Emergency medicationsDr.Olfat El-Shafiey Assistant ProfessorCritical CareAssiut University

Drugs used during the management of a cardiac arrestOxygen: 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 arrestOxygen pressure: modified oxygen pressure is very importantOxygen pressure between (5-8ml of oxygen pressure)stimulate the respiratory center of the brainOxygen pressure between (10-15ml of oxygen pressure ) irritate the respiratory center of the brainOxygen pressure between(15-20ml of oxygen pressure) cause paralysis of the respiratory center of the brainOxygen pressure between (20-30ml of oxygen pressure cause damage for the respiratory center of the brain

Drugs used during the management of a cardiac arrestEpinephrine(adrenaline)Indications:is the first drug used in cardiac arrest of any etiologyDose: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 arrestAction 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 arrestAction 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 arrestAtropineIndications: in systoleIn Pulseless electrical activity with a rate

Drugs used during the management of a cardiac arrestAminodaroneIndications:pulseless,ventricular fibrillationDose:IV of 300mg aminodarone ,diluted in 5% dextrose to a volume of 20mlSide effects:bradycardia,hypotension

Drugs used during the management of a cardiac arrestMagnesium sulphate: shock in the presence of possible hypomagnesaemiaLidocaine: ventricular fibrillation\pulseless Dose:100mg and an addition of 50mg can be given if necessary

Drugs used during the management of a cardiac arrestSodium bicarbonate:Indication:severe metabolic acidosis,hyperkalemiaDose:50 mmol given IV ,the dose can be repeated as necessaryActions: cardiac arrest results in combined respiratory and metabolic acidosis due to cessation of pulmonary gas exchange

Drugs used during the management of a cardiac arrestVasopression: 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 arrestCalcium:Actions: play a vital role in the cellular mechanisms underlying myocardial contraction

DigoxinAntiarrhythmicCardiotonicBrand names: digitoxin digoxin lanoxin digitaline

Digoxin-side effectsAdult: anxiety,blurred or yellow vision,confusion,dizziness,mental depression,headache,loss of appetite,visual auditory hallusinations,diarrhea,lower stomach pain,nausea,palpitation

Digoxin-side effectsChildren: stomach upset,loss of appetiteRare side effects: skin rash,bleeding gums

Digoxin overdoseVisual and auditory hallucinationsTinning of the earDisturbances of visionYellowish coloration surrounded by witch coloration

Medical problems may affect the use of digitalisElectrolyte disturbancesLung disease Kidney diseaseLiver diseaseOveractive thyroid

The following medication should not be used at all with DigoxinAmphetamineAppetite suppressantMedication for asthmaMedication for cold,sinus problemsCalcium channel blocking (adalet,isoptin)Beta-adrenergic blocking gentsdiuretics

Precautions before receiving digoxinCount 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 digoxinEvery 4 months patient must test the concentration of the drug in his blood to avoid digitalis toxicity and to change the doseAvoid diarrheaAvoid constipationAvoid abdominal crampsAvoid coughingReceive fruits and vegetables rich in potassium

Nitroglycerin and anginal painNitrates : brand name:isordil

Nitroglycerin and anginal painAre 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 painNitrates 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 allantihypertensive

Nitroglycin should not be used with certain Medical problems AnemiaGlaucomaHead injury

Corticosteroids Brand names : hydrocortisone,betamethasone, cortisone,dexamethasone,prednisolone, predisposeCategory: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 corticosteroidsBreast-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 corticosteroidsAntacidsBarbituratesTegretolDilantinDepakineAntidiabetic agents(corticosteroids may increase blood glucose level)Cyclosporine (cause seizures)

Medications should not be used with corticosteroidsDigitalis 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 corticosteroidsDiuretics(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 corticosteroidsImmunization 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 patientIn 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 corticosteroidsSkin test injectionscorticosteroids may cause false results in skin tests.

Medical problems may affect the use of corticosteroidsAcquired immunodeficiency syndromeFungus infectionHerpes simplex infection of the eyeRecent 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 corticosteroidsStomach ulcerIntestinal problemsUlcerative colitisGlaucoma (corticosteroids increase intraocular pressureLiver diseaseHeart diseaseUnder active thyroid

Medical problems may affect the use of corticosteroidsOsteoporosis:corticosteroids may worsen bone disease because they cause the body to lose more calciumPsychosis:this condition may be made worseSystemic lupus erythematosus:

Proper use of corticosteroidesTake this medicine with food to prevent stomach upsetDo not stop using corticosteroide without doctor`s order and it must be reduced graduallyLow-salt dietHigh potassium intake(tomato,banana,apricot,apple,fig ,nuts)Low animal fatLow caffeine intakeLow sweet or artificial sweet No spicy food

If patient will be using corticosteroids for a long timeFollow a low salt dietFollow a potassium rich dietWatch calories to prevent weight gainAdd extra protein to dietEye examination by ophthalmologist (for intraocular pressure)-before during treatmentCarry a card stating that you are using this medicine

If patient will be using corticosteroids for a long timeTell the doctor in charge that you are using this medicine:-before having skin testsBefore having any kind of surgery including dental surgery or emergency treatment If you get a serious infection or injuryAvoid close contact with anyone who has chickenpox or measles.

If patient will be using corticosteroids for a long timeFor 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 timeIf redness or swelling occurs at the place of injection ,check with your doctor.

Side effects of corticosteroidsMay lower the patient`s resistance to infectionsAny infection get may be harder to treat Less common side effects: decreased or blurred vision,increased thirstRare side effects: blindness ,burning ,numbness ,pain or tingling at near place of injection,confusion,excitement,hallucinations.

Side effects of corticosteroidsRare 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 corticosteroidsMore common side effects:Increased appetite ,nervousness or restlessness or loss of appetiteLess common or rare side effects:Darkening or lightening of skin color,dizziness ,flushing of face or cheeks ,increased joint pain

AnticoagulantDescription: 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 largerWarfarin,Dicumarol

Anticoagulant and pregnancyWarfarin,Dicumarol may cause birth defects,physical or mental growth of the fetus or newborn babyUse this medicine during the last 6 months of pregnancy may increase the chance of severe possibly fatal,bleeding in the fetus

Anticoagulant and pregnancyWarfarin,Dicumarol if taken during the last few weeks of pregnancyAnticoagulants may cause severe bleeding in both fetus and the mother before or during delivery and in the newborn infant

AnticoagulantWarfarin,Dicumarol and breast-feeding :not likely to cause problems if pass into breast milkOlder adults:increase the chance of bleeding during treatment

Anticoagulants and certain medicines should not be used together at allCordaroneTagametFlagelAnabolic steroidAntifungals medicine for overactive thyroidAspirin or other salicylatescephalosporins

Anticoagulants and certain medication does not use together at allNarcoticsThyroid hormonesDepakeneBarbituratesTegretolDilantinVitamin K

medical problems may affect the use of anticoagulantsAneurysm(swelling in a blood vessel)Bleeding in the brainLow platelet countCancerChildbirthPericarditisHemophiliaHypertensionLiver diseasePeptic ulcerWound open

Dose of anticoagulantsDicumarol 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 anticoagulantIt is important for the patient to carry identification card stating that he is using this medicineAvoid sports and activities that may cause the patient to be injuredBe careful to avoid cutting patient himselfBrushing teeth or shaving taking special care

Precautions while using anticoagulantVitamin 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 anticoagulantsWatch 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 anticoagulantsLess common side effects: cough of hoarseness,fever,or chills,lower back or side pain ,painful or difficult urination,itchingRare 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 relaxantUses: -in case of muscle contraction, strain and sprain of ligament,facilitate tracheal intubations,used during surgery, facilitate mechanical ventilation

Narcotic AnalgesicsAre used to relieve pain before or during an operation and act in the central nervous system to relieve painTo help the anesthetic work betterCodeine are used to relieve coughing

Narcotic AnalgesicsCategory:Analgesic(codeine-methadone-morphine)Anesthesia(morphine)Antidiarrheal(codeine-morphine)Antitussive(codeine-hydrocodrone-morpgine-methadone)Pulmonary edema therapy

Drug overdose of Narcotic AnalgesicsClod clammy skinConfusionSeizuresDizzinessDrowsinessLow blood pressureNervousness or restlessnessPinpoint pupils of eyes,slow heartbeat,slow breathing

Side effects of Narcotic AnalgesicsLess 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 AnalgesicsMore common side effects: nausea.vomitingLess 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 oralCodeine for pain: adult-15-60mg usually 30mg every 3 to 6 hours-children-0.5mg per KG of body weight every 4 to 6 hoursFor 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 oralChildren 3years 3.5mg every 4 to 6 hours maximum 14mg a dayChildren 4 years 4 mg every 4 to 6 hours maximum 16mg a day Children 5 years 4-5mg maximum 18mgChildren 6 to 12 years 5 to 10mg every 4 to 6 hours maximum 60mg

Dose of Narcotic Analgesics injectionFor pain Adults-15 to 0mg usually injected into a muscle or vein or under the skinChildren 0.5mg per KG of body weight injected into a muscle

Insulin

Insulin Brand Names Humulin 50Humulin LHumulin NLenteNovolinNPHRegular insulinRegular 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 mellitusIs 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 insulinPregnancy:blood sugar can reduce the chance of baby gaining too much weight,having birth defects ,or having high or low blood sugarBreast 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 timeBeta-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 levelAnti-epileptic medicationIncrease blood sugar level

Certain medications should not be used with insulin at the same timeAntihypertensive medicationIncrease blood sugar level

Medical problems and insulinThe presence of the following medical problems may affect the dose of insulin -changes in female hormones (during puberty,pregnancy,menstruation)Severe infectionMental stressDiarrheaVomitingIntestinal blockage

Medical problems and insulinThe presence of the following medical problems may affect the dose of insulinKidney diseaseLiver diseaseInjuryOveractive thyroidUnderactive pitutary gland

hypoglycemiaCan 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

hypoglycemiaCauses of hypoglycemia-delaying of mealExercising more than usualUsing too much insulinReceive actual dose of insulin but forget to eat,or eat very minimal amount of foodSuperficial breathing

hypoglycemiaManagement of hypoglycemiaFruit juiceHoney (1 tablespoon)Cheese or crackers ,half a sandwich,or drink a glass of milkDo not use chocolate because its fat slows down the sugar entering into the blood streamGlucagon is used in emergency situations such as unconsciousness (1unit of glucagon=20kg of body weight)

Hyperglycemia Causes of hyperglycemianfectionSevere 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 insulinSide effects more commonLow 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 insulinRare Side effectsSwelling of face ,fingers ,feet or ankles

Insulin and food interactionAvoid excessive animal fat intakeAvoid excessive spicy foodAvoid high salt intakeAvoid high caffeine intake

Antihistaminic and decongestantsCategory:antihistaminicDescription:are used to treat the nasal congestion ,sneezing ,preventing the effects of histamine

Antihistaminic - decongestants and pregnancy and breast -feedingCause jaundice and muscle tremors in a few newborn infants whose mothers received phenothiazines during pregnancySmall amounts pass into breast milk but it cause unusual excitement or irritability,decrease breast milk

Antihistaminic - decongestants and childrenIncreases in blood pressure,nightmares or unusual excitement,nervousness ,restlessness or irritability

Antihistaminic - decongestants and older adultsConfusion,difficult and painful urination ,dizziness,drowsiness,dryness of mouth or convulsions

Certain medications should not be used be used at all with Antihistaminic - decongestantsMedicine for abdominal or stomach spasms or cramps cause dryness of mouth ,irregular heartbeatAntiepileptic medicationsAntidepressantsAmphetaminesAppetite suppressants caffeine

Certain medications should not be used at all with Antihistaminic - decongestantsMedicine for asthma or other breathing problemsMedicine for colds ,sinus problemsBeta-adrenergic blocking agents(may cause high blood pressureaspirin

The presence of other medical problems with Antihistaminic - decongestantsDiabetes Enlarged prostateUrinary tract blockage or difficult urinationGlaucomaHigh blood pressureKidney diseaseLiver diseaseOveractive thyroid

Proper use of Antihistaminic - decongestantsWith food or glass of water or milk to lessen the irritationAntihistamines 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 antihistaminesRare side effects: muscle spasms(especially of neck and back),restlessness,jerky movements of headLess common side effects:blurred vision,confusion,difficult or painful urination,dryness of mouth,loss of appetite

Beta-Adrenergic Blocking Agents and DiureticBrand names:inderalCategory:antihypertensiveDescription: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 DiureticDescription: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 pregnancyAssociated with low blood sugar level-breathing problems-slower heart rate and low blood pressure ,jaundice ,low potassium in the newborn infant

Beta-blockers diuretics and breast -feedingPass into breast milk and may decrease the flow of breast milk.

Medications should not be used at all with Beta-blockers diureticsAminophyllineCaffeineTheophyllineAntidiabetics(drugs taken by mouth)Insulinthere is an increased risk of hyperglycemia or hypoglycemia ,increase in pulse rateCalcium channel blockers

Medications should not be used at all with Beta-blockers diureticsDigitalis 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 diureticsAllergyAsthmaFeverBronchitisEmphysemaBradycardiaDiabetes mellitus

The presence of the following medical problems may affect the use of Beta-blockers diureticsGout PancreatitisKidney diseaseLiver diseaseMental depressionOveractive thyroid

Proper use of Beta-blockers diureticsControl weightAvoid high sodium Avoid spicy foodAvoid high animal fatCheck pulse rate regularly if it was less than 50 beats per minute call your doctorAvoid high caffeine intake

Proper use of Beta-blockers diureticsControl weightAvoid high sodium Avoid spicy foodAvoid high animal fatCheck pulse rate regularly if it was less than 50 beats per minute call your doctorAvoid high caffeine intake

Proper use of Beta-blockers diureticsIncrease in the amount of urine or frequency of urination ,these effects should reducedReceive vegetables and fruits rich with potassium (tomato,fig,apricot ,apple)

Precautions while using of Beta-blockers diureticsDo not stop taking this medicine suddenly or without doctor`s order.Patient must carry medical identification stating that he is taking this medicineBefore having any kind of surgery including dental surgery or emergency medicine ,patient must inform that he is receiving this medicine

Precautions while using of Beta-blockers diureticsFor diabetic patient: this medicine may increase or decrease blood sugar levelThis 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 Beta-blockers diureticsThis 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 Beta-blockers diureticsWhen 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 sunglassesApply a sun block product that has a skin protection factorApply a sun block lipstick

Side effects of Beta-blockers diureticsLess 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 diureticsSigns 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 Beta-blockers diureticsSlow heartbeat, dizziness, severe fainting,difficulty in breathing,bluish-colored fingernails or palms of hands,convulsions

Side effects of beta-blockers and diuretics More common side effects: decreased sexual ability,dizziness,drowsiness,constipation,diarrhea,increased sensitivity of skin to sunlight,loss of appetite,numbness or tingling of fingers and toes

Calcium SupplementsCategoryAntacid(calcium carbonate)Antihyperkalemic(calcium chloride )AntihypermagnesemicAntihyperphosphatemicCardiotonicNutritional supplement

Calcium SupplementsCategoryAntacid..calcium carbonateAntihyperkalemic..calcium chlorideAntihypermagnesemic..calcium chlorideAntihyperphodphatemic..calcium citrateCardiotonic..calcium chlorideNutritional supplement..

Calcium SupplementsDescriptionCalcium supplements are taken by individuals who are unable to get enough calcium in their regular diet or who have a need for more calciumThey are used to prevent or treat several conditions that may cause hypocalcemia The body needs calcium to make strong bones

Calcium SupplementsDescriptionCalcium is also needed for the heart,muscles and nervous system to work properly.

Some calcium rich foodsNonfat dry milkLowfat ,skim or whole milkYogurtSardines with bonesRicotta cheeseSalmonCheese white

Vitamin D and calciumVitamin D helps calcium loss from the bone it is sometimes called the sunshine vitaminExpose 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 woman-fetus)The healthy growth and development of the fetus depend on a steady supply of nutrients from the motherTaking large amounts of a dietary supplement during pregnancy may be harmful to the mother and fetus and should be avoided

Dietary supplement(pregnant woman-fetus)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 allDigitalis 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 allMagnesium 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 allTetracyclines 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 supplementsDiarrheaStomach or intestinal problems Heart diseaseHypercalcemiaHyperparathyroidismKidney disease or stones

Proper use for calcium supplementDrink a full glass of water or juice when taking a calcium supplement but with full stomach.

Side effects of calcium supplementMore common side effects : dizziness ,irregular heartbeat,nausea or vomiting,skin redness ,or burning at injection site ,tingling sensationRare side effects: painful urination,drowsiness,nausea or vomiting

Side effects of overdose of calcium supplementEarly 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

SalicylatesBrand name:aspirinCategory:AnalgesicAnti-inflammatory ,nonsteroidalAntipyreticAntirheumaticantithrombotic

SalicylatesCategory:Myocardial infarctionPlatelet aggregation inhibitorDescription: salicylates are used to relive pain and reduce fever

Salicylates and dietLow sodium in dietVery low fat intakeAvoid caffeine intake

Salicylates and pregnancyToo much use of aspirin late in pregnancy may cause a decrease in the newborn`s weight and possible death of the fetus or newborn infantMay cause unwanted effects on the heart or blood flow in the fetus or in the newborn infant.

Salicylates and problems during and after deliveryCause severe bleeding in the mother before,during or after deliveryDo not take aspirin during the last three months of pregnancyCaffeine causes birth defects when given in very large doses

Salicylates and problems during and after deliveryBreast-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 salicylatesAnticoagulantsDepakineHeparinAnti-inflammatoryPain relief medicationAntidiabeticsbronchodialators

Medications should not be used with salicylatesTetracyclinesMethotrexateUrinary alkalizersAntihypertensive medications

Do not use salicylates in the following medical problemsAnemiaOveractive thyroidStomach ulcer AsthmaHypertensionKidney diseaseLiver diseaseGout hemophilia

Proper use of salicylatesDo not use salicylates with vinegarDo 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 salicylatesDrink a full glass of water after taking this medicineSalicylates liquid may be mixed with fruit juice before takingCheck 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 salicylatesOr 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 salicylatesIf 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 salicylatesIf 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 salicylatesDo not take aspirin for 5 days before any surgery..taking aspirin during this time may cause bleeding problemsIf 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 salicylatesFor diabetic patientsFalse urine sugar tests result may occur

Side effects of salicylatesGet 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 salicylatesLess common side effectsAbdominal pain,cramming,bloody or black tarry stools,ringing in ears,vomiting of blood like coffee grounds.More common side effectsAbdominal cramps nausea or vomiting

Vitamin KCategory: 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 pregnancyVitamin 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 AdometSulfonamidesAnticoagulantsAspirinCefobidPresantineDepakeneHeparininduced

The presence of other medical problems or recent delivery may affect the use of vitamin KCystic fibrosis or other diseases affecting the pancreas Diarrhea (prolonged)High blood pressureLiver diseaseStrokeSurgery within the last two monthsIntestinal problemsthese conditions may interfere with absorption of vitamin K into the bodyBleeding tendencyBrain 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 vesselPlacement of any tube into the body surgery including dental surgery

Dosing Adult and children :the usual dose is 5 to 10milligrams a dayFor 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 KLess common side effects:decreased appetite,decreased movement or activity ,difficulty in breathing,enlarged liver,general body swelling,irritability,muscle stiffnessMore common side effects:bleeding or oozing from cuts ,gums,wounds or around the place of injection,fever,low blood pressure

Side effects of vitamin KRare 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

ValiumDiazepam

Why is this medication prescribed?Is used to relive anxietyMuscle spasmsSeizures and to control agitation To treat irritable bowel syndrome

ValiumDiazepamprecautions should patient followInform your doctor that you are receiving the following:AtivanTagametDigoxinLanoxinMedication for depressionDepakene for SeizuresMedication to relieve Pain

ValiumDiazepamprecautions should patient followInform your doctor that you are receiving the following:Medication for Parkinson`s diseaseMedication for asthmaMuscle relaxantOral contraceptive Inderalzantic

ValiumDiazepamprecautions should patient followInform your doctor that you are receiving the following: sedativesSleeping pillsTheophyllineTranquillizersvitamins (these medications may add to the patient drowsing)

ValiumDiazepamprecautions should patient followIf you use antacids take diazepam first then wait one hour before taking the antacidTell 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

ValiumDiazepamprecautions should patient followDo not drive car or operate machinery until you know how this drug affectsCigarette smoking may decrease the effectiveness of this drug

ValiumDiazepamSide effectsCommon side effects:Drowsiness ,dizziness,tiredness,weakness,dry mouth,diarrhea,upset stomach,change in appetiteTell your doctor if any of these symptoms are severe: restlessness,constipation,difficulty in urination,blurred vision

ValiumDiazepamSide effectsCall 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

VentolinBrand 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 bronchitisLong acting bronchodilator that is used with anti-inflammatory attack to prevent asthma

Bronchodilators Brand names:IsuprelVentolinbronkometer

Bronchodialators The effects usually last about 12 hours ,doses should never be taken more than two times a day effectChildren 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

BronchodialatorsFor 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

BronchodialatorsRare side effects: dizziness,swelling in throat,redness of skin,increased shortness of breath ,swelling of face,lips,eyelids,tightness in chest or wheezingMore common side effects: fast heartbeat,headache,nervousness

BronchodialatorsLess common side effects: coughing,bronchial irritation,dryness or irritation of mouth

BronchodialatorsAminophyllineTheophylline

BronchodialatorsAminohylline ,theophylline used to treat \prevent the symptoms of broncheal asthma,chronic bronchitis and emphysema.these medicine relive cough,wheezing,shortness of breath

bronchodialatorsTheophylline and pregnancy: crosses the placenta cause unwanted effects such as fast heartbeats,irritabilityBreast-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 TagametCoronary dialatorsErythromycinTrentalDilantinDepakine

Bronchodialators should not be used with the following medical problems:ConvulsionsHeart failureLiver diseaseUnderactive thyroid

Proper use of bronchodialatorsIt 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 bronchodialatorsCheck 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 bronchodialatorsCheck 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 bronchodialatorsLess common side effects: heartburn,vomiting,headache,fast heart beat,increased urination,nervousness,trouble in sleepingRare side effects: skin rash