OB Meds – Flashcard

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Oxytocin (Pitocin-Syntocinon)
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Dosage: Induction/Stimulation of Labor • IV (Adults): 0.5-2 milliunits/min; ↑ by 1-2 milliunits/min q 15-60 min until pattern established (usually 5-6 milliunits/min; maximum 20 milliunits/min), then ↓ dose. 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 Route: IV or IM Frequency: IV over 24 hours, Indications: • IV: Induction of labor at term • IV: Facilitation of threatened abortion • IV, IM: Postpartum control of bleeding after expulsion of the placenta Side Effects: CNS: maternal—COMA, SEIZURES, fetal—INTRACRANIAL HEMORRHAGE. Resp: fetal—ASPHYXIA, Misc: maternal—↑ uterine motility, painful contractions Nursing Considerations: • Assess Fetal maturity, presentation, and pelvic adequacy, • Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate, • Monitor maternal blood pressure and pulse frequently and fetal heart rate continuously throughout administration, Can cause water intoxication- can cause hypochloremia or hyponatremia so monitor electrolytes Patient Considerations:Advise patient to expect contractions similar to menstrual cramps after administration has started
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Terbutaline
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Dosage/Frequency/Route:• PO (Adults and Children >15 yr): Tocolysis—2.5-10 mg q 4-6 hr until delivery (unlabeled). • 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) Indications:Management of preterm labor (tocolytic) Side Effects: CNS: nervousness, restlessness, tremor, Nursing Considerations: • Monitor maternal pulse and blood pressure, frequency and duration of contractions, and fetal heart rate. 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 and mother for hypokalemia, • Symptoms of overdose include persistent agitation, chest pain or discomfort, decreased blood pressure, dizziness, hyperglycemia, hypokalemia, seizures, tachyarrhythmias, persistent trembling, and vomiting Patient Considerations:• Preterm Labor: Notify health care professional immediately if labor resumes or if significant side effects occur
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Magnesium Sulfate
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Dosage/Frequency/Route: • 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). Indications: • Anticonvulsant associated with severe eclampsia, pre-eclampsia, or acute nephritis Unlabelled Use(s): • Preterm labor Side Effects:CV: arrhythmias, bradycardia, hypotension. GI: diarrhea Nursing Considerations: • Monitor newborn for hypotension, hyporeflexia, and respiratory depression if mother has received magnesium sulfate Patient Considerations: Explain purpose of medication to patient and family
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RhoGAM
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Dosage/Frequency/Route: Indications: administration to Rh-negative women not previously sensitized to the Rho(D) factor, unless the father or baby are conclusively Rh-negative. Appropriate uses include Side Effects: Hypersensitivity reactions include hives, generalized urticaria, tightness of the chest, wheezing, hypotension and anaphylaxis Considerations: risk of transmitting infectious agents, e.g., viruses, and theoretically the Creutzfeldt-Jakob disease (CJD) agent. RhoGAM® and MICRhoGAM® are intended for maternal administration. Do not inject the newborn infant. Local adverse reactions may include redness, swelling, and mild pain at the site of injection and a small number of patients have noted a slight elevation in temperature
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(Colace) Docusate Sodium
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Dosage/Frequency/Route: • PO (Adults and Children >12 yr): 50-400 mg in 1-4 divided doses. • PO (Infants): 5 mg/kg/day in 1-4 divided doses. • Rect (Adults): 50-100 mg or 1 unit containing 283 mg docusate sodium, soft soap, and glycerin. Indications: PO: Prevention of constipation (in patients who should avoid straining, such as after MI or rectal surgery) • Rect: Used as enema to soften fecal impaction Side Effects: EENT: throat irritation. GI: mild cramps, diarrhea Derm: rashes. Nursing Considerations: PO: Administer with a full glass of water or juice. May be administered on an empty stomach for more rapid results » Oral solution may be diluted in milk, infant formula, or fruit juice to decrease bitter taste » Do not administer within 2 hr of other laxatives, especially mineral oil. • Rect: Administer as a retention or flushing enema Patient Considerations: • Advise patients that laxatives should be used only for short-term therapy. Long-term therapy may cause electrolyte imbalance and dependence • Encourage patients to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake , and increasing mobility. • Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver) • Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present • Advise patient not to take docusate within 2 hr of other laxatives
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(Nubain) Nalbuphine
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Dosage/Route/Frequency: IM, SC, IV (Adults): Usual dose is 10 mg q 3-6 hr (single dose not to exceed 20 mg; total daily dose not to exceed 160 mg). Indications:Analgesia during labor Side Effects: CNS: dizziness, headache, sedation, GI: dry mouth, nausea, vomiting, Derm: clammy feeling, sweating. Nursing Considerations: • Assess type, location, and intensity of pain before and 1 hr after IM or 30 min (peak) after IV administration., Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation., May cause ↑ serum amylase and lipase concentrations, High Alert Med, Patient Considerations: 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 • Caution patient to change positions slowly to minimize orthostatic hypotension • Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dry mouth • Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis • Advise patient to avoid concurrent use of alcohol or other CNS depressants with this medication
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(Zofran) Ondansetron
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Dosage/Route/Frequency:PO: Prevention of postoperative nausea/vomiting—16 mg 1 hr before induction of anesthesia.• IM, IV (Adults): Prevention of postoperative nausea/vomiting—4 mg before induction of anesthesia or postoperatively. Indications: Prevention and treatment of postoperative nausea and vomiting Side Effects: CNS: headache, GI: constipation, diarrhea Nervous: EPS Nursing Considerations: • Assess patient for nausea, vomiting, abdominal distention, and bowel sounds prior to and following administration • Assess patient for extrapyramidal effects, • May cause transient ↑ in serum bilirubin, AST, and ALT levels, PO: For orally disintegrating tablets, peel back backing and remove tablet. Immediately place tablet on tongue; tablet will dissolve in seconds, then swallow with saliva. Administration of liquid is not necessary • Direct IV:Administer undiluted (2 mg/mL) immediately before induction of anesthesia or postoperatively if nausea and vomiting occur shortly after surgery Patient Considerations: • Advise patient to notify health care professional immediately if involuntary movement of eyes, face, or limbs occurs
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(Stadol) Butorphanol
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Dosage/Route/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).• 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. Indications: • Analgesia during labor Side Effects: CNS: confusion, dysphoria, hallucinations, sedation,GI: nausea, Derm: sweating, Nursing Considerations: • Assess blood pressure, pulse, and respirations before and periodically during administration, Potential for abuse. • May cause ↑ serum amylase and lipase levels, HIGH ALERT MED, Patient Considerations: • Medication may cause drowsiness or dizziness. • Encourage patients on bedrest to turn, cough, and deep-breathe every 2 hr to prevent atelectasis • Instruct patient to change positions slowly to minimize orthostatic hypotension • Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication • Advise patient that good oral hygiene, frequent mouth rinses, and sugarless gum or candy may decrease dry mouth
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(Percocet) Oxycodone
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Dosage/Route/ Frequency: PO (Adults ≥50 kg): 5-10 mg q 3-4 hr initially, as needed. Controlled-release tablets (Oxycontin) may be given q 12 hr after careful consideration as to dose, indication, and previous analgesic use/abuse history; if using combination products, acetaminophen or aspirin dose should not exceed 4 g/day and should not exceed 4 tablets/day of ibuprofen-containing products. Indications: Moderate to severe pain Side Effects: CNS: confusion, sedation,Resp: RESPIRATORY DEPRESSION., GI: constipation Nursing Considerations: • Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Assess bowel function, May ↑ plasma amylase and lipase levels, HIGH ALERT MED, Patient Considerations: is a potential drug of abuse. • May cause drowsiness or dizziness. • Advise patient to make position changes slowly to minimize orthostatic hypotension • Advise patient to avoid concurrent use of alcohol or other CNS depressants with this medication • Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis
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Ibuprofen (Advil-Motrin
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Dosage/Route/Frequency: Analgesic/antidysmenorrheal/antipyretic—200-400 mg q 4-6 hr (not to exceed 1200 mg/day), • IV (Adults): Analgesic—400-800 mg • PO (Infants and Children): Analgesic—4-10 mg/kg/dose q 6-8 hr.q 6 hr as needed (not to exceed 3200 mg/day) Indications: • PO, IV: Treatment of Mild to moderate pain, and fever Side Effects: CNS: headache, GI: GI BLEEDING, HEPATITIS, Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS Nursing Considerations: • Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria, Assess for skin reaction and at first sign discontinue use, » Serum potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST, and ALT may show ↑ levels. Blood glucose, hemoglobin, and hematocrit concentrations, leukocyte and platelet counts, and CCr may be ↓ » May cause prolonged bleeding time; may persist for <1 day following discontinuation Patient Considerations: • take ibuprofen with a full glass of water and to remain in an upright position for 15-30 min after administration, • Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, and other OTC or herbal products without consulting health care professional, Caution patient that use of ibuprofen with 3 or more glasses of alcohol per day may increase the risk of GI bleeding, Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, epigastric pain, dyspepsia, black stools, hematemasis, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs
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(Tylenol # 3)
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Dosage/Route/Frequency: acetaminophen 300 mg + codeine 30 mg Indications: Pain Relief Side Effects: GI: HEPATIC FAILURE, HEPATOTOXICITY (OVERDOSE), CNS: confusion, sedation, CV: hypotension, GI: constipation, nausea, vomiting Considerations: Evaluate hepatic, hematologic, and renal function, May alter blood glucose monitoring, Administer with a full glass of water, • May cause ↑ plasma amylase and lipase concentrations• Advise patient to change positions slowly to minimize orthostatic hypotension • Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication • Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis • Advise patient that good oral hygiene, frequent mouth rinses, and sugarless gum or candy may decrease dry mouth
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(Mylicon) Simethicone
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Dosage/Route/Frequency: • PO (Adults): 40-125 mg qid, after meals and at bedtime (up to 500 mg/day). Indications: Relief of painful symptoms of excess gas in the GI tract that may occur Dosage/Route/Frequency: • PO (Adults): 40-125 mg qid, after meals and at bedtime (up to 500 mg/day). Indications: Relief of painful symptoms of excess gas in the GI tract that may occur postoperatively Side Effects: None significant Nursing Considerations: • Assess patient for abdominal pain, distention, and bowel sounds prior to and periodically throughout course of therapy. Frequency of belching and passage of flatus should also be assessed, PO: Administer after meals and at bedtime for best results. Shake liquid preparations well prior to administration. Patient Considerations: • Explain to patient the importance of diet and exercise in the prevention of gas. • Advise patient to notify health care professional if symptoms are persistent
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Ferrous Sulfate
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Dosage/Route/Frequency: • 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 (Neonates , premature): 2-4 mg/kg/day in 1-2 divided doses, maximum of 15 mg/day Indications: PO: Treatment & prevention iron deficiency anemia Side Effects: GI: nausea, constipation, dark stools, epigastric pain Nursing Considerations: • Assess bowel function for constipation or diarrhea.• Monitor hemoglobin, hematocrit, and reticulocyte values prior to and every 3 wk during the first 2 mo of therapy and periodically thereafter. Serum ferritin and iron levels may also be monitored to assess effectiveness of therapy » Occult blood in stools may be obscured by black coloration of iron in stool. Patient Considerations: 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 • Advise patient that stools may become dark green or black • Instruct patient to follow a diet high in iron
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Rubella Vaccine
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Dosage/Route/Frequency:0.5 mL subcut, 1 or 2 doses in adults born in 1957 or later with unreliable history; high-risk groups should receive a total of 2 doses given 1 mo apart., Indications: Adults born in 1957 or later with unreliable history of MMR illness or immunization; high-risk groups (e.g., health care workers, college students, international travelers); women of childbearing age (with no evidence of rubella immunity or immunization). Side Effects: Burning, stinging, pain at injection site; arthritis/arthralgia; fever; encephalitis; allergic reactions. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission Considerations: Allergy to egg, gelatin, or neomycin; active infection; severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy (also avoid becoming pregnant for 4 wk after immunization)
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Tdap Vaccine
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Dosage/Route/Frequency: 0.5 mL IM to replace one dose of DTaP., Indications: Single dose should be given instead of Td in adults (19-64 yr) if they received their last dose of Td B10 yr ago (and did not previously receive a dose of Tdap). Side Effects: Fatigue, headache, gastrointestinal symptoms, pain at injection site Considerations: Previous reactions to DTaP; progressive neurological disease; recent (within 7 days) CNS pathology.
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Flu vaccine
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Dosage/Route/Frequency: Injection: 0.5 mL IM annually. Intranasal (for adults <50 yr): Single 0.2 mL dose (given as 0.1 mL in each nostril) annually. Indications: prevention of influenza Side Effects: Injection: local soreness, fever myalgia, possible neurologic toxicity. Intranasal: upper respiratory congestion, malaise. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission with intranasal route. Considerations: Hypersensitivity to eggs/egg products. Hypersensitivity to thimerosal (injection only). Patients with acute neurologic compromise. FluMist should be avoided in pregnancy; chronic pulmonary (including asthma), cardiovascular (not hypertension), renal, hepatic, neurological, hematologic, or metabolic (including diabetes) disorders; immunosuppression (including HIV); age B50 yr.
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Prenatal Vitamin
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Dosage/Route/Frequency: • PO (Adults and Children): 1 dose unit (tablet/capsule/dropperful)/day or amount recommended by individual manufacturer. Indications: • PO: Treatment and prevention of vitamin deficiencies. Special formulations are available for patients with particular needs, including » Prenatal multiple vitamins (with larger doses of folic acid) Side Effects: GU: urine discoloration Considerations: Explain to patient the importance of taking prenatal vitamins to ensure the health of their child, esp in prevention of spina bifida and neural tube defects
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Morphine (PCA)
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Dosage/Route/Frequency: • IM, IV, SC (Adults ≥50 kg): Usual starting dose for moderate to severe pain in opioid-naive patients—4-10 mg q 3-4 hr. MI—8-15 mg, for very severe pain additional smaller doses may be given every 3-4 hr. – IM, IV, SC (Adults and Children <50 kg): Usual starting dose for moderate to severe pain in opioid-naive patients—0.05-0.2 mg/kg q 3-4 hr, maximum: 15 mg/dose. • Epidural (Adults): Intermittent injection—5 mg/day (initially); if relief is not obtained at 60 min, 1-2 mg increments may be made; (total dose not to exceed 10 mg/day. Continuous infusion—2-4 mg/24 hr; may ↑ by 1-2 mg/day (up to 30 mg/day); Single-dose extended-release liposomal injection—lower extremity orthopedic surgery: 15 mg, lower abdominal/pelvic surgery: 10-15 mg, cesarean section: 10 mg. Use preservative-free formulation. Indications: • Severe pain Side Effects: CNS: confusion, sedation, Resp: RESPIRATORY DEPRESSION., CV: hypotension, GI: constipation Nursing Considerations: High Alert: Assess level of consciousness, blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. • Assess bowel function routinely. Institute prevention of constipation with increased intake of fluids and bulk and with laxatives to minimize constipating effects, • May ↑ plasma amylase and lipase levels Patient Considerations: • May cause drowsiness or dizziness. • Advise patient to change positions slowly to minimize orthostatic hypotension • Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication • Encourage patients who are immobilized or on prolonged bedrest to turn, cough, and breathe deeply every 2 hr to prevent atelectasis
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Erythromycin ointment
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Dosage/Route/Frequency: • PO (Neonates): Ethylsuccinate—20-50 mg/kg/day divided q 6-12 hr. Indications: Treatment of acne, Infection by organisms Side effects: CV: QT INTERVAL PROLONGATION (MAY RESULT IN TORSADES DE POINTES) , VENTRICULAR ARRHYTHMIAS. GI: nausea, vomiting, Nursing Considerations: • Monitor liver function tests periodically on patients receiving high-dose, long-term therapy, • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy Patient Considerations: • May cause nausea, vomiting, diarrhea, or stomach cramps; notify health care professional if these effects persist or if severe abdominal pain, yellow discoloration of the skin or eyes, darkened urine, pale stools, or unusual tiredness develops. • Assess for signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools)
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Vitamin K Injectable
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Dosage/Route/Frequency: • IM (Neonates): 0.5-1 mg, within 1 hr of birth, may repeat in 6-8 hr if needed. May be repeated in 2-3 wk if mother received previous anticonvulsant/anticoagulant/anti-infective/antitubercular therapy. 1-5 mg may be given IM to mother 12-24 hr before delivery. Indications: • Prevention of hemorrhagic disease of the newborn Side Effects: Misc: hyperbilirubinemia (large doses in very premature infants), Derm: flushing, rash, urticaria. Nursing Considerations: • Monitor for frank and occult bleeding • Pedi: Monitor for side effects and adverse reactions. Children may be especially sensitive to the effects and side effects of vitamin K. Neonates, especially premature neonates, may be more sensitive than older children Patient Considerations: frequent lab tests to monitor coagulation factors
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Hepatitis B vaccine
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Dosage/Route/Frequency: 0.5 mL IM at 0, 1-2, and 6-18 mo. Dose is same for patients age 0-19 yr. Infants born to HBsAg-positive mothers: Administer 0.5 mL of hepatitis B immune globulin IM and 1st dose of hepatitis B vaccine; give 2nd and 3rd doses of hepatitis B vaccine at 1 mo and 6 mo, respectively. Indications: prevention of development of Hepatitis B Side Effects: Local soreness Considerations: Hypersensitivity to yeast.
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Hepatitis B Immunoglobin
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Dosage/Route/Frequency: • IM (Neonates): 0.5 mL within 12 hr of birth. Indications: Prevents hepatitis B infection in patients who are known to have been exposed, including neonates born to HBsAg-positive women, by providing passive immunity Side Effects: Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLACTIC SHOCK AND ANGIOEDEMA . Nursing Considerations: • Assess patient for signs of anaphylaxis, Administer into the deltoid or anterolateral thigh
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Lidocaine Injection
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Dosage/Route/Frequency:• Infiltration (Adults and Children): Infiltrate affected area as needed (increased amount and frequency of use increases likelihood of systemic absorption and adverse reactions) Indications: • Local: Infiltration/mucosal/topical anesthetic Side Effects: CNS: SEIZURES, confusion, drowsiness, CV: CARDIAC ARREST, Local: stinging, Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS . Nursing Considerations: • Monitor ECG continuously and blood pressure and respiratory status frequently during administration, » IM administration may cause ↑ CPK levels, Patient Considerations: May cause dizziness or drowsiness
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Emla Cream
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Dosage/Route/Frequency: 2.5% lidocaine + 2.5% prilocaine Indications: Topical analgesic (may be used for circumcision)
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Ampicillin IV
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Dosage/Route/Frequency: • IM, IV (Adults , Children, and Infants): CCr 15-29 mL/min—Administer q 12 hr; CCr 5-14—Administer q 24 hr Indications: Treatment of infection Side Effects: CNS: SEIZURES (HIGH DOSES) . GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, Derm: rashes, Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS AND SERUM SICKNESS , Nursing Considerations: Observe patient for signs and symptoms of anaphylaxis, • May cause increased AST, ALT, LDH, bilirubin, alkaline phosphatase, BUN, and creatinine Patient Considerations: notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus.
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Gentamycin IV
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Dosage/Route/Frequency: • IM, IV (Neonates full term and/or > 1 wk): Weight 2000 g-2.5 mg/kg/dose q 8 hr. ECMO-2.5 mg/kg/dose q 18 hr, subsequent doses based on serum concentrations. Once daily-3.5-5 mg/kg/dose q 24 hr. • IM, IV (Neonates premature and/or ≤1 wk): Weight 1200 g-2.5 mg/kg/dose q 12 hr. Once daily-3.5-4 mg/kg/dose q 24 hr. Indications: • Treatment of serious gram-negative bacterial infections and infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated • In combination with other agents in the management of serious enterococcal infections • Prevention of infective endocarditis Side Effects: CNS: ataxia, vertigo. EENT: ototoxicity (vestibular and cochlear). GU: nephrotoxicity. Nursing Considerations: • Assess for infection ulture and sensitivity before initiating therapy. First dose may be given before receiving results • Evaluate eighth cranial nerve function by audiometry before and throughout therapy• Monitor intake and output and daily weight to assess hydration status and renal function • Assess for signs of superinfection• Monitor renal function by urinalysis, specific gravity, BUN, creatinine, and CCr before and throughout therapy Patient Considerations: report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating

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