Vitamin D Preg Cat: C

CATEGORY: Vitamin D: Fat-soluble vitamin

BRAND NAME DOSAGE FORMS Dosage
Calciferol Tabs, caps, oral sol, Deficiency
Delta-D Injection Pediatric PO/IM 1500-5000 international units/day
X 2-4wk, may repeat after 2 wk or
Drisdol 600,000 international units as
Vitamin D single dose
Vitamin D3 Adult PO/IM
Uses: Vit D deficiency, rickets, renal osteodystrophy, 12,000 international units/day,
hypoparathyroidism, hypophosphatemia, psoriasis, than increased to 500,000
rheumatoid arthritis. international units/day
Action: Needed for regulation of calcium Hypoparathyroidism
PO/IM 200,000 international units/day
Phosphate levels; normal bone development; parathyroid
Given with 4g calcium tab
activity; neuromuscular functioning.

PHARMACOKINETICS
_____Peak____
PO 4hr Half-
Absorption____ Distribution Metabolism_ _life_ _ Excretion
Well stored in Liver, sun 12-22hr bile, kidney
absorbed liver

Contraindications: Hypersensitivity, hypercalcemia, renal

dysfunction, hyperphosphatemia.

SIDE/ADVERSE EFFECTS: CNS: Fatigue,
weakness, drowsiness, seizures, headaches, psychosis.
CV: Hypertension, dysrhythmias. GI: Nausea, vomiting,
anorexia, cramps, diarrhea, constipation, metallic taste, dry
mouth. GU: Ployuria, nocturia, hematuria, albuminuria, renal
failure, decreased libido. INTEG: Pruitus, photophobia. MS:
Decreased bone growth, early joint pain, early muscle pain.
INTERACTIONS: DRUGS: Cholestyramine, colestipol,
Phenobarbital, phenytoin: decreased effects of vit D Verapamil:
increased toxicity • Antacids, diuretics(thiazide): increased toxicity
NSG CONSIDERATIONS:
ASSESS: Monitor BUN, urinary calcium, AST, ALT, cholesterol,
creatinine, uric acid, chloride, magnesium, electrolytes, urine pH,
phosphate-may increase. Monitor for dry mouth, metallic taste,
polyuria, bone pain, muscle weakenss, headache, fatigue, tinnitus,
change in LOC, irregular pulse, dysrhythmias, ↑ respirations,
anorexia, nausea, vomiting, cramps, diarrhea, constipation.
Renal status: decreased urinary oupput, edema in extremities, weight
gain 5lb. Nutritional status, diet for sources of vit D.
NDX: • Knowledge, deficient(teaching) •Nutrition, less than body
requirements, imbalanced (uses)
PLAN/IMPLEMENT: Administor: PO: may be increased q4 wk
depending on blood level • Store in airtight, light-resistant container at
room temp.• IM: inject deep, slowly in lg muscle mass. • IV: rotate inj
site.
PT EDUCATION: •Omit dose if missed; avoid vitamin
supplements unless prescribed. • Inform pt of necessary foods to be
included in diet •Keep appointments for evaluation, therapeutic and
toxic levels are narrow • report weakness, lethargy, headache, anorexia,
weight loss, nausea, vomiting, abdominal cramps, diarrhea,
constipation, excessive thirst, polyuria, muscle and bone pain • Caution
pt to ↓ intake of antacids and laxatives containing magnesium.
EVALUATE: Therapeutic Outcome: Calcium levels 9-10ml/dl •
decreasing symptoms of bone disease.
NOTES:
 Preg Cat C
Ascorbic acid (vitamin C)
CATEGORY: Vit C, water soluble vitamin CONTRINDICATIONS: Tartrazine, sulfite sensitivity; G6PD def
BRAND NAME DOSAGE FORMS
Ascorbicap Tablets, effervescent tabs DOSAGE
C-span chewable tabs, time-release Neonates ↑ to 6no PO 30mg/day
Cebid tabs/caps, crystals, powder, Infants 6mo-1yr PO 35mg/day
Cecol syrup, liquid, sol, inj Subcut, Child 1-3yr PO 40mg/day
Cecore 500 Cemill IM, IV Child 4-10 yr PO 45mg/day
Cevi-Bid Cetane Child 11-14yr PO 50mg/day
Ce-Vi-Sol Cenolate Adult & Child > 14yr PO 50-500mg/day
Flavorcee Cevalin Pregnancy: PO 70mg/day
Mega-C/A Plus Sunkist Breastfeeding PO 90mg/day
Ortho/CS Wound healing/chronic disease/fracture
USE: Vit C deficiency, scurvy, delayed wound and bone healing, May be given w/ zinc
Adult IM/IV/ Subcut/PO 200-500/day for 1-2mo
chronic disease, urine acidification, before gastrectomy; increased
Child IM/IV/Subcut/PO 100-200mg added doses for 1-2mo
need: breastfeeding, pregnancy, hyperthyroidism, emotional stress,
Scurvy
trauma, burns, dietary supplement.
Adult IM/IV/Subcut/PO 100-500mg/dayX2wk, then 50mg
UNLABELED USE: Common cold prevention.
Child IM/IV/Subcut/PO 100-300mg/dayx2wk, than 35mg
ACTION: Needed for wound healing, collagen synthesis, antioxidant,
Urine acidification
carbohydrate metabolism, protein, lipid syntheses, prevention of
Adult 4-12g/day in divided doses
infection.
Child 500mg q6-8hr
PHARMACOKINETICS
_____Peak____
PO 4hr Half-
Absorption____ Distribution Metabolism_ _life_ Excretion
Redily Widely, Oxidation ? Kidneys, breast
absorbed Crosses placenta milk
SIDE/ADVERSE EFFECTS: cns: Headache, insomnia, dizziness PT EDUCATION: •Teach pt necessary foods to be included in diet
fatique, flushing GI: Nausea, vomiting, diarrhea, anorexia, heartburn, thatare rich in vit C; citrus fruits, cantaloupe, tomatoes, chili
cramps GU: Polyuria, urine acidification, oxalate or urate renal stones, peppers(red) •Smoking decreases vit C levels, not to exceed prescribed
dysuria. HEMA: Hemolytic anemia in pts w/ G6PD INTEG: dose, increases will be excreted in urine, except time released • teach pt
Inflammation at inj site. not to exceed RDA recommended dose, urinary stones may occur •
INTERACTIONS DRUGS: False positive: negatives in glucose tests, Teach pt using ascorbic acid for acidification of urine to test urine pH
False negative: occult blood(lg dose), unine bilirubin, leukocyte periodically
determination. EVALUATION: Positive therapeutic outcome: •Absence of anorexia,
NSG CONSIDERATIONS: irritability, pallor, joint pain, hyperkeratosis, petechiae, poor wound
ASSESS: •nutritional status for inclusion of foods high in vit C: citrus healing • Reversal of scurvy: bleeding gums, gingivitis, loose teeth.
fruits, cantaloupe, tomatoes • vit C deficiency before, during and after
treatment, scurvy (gingivitis, bleeding gums, loose teeth), Poor bone NOTES:
development •Monitor I&O ratio, polyuria, in pts receiving lg doses,
renal stones may occur, urine pH(acidification) • ascorbic acid levels
throughout treatment if contined deficiency is suspected • Assess inj
sites for inflammation, pain, redness, thrombophlebitis if in lg doses.
NDX: •Knowledge, deficient(teaching) • Nutrition: less than body
requirements, imbalanced (uses)
PLAN/IMPLEMENT:PO route •Swallow time rel tabs or caps
whole; do not break, crush, or chew • Mix oral sol w/ foods or fluids
IM route •Not to be diluted; give deep in lg muscle mass
IV route • Give undiluted by direct IV 100mg over at least 1min, rapid
inf may cause fainting
Albuterol
CATEGORY: Bronchodilator
BRAND NAME DOSAGE FORMS
AccuNeb Provent INH/ Powder/Aerosol/Spray Preg Cat NA
GenSalbutamol Proventil HFA CONTRAINDICATIONS: Hypersensitivity to sympathomimetics,
Salbutamol NEB/IPPB tachydysrhythmias, severe cardiac disease, heart block.
Ventodisk TABS DOSAGE
Ventolin ORAL SOL Adult(exercise induced bronchospasm) INH 2 puffs 15 min before exercise
Ventolin HFA
Resp Conditions:
Vospire ER Adult & Child > 12yr INH 2 puffs q4hr
HFA PO 2-4mg tid-qid, not to exceed 8mg
Use: Prevention of exercise-induced asthma, acute bronchospasm, NEB/IPPB PO 2.5mg tid-qid
bronchitis, emphysema, bronchiectasis, reversible airway obstruction.
Geriatric: PO 2mg tid-qid,may increase gradually to 8mg/tid-qid
Action: Causes bronchodilatation by action on β² (pulmonary)
receptors by increasing levels of cyclic adenosine monophosphate Child 2-12yr INH 0.1mg/kg tid(max 2.5mg tid-qid)
(cAMP), which rrelaxes smooth muscle; produces bronchodilatation; MEB/IPPB 0.1-1.15mg/kg/dose tid-qid or 1.25mg tid-qid for child 10-15kg or
CNS, cardiac stimulation, increased dieresis, and increased gastric acid 2.5mg tid-qid >15kg
secretion; longer acting than isoproterenol SIDE/ADVERSE EFFECTS: CNS: Tremors, anxiety, insomnia, headache,
PHARMACOKINETICS dizziness, stimulation,restlessness, hallucinations, flushing, irritability CV:
_____Peak_______ Palpitations, tachycardia, hypertension, angina, hypotension, dysrhythmias
PO-2½hr PO ext rel-2-3hr ING-1-1½hr EENT: Dry nose, irritation of nose and throat GI: Heartburn, nausea, vomiting
½ MISC: Flushing, sweating, anorexia, badtaste/smell changes, hypokalemia MS:
Absorption____ Distribution Metabolism_ life_ Excretion Muscle cramps RESP: Cough, wheezing, dyspnea, Bronchospasm, dry throat.
PO Well ? Liver extensively, 3-4hr Unknown INTERACTIONS: Drug: Atomoxetine, selegiline; increased CB effects.
absorbed tissues Breast milk
NSG CONSIDERATIONS:
ASSESS: Resp function, lung sounds, heart rate, B/P, sputum• Monitor for
signs of allergic reactions; paradoxic bronchospasm; w/hold dose; notify
prescriber. NDX: Airwway clearance, ineffective (uses), •Gas exchange,
impaired, •Knowledge, deficient (teaching) PLAN/IMPLEMENT: PO Do not
break, crush, or chew ext rel tabs • Give w/ meals to ↓ gastric irritation; oral sol
for children (no alcohol, sugar) • Geriatric pts, use spacing device. AEROSOL
Shake, have pt exhale & place mouthpiece in mouth, inhale slowly while
depressing inhaler, hold breath, remove, exhale slowly; allow 1 min between
inhalations.• Store in light-resistant container; do not expose to temps >86°F
NEB/IPPB Dilute 5mg/ml sol/2.5ml 0.9% NaCl for inhalation; other solutions do
not require dilution for NEB O 2 flow or compressed air 6-10L/min
PT EDUCATION: Consult prescriber before use of OTC meds, excess
stimulation may occur; use this med before other meds & allow 5min between
each to prevent overstimulation; limit caffeine products such as chocolate, coffee,
tea, and cola. • Review package insert w/ pt for correct use; avoid getting aerosol
in eyes, blurring may result; wash inhaler in warm water and dry daily; rinse
mouth after using, avoid smoking, • Stop using if paradoxic bronchospasm
occurs, notify prescriber.• Do not use more than RX dose.• do not double doses •
Geriatric pts use spacing device. EVALUATE: Therapeutic Outcome: Absence
of dyspnea & wheezing after 1hr. • Improved airway exchange. • Improved
ABGs.
TREATMENT OF OVERDOSE: Administer a B1-adrenergic blocker.
ALPRAZOLAM-(XANAX)
Preg cat D
CATEGORY: Antianxiety/sedative/hypnotic_____________
BRAND NAME DOSAGE FORMS DOSAGE
Niravam Tablets Anxiety disorder
Xanax, Oral sol Adult PO PO 0.25-0.5mg tid, may
Xanax XR Oral disintegrating tabs may increase q3-4day PRN,
USE: Anxiet, panic disorders with or w/out agoraphobia, anxiety w/ max 4mg/day in divided doses
depressive symptoms Geriatric PO 0.125-0.25mg bid;
UNLABELED USES: Premenstrual syndrome, dysphoric disorders, Increase by 0.125mg PRN
insomnia Panic disorder:
ACTION: depresses subcortical levels of CNS, including limbic Adult PO 0.5mg tid may ↑ to 1mg/day
system, reticular formation; potentiates GABA q3-4days, max 10mg/day.
EXT REL (Xanax XR) Give daily in am 0.5-1mg
PHARMACOKINETICS
Maintenance 1-10mg/day
_____Peak____
1-2hr Half-
SIDE/ADVERSE EFFECTS: CNS: Dizziness, drowsiness,
Absorption____ Distribution Metabolism_ _life_ Excretion
Slow, complete Widely, crosses Liver to 12-15hr Kidneys- confusion, headache, anxiety, tremors, stimulation, fatigue,
blood/brain barrier active metabolites breast milk depression, insomnia, hallucinations, memory impairment, poor
Crosses placenta _____________________________ coordination. CV; Orthostatic hypotension, ECG changes,
CONTRAINDICATIONS: Breast feeding, hypersensitivity to tachycardia, hypotension. EENT; Blurred vision, tinnitus,
benzodiazepines, angle-closure glaucoma, phychosis, addiction. mydrasis. GI; Consipation, dry mouth, nausea, vomiting,
PRECAUTIONS: Geriatric, debilitated,, hepatic disease, obesity, anorexia, diarrhea, weight gain/loss, increased apetite.GU;
severe pulmonary disease. Decreased libido INTEG; Rash, dermatitis, itching.
 PT EDUCATION: • Product may be taken w/ food or fluids, and tabs may
INTERACTIONS: DRUG: Alcohol: increased CNS depression, be crushed or swallowed whole• Not for use of everyday stress or longer
Cigarette smoking: decreased drug level, CYP3A4 inhibitors than 4mo unless directed by prescriber; do not take more than prescribed
( cimetidine, disulfiram, erythromycin, fluoxetine, isoniazid, amount; may be habit forming; do not double or skip doses; memory
itraconazole, ketoconazole, metoprolol, propoxyphene, impairment is a sign of long term use.• Avoid OTC preparations wnless
propranolol, valproic acid): increased action of. Levodopa: approved by prescriber; alcohol and CNS depressants will increase CNS
decreased action of levodopa, Rifampin: decreased action of. depression. • Avoid driving, activities that require alertness, since
drowsiness may occur, avoid alcohol ingestion or other psychotropic
NSG CONSIDERATIONS:
meds; to rise slowly or fainting may occur, especially geriatric; drowsiness
ASSESS: mental status, mood, sensorium, anxiety, affect, may worsen at beginning of treatment. • Do not discontinue med abruptly
sleeping pattern, drowsiness, dizziness, especially geriatric, after long –term use; w/drawal symptoms include vomiting, cramping
physical dependency, w/drawal symptoms, anxiety, panic tremors, seizures.
attacks, agitation, seizures, headach, nausea, vomiting, muscle EVALUATE: Therapeutic outcome: ↓ anxiety, restlessness,
pain, weakness, suicidal tendencies, indications of increasing sleeplessness (short term tx only)
tolerance and abuse, w/drawal seizures may occur after rapid TREATMENT OF OVERDOSE: Lavcage, VS, supportive care, flumazenil.
decrease in dose or abrupt discontinuation, short duration of
action makes it the product of choice in the geriatric • Monitor B/P
(w/pt lying, standing), pulse,: if sjsystolic B/P drops 20 mm Hg, Hold
product, notify prescriber. • monitor I&O; indicate renal dysfunction if on
long-term treatment. NDX: Anxiety (uses)• Injury, risk for (adverse
reaction) • Knowledge, deficient (teaching) PLAN/IMPLEMENT: •Give w/
food or mild for GI symptoms, tab may be crushed, • Give sugarless gum,
hard candy, frequent sips of water for dry mouth. • Discontinue, decrease
by 0.5mg q3 days. • Place orally disintegrating tabs on tongue to dissolve.
• Give EXT REL tab in AM.