G- Phytonadione

B-AquaMEPHYTON

Antidotes

Vitamin (Fat Soluble)

ACTION: Prevention of bleeding due to hypoprothrombinemia. Require for hepatic syntehsis of blood coagulation factors II (prothrombin), VII, IX, and X.

SIDE EFFECTS: Gastric upset, Hemolytic anemia. Pain in injection site, swelling, allergic reaction and kernicterus

ROUTE: ADULT: PO,Sub-Q,IM,IV-10mg. CHILD>1 month: PO 1-2mg.

NURSING IMPLICATIONS:

• Monitor for frank and occult bleeding.Monitor pulse and B/P
• Children sensitive to effects and side effects of Vit K.
• LAB TEST:Monitor PTprior to and throughout Vit K therapy

G-Methylergonovine

B-METHERGINE

OXYTOCIC

ACTION: Uterine contraction. Directly stimulates uterine and vascular smooth muscle.

SIDE EFFECTS: Dizziness, Headache. Tinnitus, dyspnea. Hypotension, Arrhythmias, chest pain, N/V. Cramps. Diaphoresis. Allergic Reactions

ROUTE: Adults: PO: 200-400 mcg q 6-12 hr for 2-7 days.

                     IM,IV: 200 mcg q 2-4hr for up to 5 doses.

NURSING IMPLICATIONS: Monitor B/P, H/R, and uterine response while giving med. Tell doctor if uterine relaxation or if there is vaginal bleeding.

Assess for signs of ergotsm (cold, numb fingers and toes, chest pain, n/v, headache. LAB TEST: Check Ca+- hypocalcemia.

G- Rh (D) Immune Globulin

B- RhoGAM

Vaccines/ Immunizing Agents

ACTION: Prevention of Antibody response and hemolytic diseas of the newborn (erythroblastosis fetalis) in future pregnancis of women who conceived a Rh (D)-positive fetus. Prevention of Rh (D) sensitization following transfusion accident. Decreased bleed in patients with ITP.

SIDE EFFECTS: Dizziness, headache, hypertension, hypotension, N/V. ITP-anemia, IV hemolysis. Arthralgia, myalgia, pain in INJ site.

ROUTE: Given after delivery- IM give w/in 72 hrs of delivery.

NURSING IMPLICATIONS:

• Monitor pt for S/Sx of IV hemolysis (back pain, shaking chills, fever, hemoglobinuria), anemia, and renal insufficiency. LAB TESTS: Type and crossmatch of mother and newborn's cord blood must be done to determine need for med. ITP: Monitor platelet count, RBC counts and HGB.

G-Oxycodone

B-Percocet

OPIOID ANALGESICS

ACTION: Binds to opiate receptors in the CNS. Decrease pain

SIDE EFFECTS: Confusion, Sedation. Dizziness, dysphoria, euphoria, floating feeling, hallucination, RESPIRATORY DEPRESSION. OH, constipation.

ROUTE: Adults > 50kg: 5-10 mg q 3-4 hr as needed.

           Adults < 50kg and Children 6-12 yrs: 1.25 mg every 6 hr as  

           needed. Children >12: 2.5 mg q 6 hr as needed.

SAFE DOSE: Onset 10-15min, Peak 60-90min, Duration: 3-6hr

NURSING IMPLICATIONS:

* Assess type, location, and intensity of pain prior to and 1 hr (peak) after admission.

* Assess B/P, P,Reps before & periodically during adm.Also Bowel fx.

* NOTE: If Reps Rate < 10 min, assess level of sedation. Stimulation prevents significant hypoventilation.

*ANTIDOTE:NARCAN-antidote for opioids to reverse reps depression or coma.

G- OXYCODONE (5 mg) + ACETAMINOPHEN (500 mg)

B- TYLOX 5/500

COMBINATION DRUGS

Narcotic Analgesics (pain medicines)

ACTION: Combination is used to relieve moderate to moderately severe pain. Acetaminophen is used to relieve pain and reduce fever in patients.

SIDE EFFECTS: Abdominal pain,black,tarry stools,chills,dark urine,dizziness,fever,headache,itching,light-colored stools,loss of appetite,nausea,rash,unpleasant breath odor,unusual tiredness or weakness,vomiting of blood,yellow eyes or skin.

ROUTE: PO

SAFE DOSE: ADULTS- 1 cap q 6 hrs No more than 4000 mg in 24 hrs. CHILDREN- Follow DR. Orders

NURSING IMPLICATIONS:

Same as oxycodone and acetaminophen

*Assess overall health status & alcohol use before giving med.

*Assess amt, freq, and type of drugs taken in pts self-medicating, Increases risk of adverse renal effects.

*Asssess type, location, and intensity prior to and 30-60 min before giving med.

G-Ibuprofen

B-Motrin, Excedrin IB, Advil, PediaCare Children's Fever

ANTIPYRETICS, ANTI-RHEUMATICS,

NSAIDS AND NONOPIOID ANALGESICS

ACTION: Decreased pain and inflammation. Reduction of fever. Inhibits prostaglandin synthesis.

SIDE EFFECTS: Headache, dizziness, drowsiness, psychic disturbance. GI BLEEDING. Exfoliative dermatitis, Toxic Epidermal Necrolysis. Allergic reactions (ANAPHYLAXIS).

ROUTE: PO: ADULT- Anti-inflammatory 400-800mg 3-4 times daily.

PO CHILDREN 6 months -12yr: 200-400mg q 4-6hr.

TIME/ACTION: Analgesic:ONSET 30 min, PEAK 1-2hr, DURATION 4-6hr.

NURSING IMPLICATION:

* Patient w/asthma, and aspiring allergy inc risk of hypersensitivity reactions.

*GERI: High risk for poor outcomes or death from GI bleeding

*Assess pain, amt, location, and intensity before to give meds and 1-2 hrs after giving meds.

* Check for fever.

SIMETHICONE

MAALOX Gas Relief Formula, MYLANTA

Anti-flatulents

ACTION: Passage of gas through the GI tract by belching or passing flatus.

SIDE EFFECTS: None Significant

ROUTE: PO.

Adults- 40-125 mg qid, after meals and at bedtime (up to 500mg/day)

Children-2-12 yr old 40mg 4 times daily

Also available in chewable tablets, tablets, capsules, drops

TIME/ACTION: ONSET: immediate, PEAK: unknown, Duration: 3 hr

NURSING IMPLICATIONS:

*Assess pt for abdominal pain, distention, and bowel sounds before give med.

G- KETOROLAC

B- TORADOL

NSAIDS, NONOPIOID ANALGESICS

ACTION: Inhibits prostaglandin synthesis.Periperally mediated analgesia. Decreased pain.

SIDE EFFECTS: Drowsiness, abnormal thinking, GI bleeding, Oliguria, renal toxicity urinary frequency. ANAPHYLAXIS.

ROUTE: PO:  Adults< 65yr  20mg initially, followed with 40mg q 4-6 hr as neeed.

SAFE ROUTE: PO. ONSET: unknown, PEAK: 2-3 hr, DURATION: 4-6 hr or longer.

NURSING IMPLICATION:

*Patients who have asthma, aspiring induced allergy, increased risk for hypersensitivity reactions.

*Assess pain (note type, location, and intensity)before and after given med.

*May cause PROLONGED BLEEDING, if bleeding continues after  24-48 hrs., discontinue.

G- Naproxen

B- Aleve, Napro

Nonopioid analgesics , NSAIDS,

Anti-pyretics

ACTION: Suppression of inflammation

SIDE EFFECTS: Dizziness, drowsiness, headache, GI bleeding, tinnitus, constipation, dyspepsia, Nuasea, , ANAPHYLAXIS, Hematuria, Renal failure.

ROUTE: PO.Adults 250-500mg bid. 

SAFE DOSE: Analgesic Onset: 1 hr, Peak: unknown, Duration: 8-12 hr

NURSING IMPLICATIONS:

*Patients with asthma, aspirin-induced allergy, increased risk for hypersensitiviity reactions.

*Assess pain (note type, location, and intensity before to give med and 1-2 hr following adm.

*Monitor temp, note signs associated wi fever (diaphoresis, tachycardia, malaise.)

*FOR RAPID EFFECT: give 30 min before or 2 hr after meals.

Nonsteroidal

Anti-Inflamatory Drugs

USES: Mgt of pain/inflammation ofollowing surgery (bromfenac, diclofenac, ketorolac, nepafenac), allergic conjunctivitis, (ketorolac), inhibition of perioperative miosis (fiurbiprofen, suprofen) 

1.) Bromfenac(Xibrom) Adults- 1 drop of 0.06% solution in affected eye  twice daily starting 24 hr after surgery and dfor 2 wk. Irritation

2.) Diclofenac (Voltaren) Adults- 1 drop of 0.1% solution 4 times daily for up to 6 wk. Irritation

3.) Flurbiprofen (Ocufen) Adults- 1drop of 0.03%soution q 30min, begining 2 hr before surgery (4 drops total). Irritation, allergi reactions.

4.) Ketorolac (Acular) Adults and children. 3 yr. Allrgic conjunctivitis- 1 drop of 0.5% soution 4 times daily (Acular)

5.) Nepafenac (Nevanac)- Adult and children > 10yr: 1 drop of 0.1% suspension into affected eye 3 times daily.

HEPATITIS B VACCINE

The hepatitis B vaccine protects against hepatitis B, a serious disease that damages the liver. The vaccine is one of the recommended childhood immunizations.

The hepatitis B vaccine is given to children as a series of three injections (shots):

• The first shot is given to infants before leaving the hospital. If the baby's mother carries the hepatitis B virus, the baby receives the first vaccine shortly after birth.
• The second shot = 1 and 2 months of age.
• The third shot = 6 months of age.

RISKS AND SIDE EFFECTS

Most infants who receive the hepatitis B vaccine have no side effects.

Others may have minor problems soreness and redness at the injection site or a mild fever.

Serious problems are rare and are mainly due to allergic reactions to a component of the vaccine.

PNEUMONIA VACCINE

Pneumococcal

polysaccharide vaccine

PPV helps PROTECT against severe infections due to the bacteria Streptococcus pneumoniae. The bacteria frequently CAUSES meningitis and pneumonia in children, older adults, and people with chronic illnesses.

This vaccine effectively prevents illnesses caused by Streptococcus pneumoniae in children over age 2 and adults at risk.

WHO SHOULD GET THIS VACCINE

• High-risk people age 2 or older
• • Includes persons with heart disease, lung disease, kidney disease, alcoholism, diabetes, cirrhosis, cochlear implants, and leaks of cerebrospinal fluid
• Everyone age 65 years or older
• Those with sickle cell disease
• Those who have had their spleen removed
• Persons who live in nursing homes (extended-care facilities)
• Persons who live in any institution where there are people with chronic health problems
• Persons with conditions that weaken the immune system, such as cancer, HIV, or organ transplantation
• Persons who receive chronic (long-term) immunosuppressive medications, including steroids
• Alaskan natives and certain Native American populations over age 50 who live in high-risk areas

ROUTE: Injection.

NOTE: The pneumococcal polysaccharide vaccine does not protect against pneumococcal diseases in children under age 2. There is a different vaccine, the pneumococcal conjugate vaccine, which is routinely given to younger children to protect against disease due to Streptococcus pneumoniae.

SIDE EFFECTS

* Most people have no or only minor side effects from the pneumococcal vaccine.

* Pain and redness at the injection site. Small chance of allergic reactions. 

* More serious reactions, or even death after receiving the pneumococcal vaccine.

* Watch for and be familiar with how to treat minor side effects, such as low-grade fever or tenderness, at the injection site.

FLU VACCINE

An influenza vaccine protects people against the flu.

Symptoms include fever, chills, sore muscles, and cough.

There are two types of flu vaccines: a flu shot and a nasal spray-type vaccine.

WHO SHOULD GET THE VACCINE

The following people should get a flu shot every year.

• Children between the ages of 6 months and 18 years
• Children over age 5 who have a higher risk for serious illness
• Children under age 18 who take long-term aspirin therapy
• Household contacts and caregivers of children or adults with high-risk conditions (Breastfeeding women may receive the vaccine.)

RISKS AND SIDE EFFECTS

*Most people have no side effects from the flu shot.

*Soreness at the injection site or minor aches and low grade fever may be present for several days.

*The regular seasonal flu shot has been shown to be safe for pregnant women and their babies.

*Normal side effects of the nasal spray flu vaccine include fever, headache, runny nose, vomiting, and some wheezing. Side effects do not become a severe or life-threatening flu infection.

MEASLES, MUMPS,

 RUBELLA VACCINE

WHO SHOULD GET THIS VACCINE

The MMR is one of the recommended childhood immunizations. Generally, proof of MMR vaccination is required for school entry.

• The first shot = child is 12 to 15 months old. The timing of vaccination is important to make sure the child is properly protected. It must not be given too early.
• A second MMR is= at 4 - 6 years, require a second MMR at kindergarten entry.
• Adults 18 years or older who were born after 1956 should also receive MMR if they are uncertain of their immunization status or if they have only had one MMR prior to school entry.
• BIG NOTE: Women should NOT receive this vaccine if they are pregnant or planning to become pregnant within the next 1 to 3 months.

SYMPTOMS:

• MEASLES is a virus which causes a rash, cough, runny nose, eye irritation, and fever in most people, but can also lead to pneumonia, seizures, brain damage, and death in some cases.
• MUMPS virus causes fever, headache, and swollen glands, but can also lead to deafness, meningitis, swollen testicles or ovaries, and death in some cases.
• RUBELLA, also known as the German measles, is generally a mild disease, but can cause serious birth defects in the child of a woman who becomes infected while pregnant.

SIDE EFFECTS:

Potential mild to moderate adverse effects include:

• Fever (1 in 6 children)
• Rash (1 in 20)
• Swollen glands (rare)
• Seizure (1 in 3,000)
• Joint pain/stiffness (1 in 4, usually young women)
• Low platelet count/bleeding (1 in 30,000)

Severe adverse effects may include:

• Allergic reaction (less than 1 per million)
• Long-term seizure, brain damage, or deafness (so rare that the association with the vaccine is questionable)

TACE

Clorotrianisene

Female Hormone Estrogen

Chlorotrianisene is a form of estrogen. Estrogen is a female sex hormone necessary for many processes in the

Chlorotrianisene is used to treat symptoms of menopause, deficiencies in ovary function (including underdevelopment of female sexual characteristics and some types of infertility), and prostate cancer.

Do not take chlorotrianisene if you

• have breast cancer. Tell your doctor if you have (or have ever had) breast cancer.

• have vaginal bleeding that has not been diagnosed. It will be necessary to determine if any abnormal bleeding has a hormonal cause.

• have a bleeding or blood-clotting disorder. Chlorotrianisene may increase the risk that a blood clot will form.

BIG NOTE:

Chlorotrianisene is in the FDA pregnancy category X. This means that chlortrianisene will cause birth defects in an unborn baby. Do not take this medication if you are pregnant or are planning a pregnancy. Chlorotrianisene may decrease milk flow and have other effects on milk composition. Do not use this medication without first talking to your doctor if you are breast-feeding a baby.