PHARM NOTES

Acute Asthma Attack

1) increasing shortness of breath, chest tightness, coughing, and/or wheezing

• rescue inhaler
• albuterol and levalbuterol
• oral and intravenous corticosteroids
• immediately administer a short-acting beta-agonist inhaler (like albuterol) using a
spacer, sit the patient upright, monitor their breathing, and if symptoms worsen or
do not improve within a reasonable time, seek immediate medical attention,
potentially calling emergency services

A Patient Taking Digoxin/ what herb should you not take

2) Licorice – may lower warfarin

• St. john’s wort: Can lower digoxin levels.

• Hawthorne berries
• Milkweed, Lily, Siberian ginseng
• Aloes: Can cause digoxin toxicity
• Senna: Can cause digoxin toxicity
• Licorice: Can increase digoxin levels and lead to toxicity

3) Ginkgo Biloba

• HELP WITH anxiety, allergies, dementia, eye problems, peripheral artery disease
(when buildup of plaque narrows the blood vessels that carry blood to the head,
organs, and limbs), tinnitus, and other health problems.
• Don’t take with Ibuprofen, Motrin IB
• If you are epileptic or prone to seizures, avoid ginkgo
• Side effects of ginkgo may include headache, stomach upset, dizziness,
palpitations, constipation, and allergic skin reactions. If you have a known bleeding
risk, you should be cautious about ginkgo possibly increasing your risk of bleeding.
• Ginkgo has a long history of use in treating blood disorders and memory issues stop
pain when walking.

4) Nitroglycerin/ oral route sublingual rote

• to prevent angina (chest pain) caused by coronary artery disease.

• This medicine is also used to relieve an angina attack that is already occurring.
Nitroglycerin belongs to the group of medicines called nitrates.
 • 1 tablet placed under the tongue or between the cheek and gum at the first sign of
an angina attack.
• 1 tablet may be used every 5 minutes as needed, for up to 15 minutes. Do not take
more than 3 tablets in 15 minutes. To prevent angina from exercising or stress, use 1
tablet 5 to 10 minutes before the activity.

5) Transdermal teaching
• Remove the old patch from the client's skin.
• Apply the medication directly to the skin.
• Writes date on medication patch.
• Provide privacy, perform hand hygiene, and explain the procedure
• Don gloves. If applicable, remove the old patch and dispose of it per facility policy. *
Select a new site for the patch on a flat surface such as the chest, back, flank, or
upper arm.
• Remove the patch from its pouch and peel off half of its protective liner. Place the
adhesive side on the skin, then peel off the other half of the liner. Press the skin
patch firmly with the palm of your hand for at least 30 seconds, making sure it
adheres to the skin, especially at the edges.

6) Docusate teaching
• Take stool softeners exactly as directed. Do not take more or less of it or take it more
often than prescribed by your doctor. Swallow the docusate capsules whole; do not
split, chew, or crush them. Take capsules and tablets with a full glass of water.
• Take this medication by mouth, usually at bedtime with a full glass (8 ounces or 240
milliliters) of water or juice, or as directed by your doctor. The dosage is based on
your medical condition, age, and response to treatment.

7) Phenytoin

used to control certain types of seizures, and to treat and prevent seizures that may begin
during or after surgery to the brain or nervous system.

Headaches. Make sure you rest and drink plenty of fluids. ...

Feeling drowsy, sleepy or dizzy. As your body gets used to phenytoin, these side effects should
wear off. ...

Feeling nervous, unsteady or shaky. ...

Feeling or being sick (nausea or vomiting) ...
Constipation. ...

Sore or swollen gums.

8) Orlistat knows what to monitor

• Be sure to check your blood sugar regularly and tell your doctor the results.
• This medication must not be used during pregnancy.
• The most common side effect of orlistat is changes in bowel movement (BM) habits.
• Symptoms of liver disease
• Nausea, vomiting
• Sever stomach/ abdominal pain
• Dark urin
• Yellowing eyes/skin
• Kidney stones
• Back pain when urinating
• Orlistat knows what to monitor- Be sure to check your blood sugar, Take the vitamin
supplement at least 2 hours before or after taking orlistat.
• You may also take your multivitamin supplement at bedtime.
• Severe stomach pain, Bladder pain, Fatigue, Nausea, stools, or an urgent need to go
to the bathroom, inability to control bowel movements. an increased number of
bowel movements; or. stomach pain, Fatty or oily stools, Headache, Hives
•

9) Echinacea- to treat urinary tract infections, vaginal yeast (candida) infections, ear
infections (also known as otitis media), athlete's foot, sinusitis, hay fever (also called
allergic rhinitis), as well as slow-healing wounds.
• Treat common cold/flu help wound heal (Aids, Cancer, Gingivitis)
• it has been shown to work as a mild laxative that provides constipation relief
• it can be used, like antibiotics, adjunctively, to treat or prevent bacterial com-
plications associated with viral diseases such as influenza.

Valeriana- was used to treat insomnia, migraine, fatigue, and stomach cramps.
Today, valerian is promoted for insomnia, anxiety, depression, premenstrual
syndrome (PMS), menopause symptoms, and headaches. The roots and rhizomes
(underground stems) of valerian are used for medicinal purposes.

Garlic- reducing the severity of common cold symptoms, helping manage

cholesterol and blood pressure, boosting heart health, and reducing the risk of liver
injury.

support heart health by potentially lowering blood pressure and cholesterol, aiding
in the prevention of hardening of the arteries (atherosclerosis), and is also
 commonly used for its antimicrobial properties to fight infections, digestive issues,
and as a general immune system booster

Docusate teaching- Take stool softeners exactly as directed. Do not take more
or less of it or take it more often than prescribed by your doctor. Swallow the
docusate capsules whole; do not split, chew, or crush them. Take capsules and
tablets with a full glass of water.

Feverfew- help with migraine symptoms like nausea, vomiting, and light
sensitivity skin conditions inflammation, headaches, insect bites and infertility,
migraine, cancer, rheumatoid arthritis, abdominal pain, Toothaches, Feverfew is
promoted for fevers, headaches, and arthritis; topically (applied to the skin), it's
promoted for toothache and as an antiseptic and insecticide. Feverfew has been
called “medieval aspirin” or “aspirin of the 18th century.”

10) Diazepam patient teaching

• Do not take a larger dose, take it more often, or for a longer time than your doctor
tells you to.
• Tell your doctor if you have ever drunk large amounts of alcohol, if you use or have
ever used street drugs, or have overused prescription medications.
• Do not drive, use machinery, or do anything that needs mental alertness until you
know how this medication affects you.
• You may get drowsy or dizzy
• To reduce the risk of dizziness and fainting spells, do not stand or sit up quickly,
especially if you are an older patient. Alcohol may increase dizziness and
drowsiness.
• Grapefruit juice may increase the amount of diazepam in your blood.
• Do not take a larger dose, take it more often, or for a longer time than your doctor
tells you to
• Avoid drinking alcohol while taking this drug

11) METHOTREXATE patient teaching

• This medicine may make your skin more sensitive to sunlight. Wear sunscreen, eye
protection, and a hat. Do not use sunlamps or tanning beds. Tell your doctor right
away if you have a change in how much or how often you urinate, rapid weight gain,
swelling in the legs, ankles, or feet, or trouble breathing.
• Methotrexate may cause kidney damage
• drink plenty of fluids during your treatment with methotrexate, especially if you
exercise or are physically active.
• Call your doctor if you think you might be dehydrated. You may become dehydrated
if you sweat excessively or if you vomit, have diarrhea or have a fever.
• Trouble breathing, bone marrow toxicity, hepatoxicity, pneumonitis
• Blood count/liver function test should be done also chest Xray
 • May cause kidney damage

12) EPS (Extrapyramidal symptoms)

• The extrapyramidal symptoms include acute dyskinesias and dystonic reactions,
tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant
syndrome.
• taking dopamine antagonists, usually antipsychotic (neuroleptic) drugs
• (EPS) are treated with, Anticholinergic agents, Anti-parkinsonism drugs,
Benzodiazepine drugs, atypical antipsychotics, Dose reduction, Medication change,
Electroconvulsive therapy (ECT)
• Antipsychotic naive individuals, the elderly, and those with intellectual disability are
at greater risk for developing EPS. Elderly females are more likely to develop drug-
induced parkinsonism and tardive dyskinesia,
• taking dopamine antagonists, usually antipsychotic (neuroleptic) drugs
• a variety of movement disorders akathisia (motor restlessness) and dystonia’s:
torticollis (neck muscle spasm), opisthotonos (rigidity of back muscles), and
oculogyric crisis (rolling back of eyes)

13) Patient with fluid volume overload/ what does it look like /3 answers for select all that apply)
• fluid volume overload" means their body has too much fluid, often presenting with
symptoms like swelling in the legs and ankles (edema), shortness of breath, rapid
weight gain, abdominal bloating, and high blood pressure; this can be caused by
conditions like heart failure, kidney disease, or excessive fluid intake, and is typically
managed by restricting fluids and using diuretics to help the body eliminate excess
fluid.
• A patient experiencing fluid volume overload, also called hypervolemia, would likely
appear with noticeable swelling (edema) in the extremities like the feet, ankles, and
hands, along with potential symptoms like rapid weight gain, shortness of breath,
high blood pressure, distended neck veins, and may complain of discomfort or
bloating in the abdomen; depending on the severity, they might also exhibit signs of
respiratory distress due to fluid buildup in the lungs.

14) Bisacodyl patient teaching

• Do not take bisacodyl more than once a day or for more than 1 week without talking
to your doctor.
• Bisacodyl comes as a tablet to take by mouth.
• It is usually taken the evening before a bowel movement is desired.
• Bisacodyl normally causes a bowel movement within 6 to 12 hours.
• Tell your doctor if you have stomach pain, nausea, vomiting, a sudden change in
bowel movements lasting more than 2 weeks, anal fissures, or hemorrhoids.
• Do not take bisacodyl tablets at the same time as: dairy products such as milk,
cheese or yoghurt. indigestion remedies (antacids)
 • Stomach pain or cramps. Reduce your dose of bisacodyl or stop taking it until these
side effects go away.
• drink plenty of fluids during their use.

15) Allopurinol patient teaching

• Do not take more of it, do not take it more often, and do not take it for a longer time
than your doctor ordered.
• You may take this medicine after meals to avoid stomach upset.
• Take this medicine with plenty of liquids to help prevent kidney stones.
• Monitor intake and output ratios frequently
• You'll usually take it once a day, but if you're on a high dose, your doctor may advise
you to split the dose and take it twice a day.
• If your doctor has recommended you take allopurinol with lots of fluid, try to drink 2
to 3 liters of fluids every day. You can take allopurinol at any time of the day.
• This drug can cause drowsiness. You shouldn't drive, use machinery, or do other
tasks that require alertness until you know how it affects you. Fluid intake: You
should drink at least 3.4 liters (14 cups) of fluids each day.

16) Spironolactone/ what to monitor

• potassium levels,
• Monitor urine output and report if it is less than 30 ml/hour.
• Monitor serum potassium within 1 week of initiation or titration of ALDACTONE and
regularly thereafter
• you get a slow or irregular heartbeat, tingling feeling, muscle weakness or shortness
of breath – these can be signs of potassium levels being too high.
• Try to limit other food and drink that contain a lot of potassium, including bananas,
avocados, pulses, nuts and salmon.
• Heart failure, Urea and electrolytes.
• to treat high blood pressure (hypertension) and heart failure. Lowering blood
pressure can reduce the risk of strokes and heart attacks.

17) Clopidogrel adverse effects of the medication

• allergic reactions, including angioedema
• which can be life-threatening and require medical attention
• Check with your doctor right away if you have large, hive-like swelling on the face,
eyelids, lips, tongue, throat, hands, legs, feet, sex organs.
• PLATELET FUNCTION TESTS TO MONITOR CLOPIDOGREL THERAPY. Platelet
function tests play a major role in determining the effect of antiplatelet drugs, such
as clopidogrel, on inhibiting platelet aggregation.
• The main side effect of clopidogrel is bleeding more easily than normal. You may
have nosebleeds, heavier periods, bleeding gums or bruising. You can drink alcohol
with clopidogrel. But do not drink too much while taking this medicine.
18) Patient receiving warfarin what should you have on hand in case there in overdose?
• withhold 1 dose of warfarin and orally administer vitamin K1, 1-2.5 mg, particularly if
the patient is at increased risk of bleeding
• For more rapid reversal (eg, urgent surgery), administer vitamin K1, 2.5-5 mg, orally
(expected reduction of the INR should occur in about 24 h).
• It has been known for many years that vitamin K administration is an effective
method of warfarin reversal. Vitamin K is available in several formulations that can
be administered by a variety of routes (oral, subcutaneous, intramuscular, or IV).
• Taking too much warfarin can lead to life-threatening bleeding

19) Lorazepam
• to treat anxiety disorders
• It is also used for short-term relief of the symptoms of anxiety or anxiety caused by
depression.
• Lorazepam is a benzodiazepine that works in the brain to relieve symptoms of
anxiety.
• sleeping problems that are related to anxiety.
• Avoid drinking alcohol and using illegal drugs while you are taking lorazepam
• include dizziness, drowsiness, and weakness. Rare but serious lorazepam side
effects include falls, depression, and overdose.
• Take this medicine only as directed by your doctor. Do not take more of it, do not
take it more often, and do not take it for a longer time than your doctor ordered.

20) Patient receiving IV ampicillin what require priority intervention

EPINEPHRINE, OXYGEN, INTRAVENOUS STEROIDS, AND AIRWAY MANAGEMENT,

INCLUDING INTUBATION, SHOULD ALSO BE ADMINISTERED AS INDICATED.
may cause diarrhea or allergic responses in nursing infants
chewing khat significantly reduces the absorption of ampicillin,
If an allergic reaction occurs, the drug should be discontinued and appropriate therapy
instituted. SERIOUS ANAPHYLACTOID REACTIONS REQUIRE IMMEDIATE EMERGENCY
TREATMENT WITH EPINEPHRINE

21) Bumetanide teaching

• It treats swelling from heart, kidney or liver disease by helping you make more pee to
remove salt and excess water from your body.
• You should take this medication as directed at the same time each day. The brand
name of this medication is Bumex
• Report balance problems and functional limitations to the physician and caution
the patient and family/caregivers to guard against falls and trauma.
• Your doctor will monitor the potassium in your blood while you are taking this
medicine.
• Take it as directed on the prescription label at the same time every day.
 • You can take it with or without food. If it upsets your stomach, take it with food. Keep
taking it unless your health care provider tells you to stop.
• Advise patients to change position slowly as they may experience orthostatic
changes.

22) Risperidone which adverse effects to monitor

• Common side effects include feeling sleepy, problems with your movement and
headaches. It can make you feel more hungry than usual, so you may put on weight.
• feeling sleepy in the day or difficulty falling asleep at night
• problems with your movement – difficulty moving, stiff muscles with movements
which are difficult to control, a slow shuffling walk, shakes and drooling – this is
known as dyskinesia. headaches. putting on weight or changes in appetite.
What happens when patient takes heparin
• decrease the clotting ability of the blood and help prevent harmful clots from
forming in blood vessels.
What happens when a patient takes warfarin?
• the clotting mechanism is disrupted and the ability of blood to clot is reduced.
What happens if a patient has both heparin and warfarin?
• significantly increases the risk of bleeding due to the combined anticoagulant
effect, so careful monitoring of blood clotting parameters is crucial.
• When starting warfarin, heparin is usually administered concurrently for a few days
(typically 4-5 days) until the warfarin reaches a therapeutic level, as measured by
INR (international normalized ratio).

23) Digoxin
• to treat congestive heart failure
• usually in combination with a diuretic (water pill) and an angiotensin-converting
enzyme (ACE) inhibitor. It is also used to treat a heart rhythm problem called atrial
fibrillation.
• It's used to control some heart problems, such as irregular heartbeats (arrhythmias)
including atrial fibrillation. It can also help to manage the symptoms of heart failure,
usually with other medicines.
• improve the strength and efficiency of the heart, or to control the rate and rhythm of
the heartbeat. This leads to better blood circulation and reduced swelling of the
hands
• The more common side effects that can occur with digoxin include diarrhea.
dizziness. headache.

24) St. John wart

• John's wort is promoted for depression, menopausal symptoms, attention-deficit

hyperactivity disorder (ADHD), somatic symptom disorder
 • Women who are pregnant, trying to become pregnant, or breastfeeding should not
take St. John's wort.
• St. John's wort limits the effectiveness of many prescription medicines.
• can cause adverse reactions including liver toxicity in rare cases
• may potentially inhibit MAO, the ingestion of tyramine-containing foods, like aged or
smoked meats, yeast, cheeses, pickled herring,
• St. John's wort may cause increased sensitivity to sunlight, especially when taken in
large doses.

25) Ma Huang patient teaching

• It was and still is used to induce perspiration and to treat the symptoms of bronchial
asthma, colds, and influenza.
• FDA has banned dietary supplements containing ephedrine alkaloids because they
have serious safety risks
• Ephedra can also cause anxiety, dizziness, dry mouth, headache, heartburn,
insomnia, irritability, nausea, personality changes, and other symptoms.
• Ephedra should be taken between meals, without food.

26) Calcium carbonate / monitor adverse effects

• Hemodynamics must be monitored with the administration of calcium carbonate as
hypotension, bradycardia, and arrhythmias can occur.
• Calcium supplements may increase the incidence of constipation, severe diarrhea,
and abdominal pain.
• upset stomach.
• vomiting.
• stomach pain.
• belching.
• constipation.
• dry mouth.
• increased urination.
• loss of appetite.
• Calcium carbonate is a dietary supplement used when the amount of calcium taken
in the diet is not enough. Calcium is needed by the body for healthy bones, muscles,
nervous system, and heart.

27) Levodopa/ foods to avoid (Carbidopa) reinforcing teaching (apple sauce answer)
• High in protein diets
• Take levodopa and carbidopa exactly as directed. Do not take more or less of it or
take it more often than prescribed by your doctor
• Swallow the extended-release tablets whole; do not chew or crush them. Swallow
the extended-release capsules whole; do not chew, divide, or crush them.
 • Monitor for sudden somnolence and increased depression Contraindicated with
MAOIs Periodically monitor hepatic, renal, and hematopoietic functions
• Breathing problems or wheezing.
• Racing heart.
• Fever or general ill feeling.
• Swollen lymph nodes.
• Swelling of the face, lips, mouth, tongue, or throat.
• Trouble swallowing or throat tightness.
• Swallow the extended-release tablets whole; do not chew or crush them.
• Eating a low protein snack (such as a cracker, biscuit or slice of toast) when you take
your dose may help to reduce this side effect.
• Taking levodopa with high-protein meals, such as meat and fish, may reduce how
much of the drug gets into your system and how well a dose works

28) Enoxaparin/ reinforcing teaching (patient not going to understand)

• a blood thinner used to prevent or treat blood clots
• Enoxaparin (Lovebox®) is administered only by injection under the skin using a small
needle and syringe. Injections can be given once or twice a day.
• Stay away from rough sports or other situations where you could be bruised, cut, or
injured.
• Brush and floss your teeth gently. Be careful when using sharp objects, including
razors and fingernail clippers. Enoxaparin may cause bleeding problems.
• Look at the syringe to be sure the drug is clear and colorless or pale yellow.
• Anti-factor Xa level monitoring
• pain or blood clots at the injection site or bleeding or bruising more easily.

29) Lispro
• Do not use insulin lispro if it is cloudy or thickened, discolored, or if there are
particles in it. Do not mix this medicine with any other insulin.
• Insulin lispro should be injected under the skin within 15 minutes before you eat.
• Rotate injection sites to avoid damage to muscles and to prevent subcutaneous
atrophy.
• Monitor response carefully to avoid adverse effects. Always verify the name of the
insulin being given because each insulin has a different peak and duration, and the
names can be confused.

30) Parent giving child medication/ parent needs reinforcing on teaching (oral medication)
• Mix the medicine with a small amount (1 to 2 teaspoons) or juice or sweetened water. Give it
with a spoon or let your child drink it.
• Do not put medicine in a full cup if your child does not drink very much.
• consider the child's age, swallowing ability, ease of administration and accessibility of the
product
• Crushed pills can often be mixed into food items such as applesauce, yogurt, sherbet,
pudding or ice cream.

31) FLUTICASOE ADVIRSE EFFECTS TO MONITOR

• regular eye exams
• redness, or discomfort of the eyes; blurred vision; seeing halos or bright colors
around lights; or any other changes in vision.
• darkening of the skin, diarrhea, dizziness, fainting, loss of appetite, mental
depression, nausea, skin rash, unusual tiredness or weakness, or vomiting.
32) Methylphenidate/ reinforcing teaching
• a central nervous system (CNS) stimulant used to treat ADHD, can affect how some
classroom reinforcers work
• You should give your child's last daily dose of the medication before 6 o'clock in the
evening."
• Methylphenidate is a stimulant, and giving it too late in the day can cause insomnia
• Administering the last dose before 6 PM helps minimize sleep disturbances
• It should be avoided in clients with known structural cardiac abnormalities,
cardiomyopathy, serious heart rhythm arrhythmias, or coronary artery disease
• Take this medicine only as directed by your doctor. Do not take more of it, do not
take it more often, and do not take it for a longer time than your doctor ordered. If
too much is taken, it may become habit-forming and cause mental or physical
dependence. This medicine should come with a Medication Guide.

33) Amoxicillin clavulanate teaching

• Take amoxicillin and clavulanate exactly as prescribed by your doctor. Follow all
directions on your prescription label and read all medication guides or instruction
sheets.
• Amoxicillin and clavulanate potassium may work best if you take it at the start of a
meal. Take medicine every 12 hours.
• usually taken with a meal or snack every 8 hours (three times a day) or every 12
hours (twice a day).
• You can take amoxicillin before or after food. Swallow amoxicillin capsules whole
with a drink of water. Do not chew or break them
• Amoxicillin is available as a liquid for children and people who find it difficult to
swallow capsules.
34) Gentamicin
• used in adults and children 1 year of age and older to treat skin infections caused by
certain bacteria
• Topical gentamicin is in a class of medications called antibiotics. It works by killing
bacteria that cause infections’
• Do not take your medicine more often than directed
 • Take all of your medicine as directed even if you think you are better. Do not skip
doses or stop your medicine early.
• small amount of Gentamicin Sulfate Ointment USP, 0.1% should be applied gently
to lesions three to four times a day. The area treated may be covered with a gauze
dressing, if desired.
• Secondary skin infections: Infectious eczematoid dermatitis, pustular acne,
pustular psoriasis, infected seborrheic dermatitis, infected contact dermatitis
(including poison ivy), infected excoriations, and bacterial superinfections of fungal
or viral infection

35) Montelukast/ reinforcing teaching

• Never take more than 1 dose a day.
• Most people take montelukast once a day in the evening to prevent symptoms of
asthma or allergies.
• to prevent wheezing, difficulty breathing, chest tightness, and coughing caused by
asthma
• if exercise makes your asthma worse, your doctor might tell you to take montelukast
2 hours before you exercise.

36) Tuberculin skin test 9 intradermal)

• A tuberculin skin test (TST), also known as the TB skin test or Mantoux tuberculin
skin test, is a procedure that helps determine if a person has tuberculosis (TB)
• A healthcare provider injects a small amount of tuberculin, a purified protein
derivative (PPD), into the skin of the forearm.
• To administer a Tuberculin skin test, a healthcare professional will inject a small
amount of purified protein derivative (PPD) fluid, also called tuberculin,
intradermally (just below the skin surface) on the inner forearm using a fine needle,
creating a small, raised bump (wheal) that should be approximately 6-10mm in
diameter.

37) Case study

38) Captopril reinforcing teaching adverse effects

• Instruct patient to notify health care professional if immediately rash; mouth sores;
sore throat; fever; swelling of hands or feet; irregular heartbeat; chest pain; dry
cough; hoarseness; swelling of face, eyes, lips, or tongue; or difficulty swallowing or
breathing occurs or if taste impairment or skin rash persists.
• High Potassium Level (Hyperkalemia). Captopril can cause a high potassium level
(hyperkalemia),
 • Side effects that you should report to your doctor or health care professional as
soon as possible: allergic reactions like skin rash, itching or hives, swelling of the
face, lips, or tongue.

39) Clozapine
• It is primarily used to treat people with schizophrenia and schizoaffective disorder
who have had an inadequate response to two other antipsychotics,
• to treat severely ill patients with schizophrenia who have used other medicines that
did not work well.
• It is also used to lower risk of suicidal behavior in patients with schizophrenia or
schizoaffective disorder.
• Clozapine at toxic doses may cause hyperthermia, alterations in consciousness,
seizures, cardiac arrhythmias, excessive mucus production in bronchi,
hypersalivation, miosis, blood dyscrasias, pancreatitis and hepatitis

40) Etanercept nursing actions

monitor you for any improvements in your rheumatoid arthritis and for any signs of
infections.
blocking the effects of TNF-alpha
This drug should be used with caution if you have infections that repeatedly come and go.
Effects of Enbrel include less pain, stiffness, and swelling, and improvements in movement
and laboratory markers of inflammation

41) Oral comfrey lab results

shown the presence of pyrrolizidine alkaloids (PAs) in the urine of rats and humans
Comfrey contains PAs that are mutagenic, carcinogenic, and hepatotoxic.
Comfrey has toxic substances that can cause severe liver damage and even death.
Lab results urine

42) lithium/ levels

between 0.6 and 1.2 mEq/L, but not more than 1.2 mEq/L.

Sucralfate/ reinforcing teaching

43) Take this medicine on an empty stomach. Shake the oral liquid well before each use.
Measure each dose with a marked measuring spoon, oral syringe, or medicine cup. If you
are also using an antacid, take it more than one half-hour before or after taking sucralfate
oral liquid.