Acetaminophen             Non narcotic analgesic

Action Decreases fever (1) hypothalmic effect leading to sweating and vasodialation (2) inhibits the effects of pyrogens on the hyothalmic heart regulation center 

Contraindacations Renal insuffiency, anemia, liver failure, clients w/ cardiac or pulminary disease are more suseptible to acetaminophen toxicity. 

• Consult MD if more than 3 alchoholic drinks per day
• May decrease ability in infants to produce a full immune response to Vaccine if given profilactively to prevent fever

Nursing Considerations

1. Max dose 3 grams in 24 hrs for adults & children over 12. Max dose 10mg/kg children 2-12
2. Neonates 10-15 mg/kg PO q 6-8 hrs A PO loading dose of 20-25 mg/kg dose may be used
3. If possible use client wight to determine dose

Ibuprofen     Non Steroid Anti Inflammatory 

Action Anti Inflammatory effect due to cyclo oxygenase results in decreased prosteglandin synthesis. Effective inreducing joint pain, swelling & AM swelling, increase mobility in those w/ inflammatory disease

Contraindications Pregnancy esp. during the last trimester, Use in clients with aspirin triad ( broncial asthma, rhinitis,aspirin intolerance) Use to treat perioperative pain in the setting of coronary artery bypass graft surgery. Ibuprofen lysine is contraindicated in preterm infants w/ proven or suspected infection not recieving treatment

Implications (1)Do NOT use ibufoprofen as an antipyretic for more than 3 days or as an analgesic (2) Children's chewable tablets for children 4-11yrs; Junior Strenghth children 6-11 years; Oral Suspension is for children 2-11; and Oral Drops are for children 6 months to 3 years of age.(3) Do not take more than 3.2 grams/day of prescription products.(4) If GI upset occurs take with milk

ASA Aspirin     Non Steroidal anti inflammatory drug, analgesic, antipyretic

Use Analgesic(1) Pain from integumentary structures, myalgias, arthralgias, headache, dysmenorrhea, and similar types of pain (2) Gout (3) May be effective in less severe postoperative and postpartum pain; pain secondary to trauma and cancer

Morphine                     Narcotic Analgesic

Use Moderate to severe pain, used in cancer patients when all other nonnarcotic analgesics have failed

Contraindications Intrathecal- if infection is present at the injection site, IM-heart failure secondary to chronic lung disease, cardiac arrhythmias, Immediate release-Respiratory insufficency, severe CNS depression 

Considerations Don't confuse with hydromorphone(also a narcotic analgesic) 2.Don't confuse Avinza a extended release morphine sulfate with Evista (raloxifene)used to treat and prevent osteoporosis in post menopausal women. 3. Don't confuse Roxanol with Uroxatral, drug for prostatic hypertrophy or Oxytrol (drug for overactive bladder) 

Fentanyl                 Narcotic Analgesic

Use Management of breakthrough cancer pain in those (+18) with cancer who are already recieving and tolerant of opiod therapyfor underlying cancer pain. Investigational- Management of pain and anxiety in pediatric burn vicitims Parenteral (1) Induction and maintanence of anesthesia of short duration and immediate post operative (recovery room) care.

Contraindications transmucosal form is contraindicated in children who weigh less than 10kgfor the treatment of acute pain( safety for this use not esatblished), and for doses of 15 mcg/kg in children in excess of 5 mcg/kg in adults ( max 400 mcg) Use out of the hospital is contraindicated.Clients sensative to respiratory depression, use in labor and lactation

Is an Opioid antagonist Schedule II controlled substance

Implications Individually titrate to a dose that provides adequate analgesia and minimizes side effects.(2) These drugs are for opiod tolerant persons: generally used with cancer pain. Keep out of child's reach; can be fatal if ingested. Rise slowly risk of orthostatic hypotension. Don't perform tasks that require mental clarity, drug causes dizziness and drowsiness.Don't open buccal packs until ready to administer. Fentora tabls shouldn't be sucked chewed or crushed, should be placed between gum and cheek and disolved. 

Epinephrin            Sympathomimetic, direct acting

Indications Temporoary relief of shortness of breath, tightness of chest, and wheezing due to bronchospasms (2) Rapid relief of hypersensitivityreactions to odrugs and other allergens.(3) Prolong the action of anesthetics used in local and regional anesthesia.(4) Restore cardiac rythm in cardiac arrest due to various causes, although not used in cardiac failure or in hemmorhagic, traumatic, or cardiogenic shock.

Contraindications Organic heart disease, organic brain damage, hypertension,thyroid disease, local anesthesia of certain areas(fingers & toes) due to risk of tissue sloughing, labor, ccardiac dialation, coronary insufficiency, cerebrial areteriosclerosis, difficlty urinating due to an inlarged prostate gland.

Implications Medication errors have occured due to inadvertant administration of of the 1:1000 (1mg/mL)solution instead of the 1;10,000(0.1mg/mL) solution. The 1;1000 solution must be diluted before administering IV. Use extreme caution. (1) Take as directed. Review method for administration carefully. When prescribed for anaphylaxis, administer with auto injector immediately, and seek medical care. Check expiration dates. Report any increased restlessness, chest pain, heart fluttering, SOB, lact of response adverse effects, or insomnia, as dosage adjustment may be necessary. May elevate blood sugar. Avoid use of OTC without approval, limit intake of caffeine.

Digoxin                 Cardiac Glycoside

Use CHF, including that due to venous congestion, edema, dyspnea, orthopnea, and cardiac arrhythmia. May be drug of choice for CHF because of rapid onset, relatively short duration, and ability to be administered PO or IV.(2) Control of rapid ventricular contraction rate in clients atrial fibrillation or flutter.(3) Slow HR in sinus tachycardiadue to CHF.

Contraindications Ventricular fibrillation or tachycardia (unless congestive failure supervenes after protracted episode not due to digitalis) in presence of digoxin toxicity, hypersensativity to cardiac glycosides, beriberi heart disease, certain causes of hypersensitivity, cartoid sinus syndrome

Implications  Use caution in clients with ischemic heart disease, acute myocarditis, hypertrophic subortic stenosis, hypoxic or myxmedic states, Adams-Stokes or carotid sinus syndromes, cardiac amloidosis or cyanotic heart and lung disease. Use caution and at reduced dosage in elderly, debilitated clients, pregnant women and nursing mothers. (1) Due to decreased renal clearance in elderly, daily doses should not exceed 0.125 mg except when treating atrial arrythmias. (2) Measure lipids precisely using calibrated dropper /syringe. (3) obtain written peremeters for high/ low pulse rates, at which cardiac glycosides are to be held; changes in rate or rhythm may indicate toxicity. 

Nitroglycerin  caps           Vasodilator, coronary

Use Prophylaxis and long term treatment of recurrent agina. Onset of effective of capsules is not sufficiently rapid to be useful in aborting an acute anginal attack.

Implications Drug is used to control/prevent chest pain. Take as directed and have SL NTG available for acute use. (2)Do not break, chew or crush sustained release caps-swallow whole; not intended for sublingual use. Take smallest effective dose 2-4 times per day with a glass of water. Report if tolerance/lack of response evident

Nitroglycerin Patch         Vasodilator, coronary

Use Prophylaxis of angina pectoris due to CAD. The onset of action is not sufficiently rapid to be used in aborting an acute anginal attack.Investigational: Management of acute MI; erectile dysfunction;Raynaud's disease;management of Prinzmetal's angina that occurs in those without coronary heart disease.

Implications Follow instructions for specific products on package insert. Remove patch before defibrilating as patch may explode. Various products differ in the mechanisms for the delivery system;the most important factor is the amount of drug released per hour. A wide range of client variability will be noted. Variables in the absorption rate include skin, physical exercise, and elevated ambient temperature. Avoid extreme temps/humidity. Don't store outside of package.

Nitroglycerin Paste       Vasodilator, coronary

Use Prophylaxis and treatment of angina pectoris due to CAD Note: Onset of action of the ointment is not rapid enough to be used to abort an acute anginal attack. Chronic to severe pain associated with chronic anal fissures Investigational: Management of acute MI;erectile dysfunction;Raynaud disease; management of Prinzmetal's angina that occurs in clients without CAD.

Implications Do not confuse with Nitro-Bid with Nitro-Tab (also a nitroglycerin product) (1) Squeeze ointment carefully onto dose-measuring application papers(packaged with the medicine) Use applicator to spread ointment or fold paper in half and rub back and forth. Clean around tube opening and tightly cap tube after use.

Implications (2)Place the paper with the ointment onto a non hairy area of the skin and tape into place. Avoid rubbing ointment into skin. Application to the chest may be physiologically helpful, but may be applied to other nonhairy areas. Avoid distal extremities or any cut, calloused or irritated skin area. (3) Rotate sites to prevent irritation Keep a  record of areas used to avoid unecessary repetitive use of sites. Carry SNL NTG for acute chest pain relief.(4) Apply ointment in a thin, even layer covering an area of 3-6 inches in diamete; remove last dose. Date and tape the application paper over the area, or cover the area with a piece fo clear plastic cover (kitchen wrap) to prevent staining of clothing by ointment, decrease skin irritation and increase absorption

Hydrochlorothiazide     Diuretic, thiazide

Use Hypertension, used alone or with other drugs. (2) Diuretic to treat edema due to CHF, hepatic cirrhosis, or corticosteroid or estrogen therapy.May also be used for edema due to various types of renal dysfunction, including nephrotic syndrome acute glomeronephritis, or chronic renal failure.(3) Microzide may be used for once daily, low dose treatment of hypertension. This is a combination drug.

Contraindications Gereatric clients may be more sensetive to the usual adult dose.

Implications: (1) Divide daily doses in excess of 100mg(2) Give twice daily at 6-12 hr intervals.(3) When using hypertensives, hydrochlorothiazide dose is usually 50mg(4) Store from 15-30 degrees celcius. Protect from freezing and moisture. Take in the A.M. to avoid nighttime urinary frequency with 4oz of OJ of half of a banana. May take with food if GI upset. Consume 2-3 L of water daily.May cause blurred vision and dizziness; change positions slowly and avoid activities that equire mental alertness until drug effects realized.Report swelling of extremeties or weight gain of >2lbs/ day or 5 lbs/ week.

Potassium Chloride               Electrolyte

Use hypokalemia due to digitalis intoxication, diabetic acidosis, diarrhea and vomiting,attack of periodic familial paralysiscertain cases of uremia, hyperadrenalism, starvation and debilitation and corticosteroid or diuretic therapy(2) Hypokalemia with or without metabolic acidosis and following surgical conditions involving nitrogen loss, vomiting, diarrhea, suction drainage and increases urinary secretion of potassium.(3) Prophlylaxis of potassium depletion when dietary intake is not adequate in the following conditons: Clients on digitalis and diuretics for CHF, hepatic cirrhosis with with ascities, excess aldosterone with normal renal function, signifigant cardiac arrythmias, potassium lossing nephropathy.IV- Prophylaxis and treatment of moderate to severe potassium loss when PO therapy is not feasible

Contraindications Severe renal function impairment with azotemia or oliguria, postoperatively before urine flow has been reestablished, early postoperative oliguria except during GI drainage.Crush syndrome, hyperkalemia from any cause, anuria, heat cramps, acute dehydration, severe hemolytic reactions

Safety- during lactation and pregnancy (give during pregnancy only if clearly needed), and in children not established. (1) Give PO doses 2-4 times per day. Correct hypokalemia slowly over a 3-7 days to minimize risk of hyperkalemia. With esophageal compression, administer dilute liquid solutions of potassium rather than tablets. IV do not administer potassium IV undiluted. Usual method is to administer by slow IV infusion in dextrose solution at a concentration of 40-80 mEq/L and at a rate not to exceed 10-20 mEq/hrDo not infuse rapidly;high plasma levels of potassium may result in death due to cardiac depression, arrthmias, or arrest.

Spironolactone           Diuretic, potassium-sparing

Use Primary hyperaldosteronism, including diagnosis,short-term preoperative treatment,long term maintenance therapy for those who are poor surgical risks and those with bilateral micronodular or macronodular adrenal hyperplasia. congestive heart failure to manage edema and sodium retention when the client is only partially responsive to or is intolerant of other theraputic measures. Also those with CHF taking digitalis when other therapies are inappropriate.

Contraindications Clinically signifigant hypersensitivity to stavudine or any component of the product. Avoid use of stavudine and hydroxyurea, with or without didanosine, Lactation.

Implications If peiphreal neutopathy recurs after resumption of stavudine, consider permanent discontinuation. The interval between doses should be 12 hr. May be taken without regard to meals. Take exactly as prescribed q 12 hr RTC, do not exceed prescribed dose, do not share medications. Contact poison control center or emergency room right away if dosage exceeded. Advise those with diabetes that oral solution contains surcrose 50 mg/mL. Drug is not a cure, but alleviates/manages the symptoms of HIV infections and may help prolong life. May continue to aquire illnesses associated with AIDS or ARC, including opportunistic infections; must remain under close medical supervision.The risk of transmission of HIV to others through blood or sexual contact is not reduced with drug therapy practice safe sex, dont share needles.

Metoprolol                  Beta-adrenergic blocking agent

Use Alone or with other drugs to treat Hypertension. Chronic management of agina pectoris Treatment of stable symptomatic(NYHA Class II or III) heart failure of ischemic, hypertensive, or cardiomyopathic origin.  Investigative- Prophylaxis of migraine in adults both succinate and tartrate

Contraindications Myocarninal infarction in clients with an HR of less than 45 bpm, in second-or third-degree heart block, or if SBP is less than 100mm Hg. Moderate to severe cardiac heart failure. 

Implications Do not confuse with metoclopramide (GI stimulant), metaproterenol (bronchodialator), or with misoprostol (prostaglandin derivative)Do not confuse with Topral Xl with Topomax (antiepileptic, antimigrane) or Tegretol and Tegretol-XR (antiepileptic). Individualize the dosage, Once daily dosing is effective and can maintain a reduction in BP throughout the day. However lower doses eg 100mg  may not maintain full effect at the end of 24 hr period, larger or more frequent doses may be needed. If transient worsening of heart failure occurs, with increased doses of diuretics. May need to lower dose of Metaprolol or temporarily discontinue. For CHF do not increase dose until symptoms of worsening CHF have been stabilized. Initial difficulty with titration should not preclude attempts later use of metoprolol. 

Warfarin            Anticoagulant Coumarin derivative

Use Prophylaxis & treatment of venous thrombosis and its extinction. Prevention and treatment of the thromboembolic complications associated with atrial fibrilation &/or cardiac valve replacement.

Contraindications Pregnancy. Hemmorhagic tendencies or blood dyscrasias; recent or contemplated surgery of the CNS,eye, or traumatic surgery resulting in large open surfaces; bleeding tendencies associated with active ulceration or overt bleeding of the GI, GU, or respiratory hemorrhage.

Implication Can cause major or fatal bleeding most likely during the starting period. Look at the many drug interactions. Do not confuse Coumadin with Cardura or with Avandia. Frequent monitoring of PT/INR during the first week of therapy, during adjustment periods, and monthly therafter. Duration of therapy is individualized and should be continued until the danger of thrombosis and embolism has passed. If a dose is missed, the dose should be taken as soon as possible on the same day. Doubling the daily dose to make up for a missed day is inappropriate. Do not change brands, may be a difference in bioavailability. The anticoagulant effect of Warfarin is delayed. Thus Heprin is preferred initially for rapid anticoagulation. 

Lovenox     Anitcoagulant, low molecular weight heparin

Use Prophylaxis of deep vein thrombosis (DVT), which may lead to pulminary embolism in those undergoing abdominal surgery who are risk for thromboebis complications;those undergoing those undergoing hip replacement surgery during and following hospitalization

Contraindication IM use. Use with prosthetic heart valves due to possible valve thrombosis, especially in pregnant women.Hypersensitivity to enoxaparin,heparin,pork products and in those with active major bleeding;also hypersensitivityto sulfate or benzyl alchohol

Implications Spinal/epidural hematomas. Epidural or spinal hemotomas may occur in clients who are anticoagulaed with low molecular wt heparins or heparinoids. Consider adjusting dose for low weight (<45 kg) clients and those with Ccr <30 mL/min. Dosage impairment for clients with severe renal impairment (Ccr less than 30mL/min) DVT prophylaxis in abdominal surgery, hip or knee replacement surgery, or medical clients during acute illness:30mg SC once a day. Prophylaxis of ischemic complications of unstable angina and non-Qwave MI(when used with aspirin), impatien treatment of acute DVT with or with out pulminary embolism (when used with Warfain) 1mg/kg once a day  

Carbidopa/Levodopa                        Antiparkinson drug

Use Parkinsonism (idiopathic,postencephalitic,following injury to the nervous system due to carbon monoxide and maganese intoxication) Not effective in drug-induced extrapyramidal symptoms. Carbidopa alone is used in clients who require individual titration of carbidopa and levodopa. Carbidopa is used with levodopa to N&V  reduce 

Contraindications Use in suspicious, undiagnosed skin lesions or history of melanoma. Narrow angle glaucoma. Use with non select MAOIs. Use of carbidopa in children les than 18 years of age. Lactation. When both drugs are used together start with more than 20-25% of the previous daily dose of levodopa. At least 8 hours should lapse between the last dose of levodopa and the first dose of levodopa/carbidopa. 

Implications Individualize dosage. Assess for drug interactions. Do not administer carbidopa/levodopa with levodopa. At least 8 hours should lapse between the last dose of levodopa and the first dose of levodopa/carbidopa. Giving sustained sustained-release form of carbidopa/levodopa with food results in increased levodopa levels by 50% and increased peak levodopa levels by 25% Do not crush sustained release form of Sinemet; may administer as a whole or half tab. Allow at 3 days to elapse between dosage adjustments of sustained-release product. When carbidopa is used to supplement the combination, 1 tab of cabidopa may be added or omitted. Other antiparkinson drugs may be used with carbidopa/levodopa; however, the dose of the other antiparkinsons drugs may need to be adjusted

Donezepil                       Treatment of Alzheimer's disease

Use Treatment of mild to severe dementia of the Alzheimer's type. Is combined with memantine to lower the decline of mental and physical functions in Alzheimer's disease. Investigational: Vascular dementia; improve the memory in Multiple Sclerosis clients; post-stroke aphasia.

Contraindications Hypersensitivity to piperidine derivatives. Use caution with history of asthma or obstructive pulmonary disease. Safety and efficacy not determined in children.

Implications Do not confuse Aricept with Aciphex 

Donepezil orally disintegrated tablets are bioequivilant to donzepil tablets.Store at controlled room temp 59-86 F

Depacote Anticonvulsant, misc.

USE:(1)PO/IV used alone or in combination with other anticonvulsants to treat seizures in adults and children over 10. Treats simple and complex seizures.

(2)PO used as Divalproex Sodium, extended release tablets treat acute bi-polar disorder. Delayed release tablets treat migraines in adults, Stavzor delayed release tablets treat, manic episodes, complex partial seizures, or migraines. 

Contral Indications: Black box. Hepatoxicity in children under 2. Life threatening pancreatits in children and adults. Don't use in children under 10.

Nursing Implications: Do not confuse Depakote ER (extended release) with Depakote Delayed-Release. (1)Depakote delayed release is qq every 8-12 hr. Depakote ER is daily. You cannot substitute the two.

(2)To minimize depression-administer at night. (3) give as 60 min. infusion faster causes side effect chances. (4)Divide daily dosage if it exceeds 250 mg/day. (5) do not take if pregnant. (6) avoid alcohol or depressants.

Heparin          Anticoagulant, heparin

Use Prophylaxis and treatment of venous thrombosis and its extension; pulmonary embolism; peripheral arterial embolism; atrial fibrillation with embolization. Diagnosis and treatment of chronic and acute consumption of coagulopathies (disseminated intravascular coagulation)

Contraindication Hypersensitivity to Heprin. Active bleeding, blood dyscrasias (or other disorders characturized by bleeding tendencies such as hemophilia)clients with frail or weakened blood vessels, purpura, severe thrombocytopenia, liver disease with hypoprothrombinemia, suspected intercranial hemorrhage.Supperative thrombophlebitis. Inaccessible ulcerative lesions esp of GI tract

Implications Use with caution in menstration, in pregnant women, during lactation and cerebrovascular accidents. May be given by intermitten IV injection, continuous IV infusion, or deep SC injection. Continuous IV infusion is generally perferred due to higher chance of bleeding complications with other routes. Do not administer IM. Administer deep SC injection to minimize local irritation, hematoma, and tissue sloughing and to prolong drug interaction. Z-track method: Use any fat roll but abdominal fat rolls are preferred. Use 1/2 in. or 5/8 in. 25-27 gauge needle. Grasp skin layer of the fat layer of the fat roll, and lift up. Insert needle at 45 degree angle to the skin's fat layerand then administer

Levothyroxine             Thyroid

Use Replacement or supplemental therapy for congenital or aquired hypothyroidism of any etiology; except transient hypothyroidism during the recovery phase of subacute thyroiditis. Specific uses include cretinism, myxedema, ordinary hypothyroidism, primarily hypothyroidism due to functional defiency.

Contraindications/ important Drugs with thyroid hormone activity, alone or with other drugs, have been used to treat obesity. In euthyroid clients, doses within the range of daily hormonal requirements are ineffective for weight reduction.

Implications do not confuse with levothyroxine with levofloxacin. Take with a full glass of water to prevent chocking. Infants with congenital or aquired hypothyroidism institute therapy with one full doses as soon as the diagnosis is made. In infants and children who can not swallow a pill, it can be crushed and diluted in formula or water and given in a dropper. It can also be sprinkked oer cooked cereal or applesauce.

Furosemide                                 Diuretic loop

Use Use in adults and children to treat edema associated with CHF, renal disease (including nephrotic syndrome), and hepatic cirrhosis. Is especially when a drug of greater diuretic activity is desired. IV-Adjunctive therapy with acute pulmonary edema. Indicated when a rapid onset of diuresis is desired. PO- Treat hypotension alone or in conjunction with other diuretics EXCEPT ethcrynic acid

Contraindications Never use with ethcrynic acid. Anuria, hypersensitivity to drug, severe renal disease associated with azotemiaand oliguria, hepatic coma associated with electrolyte depletion. Lactation. This a potent diuretic which if given in excessive amounts can cause electrolyte depletion.

Implication Don't confuse Lasic with Lanoxin or furosemide with torsemide. Give 2-4 consecutive days a week. Food decreases bioavailablity of furosemide and ultimately the degree of diuresis. Slight discoloration resulting from light does not affect potency. However do not dispense dicolored tablets or injection. If used in conjunction with other antihypertensive agents reduce them by 50% when furosemide is added in order to prevent an excessive drop in BP.

Antivert                        Antiemetic

Use Prevention and treatment of N&V Prevention of N&V or dizziness associated with motion sickness.Vertigo associated with the diseases of the vestibular system.

Contraindication Safety for use during lactation and in children less than 12 years of age not determined. Use with caution glaucoma, obstructive disease of the GI or GU tract, and in prostatic hypertrophy. Pediatric and geriatric clients may be more sensitive to meclizine's anticholinergic effects.

Implication Take as directed; report if condition does not improve or worsens. With motion sickness, take 1 hr before departure to ensure best results. Antiemetics tend to cause drowsiness and dizziness. Do not drive or perform other hazardous tasks until drug response evident. For dryness of mouth try sugarless candy or gum, ice chips or using a saliva substute. Consume plenty of bulk and liquids to prevent constipation. Avoid CNS depressants and alcohol; markedly increased sedative effects.

Dilantin - Antiarrhythmic, Class IB;anticonvulsant,hydantoin

Use PO: Control of generalized tonic-clonic seizures. Control of complex partial (psychmotor, temporal lobe) seizures. Prevent or treat seizuresduring or following neuro surgery (tablets only). Parenteral: prevent or treat seizures during or following neurosurgery. IV: to treat status epilepticus.

Contraindications Hypersensitivity to hydantoins, exfoliative dermatitis. Use of pareneral pheyton in sinus bradycardia, second and third degree AV block, clients with Adams-Stokes syndromes. SA block. IM use for status epilepticus. Lactation. Parenteral. Phenytoin sodium injection must be administered slowly. In adults do not exceed 50 mg/minute. In neonates administer the drug at a rate not exceeding 1-3 mg/kg/min

Citalopram (antidepressant SSRI)

Use: treatment of depression in those with DSM-III and DSM-IIIR category of major depressive disorder. Investigational: Panic disorder, PMS, dysphoric disorder, PTSD, general anxiety disorder, and OCD.

Contraindications: Use with MAOIs or with alcohol. Lactation.

Special concerns: Suicidality in children, adolescents and young adults. Observe patients for clinical worsening, suicidality, or changes in behavior. Use caution in several renal impairment, history of seizure disorder, 

Implications: Do not confuse celexa with cerebyx or celebrex. Allow at least 14 days to elapse between discontinuation of an MAOI and initiation of citalopram or vice versa. Take as directed, once daily, with or without food. Use caution operating machines or cars until drug effects are known. May impair judgment, thinking, motor skills or cause drowsiness. Avoid alcohol or other CNS depressants. Do not take aspirin or aspirin-containing products. NSAIDs ginkgo biloba or any other medication or herbal product that can effect coagulation.

Omeprazole  (proton pump inhibitor)

Uses: Short-term treatment of active duodenal ulcers. Most clients heal in four weaks; others require an additional four weeks of therapy. With clarithromycin to treat duodenal ulcer associated with H. pylori. With clarithromycin and amoxicillin in those with with an one-year history duodenal ulcer or to eradicate H. pylori.

Contraindications: Lactation. Use as maintenance therapy for duodenal ulcer disease. Use with clopidogrel. OTC use in those who have trouble or pain swallowing food, are vomitting blood, or are excreting bloody or black stools.

Implications: Do not confuse Prilosec with Prozac or Prinivil. Give daily doses more than 80 mg in divided doses.  Efficacy for more than 8 weeks has not been determined. If client doesn't respond to 8 week therapy, an additional 4 weeks may help. Take at least 1 hour before eating, and swall whole; Do not open, chew, or crush. Antacids can be administered with Omeprazole. Difficulty swallowing caps = add 1 Tbs applesauce, open cap, empty pellets onto applesauce. Mix pellets with applesauce, swallow immediately. Do not heat or chew applesauce. Do not store mixture for future use.

Famotidine  (histamine H2 receptor blocking drug)

 Use: PO/injection: treatment up to 8 weeks, of active duodenal ulcers. Maintenance therapy for duodenal ulcer after active ulcer has healed. Pathologic hypersecretory conditions such as Zollinger-Ellison syndrome or multiple endocrine adenonas. Up to 6 weeks of GERD including ulcerative disease diagnosed by endoscopy or erosive esophagitis.

Contraindications: Cirrhosis of the liver, impaired renal or hepatic function, lactation.

Implications: Use antacids concomitantly if needed. Oral suspension may be substituted for tablets. Reduce dose to 1/2 usual dose in moderate to severe renal impairment. Drug is used to reduce ulcers or control acid refux S&S by reducing the amount of stomach acid produced. May take with antacids for pain relief. May cause dizziness, headaches, and anxiety; use caution with activities requiring mental alertness. Take with food at night; do not smoke after last dose. If more than one dose daily, take last dose at bedtime.