Must Know Drugs: Psych, Complex, Peds/OB, Community

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Must Know DrugsPsych, Complex, Peds/OB,
Community

• Compiled by Hannah Giboney

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Psych
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Valproic Acid (Depakote, Depakene)Ziprasidone
(Geodon)Lithium carbonate

• Anticonvulsant
• Uses partial, generalized and absence seizures,
  bipolar d/o, and migraine h/a
• S/E GI effects, hepatotoxicity, pancreatitis,
  thrombocytopenia
• Contraindications liver d/o
• Interactions phenytoin and phenobarbital

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Bupoprion (Wellbutrin, Zyban)

• Atypical antidepressant smoking deterrant
• S/E h/a, dry mouth, constipation, increased HR,
  nausea, restlessness, weight loss, seizures
• Contraindications seizure d/o, pts on MAOIs
• Interventions monitor for seizures, sip on
  fluids for dry mouth, fiber for constipation
  take daily, emphasize compliance (1-3 weeks
  before effects) don't d/c abruptly

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Risperidone (Risperdal)Olanzapine (Zyprexa)

• Atypical Antipsychotic
• Uses schizophrenia, levodopa-induced psychosis
• S/E agranulocytosis, seizures, DM, weight gain,
  heart muscle inflammation
• Contraindications agranulocytosis,
  immunosuppressive/anticancer meds, seizure d/o,
  DM
• Interventions signs of DM/weight gain, monitor
  for seizures, CBC

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Paroxetine (Paxil)

• SSRI
• Uses major depression, OCD, bulimia, PDD, panic
  d/o, PTSD
• S/E sexual dysfunction, weight gain, Serotonin
  synd (2-72hr--mental confusion, agitation,
  anxiety), w/d syndrome, hypoNa, rash, sleepiness,
  lightheadedness
• Contraindications pts on MAOIs, Warfarin, TCAs,
  Lithium, NSAIDs, or anticoagulants
• Interventions take w/ food, take daily,
  encourage compliance, no effects until 1-3 weeks

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Benztropine mesylate (Cogentin)

• Anti-parkinson Centrally-acting anticholinergic
• Symptomatic relief from dyskenesias
• S/E NV, anticholinergic effects, antihistamine
  effects
• Contraindications pts w/ narrow-angle glaucoma
• Interventions warn about possible sudden loss of
  effects of meds, may be weeks-months before
  noticeable effects

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Haloperidol (Haldol) DecanoateFluphenazine
(Prolixin-Decanoate)

• Conventional Antipsychotic
• Uses schizophrenia, bipolar d/o, tourette's
  synd, delusional d/o, schizoaffective d/o,
  dementia, huntington's chorea
• s/e seizures, EPS, anticholinergic effects,
  neuroleptic malignant syndrome
• contraindications pts in a coma, severe
  depression, parkinson's, prolactin-dependent
  breast cancer, severe hypotension pts on
  anticholinergic agents, CNS depressants or
  levodopa
• Interventions take on a regular schedule, 4-6
  weeks before effects

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Complex
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Epinephrine (Adrenalin)

• Adrenergic Agonist
• Used for cardiac stimulation in cardiac arrest
  for bronchodilation in asthma or
  allergic/anaphylactic reactions produces
  mydriasis produces local vasoconstriction when
  combined with local anesthetics and prolongs
  anesthetic action by decreasing blood blow to the
  site
• S/E dysrhythmias, tachycardia, angina,
  restlessness, urgency or urinary incontinence
• Interventions monitor VS, lung sounds, UOP
  ECG administer through a large vein

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Norepinephrine (Levophed)

• Adrenergic Agonist
• Stimulates the heart in cardiac arrest
  vasoconstricts and increases the BP in
  hypotension and shock
• S/E dysrhythmias, tachycardia, angina,
  restlessness, urgency or urinary incontinence
• Interventions monitor VS, lung sounds, UOP
  ECG administer through a large vein

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Dopamine Hydrochloride (Intropin)

• Adrenergic Agonist
• Increases BP and cardiac output through positive
  inotropic action and increases renal blood flow
  through its action on alpha and beta receptors
• Used to treat mild renal failure caused by low
  cardiac output
• S/E dysrhythmias, tachycardia, angina,
  restlessness, urgency or urinary incontinence
• Interventions monitor VS, lung sounds, UOP
  ECG administer through a large vein

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Lidocaine (Xylocaine)

• Class IB antidysrhythmic sodium channel blocker.
  Local Anesthetic.
• suppress dysrhythmias by inhibiting abnormal
  pathways of electrical conduction through the
  heart block conduction of pain impulses in
  certain area
• S/E fluid retention orthostatic hypotension,
  constipation CNS excitation spinal h/a, urinary
  retention
• Interventions monitor HR, RR, BP, ECG monitor
  serum drug levels ensure administration of
  correct form IV form must have an infusion pump
  limit fluid salt intake monitor
  resp/thyroid/neruo functions increase fiber

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Adenosine (Adenocard)

• Antidysrhythmic
• Restoration of normal sinus rhythm (SVT only)
• S/E orthostatic hypotension, constipation fluid
  retention (weight gain, peripheral edema, SOB)
• Interventions monitor HR, RR, BP, ECG maintain
  therapeutic serum drug levels do not give w/
  food that affects absorption IV form must have
  an infusion pump limit fluid salt intake
  monitor resp/thyroid/neruo functions increase
  fiber intake

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Eptifibatide (Integrillin) Abciximab (ReoPro)

• Antiplatelet GPIIb/IIIa Inhibitor
• Inhibit the aggregation of platelets in the
  clotting process, prolonging the bleeding time
• Used in the prophylaxis of long-tem conplications
  following myocardial infarction, coronary
  revascularization, stents, and brain attacks
  (stroke)
• Contraindications pts w/ bleeding d/o and known
  sensitivity
• S/E GI bleeding, bruising, hematuria, tarry
  stools
• Interventions determine sensitivity before
  administration, monitor VS, give w/ food if GI
  bleeding occurs, monitor bleeding time for S/E
  r/t bleeding educate pt how to take how to
  monitor for S/E

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Tissue Plasminogen Activator (tPA)

• Thrombolytic
• Activate plasminogen which generates plasmin (an
  enzyme that dissolves clots)
• Uses 4-6 hours onset of MI arterial thrombosis,
  DVT, occluded shunts or catheters  pulmonary
  emboli
• Contraindications internal bleeding hx of
  stroke, intracranial problems, recent surgery
  hepatic/renal dz uncontrolled HTN recent CPR
• S/E bleeding, dysrhythmias, fever, allergic rxns
• Interventions aPTT, PT, fibrinogen level,
  hematocrit, and platelet count monitor VS
  pulses monitor for bleeding, excretions for
  occult blood, for neruo changes, hypotension,
  tachycardia avoid injection direct pressure
  over puncture site 20-30min electric razor
  brush teeth gently

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Nesiritide (Natrecor)

• Vasodilator,diuretic
• recombinant version of human BNP that vasodilates
  arteries and veins
• used in treatment of decompensated HF
• S/E hypotension, confusion, dizziness,
  dysrhythmias
• Interventions give by continuous IF infusion via
  pump, monitor BP, cardiac rhythm, urine output,
  body weight, monitor for signs of resolving HF

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Propofol (Diprivan)

• IV General Anesthetic loss of consciousness
  eliminate response to painful stimuli
• Uses adjunct to inhalation anesthetics,
  induction/maintenance of anesthesia, amnesia
• S/E resp/CV depression, bacterial infection
• Interventions use open vial w/n 6hr injected
  into a large vein after IV lidocaine has been
  injected into the site to decrease pain
• Interactions CNS depressants/stimulants, opioid
  analgesics\
• Implicated in Michael Jacksons death

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Midazolam Hydrochloride (Versed)

• Benzodiazepine anxiolytic
• Action Depress CNS, muscle-relaxing,
  anticonvulsant
• Contraindications acute narrow-angle glaucoma
  use cautiously in children adults abrupt w/d
  can be life-threatening
• S/E phlebitis at IV site, apnea,
  laryngospasm,resp depression, cardiac arrest
• Toxicity somnolence, confusion, diminished
  reflexes, coma, agitation, restlessness,
  discomfort, anxiety
• Interventions liver/renal function test results
  CBC, reduced dose for elderly impaired liver
  function fall precautions avoid alcohol, taper
  dose to stop

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Mannitol (Osmitrol)

• Osmotic diuretic
• increase osmotic pressure of glomerular filtrate
• used for oliguria, prevent RF, decrease ICP,
  decrease IOP used with chemotherapy to induce
  diuresis
• S/E FE imbalance, pulmonary edema, NV, H/A,
  tachycardia, hypoNa, dehydration
• Interventions monitor VS, weight, UOP,
  electrolyte levels, lungs heart sounds,
  dehydration, neuro status, IOP, ICP change
  position slowly, do not give if med has
  crystallized in vial

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Naloxone Hydrochloride (Narcan)

• Opioid Antagonist
• Treat resp depression from opioid OD
• Interventions monitor BP, HR, RR Q 5min, then Q
  15min, then Q 30min until pt is stable
• Place pt on cardiac monitor to monitor rhythm,
  auscultate breath sounds, have resuscitation
  equipment available don't leave unattended,
  monitor pt for several hours

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Sodium bicarbonate (bicarb)

• Orally Antacids
• Action Reacts w/ gastric acid to produce neutral
  salts or salts of low acidity inactivate pepsin
  and enhance mucosal protection but don't coat the
  ulcer crater to protect it from the acid and
  pepsin elevates gastric pH above 5
• Uses PUD and GERD
• take on a schedule chew thoroughly and follow w/
  water or milk shake liquid prep before
  administration allow 1 hour between antacid  and
  other meds
• S/E rapid onset, liberating carbon dioxide,
  increasing intraABD pressure, and promotes
  flatulence used w/ caution w/ HTN and HF can
  cause systemic alkalosis in pts w/ Renal
  Impairment

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Sodium bicarbonate (bicarb)

• IV Weak alkaline used to treat acidosis (esp
  metabolic),
• Action Shifts carbonic acid/carbon dioxide
  equilibrium toward base raising blood pH
• Uses acidosis, hyperkalemia, cardiac arrest

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Peds/OB
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Mg sulfate

• CNS depressant
• Produce uterine relaxation suppress uterine
  activity in order to prevent preterm birth. Used
  for preeclamptic pts to prevent seizures.
• S/E depress resp, depress DTRs, hypotension,
  extreme muscle weakness, flushing, decreased UOP,
  pulmonary edema, serum Mg levels gt9 mg/dL
• Contraindications Mother severe (pre)eclampsia,
  vaginal bleeding, intrauterine infection, cardiac
  dz.                    Fetus gestational age
  gt37wks, cervical dilation gt4cm, fetal demise,
  lethal fetal anomaly, chorioamnionitis, acute
  fetal distress, and chronic intrauterine growth
  restriction
• Interventions use controller pump monitor DTRs,
  resp  UOP Mg levels, keep Ca gluconate at
  bedside (antidote)

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Oxytocin (Pitocin)

• stimulates smooth muscle of the uterus induces
  contraction of the myocardium intranasal/IM/IV
• Uses induce/augment labor, control postpartum
  bleeding, promote milk letdown induce/complete
  abortion
• S/E rare allergies, dysrhythmias, BP changes,
  uterine rupture, water intoxication nasal
  vasoconstriction (intranasal) uterine
  hypertonicity hypotension/rebound HTN
  postpartum hemorrhage
• Interventions monitor VS/weight/IO/LOC/lung
  sounds, the freq, duration, force of contractions
  resting uterine tone, fetal HR Q 15min give IV
  via infusion monitoring device don't leave
  unattended monitor for hypertonic contractions,
  uterine hyperstimulation or nonreassuring fetal
  HR, signs of water intoxication document. If
  necessary, turn on her side, increase IV NS rate,
  give O2 via face mask

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Betamethasone

• Corticosteroid that increases the production of
  surfactant
• Use pt in preterm labor 28-32 wks gestation
  whose labor can be safely inhibited for 48 hours
• S/E decreased resistance to infection pulmonary
  edema secondary to Na and fluid retention
  elevated blood glucose levels in pt w/ DM
• Interventions monitor maternal VS, lung sounds,
  for edema, signs of infection, WBC, blood glucose
  levels

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Concerta, Adderall, Ritalin

• CNS Stimulant amphetamines
• stimulate the cerebral cortex of the brain
  increase alertness sensitivity to stimuli
• Uses narcolepsy and ADHD adjunctive therapy for
  exogenous obesity
• S/E irritability, restlessness, tremors,
  tachycardia, dysrhythmias, HTN, dry mouth,
  anorexia/weight loss, ABD cramping,
  diarrhea/constipation, hepatic failure,
  psychoses, impotence, dependence and tolerance,
  high potential for abuse
• Interventions monitor VS, mental status, CBC,
  WBC, platelet degree of inattention,
  impulsivity, hyperactivity, sleepiness
  height/weight/growth of child take before food
  avoid caffeine/alcohol take gt6hrs before bed

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Atomoxetine (Strattera)

• CNS stimulant
• S/E tachycardia, anorexia/weight loss, elevated
  BP, dizziness, agitation
• Interventions monitor CNS s/e, BP obtain
  baseline ECG avoid OTC take last dose gt6hr
  before bed (gt14hr if XR) monitor height/weight
  in children several weeks before therapeutic
  effect

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Fluticasone/Salmeterol (Advair)

• Corticosteroid long acting bronchodilator
• Uses prevent asthma attacks or flare-ups of COPD
  (not for acute attacks or dyspnea)
• S/E h/a, churg-strauss syndrome
• Caution DM, glaucoma, seizure d/o,
  pheochromocytoma
• Interactions beta-blockers, ketoconazole, MAOIs
• Interventions assess VS, resp status allow
  1-2min between inhalations take regardless of
  symptoms do not use as rescue inhaler

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Montelukast (Singulair)

• Leukotriene modifier
• Action inhibit bronchoconstriction caused by
  specific antigens reduce airway edema and
  smooth muscle contraction
• Use prophylaxis/treatment of chronic bronchial
  sthma
• Contraindication pts w/ hypersensitivity
  breast-feeding mothers use w/ caution w/
  impaired hepatic function
• Interaction inhaled glucocorticoids increase
  risk of upper resp infection
• S/E H/A, NV, dyspepsia, diarrhea, generalized
  pain, myalgia, fever, dizziness
• Intervention monitor VS, lung sounds
  (rhonchi/wheezing), liver function lab values,
  for cyanosis take 1hr before or 2 hr after
  meals increase fluid intake don't self-d/c

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Terbutaline (Brethine)

• beta-adrenergic agonist
• Used to stop preterm labor by relaxing smooth
  muscles, inhibiting uterine activity causing
  bronchodilation
• s/e SOB, coughing, tachypnea, pulmonary edema,
  tachycardia, palpitations, chest pain,
  hypotension, fluid retention, decreased urine
  production, tremors, dizziness, muslce cramps,
  weakness, h/a, hypokalemia, hyperglycemia,
  hypocalcemia
• interventions monitor for s/e put pt on her
  side monitor VS, weight, IO, fluid restriction,
  comfort measures

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dinoprostone (Cervidil)

• prostaglandin E2
• ripen the cervix (dilation and effacement),
  stimulate uterine contractions, given vaginally
• Uses preinduction cervical ripening, induction
  of labor, induction of abortion
• S/E diarrhea, NV, stomach cramps, fever, chills,
  fllushing, h/a, hypotension, tachysystole (gt12
  contractions in 20min w/o alteration in fetal HR
  pattern), hyperstimulation of uterus, fetal
  passage of meconium
• Contraindications
• Interventions monitor VS, cervical ripening,
  Bishop score, s/e void before administration,
  maintain supine position w/ lateral tilt or
  side-lying for 30-40min

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Erythromycin

• Opthalmic ointment or drops are bacteriostatic
  bactericidal
• Use prophylactic measure to protect against N.
  gonorrhoeae C. trachomatis
• Interventions cleanse neonate's eyes before
  instilling drops or ointment, instill into
  conjunctival sacs w/n 1hr after delivery don't
  flush eyes after instillation
• Oral
• Various bacterial infections otitis media,
  bronchitits
• Adverse effect GI UPSET DIARRHEA

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Ferrous Fumarate (Hemocyte F)

• Antianemic iron supplement (same as ferrous
  sulfate, but different concentration of iron)
• Uses treat/prevent Fe-def anemia
• Contraindications non-Fe-def anemia
• S/E NV, constipation, dark stools, epigastric
  pain, teeth staining (liquid)
• Interactions tetracyclines, ascrobic acid,
  antiulcer meds
• Intervention assess nutritional status, bowel
  function monitor CBC/BMP monitor for
  toxicity/OD (stomach pain, fever, NV) warn about
  stools instruct to take 1hr before/after food
  (unless GI discomfort)

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Rhogam

• Uses prevent anti-Rh (D) antibody formation in
  Rh-neg pts exposed to Rh-positive blood (from
  baby)
• S/E elevated temp, site tenderness
• contraindications Rh-positive women, hx of
  systemic allergic rxn to preps containing human
  immunoglobulins not for newborn infant
• Intervention IM injection at 28 wks gestation
  w/n 72hr after delivery not IV monitor for temp
  elevation

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Vitamin K (AquaMEPHYTON)

• necessary to assist in production of active
  prothrombin
• Use prophylaxis tx of hemorrhagic dz of the
  newborn
• S/E hyperbilirubinemia in newborn
• Interventions protect med from light give
  during early neonatal period, in lateral aspect
  of mid-3rd of the vastus lateralis muscle of
  thigh monitor for bruising at injection site and
  for bleeding from cord monitor for jaundice and
  bilirubin level

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Amoxicillin, Amoxicillin-clavunalate (Augmentin)

• Broad-Spectrum Penicillin clavunalate helps make
  it penicillinase resistant
• Action inhibit growth of bacteria
  beta-lactamase resistant
• Uses prophylaxis bacterial endocarditis 1st
  choice for meningitis
• S/E GI effects (upset stomach, sore mouth, furry
  tongue) superinfections hypersenxitivity rxns
  (anaphylaxis)
• Interventions assess for allergies, monitor lab
  values, monitor IO, encourage fluid intake,
  initiate safety precautions (CNS effects) IV, IM
• Educate importance of compliance

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Zidovudine (AZT)

• NRTI
• Uses tx HIV and AIDS prophylaxis in exposed
  healthcare workers, HIV mothers, HIV sexual
  partners
• Action inhibit the activity of reverse
  transcriptase
• S/E NV, anemia, leukopenia, myopathy, fatigue,
  h/a
• use 3 or 4 meds (highly active antiretroviral
  therapy HAART) to delay or reverse loss of
  immune function, preserve health, and prolong life

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Community
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Rifampin

• 1st-line TB agent to inhibit bacterial RNA synth
  used with at least one other anti-TB med
• Contraindication pts w/ hypersensitivity
• Interactions decreases effects of oral
  anticoagulants, oral hypoglycemics,
  Chloromycetin, Lanoxin, Norpace, Mexitil,
  Diflucan, Dolophine, Dilantin, Calan, and others.
• S/E hypersensitivity rxn, heartburn, NVD,
  red-orange body secretions, vision changes,
  hepatotoxicity, hepatitis, increased uric acid
  levels, blood dyscrasias, colitis
• Intervention CBC, uric acid, LFT monitor stools
  (colitis) mental status
• Education warn about s/e take as prescribed
  avoid alcohol

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Isoniazid (INH)

• 1st-line med for TB
• bactericidal used in combo w/ other anti-TB meds
• Contraindications pts w/ hypersensitivity or w/
  acute liver dz
• Interactions increase risk of toxicity or
  Tegretol Dilantin may decrease ketoconazole
  concentrations tyramine foiods
• S/E hypersensitivity rxns, peripheral neuritis,
  neurotoxicity, hepatotoxicity, pyridoxine (vit
  B6) deficiency, irritation at inj site w/ IM, NV,
  dry mouth, dizziness, hyperglycemia, vision
  changes, hepatitis
• Interventions monitor LFT, CBC, blood glucose
  levels give 1hr before or 2hr after food 1hr
  before Al antacids pyridoxine reduces risk of
  neurotoxicity total compliance

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lamivudine (Epivir)

• NNRTIs
• Uses HIV and AIDS
• Action inhibit the activity of reverse
  transcriptase
• S/E nausea, nasal congestion
• use 3 or 4 meds (highly active antiretroviral
  therapy HAART) to delay or reverse loss of
  immune function, preserve health, and prolong life

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Bicillin

• PCN G
• Action inhibit growth of bacteria (gram positive
  narrow spectrum S. pneumo, S. pyogenes,
  syphillis)
• Uses prophylaxis becterial endocarditis 1st
  choice for meningitis
• S/E GI effects (sore mouth, furry tongue)
  superinfections hypersenxitivity rxns
  (anaphylaxis)
• Interventions assess for allergies, monitor lab
  values, monitor IO, encourage fluid intake,
  initiate safety precautions (CNS effects) IV, IM
• Educate importance of compliance