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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 syndromeDOSAGE: 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/dayPT 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)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 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 coursePT 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 dosesNAME: Pantoprazole (Rx) / Protonix NAME: Duloxetine (Rx) / Cymbalta BBW: Children, suicidal ideationACTION: 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 productionSIDE EFFECTS: Headache, insomnia, asthenia, fatigue, malaise, insomnia, somnolenceDiarrhea, abdominal pain, flatulence, pancreatitis, weight changes, CDAD, Rash, Hyperglycemia, weight gain/loss, hyponatremia, hypomagnesemia, vitamin B12 deficiency, MyalgiaANTIDOTE: 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 syndromeNURSING CONSIDERATIONS: [1] CDAD: Assess GI system: bowel sounds,abdomen for pain, swelling, anorexia, diarrhea with blood, mucus [2] Monitorhepatic enzymes: AST, ALT, alkaline phosphatase during treatment[3] Electrolyte imbalances: hyponatremia; hypomagnesemia in those usingthis product (3 mo-1 yr); if hypomagnesemia occurs, use of magnesiumsupplements may be sufficient; if severe, discontinuation of this product maybe required [4] Beers: Avoid in older adults for >8 wk unless for high-riskpatients, risk of Clostridium difficile, fracturesNURSING 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 SIADHCONTRAINDICATION: Hypersensitivity, closed-angle glaucoma, alcohol intoxication, alcoholism, hepatic disease, hepatitis, jaundiceNAME: Lidocaine Topical (Rx, OTC)9NAME: MultivitaminNURSING CONSIDERATIONS: [1] Assess serum level before taking MVI to prevent overdose [2] MVI can have adverse interaction with med such asabx, NSAID (ibuprofen), antacid and heart or blood pressure medication, [3] OD of vitamin can cause serious and life-threatening SECONTRAINDICATION: hypersensitivity to preservatives, colorants, or additives. Avoid ETOH w/ known intolerance, use cautiously in pts w/ anemia FC: Vitamin. USE: tx or prevent vitamin deficiency caused by poor diet, other disorders/conditions or during pregnancyTF: Topical anesthetic TU: Decreasing inflammation, itching, pain USE: Oral irritation, sore throat, toothache, cold sore, canker sore, sunburn, minor cuts, insect bites, pain, itchingDOSAGE: 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 swallowingACTION: Contain fat soluble vitamins and most water-soluble

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MCC NUR 214 - Duloxetine

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