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Emergency medications Dr.Olfat El-Shafiey Assistant Professor Critical Care Assiut University Drugs used during the management of a cardiac arrest Oxygen: high concentration oxygen should be given to all patients in cardiac arrest Oxygen in sufficient concentration to provided arterial oxygen saturation of >95% should be given to all patients and must be humidified because dry oxygen is not right for the patient Drugs used during the management of a cardiac arrest Oxygen pressure: modified oxygen pressure is very important Oxygen pressure between (5-8ml of oxygen pressure)stimulate the respiratory center of the brain Oxygen pressure between (10-15ml of oxygen pressure ) irritate the respiratory center of the brain Oxygen pressure between(15-20ml of oxygen pressure) cause paralysis of the respiratory center of the brain Oxygen pressure between (20-30ml of oxygen pressure cause damage for the respiratory center of the brain Drugs used during the management of a cardiac arrest Epinephrine(adrenaline) Indications:is the first drug used in cardiac arrest of any etiology Dose:during cardiac arrest ,the initial IV dose is I mg ,followed by 2-3mg ,diluted into a volume of 10ml of sterile water may be given via the tracheal tube Drugs used during the management of a cardiac arrest Action of epinephrine: is a directly-acting sympathomimetic amine that possess both alpha and beta adrenergic activity.epinephrine stimulates both a1 and a2 receptors to produce vasoconstriction.this increase systemic vascular resistance during CPR resulting in a relative increase in cerebral and coronary perfusion. Drugs used during the management of a cardiac arrest Action of epinephrine:in the beating heart effect of epinephrine mediated through the B1 receptors ,is to increase heart rate and force of contraction. Epinephrine increases myocardial excitability Use:available in two dilutions:1 in 10,000 (10ml of this solution contains 1mg of epinephrine) and 1 in 1,000 (1ml of a 1 in 10,000 is the more usual dilution used in cardiac arrest Drugs used during the management of a cardiac arrest Atropine Indications: in systole In Pulseless electrical activity with a rate<60b\min In sinus ,atrial bradycardia Dose: blocks the effect of the vagus nerve on both the (SA ) node and (AV)node conduction Drugs used during the management of a cardiac arrest Aminodarone Indications:pulseless,ventricular fibrillation Dose:IV of 300mg aminodarone ,diluted in 5% dextrose to a volume of 20ml Side effects:bradycardia,hypotension Drugs used during the management of a cardiac arrest Magnesium sulphate: shock in the presence of possible hypomagnesaemia Lidocaine: ventricular fibrillation\pulseless Dose:100mg and an addition of 50mg can be given if necessary Drugs used during the management of a cardiac arrest Sodium bicarbonate: Indication:severe metabolic acidosis,hyperkalemia Dose:50 mmol given IV ,the dose can be repeated as necessary Actions: cardiac arrest results in combined respiratory and metabolic acidosis due to cessation of pulmonary gas exchange Drugs used during the management of a cardiac arrest Vasopression: is a powerful vasoconstrictor that acts by stimulation of smooth muscle Fluids: normal saline or lactated ringer`s is the preferred crystalloid Calcium: pulseless electrical activity caused by:hyperkalemia,hypocalcemia,overdose of calcium channel blocking drugs Drugs used during the management of a cardiac arrest Calcium: Actions: play a vital role in the cellular mechanisms underlying myocardial contraction Digoxin Antiarrhythmic Cardiotonic Brand names: digitoxin digoxin lanoxin digitaline Digoxin-side effects Adult: anxiety,blurred or yellow vision,confusion,dizziness,mental depression,headache,loss of appetite,visual –auditory hallusinations,diarrhea,lower stomach pain,nausea,palpitation Digoxin-side effects Children: stomach upset,loss of appetite Rare side effects: skin rash,bleeding gums Digoxin overdose Visual and auditory hallucinations Tinning of the ear Disturbances of vision Yellowish coloration surrounded by witch coloration Medical problems may affect the use of digitalis Electrolyte disturbances Lung disease Kidney disease Liver disease Overactive thyroid The following medication should not be used at all with Digoxin Amphetamine Appetite suppressant Medication for asthma Medication for cold,sinus problems Calcium channel blocking (adalet,isoptin) Beta-adrenergic blocking gents diuretics Precautions before receiving digoxin Count radial pulse if it was below 60beats\min stop receiving medicine and report Instruct your patient in the morning when get up to concentrate his vision on a source of light when he watch yellowish coloration surrounded by whitch coloration,tinning or roaring of the ear ,low of concentration ,headache must call his doctor (digitalis toxicity) Precautions before receiving digoxin Every 4 months patient must test the concentration of the drug in his blood to avoid digitalis toxicity and to change the dose Avoid diarrhea Avoid constipation Avoid abdominal cramps Avoid coughing Receive fruits and vegetables rich in potassium Nitroglycerin and anginal pain Nitrates : brand name:isordil Nitroglycerin and anginal pain Are used to treat the symptoms of angina (chest pain) Are used to treat angina in three ways: 1-to relieve an attack 2-to prevent attacks from occurring by using the medication just before an attack is expected to occur 3-to reduce the number of attack that occur by using the medicine regularly on a long term basis Nitroglycerin and anginal pain Nitrates work by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload Certain medications should not be used with nitroglycerin at all antihypertensive Nitroglycin should not be used with certain Medical problems Anemia Glaucoma Head injury Corticosteroids Brand names : hydrocortisone,betamethasone, cortisone,dexamethasone,prednisolone, predispose Category:anti-inflammatory,antiemetic in cancer chemotherapy , Corticosteroids Description: are used to provide relief for inflamed areas of the body, lessen swelling,redness,itching,and allergic reactions,asthma. Corticosteroids Before using this medicine:follow a low – salt diet,a potassium –rich diet,add extra protein to diet Pregnancy:birth defects with corticosteroids Breast-feeding:corticosteroids pass into breast milk and may cause problems with growth Corticosteroids Older adults:develop high blood pressure ,osteoporosis Medications should not be used with corticosteroids Antacids Barbiturates Tegretol Dilantin Depakine Antidiabetic agents(corticosteroids may increase blood glucose level) Cyclosporine (cause seizures) Medications should not be used with corticosteroids Digitalis glycosides (corticosteroids decrease the amount of potassium in the blood),digitalis can increase the risk of having an irregular heartbeat or other problem if the amount of potassium in the blood gets too low Diuretics(using corticosteroids with diuretics may cause the diuretic to be less effective)Also corticosteroids may increase the risk of low blood potassium Medications should not be used with corticosteroids Diuretics(potassium supplements or a different type of diuretic is used in treating high blood pressure in those people who have problems keeping their blood potassium at a normal level. Immunization –while patient are being treated with this medicine and even after stop taking it,do not have any immunization without doctor`s approval. Medications should not be used with corticosteroids Immunization –Also other people living in the patient`s home should not receive the oral polio vaccine,since there is a chance they could pass the polio virus on to patient In addition ,patient should avoid close contact with other people at school or work who have recently taken the oral polio vaccine. Medications should not be used with corticosteroids Skin test injections— corticosteroids may cause false results in skin tests. Medical problems may affect the use of corticosteroids Acquired immunodeficiency syndrome Fungus infection Herpes simplex infection of the eye Recent surgery or serious injury(delay healing of operative wound) TB (delay healing) Diabetes mellitus(corticosteroides may cause a loss of control of diabetes by increasing blood sugar level Medical problems may affect the use of corticosteroids Stomach ulcer Intestinal problems Ulcerative colitis Glaucoma (corticosteroids increase intraocular pressure Liver disease Heart disease Under active thyroid Medical problems may affect the use of corticosteroids Osteoporosis:corticosteroids may worsen bone disease because they cause the body to lose more calcium Psychosis:this condition may be made worse Systemic lupus erythematosus: Proper use of corticosteroides Take this medicine with food to prevent stomach upset Do not stop using corticosteroide without doctor`s order and it must be reduced gradually Low-salt diet High potassium intake(tomato,banana,apricot,apple,fig ,nuts) Low animal fat Low caffeine intake Low sweet or artificial sweet No spicy food If patient will be using corticosteroids for a long time Follow a low –salt diet Follow a potassium –rich diet Watch calories to prevent weight gain Add extra protein to diet Eye examination by ophthalmologist (for intraocular pressure)-before –during treatment Carry a card stating that you are using this medicine If patient will be using corticosteroids for a long time Tell the doctor in charge that you are using this medicine: -before having skin tests Before having any kind of surgery including dental surgery or emergency treatment If you get a serious infection or injury Avoid close contact with anyone who has chickenpox or measles. If patient will be using corticosteroids for a long time For patients with diabetes:this medicine may affect blood glucose levels.if you notice a change in the results of your blood or urine sugar tests or if you have any questions,check with doctor. For patients having this medicine injected into their joints:if this medicine is injected into one of your joints,patient should be careful not to put too much stress or strain on that joint for a while ,even if it begins to feel better. If patient will be using corticosteroids for a long time If redness or swelling occurs at the place of injection ,check with your doctor. Side effects of corticosteroids May lower the patient`s resistance to infections Any infection get may be harder to treat Less common side effects: decreased or blurred vision,increased thirst Rare side effects: blindness ,burning ,numbness ,pain or tingling at near place of injection,confusion,excitement,hallucinations. Side effects of corticosteroids Rare side effects:mental depression,abdominal pain,bloody or black ,tarry stools ,change in vision,eye pain ,headache,irregular heartbeat,menstrual problems,muscle cramps ,muscle weakness,pain in arms,back,hips,legs,ribs,or shoulders ,redness of eyes,sensitivity of eyes to light ,unusual increase in hair growth,unusual tiredness or weakness ,vomiting ,weight gain,wounds that will not heal. Side effects of corticosteroids More common side effects: Increased appetite ,nervousness or restlessness or loss of appetite Less common or rare side effects: Darkening or lightening of skin color,dizziness ,flushing of face or cheeks ,increased joint pain Anticoagulant Description: decrease the clotting ability of the blood and help to prevent harmful clots from forming in the blood vessels,called blood thinners,they also will not dissolve clots that already have formed but they may prevent the clots from becoming larger Warfarin,Dicumarol Anticoagulant and pregnancy Warfarin,Dicumarol may cause birth defects,physical or mental growth of the fetus or newborn baby Use this medicine during the last 6 months of pregnancy may increase the chance of severe possibly fatal,bleeding in the fetus Anticoagulant and pregnancy Warfarin,Dicumarol if taken during the last few weeks of pregnancy Anticoagulants may cause severe bleeding in both fetus and the mother before or during delivery and in the newborn infant Anticoagulant Warfarin,Dicumarol and breast-feeding :not likely to cause problems if pass into breast milk Older adults:increase the chance of bleeding during treatment Anticoagulants and certain medicines should not be used together at all Cordarone Tagamet Flagel Anabolic steroid Antifungals medicine for overactive thyroid Aspirin or other salicylates cephalosporins Anticoagulants and certain medication does not use together at all Narcotics Thyroid hormones Depakene Barbiturates Tegretol Dilantin Vitamin K medical problems may affect the use of anticoagulants Aneurysm(swelling in a blood vessel) Bleeding in the brain Low platelet count Cancer Childbirth Pericarditis Hemophilia Hypertension Liver disease Peptic ulcer Wound open Dose of anticoagulants Dicumarol For preventing or treating harmful blood clots..adult dose is 25 to 200 milligrams per day ,adjusted according to blood tests. Warfarin for preventing or treating harmful blood clots..adult dose is usually 2 to 5 milligrams per day for two to four days Precautions while using anticoagulant It is important for the patient to carry identification card stating that he is using this medicine Avoid sports and activities that may cause the patient to be injured Be careful to avoid cutting patient himself Brushing teeth or shaving taking special care Precautions while using anticoagulant Vitamin K is present in green,leafy vegetables (such as broccoli,cabbage,collard greens,kale,lettuce,spinach) Avoid diarrhea because it change electrolytes Side effects of anticoagulants Watch for signs of unusual bleeding from gums when brushing teeth,blood in urine,nosebleeds,pinpoint red spots on skin,unusually heavy bleeding or oozing from cuts or wounds ,unexpected or unusually menstrual bleeding Side effects of anticoagulants Less common side effects: cough of hoarseness,fever,or chills,lower back or side pain ,painful or difficult urination,itching Rare side effects: itching on skin,blue or purple toes,dark urine,pain in toes,painful red sores on skin especially on thighs ,beasts,penis or buttocks ,sores ,ulcers or white spots in mouth or throat ,sudden increase or decrease in amount of urine,swelling of face,feet or lower legs ,trouble in breathing ,yellow eyes or skin Muscle relaxant Uses: -in case of muscle contraction, strain and sprain of ligament,facilitate tracheal intubations,used during surgery, facilitate mechanical ventilation Narcotic Analgesics Are used to relieve pain before or during an operation and act in the central nervous system to relieve pain To help the anesthetic work better Codeine are used to relieve coughing Narcotic Analgesics Category: Analgesic(codeine-methadone-morphine) Anesthesia(morphine) Antidiarrheal(codeine-morphine) Antitussive(codeine-hydrocodronemorpgine-methadone) Pulmonary edema therapy Drug overdose of Narcotic Analgesics Clod clammy skin Confusion Seizures Dizziness Drowsiness Low blood pressure Nervousness or restlessness Pinpoint pupils of eyes,slow heartbeat,slow breathing Side effects of Narcotic Analgesics Less common or rare side effects: dark urine,fast slow heart beat,hallucination,itching or skin rash,increased sweating,irregular breathing,mental depression,redness or flushing of face.ringing in the ears,shortness of breath ,uncontrolled muscle movements,yellow eyes or skin Side effects of Narcotic Analgesics More common side effects: nausea.vomiting Less common side effects: blurred vision,constipation,decreased amount of urine,difficult or painful urination,dry mouth,frequent urination,headache,loss of appetite,nervousness Dose of Narcotic Analgesics oral Codeine for pain: adult-15-60mg usually 30mg every 3 to 6 hourschildren-0.5mg per KG of body weight every 4 to 6 hours For cough: adult 16-20mg every 4 to 6 hours children:up to 2 years not recommended children 2years 3mg every 4 to 6 hours up to a maximum of 12 mg a day Dose of Narcotic Analgesics oral Children 3years 3.5mg every 4 to 6 hours maximum 14mg a day Children 4 years 4 mg every 4 to 6 hours maximum 16mg a day Children 5 years 4-5mg maximum 18mg Children 6 to 12 years 5 to 10mg every 4 to 6 hours maximum 60mg Dose of Narcotic Analgesics injection For pain Adults-15 to 0mg usually injected into a muscle or vein or under the skin Children 0.5mg per KG of body weight injected into a muscle Insulin Insulin Brand Names Humulin 50 Humulin L Humulin N Lente Novolin NPH Regular insulin Regular insulin Insulin Description Insulin is one of many hormones that helps the body turn the food we eat into energy ,also insulin helps us store energy that we use later.After we eat ,insulin works by causing sugar (glucose) to go from the blood into our body`s cells to make fat, sugar and protein. Insulin Description When we need more energy between meals ,insulin will help us use the fat,sugar ,and protein that we have stored.this occurs whether we make our own insulin in the pancreas gland or take it by injection. Diabetes mellitus Is a condition in which the body does not make enough insulin to meet its needs or does not properly use the insulin it makes.Without insulin ,glucose can not get into the body`s cells ,without glucose ,the cells will not work properly. Before using insulin Pregnancy:blood sugar can reduce the chance of baby gaining too much weight,having birth defects ,or having high or low blood sugar Breast –feeding:insulin does not pass into breast milk and will not affect the nursing infant. Certain medications should not be used with insulin at the same time Beta-adrenergic blocking agents (inderal) Beta-adrenergic blocking agents may increase the chance of developing low blood sugar levels. Corticosteroids(prednisone or cortisone) Increase blood sugar level Anti-epileptic medication Increase blood sugar level Certain medications should not be used with insulin at the same time Antihypertensive medication Increase blood sugar level Medical problems and insulin The presence of the following medical problems may affect the dose of insulin -changes in female hormones (during puberty,pregnancy,menstruation) Severe infection Mental stress Diarrhea Vomiting Intestinal blockage Medical problems and insulin The presence of the following medical problems may affect the dose of insulin Kidney disease Liver disease Injury Overactive thyroid Underactive pitutary gland hypoglycemia Can cause low blood sugar Symptoms of low sugar can include: Confusion,blurred vision,cold clammy skin,pale skin,difficulty in concentration,drowsiness,excessive hunger,fast heartbeat,headache,nervousness,slurred speech and unusual tiredness or weakness hypoglycemia Causes of hypoglycemia -delaying of meal Exercising more than usual Using too much insulin Receive actual dose of insulin but forget to eat,or eat very minimal amount of food Superficial breathing hypoglycemia Management of hypoglycemia Fruit juice Honey (1 tablespoon) Cheese or crackers ,half a sandwich,or drink a glass of milk Do not use chocolate because its fat slows down the sugar entering into the blood stream Glucagon is used in emergency situations such as unconsciousness (1unit of glucagon=20kg of body weight) Hyperglycemia Causes of hyperglycemia İnfection Severe vomiting-diarrhea Hyperglycemia Symptoms of mild high blood sugar Blurred vision,drowsiness,dry mouth,flushed and dry skin,fruit –like breath odor,increased urination,loss of appetite ,stomachache,nausea or vomiting ,tiredness ,troubled breathing (rapid and deep) and unusual thirst Hyperglycemia Symptoms of severe high blood sugar Flushed and dry skin,fruit-like breath odor,ketones in urine,troubled breathing (rapid and deep) Side effects of insulin Side effects more common Low blood sugar (mild) including anxious feeling,behavior change ,blurred vision,cold clammy skin,confusion,pale cool skin,difficulty in concentrating,drowsiness ,excessive hunger ,fast heart beat,headache,nausea,nervousness,unusual tiredness ,weight gain Side effects of insulin Rare Side effects Swelling of face ,fingers ,feet or ankles Insulin and food interaction Avoid excessive animal fat intake Avoid excessive spicy food Avoid high salt intake Avoid high caffeine intake Antihistaminic and decongestants Category:antihistaminic Description:are used to treat the nasal congestion ,sneezing ,preventing the effects of histamine Antihistaminic - decongestants and pregnancy and breast -feeding Cause jaundice and muscle tremors in a few newborn infants whose mothers received phenothiazines during pregnancy Small amounts pass into breast milk but it cause unusual excitement or irritability,decrease breast milk Antihistaminic - decongestants and children Increases in blood pressure,nightmares or unusual excitement,nervousness ,restlessness or irritability Antihistaminic - decongestants and older adults Confusion,difficult and painful urination ,dizziness,drowsiness,dryness of mouth or convulsions Certain medications should not be used be used at all with Antihistaminic - decongestants Medicine for abdominal or stomach spasms or cramps cause dryness of mouth ,irregular heartbeat Antiepileptic medications Antidepressants Amphetamines Appetite suppressants caffeine Certain medications should not be used at all with Antihistaminic - decongestants Medicine for asthma or other breathing problems Medicine for colds ,sinus problems Beta-adrenergic blocking agents(may cause high blood pressure aspirin The presence of other medical problems with Antihistaminic - decongestants Diabetes Enlarged prostate Urinary tract blockage or difficult urination Glaucoma High blood pressure Kidney disease Liver disease Overactive thyroid Proper use of Antihistaminic - decongestants With food or glass of water or milk to lessen the irritation Antihistamines may cause dryness of the mouth .nose and throat for temporary relief use sugarless Overdose of antihistamine Convulsions,drowsiness,dryness of mouth,hallusinations,headache,shortness of breath,irregular heartbeat Side effects of antihistamines Rare side effects: muscle spasms(especially of neck and back),restlessness,jerky movements of head Less common side effects:blurred vision,confusion,difficult or painful urination,dryness of mouth,loss of appetite Beta-Adrenergic Blocking Agents and Diuretic Brand names:inderal Category:antihypertensive Description:beta-adrenergic blocking agent (beta-blockers)and thiazide diuretic combination, to reduce the work load on the heart for controlling high blood pressure and to reduce the amount of fluid pressure in the body by increasing the flow of urine Beta-Adrenergic Blocking Agents and Diuretic Description:high blood pressure adds to the work load of the heart and arteries,if it continues for a long time,the heart and arteries may not function properly,this can damage the blood vessels of the brain,heart and kidneys ,resulting in a stroke ,heart failure,or kidney failure Beta-blockers –diuretics and pregnancy Associated with low blood sugar levelbreathing problems-slower heart rate and low blood pressure ,jaundice ,low potassium in the newborn infant Beta-blockers –diuretics and breast feeding Pass into breast milk and may decrease the flow of breast milk. Medications should not be used at all with Beta-blockers –diuretics Aminophylline Caffeine Theophylline Antidiabetics(drugs taken by mouth) Insulin—there is an increased risk of hyperglycemia or hypoglycemia ,increase in pulse rate Calcium channel blockers Medications should not be used at all with Beta-blockers –diuretics Digitalis glycosides – can cause high blood level of digoxin ,which may increase the chance of side effects. The presence of the following medical problems may affect the use of Beta-blockers –diuretics Allergy Asthma Fever Bronchitis Emphysema Bradycardia Diabetes mellitus The presence of the following medical problems may affect the use of Beta-blockers –diuretics Gout Pancreatitis Kidney disease Liver disease Mental depression Overactive thyroid Proper use of Beta-blockers –diuretics Control weight Avoid high sodium Avoid spicy food Avoid high animal fat Check pulse rate regularly if it was less than 50 beats per minute call your doctor Avoid high caffeine intake Proper use of Beta-blockers –diuretics Control weight Avoid high sodium Avoid spicy food Avoid high animal fat Check pulse rate regularly if it was less than 50 beats per minute call your doctor Avoid high caffeine intake Proper use of Beta-blockers –diuretics Increase in the amount of urine or frequency of urination ,these effects should reduced Receive vegetables and fruits rich with potassium (tomato,fig,apricot ,apple) Precautions while using of Betablockers –diuretics Do not stop taking this medicine suddenly or without doctor`s order. Patient must carry medical identification stating that he is taking this medicine Before having any kind of surgery including dental surgery or emergency medicine ,patient must inform that he is receiving this medicine Precautions while using of Betablockers –diuretics For diabetic patient: this medicine may increase or decrease blood sugar level This medicine cause loss of potassium –patient must eat or drink foods that have a high potassium content Beta –blockers tend to decrease blood circulation in the skin ,fingers and toes .dress warmly during cold weather and be careful during prolonged exposure to cold Precautions while using of Betablockers –diuretics This medicine may cause skin to be more sensitive to sunlight than it is normally Exposure to sunlight ,even for brief periods of time ,may cause a skin rash,itching,redness or other discoloration of the skin ,or severe sunburn Precautions while using of Betablockers –diuretics When patient begin taking this medicine: stay out of direct sunlight,especially between the hours of 10 am and 3pm if possible. Wear protective clothing including a hat,wear sunglasses Apply a sun block product that has a skin protection factor Apply a sun block lipstick Side effects of Beta-blockers –diuretics Less common side effects: breathing difficulty and wheezing ,cold hands and feet ,mental depression,slow heartbeat(less than 50 beats\min)-swelling of ankles,feet and lower legs. Rare side effects: black ,tarry stools,blood in urine or stools,chest pain ,dark urine ,fever,hallucinations ,joint pain ,lower back pain,stomach pain with nausea and vomiting ,unusual bleeding ,yellow eyes or skin Side effects of Beta-blockers –diuretics Signs and symptoms of too much potassium or sodium loss: confusion,convulsions,dryness of mouth,increased thirst,irregular heartbeats,irritability,muscle cramps ,unusual tiredness Signs and symptoms of overdose of Betablockers –diuretics Slow heartbeat, dizziness, severe fainting,difficulty in breathing,bluishcolored fingernails or palms of hands,convulsions Side effects of beta-blockers and diuretics More common side effects: decreased sexual ability,dizziness,drowsiness,constipation,diarrh ea,increased sensitivity of skin to sunlight,loss of appetite,numbness or tingling of fingers and toes Calcium Supplements Category Antacid(calcium carbonate) Antihyperkalemic(calcium chloride ) Antihypermagnesemic Antihyperphosphatemic Cardiotonic Nutritional supplement Calcium Supplements Category Antacid..calcium carbonate Antihyperkalemic..calcium chloride Antihypermagnesemic..calcium chloride Antihyperphodphatemic..calcium citrate Cardiotonic..calcium chloride Nutritional supplement.. Calcium Supplements Description Calcium supplements are taken by individuals who are unable to get enough calcium in their regular diet or who have a need for more calcium They are used to prevent or treat several conditions that may cause hypocalcemia The body needs calcium to make strong bones Calcium Supplements Description Calcium is also needed for the heart,muscles and nervous system to work properly. Some calcium rich foods Nonfat dry milk Lowfat ,skim or whole milk Yogurt Sardines with bones Ricotta cheese Salmon Cheese white Vitamin D and calcium Vitamin D helps calcium loss from the bone it is sometimes called the sunshine vitamin Expose the body 15-30minutes every day ,get all the vitamin D the body need. Do not use bone meal as a source of calcium (it is a wrong knowledge) Dietary supplement(pregnant womanfetus) The healthy growth and development of the fetus depend on a steady supply of nutrients from the mother Taking large amounts of a dietary supplement during pregnancy may be harmful to the mother and fetus and should be avoided Dietary supplement(pregnant womanfetus) Breast –feeding: It is important to receive the right amount of calcium ,but taking large amounts of a dietary support while breast-feeding may be harmful to the mother or baby and should be avoided. Medications or other dietary supplements should not be used together at all Digitalis glycosides (increase the chance of irregular heartbeat) Didronel(is used to prevent or treat problems after hip replacement surgery)use with calcium may decrease the effects of didronel should not be taken within 2 hours of calcium supplements Medications or other dietary supplements should not be used together at all Magnesium sulfate(use with calcium supplements may cause medicine to be less effective. Dilantin or depakine use with calcium supplements may decrease the effects of both medicine,calcium supplements should not be taken within 1 to 3 hours of depakine Medications or other dietary supplements should not be used together at all Tetracyclines –use with calcium supplements may decrease the effects of tetracycline calcium supplements should not be taken within 1 to 3 hours of tetracyclines Medical problems may affect the use of calcium supplements Diarrhea Stomach or intestinal problems Heart disease Hypercalcemia Hyperparathyroidism Kidney disease or stones Proper use for calcium supplement Drink a full glass of water or juice when taking a calcium supplement but with full stomach. Side effects of calcium supplement More common side effects : dizziness ,irregular heartbeat,nausea or vomiting,skin redness ,or burning at injection site ,tingling sensation Rare side effects: painful urination,drowsiness,nausea or vomiting Side effects of overdose of calcium supplement Early signs of overdose: constipation ,dryness of mouth ,headache,increased thirst,loss of appetite ,mental depression Late signs of overdose: confusion,drowsiness,irregular fast or slow heartbeat Salicylates Brand name:aspirin Category: Analgesic Anti-inflammatory ,nonsteroidal Antipyretic Antirheumatic antithrombotic Salicylates Category: Myocardial infarction Platelet aggregation inhibitor Description: salicylates are used to relive pain and reduce fever Salicylates and diet Low –sodium in diet Very low fat intake Avoid caffeine intake Salicylates and pregnancy Too much use of aspirin late in pregnancy may cause a decrease in the newborn`s weight and possible death of the fetus or newborn infant May cause unwanted effects on the heart or blood flow in the fetus or in the newborn infant. Salicylates and problems during and after delivery Cause severe bleeding in the mother before,during or after delivery Do not take aspirin during the last three months of pregnancy Caffeine causes birth defects when given in very large doses Salicylates and problems during and after delivery Breast-feeding: salicylates pass into the breast milk in small amounts have not been reported to cause problems in nursing babies. Medications should not be used with salicylates Anticoagulants Depakine Heparin Anti-inflammatory Pain relief medication Antidiabetics bronchodialators Medications should not be used with salicylates Tetracyclines Methotrexate Urinary alkalizers Antihypertensive medications Do not use salicylates in the following medical problems Anemia Overactive thyroid Stomach ulcer Asthma Hypertension Kidney disease Liver disease Gout hemophilia Proper use of salicylates Do not use salicylates with vinegar Do not place salicylate or aspirin directly on a tooth or gum surface If you are to take any medicine that contains aspirin within 7 days after having tonsillitis ,a tooth pulled or other dental or mouth surgery.do not receive aspirin during this time. Proper use of salicylates Drink a full glass of water after taking this medicine Salicylates liquid may be mixed with fruit juice before taking Check with your medical or dentist:if you are taking this medicine to relive pain and the pain lasts for more than 10 days (5 days for children) Proper use of salicylates Or if the pain gets worse ,if new symptoms occur or if redness or swelling is present.these could be signs of a serious condition that needs medical or dental treatment. If you are taking this medicine to bring down a fever and fever lasts for more than 3 days or returns ,if fever gets worse ,if new symptoms occur,or if redness or swelling is present .these could be signs of a serious condition that needs treatment. Proper use of salicylates If you are taking this medicine for a sore throat ,and the sore throat is very painful lasts for more than 2 days or occurs together with or is followed by fever ,headache,skin rash,nausea or vomiting. Proper use of salicylates If you are taking this medicine regularly as for arthritis and you notice a ringing in ears or continuing headaches,these are often the first signs that too much salicylates is being taken Proper use of salicylates Do not take aspirin for 5 days before any surgery..taking aspirin during this time may cause bleeding problems If you are taking a laxative containing cellulose ,take the salicylate at least 2 hours before or after you take laxative.taking these medicine too close together may lessen the effects of the salicylate Proper use of salicylates For diabetic patients False urine sugar tests result may occur Side effects of salicylates Get emergency help if any of the following side effects occur:any loss of hearing,bloody urine,confusion,convulsions ,severe continuous diarrhea,difficulty in swallowing ,drowsiness ,fast or deep breathing redness in the skin ,hallucinations ,nausea,vomiting ,tightness in chest ,stomach pain ,swelling of eyelids,face or lips ,disturbances of vision. Side effects of salicylates Less common side effects Abdominal pain,cramming,bloody or black tarry stools,ringing in ears,vomiting of blood like coffee grounds. More common side effects Abdominal cramps nausea or vomiting Vitamin K Category: 1-antidote to drug-induced hypoprothrombinemia 2-antihemorrhagic 3-nutritional supplement Description:vitamin K is found in various foods including green leafy vegetables ,meat and dairy products Vitamin K is routinely given to newborn infants to prevent bleeding problems Vitamin K and pregnancy Vitamin K has not been reported to cause birth defects or other problems in humans.the use of vitamin K supplements during pregnancy is not recommended because it has been reported to cause jaundice or other problems in the baby Vitamin K and breast-feeding Vitamin K taken by the mother has not been reported to cause problems in nursing babies Vitamin K and medications should not be used together Antidiabetic Adomet Sulfonamides Anticoagulants Aspirin Cefobid Presantine Depakene Heparin induced The presence of other medical problems or recent delivery may affect the use of vitamin K Cystic fibrosis or other diseases affecting the pancreas Diarrhea (prolonged) High blood pressure Liver disease Stroke Surgery within the last two months Intestinal problems—these conditions may interfere with absorption of vitamin K into the body Bleeding tendency Brain disease ,tumor Patient must tell doctor if have recently had any of the following conditions: -falls or blows to the body or head or any injury -injections into a blood vessel Placement of any tube into the body surgery including dental surgery Dosing Adult and children :the usual dose is 5 to 10milligrams a day For prevention of bleeding in newborns:the usual dose is 0.5 to 1mg injected into a muscle or under the skin ,right after delivery .the dose may be repeated after six to eight hours if needed. Side effects of vitamin K Less common side effects:decreased appetite,decreased movement or activity ,difficulty in breathing,enlarged liver,general body swelling,irritability,muscle stiffness More common side effects:bleeding or oozing from cuts ,gums,wounds or around the place of injection,fever,low blood pressure Side effects of vitamin K Rare side effects:agitation,blue or purple toes,blurred vision,changes in facial skin color,chest pain,or discomfort,chills,darkened urine,decreased urine output,depression,double vision,faster irregular breathing,gangrenous finger or toes Valium—Diazepam Why is this medication prescribed? Is used to relive anxiety Muscle spasms Seizures and to control agitation To treat irritable bowel syndrome Valium—Diazepam precautions should patient follow Inform your doctor that you are receiving the following: Ativan Tagamet Digoxin Lanoxin Medication for depression Depakene for Seizures Medication to relieve Pain Valium—Diazepam precautions should patient follow Inform your doctor that you are receiving the following: Medication for Parkinson`s disease Medication for asthma Muscle relaxant Oral contraceptive Inderal zantic Valium—Diazepam precautions should patient follow Inform your doctor that you are receiving the following: sedatives Sleeping pills Theophylline Tranquillizers vitamins (these medications may add to the patient drowsing) Valium—Diazepam precautions should patient follow If you use antacids take diazepam first then wait one hour before taking the antacid Tell your doctor if you have or have ever had glaucoma (increase glomerular filtration rate) Tell your doctor if you are pregnant,plan to become pregnant or are breast –feeding If you are having surgery ,including dental surgery ,this drug may make you drowsy Valium—Diazepam precautions should patient follow Do not drive car or operate machinery until you know how this drug affects Cigarette smoking may decrease the effectiveness of this drug Valium—Diazepam Side effects Common side effects: Drowsiness ,dizziness,tiredness,weakness,dry mouth,diarrhea,upset stomach,change in appetite Tell your doctor if any of these symptoms are severe: restlessness,constipation,difficulty in urination,blurred vision Valium—Diazepam Side effects Call you doctor immediately in the following conditions after receiving this drug: Seizures,shuffling walk,persistent tremor or inability to sit still,difficulty in breathing or swallowing,severe skin rash,yellowing of the skin or eyes ,Irregular heartbeat Ventolin Brand Names: isuprel.ventolin, bronchometer Bronchodilators Adrenergic(inhalation) breathed through the mouth to open up the bronchial tubes (air passages ) of the lungs. Are used to treat the symptoms of asthma ,chronic bronchitis Long –acting bronchodilator that is used with anti-inflammatory attack to prevent asthma Bronchodilators Brand names: Isuprel Ventolin bronkometer Bronchodialators The effects usually last about 12 hours ,doses should never be taken more than two times a day effect Children up to 4 years of age ,dose must be determined by doctor.2 inhalations taken 15 to 30 min before start exercise Bronchodialators-for preventing or treating bronchospasm Adult and children 12 years of age and older. this medicine is used in nebulizer and is taken by inhalation over 5 to 15 min.usual dose is 2.5 milligrams taken every 4 to 6 hours of needed. Bronchodialators-for preventing or treating bronchospasm Bronchodialators For capsules (powder) :for preventing or treating bronchospasm –adult and children 4 years of age and older 200-400mg taken by inhalation every 4 to 6 hours Bronchodialators Rare side effects: dizziness,swelling in throat,redness of skin,increased shortness of breath ,swelling of face,lips,eyelids,tightness in chest or wheezing More common side effects: fast heartbeat,headache,nervousness Bronchodialators Less common side effects: coughing,bronchial irritation,dryness or irritation of mouth Bronchodialators Aminophylline Theophylline Bronchodialators Aminohylline ,theophylline used to treat \prevent the symptoms of broncheal asthma,chronic bronchitis and emphysema.these medicine relive cough,wheezing,shortness of breath bronchodialators Theophylline and pregnancy: crosses the placenta cause unwanted effects such as fast heartbeats,irritability Breast-feeding:pass into the breast milk may cause irritability in nursing babies of mothers taking aminophylline ,theophylline Certain medication should not be used at the same time with: Beta-adrenergic blocking agents(inderal) ,this may prevent aminophylline,theophylline from working properly Tagamet Coronary dialators Erythromycin Trental Dilantin Depakine Bronchodialators should not be used with the following medical problems: Convulsions Heart failure Liver disease Underactive thyroid Proper use of bronchodialators It works best when taken with a glass of water on an empty stomach either 30 min to one hour before meals or 2 hours after meals. In some case patient receive drug with meals or right after meals to lessen stomach upset Proper use of bronchodialators Check the level of drug in blood at regular intervals ,to find out if dose needs to be changed (it is very important) Precautions while using of bronchodialators Check with doctor if the patient : -have fever 38C or higher for at least 24 hours - stop ,start smoking -start or stop another medications -change long term pattern of diet -avoid caffeine –containing food or beverages such as chocolate ,coca,tea,coffee,cola Side effects of bronchodialators Less common side effects: heartburn,vomiting,headache,fast heart beat,increased urination,nervousness,trouble in sleeping Rare side effects: skin rash