Nursing Implications: Administration Essay

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Calcium Channel Blockers
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Withhold drug is systolic pressure is less than 90
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Heparins
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activated partial thromboplasin time (APTT) should be maintained at approximately 1.5 to 2.5 times the control or baseline value. Normal control is 25 to 35 seconds.
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Vitamin K Antagonists
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Daily evalution of INR is necessary until stable daily dose is reached. Therapeutic PT value is 1.5 times control.
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Vitamin K Antagonists
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Nurse holds dose if INR is above 3.0 and notifies health care provider
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Thrombolytics
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Check INR, aPTT, platelet count and fibrinogen to establish baseline and to determine whether a blood coagulation disorder is present
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Thrombolytics
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Two or three hours after therapy is started fibrinogen level is measured. Alternatively nurse can check INR or aPTT for increased values.
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Thrombolytics
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During and following administration the nurse monitors BP frequently and ensures that it is well controlled.
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HMG-CoA Reductase Inhibitors (Statins)
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Administration normally takes place in evening or bedtime
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HMG-CoA Reductase Inhibitors (Statins)
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If serum aninotransferases are persistently 3 times upper limit of normal levels, it is necessary to reduce the dose or change the drug
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Bile Acid Sequestrants
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Other drugs should be taken 1 hour before or 4 to 6 hours after.
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Bile Acid Sequestrants
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Supplementation of fat soluble vitamins may be required.
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Fibrates
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Necessary to give with food to increase drug absorption.
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Cholesterol Absorption Inhibitor
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Administer at the same time of day, or at night if used in combination with statin.
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Erythrocyte Hematopoietic Drugs
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For patients with chronic renal failure adminster by bolus at end of dialysis.
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Granulocyte Colony-Stimulating Factors
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For cancer chemotherapy subcutaneous bolus injection, or IV infusion over 15 to 20 minutes
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Granulocyte Colony-Stimulating Factors
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For bone marrow transplantation give by IV infusion over 4 hours or by continuous IV or subcutaneous infusion
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Salicylates
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Should be taken with glass of water or other fluid and with food or just following food.
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Propionic Acid Derivatives
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Should be diluted in a concentration of 4 mg/ml or less using 0.9 sodium choloride, 5% dextrose, or lactated Ringers
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Oxicam Derivatives
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Should be administered with food or fluids to reduce gastric irritation.
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Oxicam Derivatives
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It is necessary to shake oral suspension gently
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Acetic Acid Derivatives
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Administer after meals or with antacid to decrease GI irritation
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Acetic Acid Derivatives
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IV administration requires dilution of 1 mg with 1mL of sterile water or normal saline
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Acetic Acid Derivatives
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It is necessary to administer dose over 5 to 10 seconds.
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Selective COX-2 Inhibitor
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Should be administered 2 hours or before antacids
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Mitotic Agent
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Should be administered with food to reduce gastric distress
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Uricosuric Agents
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Should be administered after meals to ensure absorption
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Corticosteroids
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Entire daily dose can be taken each morning.
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Nucleoside Reverse Transcriptase Inhibtors
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IV preparation should be mixed with 5% dextrose and water or normal saline
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Nucleoside Reverse Transcriptase Inhibtors
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Drug should be taken around the clock to avoid variations in serum peak and trough levels
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Nucleoside Reverse Transcriptase Inhibtors
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Infusion should take place over half hour in neonates and 1 hour in children and adults
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Non-nucleoside Reverse Transcriptase Inhibitors
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Patients who experience CNS depression should take at bedtime
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Non-nucleoside Reverse Transcriptase Inhibitors
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May take on empty stomach, should take 2 hours after consuming a high-fat meal.
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Protease Inhibitors
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Should be taken within 2 hours of a meal or on full stomach
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Protease Inhibitors
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Patients should have ECG prior to start of therapy and 3-4 days after start of therapy.
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Fusion Protein Inhibitors
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Rotation of injection sites is necessary.
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CCR5 Antagonists
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High-fat food enhances absorption.
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Second-Generation H1 Receptor Antagonists
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Fruit juices may decrease absorption.
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Indirect-Acting Cholinergics
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It is necessary to give drug with food or fluid.
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Indirect-Acting Cholinergics
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Important to administer IV slowly, and have atropine available as an antidote.
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Dopamine Receptor Agonists
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Administered with or just after food to reduce N/V
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Dopamine Receptor Agonists
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Do not give with iron preparations or multivitamin-mineral preparations that contain iron.
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Dopamine Receptor Agonists
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Do not administer with a high protein meal.
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Mood-Stabilizing Agents
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Serum drug levels should not exceed 1.5 mEq/L because of serious drug toxicity.
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Biguanides
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Drug should be taken with meals.
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Inotropes (Cardiac Glycosides)
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Therapeutic serum level is 0.8-2.0 ng/mL
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Inotropes (Cardiac Glycosides)
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Apical pulse should be taken before administration. If rate is less than 60 (adults), 70 (older children), 100 (younger children), the dose is omitted and provider notified.
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Ace Inhibitors
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Should be taken 1 hour before or 2 hours after meals.
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Angiotensin II Receptor Blockers
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Nurse assesses kidney and liver function tests, as well as serum electrolyte levels, particularly potassium.
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Class I Sodium Channel Blockers
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IV prep will have 800 mg in 50 mL of 5% dextros
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Class I Sodium Channel Blockers
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IV solution is injected slowly at rate of 1 mL a minute
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Class I Sodium Channel Blockers
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Is not compatible with furosemide in IV preperation
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Class 1B Sodium Channel Blockers
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Give IV bolus over 2 min
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Loop Diuretics
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IV injections are given over 1-2 minutes
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Loop Diuretics
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Continuous IV infusions are given at a rate of 4 mg/min or less
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Loop Diuretics
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It is necessary to mix drug with normal saline or lactate Ringer’s
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Aminoglycosides
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With conventional dosing peak levels should be taken 30 minutes after IV or 1 hour after IM
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Aminoglycosides
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With ODA take level 12 hours after start of infusion
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Aminoglycosides
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Administer penacillin-class agent 1 hour before or after drug.
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Iminostilbenes
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Drug should not be administered within 14 days of MAO inhibitor
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Iminostilbenes
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Suspension should not be mixed with other liquid medications.
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Iminostilbenes
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Medication should be taken with food to reduce GI upset.
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Tetracyclines
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Medication should be taken on empty stomach (1 hour before or 2 hours after meals)
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Tetracyclines
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Do not take with dairy products, antacids or iron supplements.
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Tetracyclines
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If patient has consumed dairy or antacids, withold drug for 2 hours.
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Macrolides
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Drink 6-8 ounces of water when taking medication
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Macrolides
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Should not be taken after taking antacids
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Macrolides
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Drug should be infused over 30-60 minutes
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Penicillins
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Give drug on empty stomach (1 hour before or 2 hours after meal)
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Cephalosporins
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Oral formulations can be administered with food or milk to minimize adverse effects
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Carbapenems
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Avoid administering to patients with life-threatening allergic reactions to penicillin
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Carbapenems
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IM administration is not recommended for people with severe or life-threatening infections such as endocarditis shock, or spticemia.
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Carbapenems
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Lidocaine is added to IM injection to decrease pain.
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Thyroid drugs
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Drug should be taken in morning on and empty stomach.
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Thyroid drugs
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If PR prior to administering drug is >100, notify the prescriber
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Proton Pump Inhibitors
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Should be administered before food intake.
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Atypical Antipsychotics
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If drug is discontinued it must be tapered over 2 weeks. Monitor for acute psychosis during this period.
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Reversible Indirect-Acting Cholinergics
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Should be taken at bed time.
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Typical Antipsychotics
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Oral administration should be given with full glass of water or milk.
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Typical Antipsychotics
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IM administration of long acting form requires deep IM in ventrogluteal muscle.
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Typical Antipsychotics
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When discontinuation of drug is required, drug must be tapered.
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Beta-Adrenergic Blockers
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Withhold if HR is less than 50 and notify provider.
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Beta-Adrenergic Blockers
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Take oral forms with meals.
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Fluroquinolones
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Give IV infusion over at least 1 hour.
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Fluroquinolones
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Enteral feedings may affect concentration. Give tube feedings 1 hour before and 2 hours after administering the drug.
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Rifamycins
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Drug should be taken on empty stomach 1 hour before or 2 hours after meal. May take with meal or large glass of water if not tolerated.
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Rifamycins
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Final concentration of IV preparation should not exceed 6 mg/mL
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Isoniazid
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Drug should be taken 1 hour before or 2 hours after meal, with a full glass of water. May be taken with food if it causes GI upset.
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Isoniazid
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If given IM it is necessary to rotate injection site.
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Biphosphonates
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Hypocalcemic patients require correction of low serum calcium levels before beginning therapy.
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Biphosphonates
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Drug should be taken at least 30 minutes before breakfast and before taking other drugs.
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Biphosphonates
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Patient must remain upright (head of bed elevated 90 degrees, sitting in chair, or standing) for at least 30 minutes after administration.
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Selective Serotonin Reputake Inhibitors
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Typically taken once daily in morning to prevent interference with sleep.
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Selective Serotonin Reputake Inhibitors
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Drug may be taken with food to prevent GI upset.
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5-Alpha Reductase Inhibitors
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Pregnant caregivers, nurses or pharmacists should not handle crushed drug.
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Sulfonamides
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Take drug before or after meals with 8oz water
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Sulfonamides
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Store drug in a light resistant container at 59-86 degrees F (15-30 degrees C).
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Gamma-Aminobutyric Acid Structural Analogs
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Drug may be taken with food to relieve GI upset.
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Serotonin Receptor Antagonists
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Use of drug may mask a progressive ileus and gastric distension following abdominal surgery.
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Sulfonylureas
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Drug should be taken before breakfast or in divided doses before meals if patient experiences gastric distress.
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Dipeptidyl Peptidase-4 Inhibitors
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Should be taken once daily with or without food.
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Azoles
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Drug should never be mixed with any other medications
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Azoles
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Continuous administration occurs at a maximum rate or 200 mg per hour.
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Azoles
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Administer with food to decrease gastric upset.
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Thiazide Diuretics
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Monitoring for transient or irreversible hearing impairment, tinnitus, or dizziness is important.
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Loop Diuretics
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Patient should be monitored for diminished hearing, a sign of ototoxicity.
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Potassium-Sparing Diuretics
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Drug should be administered at the same time each day, preferably in the morning.
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Tricyclic Antidepressants
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Drug should be taken at bedtime to aid sleep and decrease daytime sedation.
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Purine Analougues
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It is necessary to infuse parenteral form over 1 hour to prevent renal damage.
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Purine Analougues
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Nurse ensures patient is well hydrated with 2-3 L of fluid per 24 hours.
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Antithyroid Drugs
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Drug can be taken with or without food, but it must remain consistent.
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Antithyroid Drugs
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Drug should be taken around the clock in evenly divided doses.
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Benzodiazepines
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Overdose is reversed with Flumazenil
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Benzodiazepines
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Administer IV form undiluted at a rate of 5 mg/min
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Adrenergics
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Drug should be used before other inhalants, and 5 minutes shall elapse before using additional inhalants.
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Adrenergics
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Drug should be used as needed due to decreased effectiveness with overuse.
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Anticholinergics
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Drug can be mixed in nebulizer with albuterol or metaproterenol if mixture is used within 1 hour.
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Xanthines
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It is necessary to monitor serum drug levels (therapeutic levels 5-15 mcg/mL)
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Xanthines
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Drug should be taken before meals with a full glass of water, at regular intervals around the clock.
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Xanthines
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Crushing of sustained release tablets causes immediate release of potentially toxic doses.
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Inhaled Corticosteroids
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After inhalation patient should rinse mouth and throat to prevent fungal infection.
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Gastrointestinal Anticholinergics
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Patient must void before administration of drug.
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Centrally Acting Anticholinergics
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Patient must void before administration of drug.
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Centrally Acting Anticholinergics
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If GI upset is present administer with food.
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Centrally Acting Anticholinergics
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Drug may be taken with meals in presence of dry mouth and after meals if drooling or nausea occurs.
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Catechol-O-Methyltransferase Inhibitors
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It is necessary to administer the drug with carpidopa/levidopa. Addition of the drug may require a decrease in the levodopa usage.
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Catechol-O-Methyltransferase Inhibitors
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Abrupt withdrawal of tocapone can lead to serious complication Tapering of drug over 2 weeks is necessary.
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Direct-Acting Cholinergics
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Administration should occur 1 hour before or 2 hours after meals.
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Beta-Blocking Opthalmics
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When administering more than one opthalmic medication, wait 10 minutes between each medication.
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Beta-Blocking Opthalmics
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Always invert bottle and shake before use.
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Beta-Blocking Opthalmics
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Patients who wear contact lens should wait at least 15 minutes before reinsertion.

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