Important Drug Tips!!

Never mix Dilantin in anything other than NS, and don't piggyback/push any meds thru same line while infusing. Use a filter.

Dilute your phenergan, there's a whole post on this right now.

Check pulse before giving Digoxin, hold if pulse less than 60. That one applies to several meds, but Dig is the one pounded into your head in nursing school.

Never crush enteric coated or extened release meds(ex Depakote, Oxycontin, Renagel, Ditropan XL, K-dur) (to put down a tube or to mix in applesauce for those who can't swallow whole pills). MDs sometimes order these in error for those who need them crushed. If not sure look it up.

And from a "stupid mistakes" thread I remember about percocet, never crush up a pill to put in a IV, Central Line, etc. There is a difference between enteral and parentral preperations of drugs.

~Jen

As for the Lantus you mentioned, remember never to draw it up in a syringe with another insulin...can't be mixed.

As for the ones that CAN be mixed, remember the saying...clear before cloudy.

Dexamethasone -should avoid giving it after 1800 otherwise pts are "wired" for the night.

Lasix - another one to avoid giving past 1800 unless the pt has a foley.

If giving Maxeran to prevent nausea, it is usually given qid, but it should be timed before meals and at hs.

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.

Are you thinking of Insulin lispro aka Humalog. This is the very short acting one and needs to be given right before the patient eats. Make sure the meals trays are on the unit.

It's all very confusing for sure. It just takes time. We tend to get familiar with the drugs we give over and over on our particular units and it gets easier.

Not only can't Lantus be mixed, it can't be given IV - must be given SQ.

Dilantin, Mannitol and Prevacid require IV filters.

Cerebrex is preferred over Dilantin when you don't have a central line (much less irritating and less paperwork ).

Do not run IV potassium boluses faster than 10meq per hour.

With Lortab and immediate release potassium (pill or powder), it's generally best to give with a few bites of food (jello, crackers, pudding) or some milk to help avoid N/V.

If your Mannitol is crystalized when you pull it from the omniscell/pexis, put it on top of the blanket warmer (or wrap in warm blankets) to desolve the crystals. If you need it right away, just pull another non-crystalized one, but put the other in a warm place for later use.

When giving dilantin suspension, dobbhoffs/NGs need flushed before giving and the tube feedings need to be held for an hour after dose to allow for proper absorption.

Lantus must be given with meals or within 15 minutes of eating...

Ok, my experience with Lantus (long acting insulin, given once a day, lasts approx 24 hours) is that it's given at HS. Once is a while I've seen it given in the morning.

Have I missed something?

NCLEXy things i learned:

if you have a central line (single lumen) being used for TPN, don't run anything else through that lumen, if you need another line, poke a new one peripherally. with kids (and pretty much anyone) attempt IV access distally to AC to preserve those veins for the future (these veins may be needed later for av fistulas or other critical means).

according to NCLEX, hang blood or packed RBCs with only NS in y-tubing.

oh and know critical pharm values: digoxin 0.5-2

dilantin 10-20, lithium 0.5-1.5

IV potassium can be run at 20 meq/hr if pt has a central line/PICC.

Give phenergan as piggyback of 50ml/15 minutes to avoid extroversion/phlebitis and other nasty venous side effects.

For pts that are constipated and only have orders for MOM, give 30ml MOM/120 prune juice/ about 30ml of 7-up warmed up (not hot). I have rarely seen this not work at getting bowels going.

Beta blockers like metoprolol/labetolol can mask hypoglycemia symptoms in diabetic pts.

Thanks these are very helpful!!

Lantus must be given with meals or within 15 minutes of eating...

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

IV potassium can be run at 20 meq/hr if pt has a central line/PICC.

This apparently varies from facility to facility. Check your regulations and policies and run accordingly.