Important Drug Tips!!

Myxel67 · Feb 11, 2007

Correction: I went back & rechecked this--EVERYTHING I HAVE READ SAYS DON'T DILUTE AT ALL FOR IVP. NOT COMPATIBLE WITH AQUEOUS SOLUTIONS. DON'T KNOW WHERE I GOT THAT D5W IDEA

KellieNurse06 · Feb 11, 2007

I was taught that anything that says do not crush can be dissolved in water.

I actually was doing Prilosec tablets in water for tube feedings. Becaue you aren't crushing it.....and basically if you think about it..most pills that are time released will say to drink with plenty of water....so pretty much you are doing the same thing just not doing it in the body...once it's dissolved it can be swalloed easily or given by g tube.......and a big thing I've found is the meds that can clog the gtube....like with prilosec...if you go fast pushing it rather than slow...it seems to go in easier & without a problem than it does going slow......don't know why but it just does.

My instructor from school I had was an NP and taught me about that potassium pill...the huge one...and she told me you are changing the chemical composition of it by dissolving it in water......it took her like 5 times to get me to understand it ...because I too was one to ask whats the difference between crushing & dissolving......after she explained it to me I finally got it :idea: ..like a duh moment for me...lol:lol2:

RoxanRN · Feb 11, 2007

Mix only in D5W. Precipitates rapidly if mixed with NS to dilute for IVP.
I thought this was well known, but I saw a nurse on floor mix with NS the other day.

Verify what can be mixed in what solution and what your unit or facility policy is. On my floor (Neuro Critical Care in a Primary Stroke Care Center), our orders dictate the pharmacy mix everything they can in NS.

zacarias, ASN, RN · Feb 12, 2007

ok REALLY stupid question. I've been out of med/surg for song (tele stepdown), but why do you shut off tubefeeding for an hour after giving meds. I can see suction but tubefeeding?

LilRedRN1973 · Feb 12, 2007

We are to turn off tubefeeds 2 hours before and after the administration of PO Dilantin. Otherwise it binds to the tubefeeds and is not absorbed correctly, causing low Dilantin levels, from what I understand. The nutrition/dietary person will then adjust the tubefeed rate to make up for the lost calories from when the tubefeeds are off (our patients are fed continuously in the ICU, no bolus feedings are done). With other meds, I have no idea why you would shut them off.

Melanie = )

mmsparkle · Feb 12, 2007

We are to turn off tubefeeds 2 hours before and after the administration of PO Dilantin. Otherwise it binds to the tubefeeds and is not absorbed correctly, causing low Dilantin levels, from what I understand. The nutrition/dietary person will then adjust the tubefeed rate to make up for the lost calories from when the tubefeeds are off (our patients are fed continuously in the ICU, no bolus feedings are done). With other meds, I have no idea why you would shut them off.
Melanie = )

In one unit I worked in, NG feeds were stopped 2hours before and after giving (crushed) ciprofloxacin via NGT. Something to do with the the medication not mixing well with feed.

In my current unit, however, this isn't policy. You've reminded me to go ask our pharmacist about it, next time I'm back on day shifts.

AuntieRN · Feb 17, 2007

Thank you for explaining the potassium to me...i guess it makes sense now.

Myxel67 · Feb 18, 2007

About Lantus. It is so slow acting, (70 minute onset and duration of 24 hours), it can be given before bedtime without regard to meals.
Also--LANTUS insulin is for basal coverage, and not intended to provide coverage for meals. Therefore it can and should be given even when patients are NPO--especially for those with type 1 DM who can quickly go into DKA if all insulin is withheld. (Even when we don't eat, the liver puts glucose into the bloodstream and will raise BG levels.)

drizzle · Feb 18, 2007

I am only taking Pharm this semester and will be having my first exam coming up soon so I dun have any tips yet to offer... just want to say wow and thanks for all the tips!!! Keep them coming~! :wink2:

MS._Jen_RN, ASN, RN · Feb 18, 2007

I was taught that anything that says do not crush can be dissolved in water.[/Quote]As fas as I know, for some pills- doing this can be very unsafe (Oxycontin, Oramorph SR, etc.) .
I actually was doing Prilosec tablets in water for tube feedings. :
As for the Prilosec, we open the capsule and put the "beads" in Apple juice (because of the acidity) and flush with apple juice after.
Please be VERY careful and don't ascribe "any pill" or "anything" to a situation without knowing. Medications can be very different, even within the same class. You need to check on an individual basis. That's what they made drug guides for and why they put warnings on packages.
Respectfully
~Jen

hcmanp, NP · Feb 26, 2007

About Lantus. It is so slow acting, (70 minute onset and duration of 24 hours), it can be given before bedtime without regard to meals.
Also--LANTUS insulin is for basal coverage, and not intended to provide coverage for meals. Therefore it can and should be given even when patients are NPO--especially for those with type 1 DM who can quickly go into DKA if all insulin is withheld. (Even when we don't eat, the liver puts glucose into the bloodstream and will raise BG levels.)
Lantus can be hs or am. Not more than 100 units in one place.
I always heard that if a patient was NPO, the basal dosage should be reduced by as much as 50 %. Anybody know about that?

chenoaspirit, ASN, RN · Feb 26, 2007

Sorry Joy.. my mistake.. i meant lispro :imbar

Funny you made that mistake because I made that mistake when administering insulin one morning. I was supposed to admin lispro and admin lantus by mistake.