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Davis’s Drug Guide Scavenger Hunt – 16th Edition This handout is designed to assist you in locating information in the Davis’s Drug Guide. Take advantage of the many resources in this text. Locate the page or appendix of the following: 1.

Insulins and Insulin therapy: APPENDIX N, PG 1418, ED 14

2.

Information on medication errors and patient safety: PG 12, ED 14

3.

Drug Classifications: PG 29, ED 14

4.

Adult & Pediatric Immunization information: APPENDIX P, PG 1422, ED 14

5.

Pharmacokinetic topics and definitions: DRUG MONOGRAPH 93-1294

6.

Natural/Herbal Products: PG1321 ED 14

7.

How is the medication portion of the drug guide designed to make it easier for drug location? MEDICATIONS ARE IN ALPHABETICAL ORDER INSTEAD OF GROUP.

8.

Locate the reference for Drugs Associated with Increased Risk of Falls in the Elderly: PG 1346 ED 14

9.

If you were giving medications through a G-Tube, where would you locate the two-page list of DO NOT CRUSH medications? PG 1355-1356 ED14

Morphine: Which heading/headings in the Morphine profile provide(s) information about the following: Pg 860 1.

Onset, peak, duration of the drug: _ IV Onset – rapid; peak – 20 min; duration – 4-5hr

2.

How to prepare the drug for IV administration: Diluent: Dilute with at least 5 mL of sterile water or 0.9% NaCl for injection. Concentration: 0.5– 5 mg/mL. Rate: High Alert: Administer 2.5– 15 mg over 5 min. Rapid administration may lead to increased respiratory depression, hypotension, and circulatory collapse

3.

Drug to drug interactions: _MAO inhibitors w/in 14 days; increased CNS depression with alcohol, sedative/hypnotics, clomipramine, barbiturates, tricyclic antidepressants, and antihistamines

4.

Administration purpose of Morphine: _decrease in severity in pain

Davis’s Drug Guide, Scavenger Hunt (16th edition)

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5.

Drug IV compatibilities/incompatibilities: _ Hypersensitivity; Some products contain tartrazine, bisulfites, or alcohol and should be avoided in patients with known hypersensitivity.; Acute, mild, intermittent, or postoperative pain (extended/sustained-release); Significant respiratory depression (extended/sustained-release); Acute or severe bronchial asthma (extended/sustained-release); Paralytic ileus (extended/sustained-release)

6.

What to monitor during administration: _Assess level of consciousness, BP, pulse, and respirations before and periodically during administration

7.

Where to locate the ordered dose appropriate for the patient’s age/weight: __physician’s orders

8.

Respiratory depression information (list all headings that apply): _If respiratory rate is 10/min, assess level of sedation.

Answer the following questions as they relate to the specific drug listed: 1.

pantoprazole (Protonix): (IV push): How will you reconstitute the Protonix vial for IVP administration? _____Reconstitute each vial with 10 mL of 0.9% NaCl_____ What is the rate for IV push pantoprazole? _________4 mg/mL________

2.

Potassium Chloride: Continuous infusion: What is the dilution requirement for this high alert medication? ___Each single dose must be diluted and thoroughly mixed in 100 – 1000 mL of IV solution____ Peripheral IV line limit: __80 mEq/L___ Central IV line limit: ___200 mEq/L____

3.

hydromorphone (Dilaudid): Y-site Compatibility: List two Third Generation Cephalosporins that are Y-site compatible with Hydromorphone. ____cefotaxime, ceftazidime_____

4.

lorazepam (Ativan): (IV Push): What are the specific dilution instructions for administering this drug by IV push route? ___Dilute immediately before use with an equal amount of sterile water for injection, D5W, or 0.9% NaCl for injection. Pedi: to decrease the amount of benzyl alcohol delivered to neonates, dilute the 4 mg/mL injection with preservative-free sterile water for injection to make a 0.4 mg/mL dilution for IV use___

5.

heparin: (loading dose): How will you administer a loading dose of this drug? Be specific: ___Adults: 5000 units (35–70 units/kg), followed by 20,000–40,000 units infused over 24 hr (approx. 1000 units/hr or 15–18 units/kg/hr), Children > 1 year: Loading dose 75 units/kg, followed by 20 units/kg/hr, adjust to maintain aPTT of 60–85 sec., Neonates and Infants < 1 year: Loading dose 75 units/kg, followed by 28 units/kg/hr, adjust to maintain aPTT of 60–85 sec.___

Davis’s Drug Guide, Scavenger Hunt (16th edition)

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Research the following: 1.

Your patient is ordered methylprednisolone (Solumedrol) IV push 40 mg. every morning. According to the Davis Drug Guide, answer the following: a.

Reconstitute with: __Reconstitute with provided solution (Act-O-Vials, Univials) or 2 mL of bacteriostatic water (with benzyl alcohol) for injection__

b.

Your patient is receiving Sodium Bicarbonate by continuous Infusion. Is Solumedrol Y-site compatible? ____Yes________

2.

3.

What common primary IV solution is NOT compatible with phenytoin (Dilantin)? ________Dextrose____________ Your medical/surgical patient has been admitted with CHF. The patient has a primary IV bag of D5 ½ NSS with 20 mEq of KCL infusing at 80 mL/hr. The patient is also receiving furosemide (Lasix) IV drip (connected to the IVPB port of the primary IV) infusing at 10 mL/hr. The patient is complaining of nausea/vomiting and is ordered ondansetron (Zofran) 4 mg IV push. (See questions next page) a. What drugs are infusing through the same IV tubing in question 3? _____Ondansetron (Zofran) can be combined with D51/2 NSS 20 mEq of KCL in the same tubing______ b.

Are there any compatibility issues with giving IV push ondansetron (Zofran) with the combination of drugs in question “a”? If so, be specific. _____Yes, Zofran and Furosemide (Lasix) are incompatible_____

Utilize Davis’s Drug Guide to research the compatibility of the following drug combinations in an IV line. Answer Yes or No to the following combinations of drugs. 1.

Morphine IV & lorazepam IV

YES

2.

Insulin, Regular IV & diphenhydramine IV

NO

3.

digoxin IV & Sodium Bicarbonate IV

YES

4.

ondansetron IV & Magnesium Sulfate IV

YES

5.

Potassium Chloride IV & hydralazine IV

NO

Locate 2 drugs from Davis’s Drug Guide that are listed as HIGH ALERT and explain why: 1.

amiodarone

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High Alert: IV vasoactive medications are inherently dangerous; fatalities have occurred from medication errors involving amiodarone. Before administering, have second practitioner check original order, dose calculations, and infusion pump settings. Patients should be hospitalized and monitored closely during IV therapy and initiation of oral therapy. IV therapy should be administered only by physicians experienced in treating life-threatening arrhythmias. 2.

asparaginase Erwinia chrysanthemi High Alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-oftherapy dose limits; have second practitioner independently double check original order and dose calculations.

CORTICOSTEROIDS: 1. List the four different routes for this group of drugs: Oral, injectable, topical, and inhalation 2.

If you were giving a corticosteroid by the IV route, which route section would you research? Systemic: IV Administration under implementation 3. If you were giving fluticasone, which route section would you research? Inhalation

INSULINS: 1.

What is the difference in duration between regular insulin subcutaneous and regular insulin IV? Regular insulin subcutaneous has a duration of 30-60 min, while regular insulin IV has a duration of 5-7 hours 2.

List the two types of Insulin glargine and the concentration availability of each one: Lantus is available in 100 units/mL in 10-mL vials. Toujeo is available in 300 units/mL in 1.5mL prefilled pens 3. List two insulins that may be mixed with NPH insulin in the same syringe: Insuline lispro and insulin aspart

4.

5.

When mixing NPH with one of the insulins in question 3, which one should be withdrawn in the syringe first? Lispro or aspart are drawn before NPH What two insulins make up Novolog Mix 70/30?

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Insulin aspart protamine and insulin aspart injection 6.

Why would detemir (Levemir) insulin NOT be used for a sliding-scale or coverage insulin? Detemir is long acting insulin with an onset of 3-4 hours

MISCELLANEOUS: 1.

What is the only subcutaneous site for enoxaparin (Lovenox)? Inject where there is a lot of fatty tissue, such as a skin fold held by the thumb and finger.

2.

When giving Morphine or hydromorphone (Dilaudid) by IV push, what is the common diluent instruction for these two medications? Dilute with at least 5mL of sterile water or 0.9% NaCl for injection. Pg 655

3.

Your patient has been ordered an aminoglycoside IVPB every 8 hrs, and a cephalosporin every 12 hrs. a.

List 2 aminoglycosides that require a peak and trough to monitor blood levels during therapy. AMIKACIN AND GENTAMICIN PG 135 ED 14

b.

What are the 2 restrictions when administering an aminoglycoside and a cephalosporin concurrently? MUST NOT BE ADMINISTERED AT THE SAME SITE AND THEY HAVE TO BE GIVEN AT LEAST AN HOUR APART. PG 137 ED 14

4.

Why does a patient taking metformin (Glucophage) need B12 and folic acid monitored every 1-2 years? Patients can experience decreased B12 levels and an increase in lactic acidosis (pg 810).

5.

What is the most common GI adverse reaction/side effect of narcotics? p83 Constipation

HEPARIN: pg 631 1.

Your patient has been admitted with a venous thromboembolism in the left calf. He has been ordered a continuous Heparin IV infusion. Answer the following questions regarding this patient. a. How often should the aPTT level be monitored during early therapy? __ During continuous administration, monitor aPTT levels every 4 hr during early therapy b.

What is the desired outcome of the aPTT level without signs of hemorrhage? __60-85s

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c.

d.

What is the antidote for heparin in case of toxicity/overdose? ___ Protamine sulfate is the antidote

The patient has been ordered 25,000 units of heparin in a 500 mL bag of D5W to infuse at 1000 units/hr. How many mL/hr will you set the IV pump? __20 mL/hr

ANTIHYPERTENSIVES: 1.

You are giving your 60-year-old male patient metoprolol (Lopressor) PO for hypertension this morning. His blood pressure is 134/75. p832 a.

2.

What is the heart rate parameter for the administration of PO metoprolol? Take apical pulse before administering. If...