Drugs Not Given Together...

[simprocon]

Hi guys, i am a new grad rn in my last few days of a two week orientation at a snf/ltc institution, i am getting the hang of things, i see how the nurses just crush meds together, and give them all at once. I learned yesterday for example that questran shouldn't be given with vanco, and like levaquin and vitamins also... So is there common meds that you know should not be given together. I already know the meds to NOT crush, but yeah its a lot to comprehend. Also for g tube i know dilantin you can't give anything or start feeding 1 hr before or after. Please help. Oh and if state is here, you can crush meds all together in one bag (the little pill crusher bags) right.

[mentalhealthRN]

I would contact your facilities pharmacy and speak to the pharmacist. They may even have a person who works specifically doing education stuff--ours did. And tell that person these things-- they have charts they can give you with what can and can't be crushed. They may also have some sort of cheat sheet type of things for meds that can't be given together, that have special instructions, etc. The pharmacist/pharmacy you use can be a good resource. Use them. I have learned little things here and there over the years from pharmacists--they know a lot of stuff! lol. Like cholesterol lowering meds should be given at HS as the body produces the highest levels of cholesterol overnight so having the med level the highest during the time when the production is also at its highest will lower the person's blood level of cholesterol overall better. And you know synthroid should always be given in the AM. -- around 9am is when the body produces the most HGH that is needed to work with the synthroid. -- anyways.they have lots of tips and are a great resource. See what they have in charts/written that you could keep with you on a clipboard or something on your cart when you are passing meds.

[Esme12, ASN, BSN, RN]

This is what your pharmacy is for......but you can also look them up either in the PDR (but that can be confusing) or, if your unit does not have one, invest in a good nursing drug reference look up book. When you buy your own book you can highlight what you want, mark what you want and you become comfortable and familiar with the contents. When I started nursing back in the stoneage.....I looked up everything before I gave it.....I learned a lot about the drugs and how to give them. as time went by I looked up less and less :)

[JoblessNewGradRN]

Make a list of the common drugs in your unit and make drug cards or buy them. You can always check info on the drugs from nursing drug guides in the nurse's station or by going online. The best thing for you to do is look up the drugs and your policies and know for yourself how to do stuff safely...or use your resources like pharmacy or a charge nurse. God forbid somebody forgets to list a lethal interaction for you on this thread...

[CapeCodMermaid, RN]

OKAY so my pharmacy consultant says synthroid should be given at 6am on an empty stomach.

Of course Fosamax and the like must be given on an empty stomach alone with plenty of water.

Ask your consultant, and follow the policies of your facility.

[debRN0417]

When the state is there follow your facility policy and the standard of practice. You can crush them all together but make sure they are compatable and that you are not crushing things that should not be crushed. Watch about OTC things that cannot be crushed. I saw Prilosec crushed not long ago. As long as you flush the tube before and after you are ok. If you want to crush each seperately then fine but make sure you flush after each one and that you are not overloading the resident with water due to your flushes. Make sure when you administer Fosamax that the resident is in an upright position and remains that way for 30 minutes after. It would not be a med error if you let the resident lie down immediately after, but it is an error with technique. Most of the time the pharmacy will alert you...but DONT COUNT ON IT! Know your meds. Look them up. That is the best and safest way. If it says SHAKE well then SHAKE well. Don't just swirl it around. Make sure that you administer the medications as ordered. If you have a question or are not sure- no one is going to fault you for stopping and looking it up or calling the pharmacy. Better to be safe than sorry....

[VivaLasViejas, ASN, RN]

Generally, for tube feeders I ask the pharmacy to fill as many Rx in liquid form as possible. Many common meds such as Dilantin, K+, lorazepam, APAP and vitamins come in the liquid form, making them much easier to administer the way it's supposed to be done (one at a time). You can also ask the physician to consider alternatives to meds that can't be crushed or 'liquidated' in order to cut down on the number of difficult-to-administer meds; sometimes they prescribe a certain drug because it's one they are comfortable with, and if you can make the case for an alternate med--- such as equal or better therapeutic results along with ease of administration---they're more apt to go along with your recommendations. Good luck!

[lovingtheunloved, ASN, RN]

Just to throw this in here, since one of our physicians LOVES calcium supplements...synthroid also needs to be given at least 2 hours before calcium.

[agldragonRN]

our pharmacy will ding us if you don't put the appropriate times for the meds, such as lopressor, calcium, and potassium should be given with food. simvastatin, lipitor, famotidine, and elavil should be given at night.

antibiotics should be given 2 hours before/after multivitamin/centrum. coumadin and multaq is contraindicated. coumadin and bactrim should be avoided. there are so many more but i cannot think of them now.