Pharmacology

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Author:
amgomez
ID:
107200
Filename:
Pharmacology
Updated:
2011-10-08 00:48:38
Tags:
Pain Inflammation Drugs Administration Considerations
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Description:
Administration Considerations
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  1. How should the NSAID (COX-2 inhibitor) celecoxib (Celebrex) be given?
    • Give 2 hr before or after magnesium- or aluminum-based antacids.
    • Monitor for initial and continued therapeutic effects.
  2. How should the opioid antagonist drug naloxone (Narcan) be given?
    • Give IM, IV, or subcutaneous.
    • Titrate doses carefully.
    • Monitor vital signs.
    • Be aware that the drug might increase pain by reducing opioid effects and precipitate acute withdrawal for a patient who is opioid-dependent.
    • Prepare to give every 2 to 3 min until reversal of undesirable effects.
    • Prepare to begin administration again as the effects of opioids might persist beyond the effects of the reversal agent.
    • Observe for nausea, vomiting, tachycardia, and diaphoresis (indications of opioid reversal).
    • Give naloxone (Narcan) to reverse effects.
  3. How should the NSAIDs (COX-1 and COX-2 inhibitors) aspirin/acetylsalicylic acid (Aspirin) and ibuprofen (Advil, Motrin) be given?
    • Make sure a patient swallows enteric-coated or sustained-release forms whole and does not crush or chew them.
    • Discontinue 1 week before scheduled surgery.
    • Monitor for initial and continued therapeutic effects.
  4. How should the opioid agonist-antagonist drugs butorphanol (Stadol) and pentazocine (Talwin) be given?
    • Give butorphanol IM, IV, or intranasally, and pentazocine orally.
    • Measure baseline vital signs before administration, and monitor throughout therapy. Do not give the drug if the respirations are slower than 12/min.
    • Have naloxone (Narcan) and resuscitation equipment available.
    • For intranasal administration, give one spray, and repeat every 60 to 90 min as needed.
    • For preoperative IM administration, give 60 to 90 min before surgery.
    • Monitor therapeutic effects.
    • Do not discontinue the drug abruptly.
  5. How should the glucocorticoid drug prednisone (Deltasone) be given?
    • Give orally, IV, IM, subcutaneous, topically, intranasally, or by inhalation, depending on the indication.
    • For long-term use (10 days or more), take in the morning using alternate-day dosing.
    • Taper the dose slowly when symptoms are controlled to establish the lowest possible oral dose.
    • For short-term oral use, give the largest dose on the first day with progressively smaller doses during the next eight days.
    • Give supplemental doses as needed in times of stress.
  6. How should the opioid agonist drugs morphine and meperidine (Demerol) be given?
    • Measure baseline vital signs before administration, and monitor throughout therapy.
    • Give orally, IM, IV, subcutaneous, rectally, or epidurally.
    • Make sure a patient swallows sustained-release forms whole and does not crush or chew them.
    • Administer IV opioids slowly and with recommended dilution over 4 to 5 min; have naloxone (Narcan) and resuscitation equipment available.
    • Monitor PCA use and pump settings carefully.
    • Give to patients with cancer on a fixed, around-the-clock dosing schedule, not PRN.
  7. How should the centrally acting nonopioid drug tramadol (Ultram) be given?
    • Tell patient that it takes 1 hr for the analgesic effect to begin.
    • Make sure a patient swallows the extended-release form whole and does not crush or chew it.
  8. How should the uricosuric drug allopurinol (Zyloprim) be given?
    • Give orally or intravenously.
    • Monitor uric acid levels (initially, every 1 to 2 weeks to establish the appropriate dosage).
    • Obtain baseline CBC and test liver and kidney function before therapy, and monitor periodically thereafter.
    • Allow crushing tablets and mixing them with food or fluid.
    • Give intravenously using recommended dilution, and infuse over 30 to 60 min.
    • Make sure a patient drinks at least 3 L of fluid per day.
  9. How should the drug acetaminophen (Tylenol) be given?
    • Give orally or rectally every 6 hr.
    • Maximum daily dose is 3 g a day for an adult patient.
    • Use manufacturer's age-adjusted doses for an infant or child patient.
    • The drug is available in more than 600 over-the-counter (OTC) and prescription preparations.

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