol or narcotic use, sulfite sensitivity, history of drug use, pregnant or breast feeding, children • Adverse reactions: dizziness, drowsiness, euphoria, hallucinations, headache, sedation, dysphoria, insomnia, unusual dreams, weakness, depression, irritability, excitement, tremor, paresthesia, hypertension, hypotension, syncope, tachycardia, circulatory depression, shock, blurred vision, diplopia, nystagmus, miosis, tinnitus, nausea, vomiting, constipation, diarrhea, dry mouth, ileus, cramps, abdominal distress, anorexia, urinary retention, thrombocytopenia purpura, dyspnea, respiratory depression, clammy skin, diaphoresis, rash, urticaria, nodules, cutaneous depression, sclerosis, dermatitis, pruritis, flushing, altered taste, chills, stinging at injection site

  44. Talwin, cont. • Interactions: • Drug to drug: increased CNS depression with barbiturates, sedating antihistamines, & other sedating drugs; decreased effect with opioids • Drug to diagnostics: increased amylase & lipase, decreased WBCs • Drug to herbs: increased CNS depression with chamomile, hops, kava, skullcap, valerian • Drug to behavior: increased CNS depression with alcohol

  45. Toradol – ketoralac tromethamine • Class- NSAID • Actions- Interferes with prostaglandin biosynthesis by inhibiting cyclooxygenase pathway of arachidonic acid metabolism; also acts as potent inhibitor of platelet aggregation • Indications- Short term management of moderately severe acute pain • Contraindications- advanced renal impairment or patients at risk for renal failure, suspected or confirmed cerebrovascular bleeding or bleeding for other sources, known hypersensitivity, not for intrathecal or epidural administration due to alcohol content, not for use during labor or during breastfeeding, concurrent use of aspirin, other NSAIDs or probenicid, peptic ulcer disease

  46. Toradol, cont. • Availability: Injection: 15 mg/ml, 30 mg/ml Tablets: 10 mg • Dosage: Initially 30 mg IV or 60 mg IM as a single dose; or 30 mg IM or IV q6 hrs not to exceed 120 mg/day. Do not exceed 15 mg IV for pediatric patients or older patients weighing less than 50 kg

  47. Toradol, cont. • Use cautiously in: mild to moderate renal impairment or cardiovascular disease, elderly patients, pregnant patients, or children • Adverse reactions: drowsiness, headache, dizziness, hypertension, tinnitus, nausea, vomiting, diarrhea, constipation, flatulence, dyspepsia, epigastric pain, stomatitis, thrombocytopenia, rash, pruritis, diaphoresis, excessive thirst, edema, injection site pain

  48. Toradol, cont. • Interactions: Drug-drug: decreased antihypertensive effect with ACE inhibitors and Beta blockers, prolonged prothrombin time with anticoagulants, altered metabolism with aspirin, decreased absorption with cholestyramine, additive adverse g.i. effects with corticosteroids or other NSAIDs, decreased diuretic effect with diuretics, increased blood levels with lithium and methotrexate Drug-diagnostic tests: prolonged bleeding times for 24-48 hours after therapy ends Drug-herb: increased risk of bleeding with anise, arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, ginseng

  49. Zofran-ondansetron hydrochloride • Class- serotonin type 3 (5-HT3) antagonist, antiemetic • Action- blocks serotonin at 5-HT3 receptor sites in vagal nerve terminals by disrupting CNS chemoreceptor trigger zone • Indications- to prevent nausea & vomiting caused by emetogenic chemotherapy, post-op nausea & vomiting • Contraindications- hypersensitivity to drug

  50. Zofran, cont. • Availability: • Injection- 2 mg/ml in 2 & 20 ml vials • Premixed injection- 32 mg/50 ml • Oral solution- 4 mg/5 ml • Tablets- 4 mg, 8 mg, 24 mg • Orally disintegrating tabs- 4 mg, 8 mg • Dosage: • Adults & children >12 y.o.: 8 mg tab or 10 ml oral solution PO bid, first dose 30 min. before chemo & repeat in 8h then similar dosing q12h for 1-2 days after chemo • Children 4-11 y.o.: 4 mg tab or 5 ml oral solution PO q8h then follow process as above • Adults & children > 12 y.o.: 32 mg IV infused over 15 min 30 min prior to chemo or three 0.15 mg/kg doses IV with first dose over 15 min. 30 min. before chemo then 4 & 8 hours later; 4 mg IV over 2-5 min q4 hours for pre-op use, nausea /vomiting • Dose adjustment- hepatic impairment

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