1.

Morphine-Naloxone- Narcan (page 152-154)

Opioid antagonist given IV to treat opioid overdose repeat in 2-8 minutes if
needed in 2-3 minute intervals due to respiratory depressant effects may
reappear, it can also be a postoperative anesthesia reversal. Naloxone and
Naltrexone bind to occupy all the receptor sites reversing respiratory
depression. Also used in opioid addiction and can be used in small doses to
treat itching associated with opioid use. When an opioid is discontinued
quickly or opioid antagonist administered this leads to opioid withdrawal,
also known as abstinence syndrome. This can occur in as little as 2 weeks of
opioid therapy in opioid naive patients. Gradual dosage reduction after
chronic opioid use, when possible, helps to minimize the risk and severity of
withdrawal symptoms. Careful titration of dose until the patient begins to
breathe independently will prevent over-reversal. The effects of naloxone
are short-lived and usually last about 1 hour. Not recommended for
treatment of cancer pain (naloxone/naltrexone pg 166.)
ADVERSE EFFECTS are raised or lowered blood pressure, dysrhythmias,
pulmonary edema, and withdrawal.
2. Med Administration/Math
3. Med Administration/Math - IV-ml/hr
4. Laxatives, use, types (page 821)

Bisacodyl (Dulcolax) Stimulant laxative 5-15 mg oral daily or 10 mg

suppository as a single dose
Docusate sodium (colace) Fecal softener, emollient, laxative PO 50300 mg/day divided daily qid onset 1-3 days
Glycerin (Sani-supp, Colace, fleet Babylax) Hyperosmotic laxative,
rectal only insert one suppository PR daily prn, attempt to retain 15-30
min, suppository does not have to melt to induce BM
Lactulose (Enulose) Disaccharide, hyperosmotic laxative PO 15-30
ml daily or 2x daily onset 24 hrs
Magnesium citrate(generic only) Magnesium sulfate (Epsom
salts) Saline laxative PO citrate 120-300 ml for 1 dose onset 0.5-3 hr
Methylcellulose (Citrucel) bulk forming laxative PO 1 heaping tbsp.
in 8 oz cold water daily tid onset 12-24 hour
Mineral oil (plain, fleet mineral oil enema) emollient laxative PO
15-45 ml oil taken at bedtime PR rectal enema, 118 ml one time onset
6-8 hour
Polyethylene glycol (Colyte, GoLYTELY, Half-Lytely, Miralax)
Hyperosmotic laxative PO 4-l solution, usually ending before procedure
pt needs to fast at least 4 hours before drinking solution onset 1 hr
Psyllium (Metamucil, Fiberall) Bulk forming laxative PO 1
rounded tsp in 8oz water or juice daily tid onset 12-24 hr

Senna (Senokt) Stimulant irritant laxative PO tabs start with 2 tabs

daily (max 4 tabs bid) 12-24 onset, PO liquid 15 ml daily (max 30 ml
bid) onset 6-24 hr

5. Diclofenac-liver (Not in the book) :

It is and NSAID Diclofenac is used commonly to treat mild to moderate
postoperative or post-traumatic pain, in particular when inflammation is also
present,[6] and is effective against menstrual pain and endometriosis.
Diclofenac has been found to increase the blood pressure in patients with
Shy-Drager syndrome and diabetes mellitus.[citation needed] Currently, this
use is highly investigative and cannot be recommended as routine
treatment. Under several trade names none of which in the bookVoltaren
or now Novartis.
6. Lasix- nutrition (page 455) :
most commonly used loop diuretic in clinical practice and the prototypical
drug in this class. Used in the management of pulmonary edema and the
edema associated with heart failure, liver disease, nephrotic syndrome, and
ascites. Also used to treat hypertension usually caused by heart failure.
Furosemide is contraindicated in hypersensitive pts or to sulfonamides and in
pt with anuria, hypovolemia, or electrolyte depletion. It is available in oral
form as a solution, tablet, injectable. Pregnancy category C.
7. Morphine Sulfate -herbal ginkgo reactions
8. Rapid Acting Insulin:
3 types- Lispro(HumaLog) , Aspart (NovoLog), Glulisine (Apidra)
Onset action 15 minutes, short duration
Given @ meal time to avoid fast increase of blood sugar
9. Tetracycline- Avoid Dairy:
10. Baclofen- Muscle Relaxant:
11. Verapamil (Calan)- Evaluate Effect:
Antidysrhythmic/ calcium channel blocker.
Used for atrial fib/flutter, angina, hypertension.
ASSESS: Vitals, skin color/ temp., urine output, decreased chest
discomfort/fatigue
12. Hydromorphone- Dilaudid Side effects:

1 mg of Dilaudid= 7 mg of morphine
Side Effects: Respiratory depression, flushing, dysphoria, euphoria, sedation,
disorientation, rash constipation, hypotension

13. Hyperthyroidism-med administration:

-Propylthiouracil (PTU) is an antithyroid drug. 2 weeks of PTU therapy before
symptoms improve. Assess vital signs. Only available PO. Take at same time
every day with a meal/snack to decrease stomach upset. Only use during 1st
trimester of pregnancy. Avoid high iodine foods, iodized salt and shellfish.
-Methimazole (Tapazole) is the only other antithyroid drug, but it is rarely
used clinically. It can be used in the 2nd and 3rd trimester of pregnancy (but
may cause fetal scalp abnormalities)
-Radioactive Iodine: Not to be given to pregnant women.
**Antithyroid drugs can cause leukopenia if taken with bone marrow
suppressants and increase the effect of oral anticoagulants.
**Never stop abruptly or take OTC drugs with them, consult doctor
first.
**Monitor liver function test and CBC counts.
14. KCl-IV administration guidelines:
IV doses of potassium must ALWAYS be given in a diluted form, or it can
result in cardiac arrest. Always double check the order and what comes from
pharmacy. Pt MUST have adequate renal function/urine output (30ml/hr) in
order to administer. Never given as IV push or bolus. Can give 20 meq/hr is
on telemetry, and only 10 meq/hr if not. Concentration should be less than
40 meq/L.
15. Peptic ulcer disease-med timing/ administration:

Antacids need to be taken with an 8oz glass of water to promote

absorption.
Famotidine (Pepcid): Tablet, IV, or suspension. Taken with no regard to
food/meals. Take with water.
Cimetidine (Tagamet): Taken WITH MEALS. If using an antacid
congruently, must wait 1-2hrs to take it.
Lansoprazole (Prevacid): Capsule can be opened (not crushed) and
sprinkled over applesauce.
Pantoprazole (Protonix): Given PO (no crushing/splitting) and IV.

Simethicone (Mylicon): Given AFTER MEALS and AT BEDTIME.

Thoroughly chew tablets or shake suspensions.
Ranitidine (Zantac): PO is either 2x/day or once AT BEDTIME; IV is Q8
diluted. If using an antacid congruently, take it 1hr before or 1hr after
the zantac.
Omeprazole (Prilosec): Take 30-60MIN BEFORE MEALS. Available PO
(taken whole) and IV.
Sucralfate (Carafate): Take any other drugs 2hrs before this one. Given
1HR BEFORE MEALS and AT BEDTIME. Tablets can be crushed or
dissolved in water. Avoid antacids 30 min before and after.
Misoprostol (Cytotec): For pts also taking NSAIDS. For ulcer prevention.
Not for pregnant women. 4x/day WITH MEALS and AT BEDTIME.

16. Spiriva-COPD:
Tiotropium (Spiriva) is an anticholinergic bronchodilator, given once a day.
Similar to Ipratropium (Atrovent). It is commonly combined with albuterol,
which is known as Combivent (MDI) or Duoneb (nebulizer inhalant). Helps to
reduce secretions.
17. Steroids-discontinue protocol/recommendations:
Do not discontinue corticosteroids abruptly, contact doctor first.This may
cause Addisonian crisis or death due to adrenal suppression, so you should
taper off of them slowly. Keep track of how many doses you have left so you
dont run out.
18. Vancomycin peak-trough levels:
Optimum peak level is 18-50 mcg/ml
Optimum trough level is 10-20 mcg/ml (Should be drawn immediately before
the next dose).
However, many practitioners use a trough level or 15-20 mcg/ml as their
goal.
19. (Orlistat) Xenical-weight management (207, 210t &211t)
Anorexiants are any substance that suppresses appetite. Anorexiants are
CNS stimulant drugs used to promote weight loss in obesity; their
effectiveness has not been proven. Benzphetamine and methamphetamine
are the only amphetamines currently approved for treating obesity. Orlistat
(Xenical) AKA Alli is a related non-stimulant drug used to treat obesity. It
works locally in the small and large intestines, where it inhibits absorption of
caloric intake from fatty foods. OTC version was released in 2007. It works by
binding to gastric and pancreatic enzymes called lipases. Blocking these

enzymes reduces fat absorption by roughly 30%. Restricting dietary intake of

fat to less than 30% of total calories can help reduce some of the GI adverse
effects, which include oily spotting, flatulence, and fecal incontinence in 20%
to 40% of patients. Decreases in serum concentrations of vitamins A, D, and
E and beta carotene are seen as a result of blocking of fat absorption.
Supplementation with fat-soluble vitamins corrects this deficiency.
20. Medications-post meal administration (21 Box 2-1, 841
Many medications are taken on an empty stomach with at least 6 ounces of
water. The nurse must give patients specific instructions regarding those
medications that are not to be taken with food. Medications that are
generally taken with food include carbamazepine, iron and iron-containing
products, hydralazine, lithium, propranolol, spironolactone, NSAIDS.

21. Mega Vitamin C (841-842)

One controversial topic related to vitamins is that of nutrient megadosing
as a strategy both for health promotion and maintenance and for treatment
of various illnesses. Some cancer patients elect to use supplemental
megadosing of specific nutrients in hopes of strengthening their bodys
response to more conventional cancer treatments. The American Dietetic
Association defines megadosing as doses of a nutrient that are 10 or more
times the recommended amount.
Megadosing on vitamin C is not a way to cure/prevent cold or
cancer.Megadosing can be helpful when long term drug therapy depletes
vitamin stores, GI malabsorption syndromes, treatment of pernicious
(harmful effect in gradual or subtle way) anemia, when vitamins act as a
drug like vitamin B3 50-100X higher dosages reduces blood levels of
triglycerides and low-density lipoprotein cholesterol. Megadosing can be
harmful when excess of one or more nutrients can result in deficiencies of
other nutrients due to their chemical competition for sites of absorption,
toxic accumulations (hypervitaminosis) especially fat soluble (A, D, K), less
likely in water soluble (B and C) because they are excreted in the urinary
system.
22. Anticoagulant-Geriatric concerns (414-420, Table 26-3,)

Lots of drug interactions, geriatric patients with polypharmacy pose a

concern, contraindicated for indwelling catheter
23. (Donepezil) Aricept-nursing problem (325 -326)
Is a cholinesterase inhibitor that works centrally in the brain to increase
levels of acetylcholine by inhibiting acetylcholinesterase. It is used in the
treatment of mild to moderate Alzheimers disease. Adverse effects are
normally mild and resolve on their own and be avoided with careful dose
titration. GI upset, drowsiness, dizziness, insomnia, and muscle cramps. Oral
tablet and disintegrating tablet. Patients cannot swallow. Onset of action is 3
weeks. Note any changes within the first 6 weeks of therapy. Gingko may be
used by some health care providers for organic brain syndrome.
24. (Rosuvastatin) Crestor-evaluate effect
Statin-High and moderate Intensity Statin Therapy.

25. Nitroglycerin-IV hypertension (Antianginal Drug)Pg.363-365:

Nitroglycerin is a Rapid and long-acting nitrate.
Nitrates have a potent dilating effect on the Lg. and Sm. Coronary arteries causing
redistribution of blood and oxygen to previous ischemic myocardial tissue, reducing
symptoms of angina.
Nitroglycerin is available I.V Form and use to control blood pressure in hypertensive pt.,
ischemic pain, heart failure, edema associated with acute MI. Hypertensive emergency
situations. Oral Nitroglycerin is avoided due to its large first pass effect.
Available- IV, SL, topical, oral, and aerosol. Administration: IC continuous infusion 5200mcg/min
Interactions: numerous reports of death with Nitroglycerin interacting with Erectile
dysfunction medications. (Contraindicated with ED drugs: Levitra, Viagra, Cialis.)
Contraindicated: severe anemia, closed-angle-glaucoma, hypotension or severe head injury.
Most Common Adverse effect- Most common headache, reflex tachycardia.

26. (Pentoxifylline) Antiplatelet Drug/ Methylxanthine derivative

Pg. 420-421:
One of the earliest antiplatelet drugs, but not commonly used. Referred to as
hemorheologic drug or the drug that alters the dynamic of blood. Reduces

the viscosity of blood by increasing flexibility of red blood cells and reducing
the aggregation of platelets. Inhibits ADP, serotonin, platelet factor IV.
Stimulates the synthesis and release of prostacyclin from blood vessels.
Antiplatelet drugs- Hold drugs 5-7 days prior to surgery/procedures due to
risk and alterations of bleeding.
Check Laboratory values: CBC, Hemoglobin levels, hematocrit, platelet
counts and PT and INR values. If platelets falls below 80,000 count cells/mm.
Notify prescriber antiplatelet therapy most likely will not be initiated.
27. Exenatide-Byetta Pg. 513:
The first Incretin mimetic drug approved by the FDA. Incretins are hormones released by the
GI tract in response to food. Stimulates insulin secretion; reduce postprandial glucagon
production; slow gastric emptying and increase satiety. Exenatide is a long acting analog of
GLP-1 that initially derived from the salivary glands. Available only by subcutaneous injection
given daily.Dosing: usually starting dose of exenatide is 5 mcg within 1 hour of both the
morning and evening meals. If necessary dosage may be increased after 1 month to 10 mcg
twice daily before meals.
Indicated only for type 2 diabetics who have been unable to achieve blood glucose control
with metformin, sulfonylurea and glitazone. Medication is best given 60 minutes before a
meal. Adverse effects: Nausea, vomiting and diarrhea. Rare cases of hemorrhagic or
necrotizing pancreatitis have also been reported. Black box warning for the risk of
developing thyroid C-cell tumors. Pt. have also experienced a weight loss of 5-10lbs.Should
not be used with insulin.Contraindicated: history of family history of medullary thyroid
carcinoma and patients with multiple endocrine neoplasia syndrome type 2.Interactions:
incretin mimetics can delay absorption of other orally administered drugs by slowing gastric
emptying. In patients also taking sulfonylurea drugs doses may need to be reduced if
hypoglycemia appears.

28. Acetaminophen- Jaundice pg.161 & 157:

Adults who digest higher than recommended amounts of Acetaminophen are
at high risk for liver Dysfunction, loss of appetite, Jaundice and nausea.
Acetaminophen is contraindicated for patient with severe liver disease and a
genetic disease called: glucose-6-phosphate dehydrogenase (G6PD)
deficiency.
Indicated for mild to moderate pain, fever, flu syndromes, Reyes syndrome.
Adverse Effects: hepatotoxicity is the most serious adverse effect associated
with excessive doses of the drug. Other possible adverse effects: skin
disorders, nausea and vomiting. Less common, but severe are blood
disorders or dyscrasias and nephrotoxicities.
Acetylcysteine is the recommended antidote for acetaminophen toxicity. It
prevents the metabolites of acetaminophen from forming.
29.Diflucan (Fluconazole)- Antifungal Drug Pg. 672:

Indicated for the treatment of esophageal, oropharyngeal, peritoneal,

urinary tract, vaginal and systemic candida infections and cryptococcal
meningitis.
Common Adverse effects: Increased liver enzymes levels, dizziness, nausea,
vomiting, and diarrhea and stomach pain.
Table 42-2 pg. 673 Use with cause in patient with renal of hepatic
dysfunctions.
30.Lactulose Hyperosmotic Laxative Pg. 821, 822, 823,825:
Pg. 821 Relieves constipation by increasing the water content of the feces, which
results in distention, peristalsis and evacuation. Also used to evacuate the bowels
for diagnostic for surgical procedures.
Pg. 822 Lactulose is not digested in the stomach or absorbed in the small bowel. It
passes unchanged into the large intestines, where it then metabolizes. The drug
induced acidic environment also reduced blood ammonia levels by converting
ammonia to ammonium. This is a helpful reduction of serum ammonia levels in
patients with hepatic encephalopathy.Lactulose is contraindicated for patients on a
low lactose diet.Available as a solution for either oral or rectal use.
Pg.825 lactulose may be taken with juice, milk, or water to increase palatability.
Note that the normal color of the oral solution is a pale yellow. Pg. 823 Asses
baseline fluid electrolyte levels to identify any deficits prior to use, Abdominal
examination and bowel patterns (also abdominal pain and degree of peristalsis).
Also, check history of abdominal surgery, nausea, vomiting, or weight loss. pg.823
Older adult patients react more adversely to this class of laxatives, avoid use in
older patients.
Pg.825 Evaluate therapeutic responses to medications by: improvements in GIrelated signs and symptoms reported by the patient (decrease constipation).
Normal bowel patterns with normal bowel sounds.

31. Superinfection (pg 602):

Can occur when antibiotics reduce or completely eliminate the normal
bacterial flora, which consists of certain bacteria and fungi that are needed
to maintain normal function in various organs. When these bacteria are
eliminated it allows other bacteria or fungi to take over and cause an
infection. An example would be a vaginal yeast infection, when normal flora
is wiped out because of antibiotics and the vaginal yeast is no longer kept in
balance. Diarrhea is also a common adverse effect of antibiotics, but it can
turn into a super infection called C-Diff (normal flora is killed and bad
bacteria comes in and takes over. Another type of super infection is when a
second infection comes after the original infection (having a primary viral

infection and then getting bacterial pneumonia because of the viral

infection).
32. Zantac (Ranitidine) pg 806 & 810:
H2 receptor antagonist, most widely used because of less drug interactions.
Available in an oral and IV form. Orals is doused at 150mg twice a day or
300mg at bedtime, IV for is dosed at 50 mg every 8 hours. Assess renal and
liver function tests and LOC. Give as ordered, if given with an antacid, give
antacid 1 hour before or 1 hour after ranitidine. Dilute IV forms with
appropriate fluids. With H2 receptors hypotension can occur with rapid
infusion, so careful monitoring is critical to patient safety.
33. Influenza-vaccination:
Used to prevent influenza, needs to be given every year before flu season.
Flutist is given intranasally whereas the others are given as an IM injections.
Every year a new flu vaccine is developed by virology researchers. either a
pregnancy category B or C. The effectiveness varies with age or
immunocompetence of the vaccine recipient and the degree of similarity
between the virus strains that are in the vaccine and the virus that is
predominant during a given flu season. healthy people younger than 65
years old have a 70% chance of avoiding illness caused by influenza virus.
the CDC now recommends people older than 6 months receive the vaccine.
Fluzone is a high dose for older people, it contains 4 times more virus
antigens. in older adults the vaccines can prevent hospitalization and
pneumonia by up to 50-60% and can prevent death 80% of the time.
34. Myasthenia gravis-tensilon effectiveness (pg 325):
has been shown to increase muscle strength with myasthenia gravis and is
used to relieve the symptoms. It is used to diagnose myasthenia gravis. it
can also be used to differentiate between myasthenia gravis and a
cholinergic crisis.

35. Epoetin alfa-CKD (pg 863-864):

a biosynthetic form of the natural hormone erythropoietin (normally secreted
by the kidneys in response to low RBCs.) It promotes the synthesis of RBCs
in the bone marrow. Used to treat anemia that is associated with end-stage

renal disease, chemotherapy induced anemia, and anemia associated with

zidovudine therapy.This medication is ineffective without adequate body iron
stores and bone marrow function. Only available as an injection (either IV or
Subcutaneous). Contraindications in uncontrolled hypertension and when
hemoglobin levels are above 11g/dL for renal patients, patients with head or
neck cancers or patients at risk for thrombosis. It is recommended to be
dosed to a target hemoglobin levels of 11g/dL for dialysis patients and
10g/dL for Chronic Kidney patients not on dialysis.
36. Actonel administration:
Immediate release: take at least 30 min with 6-8 oz of water before first food
or drink of the day. Only take with water. stand or sit upright for 30 minutes.
Delayed release: take immediately after breakfast with 4 oz or more with
plain water. do not lay down for 30 minutes
37. Carbidopa-levodopa toxicity:
Liver and renal function tests should be performed regularly as a decrease in
function will slow the metabolism and excretion of levodopa. This may lead
to toxicity.
38. Ketorolac (Toradol) effects:
Used for its analgesic effects. Comparable to narcotic drugs like morphine
but lacks the addictive properties of opioids. Used in the treatment of
moderate to severe acute pain of only 5 days or less. Contraindicated as a
prophylactic analgesic prior to surgery. Inhibits platelet formation.
39. Bactrim (Sulfamethoxazole) effect:
Do not actually destroy bacteria but rather inhibit their growth. Bacteriostatic
antibiotics interfering with bacteria synthesis of folic acid. Treats UTI's,
MRSA. Adverse effects-Stevens Johnson syndrome (redmans syndrome) Must
be given on empty stomach 1hr before or 2 hr after.
40. Muscarinic drugs-actionPrimarily target effects on the GI, bladder, and eye. Increased gastric
secretions, GI motility, and urine frequency. Constriction of the pupils,
reduced heart rate and vasodilation. Bronchials constrict and airways narrow.
Relaxes the trigone and sphincter muscles and increases voiding pressure by
contracting the detrusor muscle.

41. NSAIDS-POC-

42. St. John's Wort:

May interact with many drugs including antidepressants, antihistamines,
digoxin, immunosuppressants, theophylline, warfarin, and oral
contraceptives. (Herbal Prozac) use- depression, anxiety, sleep disorders,
nervousness. Side effects- GI upset, dizziness.
43. Acyclovir (Zovirax):
Drug of choice for both initial and recurrent episodes of herpes simplex type
1 & 2, herpes zoster (shingles), and chicken pox. Adverse effects are nausea,
diarrhea, headache, burning when topically applied. Route: oral, topical,
injectable. Before giving, assess vitals and take a thorough medication
history. Assess pain levels associated with the zoster lesions prior to giving
the medication because relief of pain is expected with use of the drug. Most
common contraindication are drug interactions and drug allergies.
44. Asthma-leukotriene inhibitors:
Newer class of asthma medications that inhibits leukotrienes. Leukotrienes
cause inflammation, bronchoconstriction, and mucous production resulting in
coughing, wheezing, and shortness of breath. Indications are prophylaxis,
long term treatment and prevention of asthma. Not meant for acute
exacerbations. Assess liver function before and throughout therapy. Take
every night on a continuous schedule. Most common type of these drugs is
Montelukast (Singulair).
45. Proventil (Albuterol) Assess:
Short acting beta 2 agonist. Assessment is for improved breathing, open
airway, lung sounds, pulse, and BP.
46. Rifampin (Rifadin)-body fluids:
Used in the treatment of TB. Body fluids may turn red or orange including
urine, stool, saliva, sputum, sweat, and tears.
47. Tetracyclines-oral contraceptives:
Bacteriostatic drugs that inhibit bacterial protein synthesis by binding to the
30S bacterial ribosome. Do not give to children under age 8 due to
discoloration of teeth. Do not give with dairy, avoid sunlight, and avoid use in
pregnant women and nursing mothers. Can retard fetal skeletal
development in utero. Decreases the effectiveness of birth control pills.

48. Glaucoma-miotic use:

Miotics include both direct acting cholinergics and indirect acting
cholinergics. The primary effect of these drugs is papillary constriction or
miosis. Cholinergic receptors are stimulated in the brain resulting in
several effects on the eye. Vasodilation of blood vessels around the eye,
contraction of ciliary muscles, drainage of aqueous humor, and reduced
intraocular pressure. Miotics are used for the treatment of open angle
glaucoma, angle-closure glaucoma, and convergent strabismus.
49. Anabolic steroids-side effects:
They mimic the effects of male sex hormones. Long term use leads to
elevated LDLs, HDLs, acne, hypertension, liver damage, and cardiovascular
disease
50. Glucagon emergency kit:
Glucagon rescue is the emergency injection of glucagon in case of severe
diabetic hypoglycemia. It is needed during seizures and/or unconsciousness
by an insulin user who is unable at that point to help themselves. Glucagon
will facilitate the release of stored glucose back into the bloodstream, raising
the blood glucose level.
51. Gout-medications:
NSAIDs are considered first-line therapy for most patients with gout. The
specific anti-gout drugs: allopurinol (Zyloprim), febuxostat (Uloric),
colchicine, probenecid (generic), and sulfinpyrazone are targeted in the
underlying defect in uric acid metabolism, which causes either
overproduction or underproduction of uric acid, which leads to gout.
Colchicine is the oldest available therapy for acute gout and is considered
second-line therapy after NSAIDs and is given in an initial dose of 0.6 to 1.2
mg, followed by 0.6 mg/hr. until pain is relieved, the patient develops severe
nausea and diarrhea, or a total of 6 mg has been administered. 3 days must
pass before a second course of therapy is initiated.
52. Lithium toxicity:
The levels of lithium required to produce a therapeutic effect are close to the
toxic levels. Lithium is indicated for the treatment of manic episodes in
bipolar disorder as well as for maintenance therapy to prevent such
episodes. Therefore, the patients serum sodium levels need to be kept in

the normal range which helps to maintain therapeutic lithium levels.

Patients should be advised not to drastically change their sodium intake
while taking lithium and to avoid over hydration as well as dehydration.
53. Haldol-Side Effects:
which is an antipsychotic drug, has many adverse effects: Akathisia,
extrapyramidal symptoms, hypotension, neuroleptic malignant syndrome,
confusion, headache, mild GI disturbance, dry mouth, amenorrhea,
gynecomastia, visual disturbances, hyperpyrexia, edema, tardive dyskinesia,
skin rash, photosensitivity, weight gain, urinary retention.

54. Lamisil-contraindications:
Depression, Liver Problems, Systemic Lupus Erythematosus, Abnormal Liver
Function Tests, A Mother who is Producing Milk and Breastfeeding, Moderate
to Severe Kidney Impairment, Severely Decreased Levels of Neutrophils in
the Blood.
55. Psychosis - Aricept-ef:
donepezil (Aricept) is a cholinesterase inhibitor that works centrally in the
brain to increase levels of acetylcholine by inhibiting acetylcholinesterase. It
is used in the treatment of mild to moderate Alzheimers disease. It is also
used as an add-on treatment for patients with dementia and Parkinsons
disease.