OB Med Cards

ENGERIX-B Hepatitis B vaccine/recombinant Therapeutic Classification- Hepatitis B Vaccine Action- It contains purified surface antigen of the virus obtained by culturing genetically engineered Saccharomyces cerevisiae cells, which carry the surface antigen gene of the hepatitis B virus. Dose and Frequency- Persons From Birth Through 19 Years of Age Primary immunization for infants (born of hepatitis B surface antigen [HBsAg]-negative or HBsAg-positive mothers), children (birth through 10 years of age), and adolescents (11 through 19 years of age) consists of a series of 3 doses (0.5 mL each) given on a 0-, 1-, and 6-month schedule. Persons 20 Years of Age and Older Primary immunization for persons 20 years of age and older consists of a series of 3 doses (1 mL each) given on a 0-, 1-, and 6-month schedule.

Adults on Hemodialysis Primary immunization consists of a series of 4 doses (2 mL each) given as a single 2-mL dose or two 1-mL doses on a 0-, 1-, 2-, and 6-month schedule. In hemodialysis patients, antibody response is lower than in healthy persons and protection may persist only as long as antibody levels remain above 10 mIU/mL. Therefore, the need for booster doses should be assessed by annual antibody testing. A 2-mL booster dose (as a single 2-mL dose or two 1-mL doses) should be given when antibody levels decline below 10 mIU/mL. Major Side Effects- The most common solicited adverse events were injection site soreness and fatigue Nursing Implications- Monitor Injection site for soreness, fatigue, and abnormalities

Name- Erythromycin Classification- Macrolide Therapeutic- Treat bacterial infections Erythromycin can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby. Side Effects- Get emergency medical help if you have any of these signs of an allergic reaction to erythromycin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: diarrhea that is watery or bloody;headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats; hearing problems (rare);liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Dose- Adults: The usual dosage is one 250-milligram (mg) tablet four times daily in equally spaced doses or one 500-mg tablet every 12 hours. Dosage may be increased up to 4 grams (g) per day based on the severity of the infection. Children: Age, weight, and severity of the infection determine the correct dosage. The usual dosage is from 30-50 mg daily per 2.2 pounds of body weight, divided into equal doses. For more severe infections, the dosage may be doubled but should not exceed 4 g per day. Acute Pelvic Inflammatory Disease Adults: The usual treatment is 3 days of intravenous (in the vein) Erythromycin followed by 500 mg by mouth given every 12 hours for 7 days. Conjunctivitis (Pink Eye) Newborns: The dosage is 50 mg per 2.2 pounds of body weight per day given in four divided doses for at least 2 weeks, given as a liquid. Intestinal Infections Adults: 500 mg given every 12 hours or 250 mg given every 6 hours for 10-14 days. Children: 30-50 mg per 2.2 pounds of body weight per day given in divided doses for 10-14 days. Legionnaires' Disease

Adults: The usual dosage ranges from 1-4 grams (g) daily, divided into smaller doses. No optimal dose has been established. Pneumonia Infants: The recommended dose is 50 mg per 2.2 pounds of body weight per day given in 4 divided doses for at least 3 weeks, given as a liquid. Rheumatic Fever Prevention People allergic to penicillin and sulfonamides: 250 mg given twice a day. Syphilis Adults: The usual dosage is 30-40 g given in divided doses over a period of 10-15 days. Uncomplicated Urinary, Reproductive Tract, or Rectal Infections For adults who cannot take tetracycline: The usual dosage is 500 mg given four times a day for at least 7 days. Upper Respiratory Tract Infections Adults and Children: Your doctor will determine the correct dose based on the infection. Urethral Infections For adults who cannot take tetracycline: The usual dosage is 500 mg given four times a day for at least 7 days. Urinary Tract Infections During Pregnancy Adults: The usual dosage is 500 mg given on an empty stomach four times a day for at least 7 days. For women who cannot tolerate this regimen, a decreased dose 500 mg given every 12 hours or 250 mg given four times a day for at least 14 days. Whooping Cough Children: Although an optimal dose and duration of therapy have not been established, a daily dose of 40-50 mg per 2.2 pounds of body weight given in divided doses for 5-14 days has been utilized in clinical trials. Implementation- Delayed-release formulations may be taken with or without food. If the drug upsets your stomach, taking it with meals may help. Delayed-release tablets and capsules that are coated to slow their breakdown should be swallowed whole. Do not crush or break. If you are not sure about the form of Erythromycin you are taking, ask your pharmacist. Chewable forms of Erythromycin should be crushed or chewed before being swallowed. The liquid should be shaken well before each use. To clear up your infection completely, take Erythromycin for the full course of treatment, even if you feel better in a few days.

Colace

Brand Name: Colace Generic Name: docusate sodium Classification: Therapeutic- laxative Pharm: stool softener Mechanism of Action: Surfactant laxative, reduces tension of oil-water interface of the stool; enhances incorporation of water and fat into stool, causing stool to soften Indications: PO- prevention of constipation (in pts who should avoid straining, such as after MI or rectal surgery) Contraindications: abdominal pain, nausea, or vomiting, especially with fever and acute abdomen Route/Dosage: PO (Adults and Children >12 yr): 50-400 mg in 1-4 divided doses Adverse Reactions/Side Effects: throat irritation, mild cramps, diarrhea, and rashes Assessment: Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool Implementation: PO Administer with a full glass of water or juice. May be administered on empty stomach for more rapid results Patient/Family Teaching: Instruct patients with cardiac disease to avoid straining during bms Do not use laxatives when abd pain, nausea, vomiting, or fever is present.

Codeine Ther. Class.-allergy, cold and cough remedies antitussives, opioid analgesics Pharm. Class.-opioid agonists Action- Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Decreases cough reflex. Decreases GI motility. Dose and Frequency- PO: (Adults) Analgesic- 15-60 mg q 3-6 hr as needed. Antitussive- 10-20 mg q 4-6 hr as needed (not to exceed 120 mg/day). Antidiarrheal - 30 mg up to 4 times daily. PO: (Children 6-12 yr): Analgesic- 0.5-1 mg/kg (up to 60 mg) q 4-6 hr (up to 4 times daily) as needed. Antitussive- 5-10 mg q 4-6 hr as needed (not to exceed 60 mg/day). Antidiarrheal- 0.5 mg/kg up to 4 times daily. PO: (Children 2-5 yr): Analgesic- 0.5-1 mg/kg (up to 60 mg) q 4-6 hr (up to 4 times daily) as needed. Antitussive- 1-1.5 mg/kg divided q 4-6 hr as needed. Antidiarrheal- 0.5 mg/kg up to 4 times daily. Renal Impairment (Adults and Children) CCr 10-50 mL/min- Administer 75% of the dose; CCr <10 mL/min- Administer 50% of the dose. Implementation- High Alert: Accidental overdosage of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check dose calculations and route of administration. High Alert: Do not confuse codeine with Lodine (etodolac). Explain therapeutic value of medication before administration to enhance the analgesic effect. Regularly administered doses may be more effective than prn administration. Analgesic is more effective if given before pain becomes severe.

Coadministration with nonopioid analgesics may have additive analgesic effects and permit lower doses. Medications should be discontinued gradually after long-term use to prevent withdrawal symptoms. When combined with nonopioid analgesics (aspirin, acetaminophen) #2 = 15 mg, #3 = 30 mg, #4 = 60 mg codeine. Codeine as an individual drug is a Schedule II substance. In combination with other drugs, tablet form is Schedule III, and elixir or cough suppressant is Schedule V (see controlled substances schedules). PO: Oral doses may be administered with food or milk to minimize GI irritation. Major Side Effects- CNS: confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, EENT: blurred vision, diplopia, miosis Resp: respiratory depression, CV: hypotension, bradycardia, GI: constipation, nausea, vomiting GU: urinary retention, Derm: flushing, sweating Misc: physical dependence, psychological dependence, tolerance Nursing Implications- Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids, bulk, and laxatives to minimize constipating effects. Stimulant laxatives should be administered routinely if opioid use exceeds 2-3 days, unless contraindicated. Patient/Family Teaching- May cause drowsiness or dizziness. Advise patient to call for assistance when ambulating or smoking. Caution ambulatory patient to avoid driving or other activities requiring alertness until response to medication is known.

Brand Name- Brething Generic Name- terbutaline Ther. Class.- bronchodilators Pharm. Class.- adrenergics Mechanism of Action- Results in the accumulation of cyclic adenosine monophosphate (cAMP) at beta-adrenergic receptors. Produces bronchodilation. Inhibits the release of mediators of immediate hypersensitivity reactions from mast cells. Relatively selective for beta2(pulmonary)-adrenergic receptor sites, with less effect on beta1(cardiac)-adrenergic receptors. Dose and Frequency- PO: (Adults and Children >15 yr): Bronchodilation- 2.5-5 mg 3 times daily, given q 6 hr (not to exceed 15 mg/24 hr). PO: (Children 12-15 yr): Bronchodilation -2.5 mg 3 times daily (given q 6 hr) (not to exceed 7.5 mg/24 hr). PO: (Children <12 yr): Bronchodilation- 0.05 mg/kg 3 times daily; may ↑ gradually (not to exceed 0.15 mg/kg 3-4 times daily or 5 mg/24 hr. SC: (Adults and Children ≥12 yr): Bronchodilation- 250 mcg; may repeat in 15-30 min (not to exceed 500 mcg/4 hr). SC: (Children <12 yr): Bronchodilation- 0.005-0.01 mg/kg; may repeat in 15-20 min. IV: (Adults) Tocolysis- 2.5-10 mcg/min infusion; ↑ by 5 mcg/min q 10 min until contractions stop (not to exceed 30 mcg/min). After contractions have stopped for 30 min, ↓ infusion rate to lowest effective amount and maintain for 4-8 hr (unlabeled). Implementation- Do not confuse Brethine (terbutaline) with Methergine (methylergonovine). PO: Administer with meals to minimize gastric irritation. Tablet may be crushed and mixed with food or fluids for patients with difficulty swallowing. SC: Administer subcut injections in lateral deltoid area. Do not use solution if discolored. IV Administration pH: 3.0-5.0.

Continuous Infusion: Diluent: May be diluted in D5W, 0.9% NaCl, or 0.45% NaCl. Concentration: 1 mg/mL (undiluted). Rate: Use infusion pump to ensure accurate dose. Begin infusion at 10 mcg/min. Increase dosage by 5 mcg every 10 min until contractions cease. Maximum dose is 80 mcg/min. Begin to taper dose in 5-mcg decrements after a 30-60 min contraction-free period is attained. Switch to oral dose form after patient is contraction-free 4-8 hr on the lowest effective dose. Y-Site Compatibility insulin Major Side Effects- CNS: nervousness, restlessness, tremor, headache, insomnia, Resp: pulmonary edema CV: angina, arrhythmias, hypertension, myocardial ischemia, tachycardia, GI: nausea, vomiting, Endo: hyperglycemia, F and E: hypokalemia Nursing Implications- Bronchodilator: Assess lung sounds, respiratory pattern, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced, and notify health care professional of abnormal findings. Monitor pulmonary function tests before initiating therapy and periodically throughout therapy to determine effectiveness of medication. Preterm Labor: Monitor maternal pulse and BP, frequency and duration of contractions, and fetal heart rate. Notify health care professional if contractions persist or increase in frequency or duration or if symptoms of maternal or fetal distress occur. Maternal side effects include tachycardia, palpitations, tremor, anxiety, and headache. Assess maternal respiratory status for symptoms of pulmonary edema (increased rate, dyspnea, rales/crackles, frothy sputum). Monitor mother and neonate for symptoms of hypoglycemia (anxiety; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nausea; nervousness; rapid pulse; shakiness; unusual tiredness; or weakness) and mother for hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias). Patient/Family Teaching- Preterm Labor: Notify health care professional immediately if labor resumes or if significant side effects occur.

Brand Name- Reglan Generic Name- metoclopramide Ther. Class.- antiemetics Action- Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying. Dose and Frequency- Prevention of Chemotherapy-Induced Vomiting PO: IV: (Adults and Children) 1-2 mg/kg 30 min before chemotherapy. Additional doses of 1-2 mg/kg may be given q 2-4 hr, pretreatment with diphenhydramine will ↓ the risk of extrapyramidal reactions to this dose. Facilitation of Small Bowel Intubation IV: (Adults and Children > 14 yr): 10 mg over 1-2 min. IV: (Children 6-14 yr): 2.5-5 mg (dose should not exceed 0.5 mg/kg) over 1-2 min. IV: (Children <6 yr): 0.1 mg/kg over 1-2 min. Diabetic Gastroparesis PO: IV: (Adults) 10 mg 30 min before meals and at bedtime for 2-8 weeks. Gastroesophageal Reflux PO: IM: IV: (Adults) 10-15 mg 30 min before meals and at bedtime (not to exceed 0.5 mg/kg/day). A single dose of 20 mg may be given preventively. Some patients may respond to doses as small as 5 mg. PO: IM: IV: (Neonates, Infants, and Children): 0.4-0.8 mg/kg/day in 4 divided doses. Postoperative Nausea/Vomiting IM: IV: (Adults and Children > 14 yr): 10 mg at the end of surgical procedure, repeat in 6-8 hr if needed. IM: IV: (Children <14 yr): 0.1-0.2 mg/kg/dose, repeat in 6-8 hr if needed. Treatment of Hiccups PO: IM: (Adults) 10-20 mg 4 times daily PO; may be preceded by a single 10-mg dose IM (unlabeled). Implementation- PO: Administer doses 30 min before meals and at bedtime.

Do not to remove orally disintegrating tablets from the bottle until just prior to dosing. Remove tablet from bottle with dry hands and immediately place on tongue to disintegrate and swallow with saliva. Tablet typically disintegrates in 1-1.5 minutes. Administration with liquid is not necessary. IM: For prevention of postoperative nausea and vomiting, inject IM near the end of surgery. IV Administration Direct IV: Administer IV dose 30 min before administration of chemotherapeutic agent. Rate: Doses may be given slowly over 1-2 min. Rapid administration causes a transient but intense feeling of anxiety and restlessness followed by drowsiness. Intermittent Infusion: Diluent: May be diluted for IV infusion in 50 mL of D5W, 0.9% NaCl, D5/0.45% NaCl, Ringer's solution, or LR. Diluted solution is stable for 48 hr if protected from light or 24 hr under normal light. Concentration: May dilute to 0.2 mg/mL or give undiluted at 5 mg/mL. Rate: Infuse slowly (maximum rate 5 mg/min) over at least 15-30 min. Major Side Effects- CNS: drowsiness, extrapyramidal reactions, restlessness, NEUROLEPTIC MALIGNANT SYNDROME, anxiety, depression, irritability, tardive dyskinesia, CV: arrhythmias (supraventricular tachycardia, bradycardia), hypertension, hypotension Nursing Implications- Monitor for neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered consciousness, irregular pulse or BP, tachycardia, and diaphoresis). Patient/Family Teaching- Instruct patient to take metoclopramide as directed. Take missed doses as soon as remembered if not almost time for next dose. Advise patient to read the Medication Guide before starting therapy and with each Rx refill in case of changes.

Milk of Magnesia Brand Name- MOM Generic Name- magnesium hydroxide Ther. Class.- mineral and electrolyte, replacements/supplements, laxatives Pharm. Class.-salines Action- Essential for the activity of many enzymes. Play an important role in neurotransmission and muscular excitability. Are osmotically active in GI tract, drawing water into the lumen and causing peristalsis.

Dose and Frequency- Antacid PO: (Adults) Magnesium oxide- 140 mg 3-4 times/day or 400-840 mg/day; Magnesium hydroxide (Milk of Magnesia)- 5-15 mL/dose up to 4 times/day as liquid or 2.5-7.5 mL/dose up to 4 times/day as liquid concentrate mg/dose or 622-1244 mg/dose (2-4 tabs) up to 4 times/day. PO: (Children ): Magnesium hydroxide (Milk of Magnesia)- 2.5-5 mL/dose up to 4 times/day as liquid or 311 mg (1 tab) up to 4 times/day. Major Side Effects- GI: diarrhea, Derm: flushing, sweating Nursing Implications- Antacid: Assess for heartburn and indigestion as well as location, duration, character, and precipitating factors of gastric pain. Patient/Family Teaching- Antacids: Caution patient to consult health care professional before taking antacids for more than 2 wk if problem is recurring, if relief is not obtained, or if symptoms of gastric bleeding (black, tarry stools; coffee-ground emesis) occur.

Percocet

Drug Name- Percocet (oxycodone + acetaminophen) Drug Classification- opioid analgesic Mechanism of Action- Oxycodone: Opioid analgesic; semisynthetic pure opioid agonist whose principal therapeutic action is analgesia. Effects are mediated by receptors (eg, µ and kappa) in the CNS for endogenous opioid-like compounds (eg, endorphins, enkephalins). Dose and Frequency- ADULT DOSAGE Moderate to Moderately Severe Pain 2.5mg-325mg Strength: Usual: 1 or 2 tabs q6h prn Max: 12 tabs/day 5mg-325mg Strength: Usual: 1 tab q6h prn Max: 12 tabs/day 7.5mg-325mg Strength: Usual: 1 tab q6h prn Max: 8 tabs/day 10mg-325mg Strength: Usual: 1 tab q6h prn Max: 6 tabs/day If pain is constant, administer at regular intervals on an around-the-clock schedule Max APAP Dose: 4g/day Route- Oral Major Side Effects- Lightheadedness, dizziness, drowsiness/sedation, N/V, respiratory depression, apnea, respiratory arrest, circulatory depression, hypotension, shock. Nursing Implications- Assess for level of pain intensity, type of pain, patient's general condition and medical status, or any other conditions where treatment is contraindicated or cautioned. Assess for drug hypersensitivity, renal/hepatic/pulmonary impairment, pregnancy/nursing status, and possible drug interactions. Patient/Family Teaching- Inform about the signs of serious skin reactions. Advise to destroy unused tabs by flushing down the toilet. Inform that drug may impair mental/physical abilities required to perform hazardous tasks. Instruct to avoid alcohol or other CNS depressants. Advise not to adjust dose without consulting physician and not to abruptly d/c if on treatment for more than a few weeks.

magnesium sulfate Ther. Class.-mineral and electrolyte replacements/supplements Pharm. Class.- minerals electrolytes Mechanism of Action- Essential for the activity of many enzymes. Plays an important role in neurotransmission and muscular excitability. Dose and Frequency-Treatment of Deficiency (Expressed as mg of Magnesium) IM: IV: (Adults) Severe deficiency- 8-12 g/day in divided doses; mild deficiency- 1 g q 6 hr for 4 doses or 250 mg/kg over 4 hr. IM: IV: (Children > 1 mo): 25-50 mg/kg/dose q 4-6 hr for 3-4 doses, maximum single dose: 2 g. IV: Neonates 25-50 mg/kg/dose q 8-12 hr for 2-3 doses. Seizures/Hypertension IM: IV: (Adults) 1 g q 6 hr for 4 doses as needed. IM: IV: Children 20-100 mg/kg/dose q 4-6 hr as needed, may use up to 200 mg/kg/dose in severe cases. Torsade de Pointes IV: (Infants and Children): 25-50 mg/kg/dose, maximum dose: 2 g. Bronchodilation IV: (Adults) 2 g single dose. IV: Children 25 mg/kg/dose, maximum dose: 2 g. Eclampsia/Pre-Eclampsia IV: IM: (Adults) 4-5 g by IV infusion, concurrently with up to 5 g IM in each buttock; then 4-5 g IM q 4 hr or 4 g by IV infusion followed by 1-2 g/hr continuous infusion (not to exceed 40 g/day or 20 g/48 hr in the presence of severe renal insufficiency). Part of Parenteral Nutrition IV: (Adults) 4-24 mEq/day. IV: Children 0.25-0.5 mEq/kg/day. Implementation- High Alert: Accidental overdosage of IV magnesium has resulted in serious patient harm and death. Have second practitioner independently double-check original order, dose calculations, and infusion pump settings. Do not confuse milligram (mg), gram (g), or millequivalent (mEq) dosages.

IM: Administer deep IM into gluteal sites. Administer subsequent injections in alternate sides. Dilute to a concentration of 200 mg/mL prior to injection. IV Administration Direct IV: Diluent: 50% solution must be diluted in 0.9% NaCl or D5W to a concentration of ≤20% prior to administration. Concentration: ≤20%. Rate: Administer at a rate not to exceed 150 mg/min. Continuous Infusion: Diluent: Dilute in D5W, 0.9% NaCl, or LR. Concentration: 0.5 mEq/mL (60 mg/mL) (may use maximum concentration of 1.6 mEq/mL) (200 mg/mL) in fluid-restricted patients). Rate: Infuse over 2-4 hr. Do not exceed a rate of 1 mEq/kg/hr (125 mg/kg/hr). When rapid infusions are needed (severe asthma or torsade de pointes) may infuse over 10-20 min. Major Side Effects- CNS: drowsiness, Resp: ↓ respiratory rate, CV: arrhythmias, bradycardia, hypotension, GI: diarrhea, MS: muscle weakness, Derm: flushing, sweating Metabolic: hypothermia Nursing Implications- Hypomagnesemia/Anticonvulsant: Monitor pulse, BP, respirations, and ECG frequently throughout administration of parenteral magnesium sulfate. Respirations should be at least 16/min before each dose. Monitor neurologic status before and throughout therapy. Institute seizure precautions. Patellar reflex (knee jerk) should be tested before each parenteral dose of magnesium sulfate. If response is absent, no additional doses should be administered until positive response is obtained. Monitor newborn for hypotension, hyporeflexia, and respiratory depression if mother has received magnesium sulfate. Monitor intake and output ratios. Urine output should be maintained at a level of at least 100 mL/4 hr. Patient/Family Teaching- Explain purpose of medication to patient and family.

Brand Name- Rhophylac Generic Name- Rho(D) IMMUNE GLOBULIN Ther. Class.-vaccines/immunizing agents Pharm. Class.-immune globulins Mechanism of Action- Prevent production of anti-Rho(D) antibodies in Rho(D)-negative patients who were exposed to Rho(D)-positive blood. Increase platelet counts in patients with ITP. Dose and Frequency- Rho(D) Immune Globulin (for IM use only) Following Delivery IM: (Adults) HyperRHO S/D Full Dose, RhoGAM- 1 vial standard dose (300 mcg) within 72 hr of delivery. Before Delivery IM: (Adults) HyperRHO S/D Full Dose, RhoGAM- 1 vial standard dose (300 mcg) at 26-28 wk. Termination of Pregnancy (<13 wk Gestation) IM: (Adults) HyperRHO S/D Mini-Dose, MICRhoGAM- 1 vial of microdose (50 mcg) within 72 hr. Termination of Pregnancy (>13 wk Gestation) IM: (Adults) RhoGAM- 1 vial standard dose (300 mcg) within 72 hr. Large Fetal-Maternal Hemorrhage (>15 mL) IM: (Adults) RhoGAM- 20 mcg/mL of Rho(D)-positive fetal RBCs. Transfusion Accident IM: (Adults) HyperRHO S/D Full Dose, RhoGAM- (Volume of Rh-positive blood administered × Hct of donor blood)/15 = number of vials of standard dose (300 mcg) preparation (round to next whole number of vials). Rho(D) Immune Globulin IV (for IM or IV Use) Following Delivery IM: IV: (Adults) WinRho SDF- 600 IU (120 mcg) within 72 hr of delivery. Rhophylac- 1500 IU (300 mcg) within 72 hr of delivery. Prior to Delivery IM: IV: (Adults) WinRho SDF, Rhophylac- 1500 IU (300 mcg) at 28 wk; if initiated earlier in pregnancy, repeat q 12 wk. Following Amniocentesis or Chorionic Villus Sampling IM: IV: (Adults) WinRho SDF (before 34 wk gestation)- 1500 IU (300 mcg) immediately; repeat q 12 wk during pregnancy. Rhophylac- 1500 IU (300 mcg) within 72 hr of procedure. Termination of Pregnancy, Amniocentesis, or Any Other Manipulation IM: IV: (Adults) WinRho SDF- 600 IU (120 mcg) within 72 hr after event. Large Fetal-Maternal Hemorrhage/Transfusion Accident IM: (Adults) WinRho SDF- 6000 IU (1200 mcg) q 12 hr until total dose is given (total dose determined by amount of blood loss/hemorrhage). IV: (Adults) 3000 IU (600 mcg) q 8 hr until total dose is given (total dose determined by amount of blood loss/hemorrhage).

Immune Thrombocytopenic Purpura IV: (Adults and Children) WinRho SDF, Rhophylac- 50 mcg (250 IU)/kg initially (if Hgb <10 g/dL, ↓ dose to 25-40 mcg [125-200 IU]/kg); further dosing/frequency determined by clinical response (range 25-60 mcg [125-300 IU]/kg). Each dose may be given as a single dose or in 2 divided doses on separate days. Implementation- Do not give to infant, to Rho(D)-positive individual, or to Rho(D)-negative individual previously sensitized to the Rho(D) antigen. However, there is no more risk than when given to a woman who is not sensitized. When in doubt, administer Rho(D) immune globulin. Do not confuse IM and IV formulations. Rh immune globulin for IV administration is labelled "Rh Immune Globulin Intravenous." Rh Immune Globulin Intravenous may be given IM; however, Rh Immune Globulin (microdose and standard dose) is for IM use only and cannot be given IV. When using prefilled syringes, allow solution to reach room temperature before administration. IM: Reconstitute Rho(D) immune globulin IV for IM use immediately before use with 1.25 mL of 0.9% NaCl. Inject diluent onto inside wall of vial and wet pellet by gently swirling until dissolved. Do not shake. Administer into the deltoid muscle. Dose should be given within 3 hr but may be given up to 72 hr after delivery, miscarriage, abortion, or transfusion. IV Administration pH: 6.5-7.6. Direct IV: Reconstitute Rho(D) immune globulin IV for IV administration immediately before use with 2.5 mL of 0.9% NaCl. Inject diluent onto inside wall of vial and wet pellet by gently swirling until dissolved. Do not shake. Rate: Administer over 3-5 min. Major Side Effects- CNS: dizziness, headache CV: hypertension, hypotension, Derm: rash, GI: diarrhea, nausea, vomiting, GU: acute renal failure Hemat: ITP: DISSEMINATED INTRAVASCULAR, COAGULATION, INTRAVASCULAR HEMOLYSIS, anemia, MS: arthralgia, myalgia, Local: pain at injection site, Misc: fever Nursing Implications- IV: Assess vital signs periodically during therapy in patients receiving IV Rho(D) immune globulin. ITP: Monitor patient for signs and symptoms of intravascular hemolysis (IVH) (back pain, shaking chills, fever, hemoglobinuria), anemia, and renal insufficiency. If transfusions are required, use Rho(D)-negative packed red blood cells to prevent exacerbation of IVH. Patient/Family Teaching- Pregnancy: Explain to patient that the purpose of this medication is to protect future Rho(D)-positive infants. ITP: Explain purpose of medication to patient.

Brand Name- Femiron Generic Name- ferrous fumarate Ther. Class.- antianemics Pharm. Class.- iron supplements Mechanism of Action- An essential mineral found in hemoglobin, myoglobin, and many enzymes. Enters the bloodstream and is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow) where it becomes part of iron stores. Dose and Frequency- Oral iron dosages are expressed as mg of elemental iron. Multiple salt forms exist-see approximate equivalent doses below or consider % elemental iron of each salt for dose conversions. Approximate Equivalent Doses (mg of iron salt): Ferrous fumarate- 197; Ferrous gluconate- 560; Ferrous sulfate- 324; Ferrous sulfate, exsiccated- 217. PO: (Adults) Deficiency -2-3 mg/kg/day in 2-4 divided doses or 60-100 mg elemental iron twice daily. Prophylaxis- 60-100 mg elemental iron daily. PO: (Infants and Children): Severe deficiency- 4-6 mg/kg/day in 3 divided doses. Mild to moderate deficiency- 3 mg/kg/day in 1-2 divided doses. Prophylaxis- 1-2 mg/kg/day in 1-2 divided dose (maximum: 15 mg/day). PO: (Neonates, premature): 2-4 mg/kg/day in 1-2 divided doses, maximum of 15 mg/day.

Implementation- Discontinue oral iron preparations prior to parenteral administration. Oral preparations are most effectively absorbed if administered 1 hr before or 2 hr after meals. If gastric irritation occurs, administer with meals. Take tablets and capsules with a full glass of water or juice. Do not crush or chew enteric-coated tablets and do not open capsules. Liquid preparations may stain teeth. Dilute in water or fruit juice, full glass (240 mL) for adults and ½ glass (120 mL) for children, and administer with a straw or place drops at back of throat. Avoid using antacids, coffee, tea, dairy products, eggs, or whole-grain breads with or within 1 hr after administration of ferrous salts. Iron absorption is decreased by 33% if iron and calcium are given with meals. Major Side Effects- CNS: dizziness, headache, syncope GI: nausea, constipation, dark stools, epigastric pain, GI bleeding, vomiting, Misc: temporary staining of teeth (liquid preparations) Nursing Implications- Assess nutritional status and dietary history to determine possible cause of anemia and need for patient teaching. Assess bowel function for constipation or diarrhea. Notify physician or other health care professional and use appropriate nursing measures should these occur. Patient/Family Teaching- Explain purpose of iron therapy to patient. Encourage patient to comply with medication regimen. Take missed doses as soon as remembered within 12 hr; otherwise, return to regular dosing schedule. Do not double doses.

Tylenol #3 (Tylenol + Codeine) Look at Codeine drug card Brand Name-Tylenol Generic Name- acetaminophen Ther. Class.- antipyretics, nonopioid analgesics Mechanism of Action- Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. Has no significant anti-inflammatory properties or GI toxicity. Dose and Frequency- Children ≤12 yr should not receive >5 PO or rectal doses/24 hr without notifying physician or other health care professional. No dosage adjustment needed when converting between IV and PO acetaminophen in adults and children ≥50 kg PO: (Adults and Children >12 yr): 325-650 mg q 6 hr or 1 g 3-4 times daily or 1300 mg q 8 hr (not to exceed 3 g or 2 g/24 hr in patients with hepatic/renal impairment). PO: (Children 1-12 yr): 10-15 mg/kg/dose q 6 hr as needed (not to exceed 5 doses/24 hr). PO: Infants 10-15 mg/kg/dose q 6 hr as needed (not to exceed 5 doses/24 hr). PO: Neonates 10-15 mg/kg/dose q 6-8 hr as needed. IV: (Adults and Children ≥13 yr and ≥50 kg): 1000 mg q 6 hr or 650 mg q 4 hr (not to exceed 1000 mg/dose, 4 g/day, and less than 4 hr dosing interval). IV: (Adults and Children ≥13 yr and <50 kg): 15 mg/kg q 6 hr or 12.5 mg/kg q 4 hr (not to exceed 15 mg/kg/dose, 75 mg/kg/day, and less than 4 hr dosing interval). IV: (Children 2-12 yr): 15 mg/kg q 6 hr or 12.5 mg/kg q 4 hr (not to exceed 15 mg/kg/dose, 75 mg/kg/day, and less than 4 hr dosing interval). IV: (Infants and Children <2yr): 7.5-15 mg/kg/dose q 6 hr (not to exceed 60 mg/kg/day). Rect: (Adults and Children >12 yr): 325-650 mg q 4-6 hr as needed or 1 g 3-4 times/day (not to exceed 4 g/24 hr). Rect: (Children 1-12 yr): 10-20 mg/kg/dose q 4-6 hr as needed. Rect: Infants 10-20 mg/kg/dose q 4-6 hr as needed. Rect: Neonates 10-15 mg/kg/dose q 6-8 hr as needed.

Implementation- Do not confuse Tylenol with Tylenol PM. To prevent fatal medication errors ensure dose in milligrams (mg) and milliliters (mL) is not confused; dosing is based on weight for patients under 50 kg; programming of infusion pump accurate; and total daily dose of acetaminophen from all sources does not exceed maximum daily limits. When combined with opioids do not exceed the maximum recommended daily dose of acetaminophen. PO: Administer with a full glass of water. May be taken with food or on an empty stomach. IV Administration Intermittent Infusion: For 1000 mg dose, insert vented IV set through septum of 100 mL vial; may be administered without further dilution. For doses <1000 mg, withdraw appropriate dose from vial place in a separate empty, sterile container for IV infusion. Place small volume pediatric doses up to 60 mL in a syringe and administer via syringe pump. Solution is clear and colorless; do not administer solutions that are discolored of contain particulate matter. Administer within 6 hrs of breaking vial seal. Rate: Infuse over 15 min. Monitor end of infusion in order to prevent air embolism, especially if acetaminophen is primary infusion. Major Side Effects- Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash, urticaria, HEPATOTOXICITY (↑ DOSES), constipation (↑ in children) (IV), ↑ liver enzymes, nausea (IV), vomiting (IV) Nursing Implications- Assess overall health status and alcohol usage before administering acetaminophen. Patients who are malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. Assess amount, frequency, and type of drugs taken in patients self-medicating, especially with OTC drugs. Prolonged use of acetaminophen increases the risk of adverse renal effects. For short-term use, combined doses of acetaminophen and salicylates should not exceed the recommended dose of either drug given alone. Do not exceed maximum daily dose of acetaminophen when considering all routes of administration and all combination products containing acetaminophen. Patient/Family Teaching- Chronic excessive use of >4 g/day (2 g in chronic alcoholics) may lead to hepatotoxicity, renal or cardiac damage.

Percocet (oxycodone + acetaminophen) Look at acetaminophen drug card Brand Name- OxyCONTIN Generic Name- oxyCODONE Ther. Class.-opioid analgesics Pharm. Class.-opioid agonists, opioid agonists nonopioid analgesic combinations Action- Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression. Dose and Frequency- Larger doses may be required during chronic therapy PO: (Adults ≥50 kg): 5-10 mg q 3-4 hr initially, as needed. Controlled-release tablets (Oxycontin) may be given q 12 hr. PO: (Adults <50 kg ): 0.2 mg/kg q 3-4 hr initially, as needed. PO: Children 0.05-0.15 mg/kg q 4-6 hr as needed, as immediate-release product Rect: (Adults) 10-40 mg 3-4 times daily initially, as needed.

Implementation- High Alert: Accidental overdose of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order and dose calculations. Do not confuse short-acting oxycodone with long-acting Oxycontin. Do not confuse oxycodone with hydrocodone. Do not confuse Oxycontin with MS Contin. Taking broken, chewed, crushed or dissolved controlled-release tablets leads to rapid release and absorption of a potentially fatal dose of oxycodone. Major Side Effects- CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams, EENT: blurred vision, diplopia, miosis, Resp: RESPIRATORY DEPRESSION, constipation Nursing Implications- Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use. Patient/Family Teaching- Advise patient that oxycodone is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for whom it was prescribed.

Generic- Benzocaine 20% Brand Name- Americaine Ther. Class.- anesthetics (topical/local) Action- Inhibit initiation and conduction of sensory nerve impulses. Dose and Frequency- Benzocaine Topical/Mucosal: (Adults and Children) Apply cream, ointment, topical solutions, or dental/oral products as needed. Lozenges may be used hourly (not to exceed 12 lozenges/day). Rectal products may be used twice daily. Dibucaine Topical: (Adults and Children) Apply as needed (not to exceed 30 g/day in adults or 7.5 g/day in children). Can be used 3-4 times daily. Dyclonine Mucosal: (Adults) 2- or 3-mg lozenge may be dissolved in the mouth q 2 hr (not to exceed 10 lozenges/day), or solution may be used 4 times daily. Mucosal: (Children ≥ 2 yr): 1.2-mg lozenge may be dissolved in mouth q 2 hr (not to exceed 10 lozenges/day). Pramoxine Topical/Mucosal: (Adults) Topical products may be used q 3 hr as needed. Rectal products may be used up to 5 times daily.

Implementation- High Alert: Overuse of topical anesthetic sprays on mucous membranes can result in methemoglobinemia. Avoid overuse or too liberal application. Topical: Alcohol-free preparation is available for teething pain in babies. Apply to gums by rubbing gel on with fingers or cotton swab. Throat Spray: Ensure that gag reflex is intact before allowing patient to drink or eat. Major Side Effects- burning, edema, irritation, stinging, tenderness, urticaria, Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS Nursing Implications- Assess type, location, and intensity of pain before and a few minutes after administration of anesthetic. Assess integrity of involved skin and mucous membranes before and periodically throughout course of therapy. Notify health care professional if signs of infection or irritation develop. Patient/Family Teaching- Instruct patient on correct application technique. High Alert: Inform patient of potential harm from overuse. Emphasize need to avoid contact with eyes

Brand Name- Pepcid Generic Name- famotidine Ther. Class.- antiulcer agents Pharm. Class.-histamine h2 antagonists Action- Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. Dose and Frequency- PO: (Adults) Short-term treatment of active ulcers- 40 mg/day at bedtime or 20 mg twice daily for up to 8 wk.Duodenal ulcer prophylaxis- 20 mg once daily at bedtime. GERD- 20 mg twice daily for up to 6 wk; up to 40 mg twice daily for up to 12 wk for esophagitis with erosions, ulcerations, and continuing symptoms. Gastric hypersecretory conditions- 20 mg q 6 hr initially, up to 160 mg q 6 hr. OTC use- 10 mg for relief of symptoms; for prevention-10 mg 60 min before eating or take 10 mg as chewable tablet 15 minutes before heartburn-inducing foods or beverages (not to exceed 20 mg/24 hr for up to 2 wk). PO: IV: (Children 1-12 yr): Peptic ulcer- 0.5 mg/kg/day as a single bedtime dose or in divided doses twice daily (maximum: 40 mg daily); GERD- 1 mg/kg/day in divided doses twice daily (maximum: 80 mg daily). PO: (Infants > 3 mo-1 yr): GERD- 0.5 mg/kg/dose twice daily. PO: (Infants and neonates < 3 mo): GERD- 0.5 mg/kg/dose once daily. IV: (Adults) 20 mg q 12 hr. Renal Impairment PO: (Adults) CCr 10-50 mL/min- administer normal dose q 24 hr or 50% dose at normal dosing intervalCCr <10 mL/min- 20 mg at bedtime; interval may need to be ↑ to every 36-48 hr.

Implementation- PO: Administer with meals or immediately afterward and at bedtime to prolong effect. Doses administered once daily should be administered at bedtime to prolong effect. Shake oral suspension prior to administration. Discard unused suspension after 30 days. Open blister for oral disintegrating tablets with dry hands, place tablet on tongue to disintegrate and swallow with saliva; no water is needed. IV Administration pH: 5.0-6.4. Direct IV: Diluent: 0.9% NaCl for injection. Concentration: not >4 mg/mL. Rate: Administer at a rate of 10 mg/min over at least 2 min. Rapid administration may cause hypotension. Intermittent Infusion: Diluent: Dilute each 20 mg in 100 mL of 0.9% NaCl, D5W, D10W, or lactated Ringer's solution. Concentration: 0.2 mg/mL. Diluted solution is stable for 48 hr at room temperature. Do not use solution that is discolored or contains a precipitate. Rate: Administer over 15-30 min. Major Side Effects- CV: ARRHYTHMIAS GI: constipation, diarrhea, nausea GU: ↓ sperm count, erectile dysfunction Endo: gynecomastia, Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA Nursing Implications- Assess for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Geri: Assess elderly and debilitated patients routinely for confusion. Report promptly. Patient/Family Teaching- Instruct patient to take medication as directed for the full course of therapy, even if feeling better. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses.

Brand Name- Phenergan Generic Name- promethazine Ther. Class.- antiemetics, antihistamines, sedative/hypnotics Pharm. Class.- phenothiazines Mechanism of Action- Blocks the effects of histamine. Has inhibitory effect on the chemoreceptor trigger zone in the medulla, resulting in antiemetic properties. Alters the effects of dopamine in the CNS. Possesses significant anticholinergic activity. Produces CNS depression by indirectly decreased stimulation of the CNS reticular system. Route/Dosage Antihistamine PO: (Adults) 6.25-12.5 mg 3 times/day and 25 mg at bedtime. PO: (Children ≥2 yr): 0.1 mg/kg/dose (not to exceed 12.5 mg) q 6 hr during the day and 0.5 mg/kg/dose (not to exceed 25 mg) at bedtime. IM: IV: Rect: (Adults) 25 mg; may repeat in 2 hr. Rect: (Children ≥2 yr): 0.125 mg/kg q 4-6 hr or 0.5 mg/kg at bedtime. Antivertigo (Motion Sickness) PO: (Adults) 25 mg 30-60 min before departure; may be repeated in 8-12 hr. PO: Rect: (Children ≥2 yr): 0.5 mg/kg (not to exceed 25 mg) 30-60 min before departure; may be given q 12 hr as needed. Sedation PO: Rect: IM: IV: (Adults) 25-50 mg; may repeat q 4-6 hr if needed. PO: Rect: IM: (Children >2 yr): 0.5-1 mg/kg (not to exceed 50 mg) q 6 hr as needed. Sedation during Labor IM: IV: (Adults) 50 mg in early labor; when labor is established, additional doses of 25-75 mg may be given 1-2 times at 4-hr intervals (should not exceed 100 mg/24 hr). Antiemetic PO: Rect: IM: IV: (Adults) 12.5-25 mg q 4 hr as needed; initial PO dose should be 25 mg. PO: Rect: IM: IV: (Children ≥2 yr): 0.25-1 mg/kg (not to exceed 25 mg) q 4-6 hr.

Implementation- When administering promethazine concurrently with opioid analgesics, supervise ambulation closely to prevent injury from increased sedation. 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. IM: Administer deep into well-developed muscle. Subcut or inadvertent intra-arterial administration may cause severe tissue necrosis. IV Administration Direct IV: Diluent: Dilute with 0.9% NaCl or D5W. Concentration: Doses should not exceed a concentration of 25 mg/mL. Administer through a large-bore vein through a running IV line into the most distal port. Slight yellow color does not alter potency. Do not use if precipitate is present. Rate: Administer each 25 mg slowly, over at least 10-15 min (maximum rate = 25 mg/min). Rapid administration may produce a transient fall in BP. Major Side Effects- NEUROLEPTIC MALIGNANT SYNDROME, confusion, disorientation, sedation, dizziness, extrapyramidal reactions, fatigue, insomnia, nervousness, blurred vision, diplopia, tinnitus, bradycardia, hypertension, hypotension, tachycardia, constipation, drug-induced hepatitis, dry mouth, photosensitivity, severe tissue necrosis upon infiltration at IV site, rashes, blood dyscrasias Nursing Implications- Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur. IV: High Alert: If administered IV, assess for burning and pain at IV site; may cause severe tissue injury. Avoid IV administration, if possible. If pain occurs, discontinue administration immediately. Patient/Family Teaching- Motion Sickness: When used as prophylaxis for motion sickness, advise patient to take medication at least 30 min and preferably 1-2 hr before exposure to conditions that may cause motion sickness.

Brand Name- Multi Vitamin Concentrate Generic Name- multiple vitamins Ther. Class.- vitamins Mechanism of Action- Contain fat-soluble vitamins (A, D, and E) and most water-soluble vitamins (B-complex vitamins B1, B2, B3, B5, B6, B12, vitamin C, biotin, and folic acid). These vitamins are a diverse group of compounds necessary for normal growth and development. Many act as coenzymes or catalysts in numerous metabolic processes. Liquid products do not contain folic acid. Dose and Frequency- PO: (Adults and Children) 1 dose unit (tablet/capsule/dropperful)/day or amount recommended by individual manufacturer. IV: (Adults and Children) Amount sufficient to meet RDA for age group. Usually added to large-volume parenteral or total parenteral nutrition (hyperalimentation) solution. Implementation- Vitamins are usually given orally but may be given parenterally to patients in whom oral administration is not feasible. Combinations with >1 mg folic acid require a prescription. PO: Forms are not standardized. Chewable tablets should be crushed or chewed before swallowing. Liquid preparations may be dropped directly into the mouth or mixed with juice or cereal. Major Side Effects- In recommended doses, adverse reactions are extremely rare, GU: urine discoloration (preparations with B vitamins), Misc: allergic reactions to preservatives, additives, or colorants

Major Side Effects- In recommended doses, adverse reactions are extremely rare, GU: urine discoloration (preparations with B vitamins), Misc: allergic reactions to preservatives, additives, or colorants Nursing Implications- Assess patient for signs of nutritional deficiency before and throughout therapy. Patients at risk include geriatric patients and those who are debilitated, burned, or unable to take oral nutrition and those with malabsorption syndromes or chronic alcoholism. Toxicity Overdose: Toxicity rarely occurs with multivitamin preparations because of the small amounts per unit of fat-soluble vitamins. For symptoms, see individual vitamin entries. If overdose occurs, treatment includes induction of emesis or gastric lavage, calcium gluconate IV if hypocalcemic, and maintenance of high urine output. Patient/Family Teaching- Encourage patient to comply with recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet with foods from the 4 basic food groups. Advise parents not to refer to chewable multivitamins for children as candy.

Simethicone Chewable tablets Brand Name- Mylicon Generic Name- simethicone Ther. Class.- antiflatulent Action- Causes the coalescence of gas bubbles. Does not prevent the formation of gas. Dose and Frequency- PO: (Adults) 40-125 mg qid, after meals and at bedtime (up to 500 mg/day). PO: (Children 2-12 yr): 40 mg 4 times daily. PO: (Children <2 yr): 20 mg 4 times daily (up to 240 mg/day). Implementation- PO: Administer after meals and at bedtime for best results. Shake liquid preparations well prior to administration. Chewable tablets should be chewed thoroughly before swallowing for faster and more complete results. Drops can be mixed with 30 mL of cool water, infant formula, or other liquid as directed. Shake well before using.

Major Side Effects- None significant. Nursing Implications- PO: Administer after meals and at bedtime for best results. Shake liquid preparations well prior to administration. Chewable tablets should be chewed thoroughly before swallowing for faster and more complete results. Drops can be mixed with 30 mL of cool water, infant formula, or other liquid as directed. Shake well before using. Patient/Family Teaching- Explain to patient the importance of diet and exercise in the prevention of gas. Also explain that this medication does not prevent the formation of gas. Advise patient to notify health care professional if symptoms are persistent.

Ferrous Sulfate (Iron) Drug Classification- Ther. Class.-antianemics Pharm. Class.-iron supplements Action- Iron is an essential component in the physiological formation of hemoglobin, adequate amounts of which are necessary for effective erythropoiesis and the resultant oxygen transport capacity of the blood. A similar function is provided by iron in myoglobin production. Iron also serves as a cofactor of several essential enzymes, including cytochromes that are involved in electron transport. Iron is necessary for catecholamine metabolism and the proper functioning of neutrophils. Dose and Frequency-Initial: 300 to 325 mg of regular-release ferrous sulfate orally once a day. Maintenance: Regular-release ferrous sulfate: 325 mg orally 3 times a day. Alternatively, 300 mg orally 4 times a day may be given. Extended-release ferrous sulfate: 160 mg orally 1 to 2 times a day. Resolution of iron deficiency anemia may require ferrous sulfate supplementation for several weeks or months, depending on the duration and severity of the anemia.

Major Side Effects- Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; blood or streaks of blood in the stool; fever; severe or persistent nausea, stomach pain, or vomiting; vomit that looks like blood or coffee grounds. Nursing Implications- Monitor for adverse effects, monitor stool Implementation- Take ferrous sulfate on an empty stomach, at least 1 hour before or 2 hours after a meal. Avoid taking antacids or antibiotics within 2 hours before or after taking ferrous sulfate . Take ferrous sulfate with a full glass of water. Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time. Ferrous sulfate can stain your teeth, but this effect is temporary. To prevent tooth staining, mix the liquid form of ferrous sulfate with water or fruit juice (not with milk) and drink the mixture through a straw. You may also clean your teeth with baking soda once per week to treat any tooth staining.

Brand Name- Stadol Generic Name- butorphanol Drug Classification- Ther. Class. opioid analgesics Pharm. Class. opioid agonists antagonists Mechanism of Action- Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Has partial antagonist properties that may result in opioid withdrawal in physically dependent patients. Dose and Frequency- IM: (Adults) 2 mg q 3-4 hr as needed (range 1-4 mg). IV: (Adults) 1 mg q 3-4 hr as needed (range 0.5-2 mg). IM: IV: Geriatric Patients 1 mg q 4-6 hr, ↑ as necessary. Intranasal: (Adults) 1 mg (1 spray in 1 nostril) initially. An additional dose may be given 60-90 min later. This sequence may be repeated in 3-4 hr. If pain is severe, an initial dose of 2 mg (1 spray in each nostril) may be given. May be repeated in 3-4 hr. Implementation- High Alert: Accidental overdosage of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order, dose calculations, route of administration, and infusion pump programming. IM: Administer IM injections deep into well-developed muscle. Rotate sites of injections. Intranasal: Administer 1 spray in 1 nostril. IV Administration pH: 3.0-5.5. Direct IV: Diluent: May give IV undiluted. Concentration: 1-2 mg/mL. Rate: Administer over 3-5 min. High Alert: Rapid administration may cause respiratory depression, hypotension, and cardiac arrest.

Major Side Effects- confusion, dysphoria, hallucinations, sedation, euphoria, floating feeling, headache, unusual dreams, nausea, constipation, dry mouth, ileus, vomiting, urinary retention, sweating, clammy feeling Nursing Implications- Assess type, location, and intensity of pain before and 30-60 min after IM, 5 min after IV, and 60-90 min after intranasal administration. When titrating opioid doses, increases of 25-50% should be administered until there is either a 50% reduction in the patient's pain rating on a numerical or visual analogue scale or the patient reports satisfactory pain relief. A repeat dose can be safely administered at the time of the peak if previous dose is ineffective and side effects are minimal. Patients requiring doses higher than 4 mg should be converted to an opioid agonist. Butorphanol is not recommended for prolonged use or as first-line therapy for acute or cancer pain. Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Dose may need to be decreased by 25-50%. Respiratory depression does not increase in severity, only in duration, with increased dosage. Patient/Family Teaching- Instruct patient on how and when to ask for pain medication.Medication may cause drowsiness or dizziness. Advise patient to call for assistance when ambulating and to avoid driving or other activities requiring alertness until response to the medication is known. Encourage patients on bedrest to turn, cough, and deep-breathe every 2 hr to prevent atelectasis.

Dermoplast

Name- Dermoplast (Benzocaine 20% & Menthol 0.5%) Drug Classification- Therapeutic- pain reliever Pharmacologic- topical analgesic Mechanism of Action- Local anesthetics block both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions. This reversibly stabilizes the membrane and inhibits depolarization, resulting in the failure of a propagated action potential and subsequent conduction blockade. Dose and Frequency- Adults and Children 2 years and older: Apply to affected area not more than 3 to 4 times daily. Children under 2: Consult a Doctor Route- Topical Major Side Effects- itching, rash, or irritation, anaphylaxis Nursing Implications- Avoid contact with eyes, mouth and mucous membranes. Contents flammable. Keep away from fire, open flame and heat. Do not use this product if you have a history of allergy to local anesthetics such as procaine, beautician, benzocaine, or other "caine" anesthetics. Stop use if condition worsens.

Tucks (Witch Haze) Pads for perineal pain

Name- Tucks pads (Witch hazel 50%) Drug Classification- Therapeutic- perineal pain Pharmacologic- astringent Dose and Frequency- Apply externally to the affected area up to 6 times daily or after each bowel movement Route- Topical Major Side Effects- rectal bleeding, worsening of condition Nursing Implications- when practical, clean the affected area with mild soap and warm water, and rinse thoroughly Gently dry by patting or blotting with toilet tissue or a soft cloth before applying Apply externally to the effected area up to 6 times daily or after each bowel movement After application, discard pad

Tylenol 3 (acetaminophen and codeine)

Name- Tylenol 3 Drug Classification- opioid analgesic Mechanism of Action- Codeine: Narcotic analgesic; centrally acting analgesic. APAP: Nonopiate, nonsalicylate analgesic; peripherally acting analgesic. Dose and Frequency- ADULT DOSAGE Mild to Moderately Severe Pain Adjust dose according to severity of pain and response Usual Range (Single Dose): 15mg-60mg codeine; 300mg-1000mg acetaminophen (APAP); may repeat doses up to q4h Max: 360mg/24 hrs codeine; 4000mg/24 hrs APAP Route- oral Major Side Effects- Acute liver failure, drowsiness, lightheadedness, dizziness, sedation, SOB, N/V. Nursing Implications- Assess for hypersensitivity to drug, hepatic/renal impairment, head injury, intracranial lesions, acute abdominal conditions, any other conditions where treatment is contraindicated or cautioned, pregnancy/nursing status, and possible drug interactions. Monitor- Monitor for signs/symptoms of hepatotoxicity, respiratory depression, skin reactions, hypersensitivity, anaphylaxis, elevation in CSF pressure, drug abuse, tolerance, dependence, and other adverse reactions. Monitor effects of therapy with serial LFTs and/or renal function tests in patients with severe hepatic/renal disease. Closely monitor newborn infants for signs of respiratory depression if the mother received the drug during labor. Patient/Family Teaching- Advise that drug may impair mental/physical abilities. Instruct to avoid performing potentially hazardous tasks (eg, driving, operating machinery), drinking alcohol, or taking other CNS depressants while on therapy. Inform that drug may be habit-forming; instruct to take ud.

Brand Name- Procardia Generic name- NIFEdipine Ther. Class. antianginals, antihypertensives Pharm. Class.- calcium channel blockers Mechanism of Action- Inhibits calcium transport into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Dose and Frequency- PO: (Adults) 10-30 mg 3 times daily (not to exceed 180 mg/day), or 10-20 mg twice daily as immediate-release form, or 30-90 mg once daily as sustained-release (CC, XL) form (not to exceed 90-120 mg/day). Implementation- PO: May be administered without regard to meals. May be administered with meals if GI irritation becomes a problem. Major Side Effects- STEVENS-JOHNSON SYNDROME, gingival hyperplasia, flushing, dermatitis, erythema multiforme, ↑ sweating, photosensitivity, pruritus/urticaria, rash, Endo: gynecomastia, hyperglycemia, ARRHYTHMIAS, HF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia, headache, abnormal dreams, anxiety, confusion, dizziness, drowsiness, jitteriness, nervousness, psychiatric disturbances, weakness

Nursing Implications- Monitor BP and pulse before therapy, during dose titration, and periodically during therapy. Monitor ECG periodically during prolonged therapy. Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention). Patients receiving digoxin concurrently with nifedipine should have routine tests of serum digoxin levels and be monitored for signs and symptoms of digoxin toxicity. Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia. Patient/Family Teaching- Advise patient to notify health care professional if rash, irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.

Brand Name- Lactated Ringer's Solution Generic Name- sodium chloride Therapeutic Classification-fluid and electrolyte replenishment Mechanism of Action- Lactated Ringer's is a sterile solution for fluid and electrolyte replenishment. It restores fluid and electrolyte balances, produces diuresis, and acts as alkalizing agent (reduces acidity). The FDA approved Ringer's solution in plastic containers in 1971 Dose- As directed by a physician. Dosage is dependent upon the age, weight and clinical condition of the patient as well as laboratory determinations. Major Side Effects- Allergic reactions or anaphylactoid symptoms such as localized or generalized urticaria and pruritis; periorbital, facial, and/or laryngeal edema; coughing, sneezing, and/or difficulty with breathing have been reported during administration of Lactated Ringer's Injection, USP. The reporting frequency of these signs and symptoms is higher in women during pregnancy. Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of infection, extravasation, and hypervolemia.

Nursing Implications- Monitor for all adverse reactions. If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures, and save the remainder of the fluid for examination if deemed necessary. Implementation- Preparation for Administration Suspend container from eyelet support. Remove protector from outlet port at bottom of container. Attach administration set. Refer to complete directions accompanying set. To Add Medication To add medication before solution administration Prepare medication site. Using syringe with 19 to 22 gauge needle, puncture medication port and inject. Mix solution and medication thoroughly. For high density medication such as potassium chloride, squeeze ports while ports are upright and mix thoroughly. To add medication during solution administration Close clamp on the set. Prepare medication site. Using syringe with 19 to 22 gauge needle, puncture resealable medication port and inject. Remove container from IV pole and/or turn to an upright position. Evacuate both ports by squeezing them while container is in the upright position. Mix solution and medication thoroughly. Return container to in use position and continue administration.

Brand Name- Benadryl Generic Name- diphenhydramine Ther. Class.-allergy, cold and cough remedies, antihistamines, antitussives Action- Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine. Significant CNS depressant and anticholinergic properties. Dose and Frequency- PO: (Adults and Children >12 yr): Antihistaminic/antiemetic/antivertiginic- 25-50 mg q 4-6 hr, not to exceed 300 mg/day. Antitussive- 25 mg q 4 hr as needed, not to exceed 150 mg/day. Antidyskinetic- 25-50 mg q 4 hr (not to exceed 400 mg/day). Sedative/hypnotic- 50 mg 20-30 min before bedtime. PO: (Children 6-12 yr): Antihistaminic/antiemetic/antivertiginic- 12.5-25 mg q 4-6 hr (not to exceed 150 mg/day). Antidyskinetic- 1-1.5 mg/kg q 6-8 hr as needed (not to exceed 300 mg/day). Antitussive- 12.5 mg q 4 hr (not to exceed 75 mg/day). Sedative/hypnotic- 1 mg/kg/dose 20-30 min before bedtime (not to exceed 50 mg). PO: (Children 2-6 yr): Antihistaminic/antiemetic/antivertiginic- 6.25-12.5 mg q 4-6 hr (not to exceed 37.5 mg/day). Antidyskinetic- 1-1.5 mg/kg q 4-6 hr as needed (not to exceed 300 mg/day). Antitussive- 6.25 mg q 4 hr (not to exceed 37.5 mg/24 hr). Sedative/hypnotic- 1 mg/kg/dose 20-30 min before bedtime (not to exceed 50 mg). IM: IV: (Adults) 25-50 mg q 4 hr as needed (may need up to 100-mg dose, not to exceed 400 mg/day). IM: IV: Children 1.25 mg/kg (37.5 mg/m2 ) 4 times daily (not to exceed 300 mg/day). Topical: (Adults and Children ≥2 yr): Apply to affected area up to 3-4 times daily. Implementation- Do not confuse Benadryl with benazepril. When used for insomnia, administer 20 min before bedtime and schedule activities to minimize interruption of sleep. When used for prophylaxis of motion sickness, administer at least 30 min and preferably 1-2 hr before exposure to conditions that may precipitate motion sickness.

PO: Administer with meals or milk to minimize GI irritation. Capsule may be emptied and contents taken with water or food. Orally disintegrating tablets and strips should be left in the package until use. Remove from the blister pouch. Do not push tablet through the blister; peel open the blister pack with dry hands and place tablet on tongue. Tablet will dissolve rapidly and be swallowed with saliva. No liquid is needed to take the orally disintegrating tablet. IM: Administer 50 mg/mL into well-developed muscle. Avoid subcut injections. Topical: Apply a thin coat and rub gently until absorbed. Only for topical use; avoid ingestion. Major Side Effects- drowsiness, dizziness, headache, paradoxical excitation (increased in children), EENT: blurred vision, tinnitus, CV: hypotension, palpitations GI: anorexia, dry mouth, constipation, nausea Nursing Implications- Diphenhydramine has multiple uses. Determine why the medication was ordered and assess symptoms that apply to the individual patient. Geri: Appears in the Beers list. May cause sedation and confusion due to increased sensitivity to anticholinergic effects. Monitor carefully, assess for confusion, delirium, other anticholinergic side effects and fall risk. Institute measures to prevent falls. Prevention and Treatment of Anaphylaxis: Assess for urticaria and for patency of airway. Allergic Rhinitis: Assess degree of nasal stuffiness, rhinorrhea, and sneezing. Parkinsonism and Extrapyramidal Reactions: Assess movement disorder before and after administration. Insomnia: Assess sleep patterns. Motion Sickness: Assess nausea, vomiting, bowel sounds, and abdominal pain. Cough Suppressant: Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced. Unless contraindicated, maintain fluid intake of 1500-2000 mL daily to decrease viscosity of bronchial secretions. Pruritus: Assess degree of itching, skin rash, and inflammation. Patient/Family Teaching- Caution parents to avoid OTC cough and cold products while breast feeding or to children <4 yr.

Brand Name- Anaxprox DS Generic Name- naproxen sodium Pregnancy Category Category B (first trimester) Ther. Class.- nonopioid analgesics nonsteroidal anti inflammatory agents antipyretics Mechanism of Action- Inhibits prostaglandin synthesis. Dose and Frequency- 275 mg naproxen sodium is equivalent to 250 mg naproxen Anti-Inflammatory/Analgesic/Antidysmenorrheal PO: (Adults) Naproxen- 250-500 mg twice daily (up to 1.5 g/day). Delayed-release naproxen- 375-500 mg twice daily. Naproxen sodium- 275-550 mg twice daily (up to 1.65 g/day). PO: (Children >2 yr): Analgesia: 5-7 mg/kg/dose q 8-12 hr. Inflammatory disease: 10-15 mg/kg/day divided q 12 hr, maximum: 1000 mg/day. Antigout PO: (Adults) Naproxen- 750 mg naproxen initially, then 250 mg q 8 hr. Naproxen sodium- 825 mg initially, then 275 mg q 8 hr. OTC Use (naproxen sodium) PO: (Adults) 200 mg q 8-12 hr or 400 mg followed by 200 mg q 12 hr (not to exceed 600 mg/24 hr). PO: (Geriatric Patients >65 yr): Not to exceed 200 mg q 12 hr. Implementation- Administration in higher than recommended doses does not provide increased effectiveness but may cause increased side effects. Use lowest effective dose for the shortest duration possible to minimize cardiac risks. Coadministration with opioid analgesics may have additive analgesic effects and may permit lower opioid doses. Analgesic is more effective if given before pain becomes severe.

PO: For rapid initial effect, administer 30 min before or 2 hr after meals. May be administered with food, milk, or antacids to decrease GI irritation. Food slows but does not reduce the extent of absorption. Do not mix suspension with antacid or other liquid prior to administration. Swallow extended-release, delayed-release, and controlled-release tablets whole; do not break, crush, or chew. Dysmenorrhea: Administer as soon as possible after the onset of menses. Prophylactic treatment has not been shown to be effective. Major Side Effects- CNS: dizziness, drowsiness, headache EENT: tinnitus, visual disturbances Resp: dyspnea CV: edema, palpitations, tachycardia GI: DRUG-INDUCED HEPATITIS, GI BLEEDING, constipation, dyspepsia, nausea, anorexia, diarrhea, discomfort, flatulence, vomiting GU: cystitis, hematuria, renal failure Derm: photosensitivity, rashes, sweating, pseudoporphyria (12% incidence in children with juvenile rheumatoid arthritis-discontinue therapy if this occurs) Hemat: blood dyscrasias, prolonged bleeding time Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS AND STEVENS-JOHNSON SYNDROME Nursing Implications- Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Pain: Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. Arthritis: Assess pain and range of motion prior to and 1-2 hr following administration. Fever: Monitor temperature; note signs associated with fever (diaphoresis, tachycardia, malaise). Patient/Family Teaching- Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, or other OTC medications without consulting health care professional. Use of naproxen with 3 or more glasses of alcohol per day may increase risk of GI bleeding.

Brand Name- Pitocin Generic Name- oxytocin Ther. Class.-hormones Pharm. Class.- oxytocics Mechanism of Action- Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor. Has vasopressor and antidiuretic effects. Route/Dosage- Induction/Stimulation of Labor IV: (Adults) 0.5-1 milliunits/min; ↑ by 1-2 milliunits/min q 30-60 min until desired contraction pattern established; dose may be ↓ after desired frequency of contractions is reached and labor has progressed to 5-6 cm dilation. Postpartum Hemorrhage IV: (Adults) 10 units infused at 20-40 milliunits/min. IM: (Adults) 10 units after delivery of placenta. Incomplete/Inevitable Abortion IV: (Adults) 10 units at a rate of 20-40 milliunits/min. Implementation- IV Administration Continuous Infusion: Rotate infusion container to ensure thorough mixing. Store solution in refrigerator, but do not freeze. Infuse via infusion pump for accurate dose. Oxytocin should be connected via Y-site injection to an IV of 0.9% NaCl for use during adverse reactions. Magnesium sulfate should be available if needed for relaxation of myometrium. Induction of Labor: Diluent: Dilute 1 mL (10 units) in 1 L of compatible infusion fluid (0.9% NaCl, D5W, or LR). Concentration: 10 milliunits/mL. Rate: Begin infusion at 0.5-2 milliunits/min (0.05-0.2 mL); increase in increments of 1-2 milliunits/min at 15-30-min intervals until contractions simulate normal labor.

Postpartum Bleeding: Diluent: For control of postpartum bleeding, dilute 1-4 mL (10-40 units) in 1 L of compatible infusion fluid. Concentration: 10-40 milliunits/mL. Rate: Begin infusion at a rate of 20-40 milliunits/min to control uterine atony. Adjust rate as indicated. Incomplete or Inevitable Abortion: Diluent: For incomplete or inevitable abortion, dilute 1 mL (10 units) in 500 mL of 0.9% NaCl or D5W. Concentration: 20 milliunits/mL. Rate: Infuse at a rate of 20-40 milliunits/min. Major Side Effects- Maternal adverse reactions are noted for IV use only CNS: maternal: COMA, SEIZURESfetal: INTRACRANIAL HEMORRHAGE Resp: fetal: ASPHYXIA, hypoxia CV: maternal: hypotensionfetal: arrhythmias F and E: maternal: hypochloremia, hyponatremia, water intoxication Misc: maternal: ↑ uterine motility, painful contractions, abruptio placentae, ↓ uterine blood flow, hypersensitivity Nursing Implications- Fetal maturity, presentation, and pelvic adequacy should be assessed prior to administration of oxytocin for induction of labor. Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate frequently throughout administration. If contractions occur <2 min apart and are >50-65 mm Hg on monitor, if they last 60-90 sec or longer, or if a significant change in fetal heart rate develops, stop infusion and turn patient on her left side to prevent fetal anoxia. Notify health care professional immediately. Monitor maternal BP and pulse frequently and fetal heart rate continuously throughout administration. Patient/Family Teaching- Advise patient to expect contractions similar to menstrual cramps after administration has started.

Dextrose 5% Lactated Ringers

Therapeutic Classification- Fluid Replacement Action- One liter has an ionic concentration of 130 mEq sodium, 4 mEq potassium, 2.7 mEq calcium, 109 mEq chloride and 28 mEq lactate. The osmolarity is 525 mOsmol/L (calc). Normal physiologic range is approximately 280 to 310 mOsmol/L. Administration of substantially hypertonic solutions may cause vein damage. The caloric content is 180 kcal/L. Adverse Side Effects- Allergic reactions or anaphylactoid symptoms such as localized or generalized urticaria and pruritis; periorbital, facial, and/or laryngeal edema, coughing, sneezing, and/or difficulty with breathing have been reported during administration of Lactated Ringer's and 5% Dextrose Injection, USP. The reporting frequency of these signs and symptoms is higher in women during pregnancy. Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia. Dosage- Your doctor will determine your individual dosage. Nursing Implications- Monitor for itching, swelling of the face, coughing, sneezing, and difficulty breathing. Assess for vein damage

Tylox (oxycodon + acetaminophen) Look at oxycodone and acetaminophen Drug Cards

Tylox- combination of acetaminophen and oxycodone Classification- pain reliever Side Effects- shallow breathing, slow heartbeat; a light-headed feeling, like you might pass out; confusion, unusual thoughts or behavior; seizure (convulsions); problems with urination; or nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes). Dose and Frequency- Adults: The usual dose is one capsule every 6 hours, as needed for pain. Your healthcare provider may adjust your dose as needed, until the desired effect is achieved. Implementation- Monitor patient for lightheadedness, dizziness, drowsiness, nausea, vomiting. Drink 6 to 8 full glasses of water daily to help prevent constipation while you are taking Tylox capsule. Do not use a stool softener (laxative) without first asking your doctor. Pregnancy Category C Asess- An overdose of acetaminophen can damage your liver or cause death. Call your doctor at once if you have nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of your skin or eyes). Patient/Family Teaching- Tylox may impair your thinking or reactions. Avoid driving or operating machinery until you know how Tylox will affect you.

Vitamin K

Uses- Vitamin K is needed for proper bone formation and blood clotting. In both cases, vitamin K does this by helping the body transport calcium. Vitamin K is used by doctors when treating an overdose of the drug warfarin. Also, doctors prescribe vitamin K to prevent excessive bleeding in people taking warfarin but requiring surgery. There is promising preliminary evidence that vitamin K2 (not vitamin K1), may improve a group of blood disorders known as myelodysplastic syndromes,1 which carry a significantly increased risk of progression to acute myeloid leukemia. Dosage- The recommended dietary allowance for vitamin K is about 1 mcg per 2.2 pounds of body weight per day or about 65 to 80 mcg per day for most adults.34 This level of intake may be achieved by consuming adequate amounts of leafy green vegetables. However, studies have shown that many men and women aged 18 to 44 years ingest less than the recommended amount of vitamin K.35, 36 Interactions- Vitamin K facilitates the effects of calcium in building bone and proper blood clotting. Side Effects- Allergic reactions to vitamin K injections have been reported on rare occasions.