NAME Duloxetine Rx Cymbalta BBW Children suicidal ideation FC Antidepressant miscellaneous CC Serotonin norepinephrine reuptake inhibitor SNRI TU Decreased depression decreased neuropathic pain USE Major depressive disorder MDD neuropathic pain associated with diabetic neuropathy generalized anxiety disorder fibromyalgia chronic low back pain osteoarthritis pain NAME Pantoprazole Rx Protonix FC Proton pump inhibitor CC Benzimidazole TU Absence of epigastric fullness pain swelling USE Gastroesophageal reflux disease GERD severe erosive esophagitis maintenance long term pathological hypersecretory conditions including Zollinger Ellison syndrome DOSAGE Depression Adult PO 40 60 mg day as a single dose or 2 divided doses Diabetic neuropathy Adult PO 60 mg qday Generalized anxiety disorder Adult PO 60 mg day may start with 30 mg day 1 wk then increase to 60 mg day maintenance 60 120 mg day PT EDUCATION Advise that product is dispensed in small amounts because of suicide potential especially in the beginning of therapy use caution when driving or other activities requiring alertness because of drowsiness dizziness blurred vision avoid alcohol ingestion other CNS depressants MAOIs notify prescriber of nausea vomiting dizziness facial flushing shivering sweating confusion hallucinations incoordination may indicate serotonin syndrome Abrupt discontinuation Advise patient not to discontinue medication quickly after long term use may cause nausea headache malaise wear sunscreen or large hat since photosensitivity may occur notify prescriber if pregnancy is planned or suspected or if breastfeeding Tell patient that improvement may occur in 4 8 wk up to 12 wk geriatric patients ACTION Insomnia anxiety dizziness tremor somnolence fatigue decreased appetite decreased weight agitation diaphoresis hallucinations neuroleptic malignant syndrome like reaction aggression seizures headache abnormal dreams flushing hot flashes chills Thrombophlebitis peripheral edema palpitations hypertension supraventricular dysrhythmia orthostatic hypotension Abnormal vision Hypoglycemia SIADH Constipation diarrhea dysphagia nausea vomiting anorexia dry mouth colitis gastritis abdominal pain hepatic failure Abnormal ejaculation urinary hesitation ejaculation delayed erectile dysfunction urinary frequency retention gyn bleeding Photosensitivity bruising sweating Gait disturbances muscle spasm restless legs syndrome myalgia Anaphylaxis angioedema serotonin syndrome Stevens Johnson syndrome NURSING CONSIDERATIONS BBW Depression Assess mental status mood sensorium affect suicidal tendencies increase in psychiatric symptoms depression panic monitor children weekly face to face during first 4 wk or dosage change then every other wk for next 4 wk then at 12 wk 1 Hypo hyperglycemia Assess for each during treatment and before dosing 2 Assess B P lying standing pulse q4hr if systolic B P drops 20 mm Hg hold product notify prescriber take VS q4hr in patients with CV disease 3 Monitor hepatic studies AST ALT bilirubin 4 Monitor weight qwk weight loss or gain appetite may increase peripheral edema may occur 5 Offer sugarless gum hard candy frequent sips of water for dry mouth 6 Assess for withdrawal symptoms headache nausea vomiting muscle pain weakness not usual unless product is discontinued abruptly 7 Assess for neuroleptic malignant syndrome like reaction 8 Serotonin syndrome assess for nausea vomiting dizziness facial flushing shivering sweating 9 Sexual dysfunction ejaculation dysfunction erectile dysfunction decreased libido orgasm dysfunction 10 Beers Use with caution in older adults may exacerbate or cause SIADH CONTRAINDICATION Hypersensitivity closed angle glaucoma alcohol intoxication alcoholism hepatic disease hepatitis jaundice DOSAGE GERD Adult PO 40 mg day 8 wk may repeat course Erosive esophagitis Adult IV 40 mg day 7 10 days PO 40 mg day 8 wk may repeat PO course PT EDUCATION severe diarrhea product may have to be discontinued CDAD Advise patient with diabetes that hyperglycemia may occur avoid hazardous activities dizziness may occur avoid alcohol salicylates ibuprofen may cause GI irritation Inform patient to take as directed not to skip or double doses ACTION Suppresses gastric secretion by inhibiting hydrogen potassium ATPase enzyme system in gastric parietal cell characterized as gastric acid pump inhibitor since it blocks final step of acid production SIDE EFFECTS Headache insomnia asthenia fatigue malaise insomnia somnolence Diarrhea abdominal pain flatulence pancreatitis weight changes CDAD Rash Hyperglycemia weight gain loss hyponatremia hypomagnesemia vitamin B12 deficiency Myalgia NURSING CONSIDERATIONS 1 CDAD Assess GI system bowel sounds abdomen for pain swelling anorexia diarrhea with blood mucus 2 Monitor hepatic enzymes AST ALT alkaline phosphatase during treatment 3 Electrolyte imbalances hyponatremia hypomagnesemia in those using this product 3 mo 1 yr if hypomagnesemia occurs use of magnesium supplements may be sufficient if severe discontinuation of this product may be required 4 Beers Avoid in older adults for 8 wk unless for high risk patients risk of Clostridium difficile fractures NAME Multivitamin FC Vitamin USE tx or prevent vitamin deficiency caused by poor diet other disorders conditions or during pregnancy NAME Lidocaine Topical Rx OTC 9 TF Topical anesthetic TU Decreasing inflammation itching pain USE Oral irritation sore throat toothache cold sore canker sore sunburn minor cuts insect bites pain itching DOSAGE Given through oral PO usually taken once a day as directed PT EDUCATION call HCP for any adverse effect such as allergic reaction difficult breathing trouble swallowing DOSAGE Adult and child TOP apply qid as needed RECT insert tid and after each BM PT EDUCATION Teach patient to avoid contact with eyes Teach patient not to use for prolonged periods use for 1 wk if condition remains prescriber should be contacted ANTIDOTE ACTION Contain fat soluble vitamins and most water soluble vitamins Many acts as coenzymes or catalysts in numerous metabolic processes SIDE EFFECTS Urine discoloration allergic reactions to preservatives additives colorants NURSING CONSIDERATIONS 1 Assess serum level before taking MVI to prevent overdose 2 MVI can have adverse interaction with med such as abx NSAID ibuprofen antacid and heart or blood pressure medication 3 OD of vitamin can cause serious and life threatening SE ACTION Inhibits conduction of nerve impulses from sensory nerves SIDE EFFECTS