Type of Drug:

Antiviral

Use:

Used to prevent viral infections. Most effective against the herpes family of viruses.

How Supplied:

200 mg. capsules, 400 mg, 800 mg, tablets and liquid form.

Special Instructions:

1. The following may occur and should be reported at your next clinic visit: nausea; vomiting; diarrhea; headache; loss of appetite; shakiness of hands.

2. The following may occur and should be reported to your physician as soon as possible: skin rash; hives; repeated diarrhea, nausea or vomiting; stomach pain or cramping.

3. If you miss a dose take it as soon as possible. If it is near the time for the next scheduled dose, skip the missed dose and continue on the regular schedule.

4. Do not discontinue taking acyclovir unless instructed by your physician.

Alpha Interferon

Type of Drug:

Biological response modifier

Use:

Interferons are substances naturally produced and secreted by cells in response to infections.

How Supplied:

Given as subcutaneous injection, often daily.

Special Instructions:

1. A flu-like reaction with nausea, vomiting, aching muscles, fever, chills, and headache commonly occurs. Tylenol taken before each dose may alleviate this side effect. The flu-like symptoms are most prominent during the first week of treatment and gradually decrease.

2. Interferon may cause dizziness, tiredness, or a decrease in alertness. It may add to the effect of other medications such as antihistamines, sedatives, relaxants, or pain medication.

3. The following may also occur and should be reported to your nurse or physician: chest pain, confusion, nervousness, irregular heart rate, difficulty sleeping, numbness or tingling fingers, toes, and face, dry mouth, dry skin, decreased salivary flow, unusual bleeding or bruising, hives, and itching.

4. Low or high blood pressure may occur. Weight and fluid status should be monitored.

5. Lab values may be altered: decrease in hemoglobin, WBC's, platelets, increase in clotting times, and liver functions.

6. Most side effects are completely reversible within a short time after discontinuing the drug.

Amphotericin B

Type of Drug:

Antifungal

Use:

Amphotericin B is used to treat a wide spectrum of systemic fungal infections.

How Supplied:

Given as IV infusion over two hours.

Special Instructions:

1. Contact your physician if the following occurs: Skin rash, hives, stomach pain, nausea, vomiting, diarrhea, loss of appetite, weight loss, muscle weakness or cramps, fatigue, fever, chills, hearing loss, or blurred vision.

2. Your child will be premedicated with tylenol, benadryl, hydrocortisone, and demerol. If you are giving amphotericin B at home, give all four of these drugs before starting the amphotericin B.

3. For home administration, the amphotericin will be delivered via an "intermate".

4. If your child experiences chills during the infusion, another dose of demerol may be prescribed. If chilling continues to occur, the infusion time may be increased to three hours.

5. Amphotericin B causes the loss of potassium. This may continue to be a problem for several days after the amphotericin B has been discontinued.

6. Amphotericin may cause abnormal renal function, hypomagnesemia (decrease in magnesium), and proteinuria (excess of serum proteins in the urine).

Benadryl (Diphenhydramine Hydrochloride)

Type of Drug:

Antihistamine, Antiemetic

Use:

Benadryl is used as a premedication for amphotericin B and blood products to prevent or reduce its side effects.

How Supplied:

25 mg, 50 mg, capsules, liquid form and IV.

Special Instructions:

1. Drowsiness is the most common side effect. This may occur rapidly with IV injection. Most prominent during first few days and often disappears with continued use.

2. The following may also occur and should be reported at your next visit: dizziness; dry mouth; restlessness; confusion; headache.

3. Benadryl may be injected over a minimum of one minute, or as tolerated by your child. May cause hot, burning sensation if given too quickly.

Calcium Carbonate, Calcium Gluconate, Tums

Type of Drug:

Calcium Supplement

Use:

A calcium supplement is used for those whose calcium intake may be inadequate.

How Supplied:

650 mg tablets, 500 mg chewable tablets (tums), and liquid form.

Special Instructions:

1. If the following occurs, report to your physician as soon as possible: shaking or tremors, tingling, increased thirst and increased urine output; confusion; weakness or lethargy.

2. If the following occurs, report the occurrence at your next clinic visit: nausea and vomiting; constipation; abdominal pain.

3. If you miss a dose of calcium and remember within 2 hours, take the dose right away, then resume the regular schedule.

If you do not remember until several hours past the missed dose, skip the dose and resume your regular schedule. Never take double doses unless otherwise instructed.

4. Many antacids contain a calcium compound. If your child would prefer a different type of antacid, please review the package label with your nurse or physician before switching products.

Carafate

Type of Drug:

Anti-ulcer

Use:

Carafate forms an ulcer-complex that covers the ulcer site and protects against further attack by acid.

How Supplied:

1 gram tablets

Special Instructions:

1. The following may occur and should be reported at your next clinic visit: constipation, diarrhea, nausea, dry mouth, dizziness, rash.

2. The following could occur and should be reported to your physician as soon as possible: hives, swelling, difficulty breathing.

3. If also on famotidine, give at least two hours apart.

4. Give one hour before meals and at bedtime.

5. Antacids should not be taken within 1/2 hour before or one hour after carafate.

6. If you miss a dose, take it as soon as possible. If it is near the time for next dose, skip the missed dose and take the next dose as scheduled.

Cimetidine (Tagamet)

Type of Drug:

Antiulcer agent, inhibits gastric acid secretion.

Use:

Cimetidine is used to prevent and/or treat ulcers. It works by decreasing the amount of acid secreted in the stomach.

How Supplied:

200 mg, 300 mg, 400 mg, tablets, and liquid form

Special Instructions:

1. If the following occurs, report to your physician as soon as possible: confusion, sore throat and fever, unusual bleeding or bruising, unusual tiredness or weakness.

2. If the following occurs, report the occurrence to your physician at your next clinic visit: diarrhea, dizziness, headache, muscle cramps or pain, or skin rash.

3. If you miss a dose of cimetidine, take it as soon as possible, then resume the regular schedule. However, if it is almost time for your next dose, skip the missed dose and resume your regular schedule. Do not double doses.

4. This medicine works best when taken at meals and bedtime.

5. Do not take this medicine at the same time as an antacid (such as maalox). Allow one hour to pass between taking cimetidine and an antacid.

Ciprofloxacin Hydrochloride (Cipro)

Type of Drug:

Broad spectrum antibiotic

Use:

Cipro is used for major and minor infections including Staph epidermis and Staph aureus sepsis, urinary tract infections, pneumonia, etc. Has less activity against other gram positive bacteria. The oral drug is well absorbed which makes it also helpful.

How Supplied:

250 mg, 500 mg, 750 mg tablets

Special Instructions:

1. Be sure to drink plenty of fluids while taking cipro.

2. Avoid taking amphojel or mylanta while on cipro. If you must take one, take it two hours before or after the cipro.

3. Cipro can be taken with or without meals.

4. If the following occur, contact your physician: nausea, diarrhea, vomiting, headache, abdominal pain, tremor, restlessness, confusion, light-headedness, dizziness, joint pain, rash, or breathing difficulties.

5. If you miss a dose, try to make it up that day; if this is not possible, skip the missed dose and continue your normal schedule.

Clotrimazole (vaginal tablets or troches)

Type of Drug:

Antifungal, anti-infective

Use:

Clotrimazole is used to prevent or treat fungal infections of the mouth (thrush).

How Supplied:

10 mg oral troche, 100 mg vaginal tablet.

Special Instructions:

1. The tablet should be held in the mouth and allowed to dissolve slowly over 15-30 minutes, swallowing as it dissolves. Do not chew or swallow the tablets whole. Be sure and move the tablet around in your mouth.

2. If you prefer, you can crush the clotrimazole and mix it with water. It must then be swished in your mouth for 30-60 seconds and then swallowed.

3. If you miss a dose, try to make it up that day. If that is not possible, skip the dose and continue the regular schedule.

4. If you notice an increase in white plaques or sores in your mouth, contact your physician.

5. The following may occur and should be reported to your physician: stomach cramping or pain, diarrhea, nausea or vomiting.

Cyclosporin (Neoral)

Type of Drug:

Immunosuppressive

Use:

Cyclosporin is utilized to treat graft-versus-host disease.

How Supplied:

25 mg, 50 mg, 100 mg, capsules, and liquid form.

Special Instructions:

1. The following may occur and should be reported at your next visit: hand trembling or shakiness; headache; nausea or vomiting; leg cramps.

2. If the following occur, contact your physician as soon as possible: severe stomach pains; repeated nausea and vomiting; persistent or severe headache.

3. If you are using liquid, it should be diluted in orange juice or apple juice at room temperature. Grapefruit juice affects metabolism of cyclosporin and should be avoided. The combination of neoral oral solution with milk can be distasteful. Don't allow the mixture to stand; drink immediately. If you drink it out of a med cup or small glass, it is best to rinse the glass with more liquid and drink it also.

4. We recommend taking oral cyclosporin(capsule or liquid), with the same liquid and liquid volume for each dose. Patients should take cyclosporin consistently in relation to meals to decrease dietary effects on drug absorption.

5. For the liquid cyclosporin, use only the dropper provided to measure the dose. Don't wash the dropper after use, but simply clean off with a paper towel.

6. If you miss a dose and it is within 12 hours of the missed dose, take it as soon as possible. If over 12 hours has passed since the missed dose, skip the dose and take the next scheduled dose. Do not double dose or discontinue cyclosporin without your physician's instruction.

7. Cyclosporin levels in your blood will be monitored. You may be asked to draw the blood at home and bring it to the Clinic with you.

Demerol (Meperidine hydrochloride)

Type of Drug:

Narcotic analgesic

Use:

Demerol is used as a premedication for amphotericin B to prevent or reduce its side effects.

How Supplied:

Usually given as IV bolus.

Special Instructions:

1. Drowsiness is the most commonly occurring side effect. Other side effects that may occur include: dizziness; feeling faint; lightheadedness; nausea or vomiting; urinary retention; constipation; facial flushing; restlessness.

2. If the following occur, contact your physician as soon as possible: skin rash; shortness of breath or trouble breathing; blurred or double vision or other changes in vision.

3. Demerol may be mixed with Hydrocortisone and normal saline to dilute it. Inject over a minimum of five minutes.

4. If your child experiences chills or shaking during the amphotericin B, notify your physician. He/she may prescribe another dose of demerol to be given during the infusion.

Fluconazole (Diflucan)

Type of Drug:

Antifungal

Use:

Fluconazole is a broad spectrum antifungal agent used to treat or prevent fungal infections, particularly candida, histoplasmosis, and cryptococcus.

How Supplied:

100 mg, 200 mg tablets

Special Instructions:

1. Frequently a larger dose or "loading dose" of fluconazole is given prior to starting your regular, lower daily dose.

2. Fluconazole may be ordered to be given by mouth or intravenously.

3. If you notice an increase in white plaques or sores in your mouth, contact your physician.

4. Possible side effects of fluconazole include liver problems or a skin rash. Notify your physician as soon as possible if you see the development of a rash, stomach pain, anorexia, dark urine, any changes in skin coloring, or yellow in the white part of your eyes.

5. If nausea, vomiting, or diarrhea develop, notify your physician at your next clinic visit.

6. If you miss a dose, try to make it up that day. If this is not possible, skip the missed dose and continue your normal schedule.

Intravenous Immune Globulin

Type of Drug:

Immune Globulin

Use:

Intravenous immune globulin is used to provide antibody levels for the prevention of a variety of infectious diseases until immune function returns.

Special Instructions:

1. Given IV over two hours.

2. The following may occur and should be reported to your nurse or physician: headache, nausea, vomiting, abdominal cramps, fever, chills, shortness of breath, dizziness, skin rash, back, or hip pain.

3. A drop in blood pressure may occur and is usually related to rate of infusion.

4. An allergic reaction may occur.

Ganciclovir

Type of Drug:

Antiviral

Use:

Ganciclovir is used to treat CMV infection.

Special Instructions:

1. Given IV over one hour.

2. The following may occur and should be reported at your next clinic visit: nausea, vomiting, diarrhea, headache, loss of appetite, shakiness of hands, puffiness of extremities.

3. The following may occur and should be reported to your physician as soon as possible: skin rash, hives, repeated nausea/vomiting or diarrhea, stomach pain, cramping, blood in urine.

4. Ganciclovir may suppress white blood cell, neutrophil, and platelet counts.

5. Ganciclovir may also cause renal/kidney problems. You may be asked to occasionally collect a 24-hour urine collection to help monitor how your kidneys are functioning.

6. Ganciclovir may be given via an Intermate.

7. Ganciclovir needs to be handled carefully. Latex gloves should be worn when you are setting up to administer the ganciclovir. If you should accidentally spill any ganciclovir on your skin or your child's skin, you should immediately wash the skin with soap and water for five minutes. If you would spill any ganciclovir elsewhere, wear latex gloves and clean up the spill with disposable towels. Then scrub the affected area with soap and water. Place the towels and gloves in a plastic bag when finished and put this waste in your sharps container. The sharps container should be returned to your vendor (if you have one) or to the hospital when you come for an appointment.

Hydralazine

Type of Drug:

Anti-hypertensive

Use:

Hydralazine is used to treat high blood pressure.

How Supplied:

10 mg, 25 mg, 50 mg, tablets.

Special Instructions:

1. In general, side effects with hydralazine are rare at lower doses. However, check with your doctor as soon as possible if any of the following occur: blisters on skin, chest pain, sore throat and fever, joint pain, swelling of the lymph glands.

2. The following may occur and should be reported at your next clinic visit: diarrhea, headache, loss of appetite, nausea or vomiting, rapid heartbeat, dizziness, lightheadedness.

3. If you miss a dose, take the medicine as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

4. Store the tablets away from heat and direct light; do not store in the bathroom medicine cabinet because the heat or moisture may cause the medicine to breakdown.

Hydrocortisone

Type of Drug:

Corticosteroid

Use:

Hydrocortisone is used as a premedication for amphotericin B to prevent or reduce its side effects.

Special Instructions:

1. Hydrocortisone may be mixed with demerol and normal saline to dilute it. Inject over a minimum of five minutes.

2. A burning sensation in the legs or buttocks may be experienced with rapid infusion. If this occurs, inject the Hydrocortisone over a longer period of time.

Inderal (Propanolol)

Type of Drug:

Antihypertensive

Use:

Used to decrease high blood pressure.

How Supplied:

10 mg, 20 mg, 40 mg, 60 mg, 80 mg, tablets, 60 mg, 80 mg, 120 mg,

160 mg, long acting capsules, and liquid form.

Special Instructions:

1. Side effects include dizziness, difficulty breathing, nausea, vomiting, rash, bronchospasm, hypotension, disturbed vision or hearing.

2. If a dose is missed and remembered within two hours, take the dose immediately and continue with the next scheduled dose.

3. If the missed dose is not remembered until several hours after it was scheduled, simply skip this dose entirely. Do not take double doses.

Amphotericin (Intranasal)

Type of Drug:

Antifungal

Use:

Intranasal amphotericin is used prophylactically to help prevent fungal infections.

Special Instructions:

1. When you are ready for discharge, you will receive a prescription for sterile disposable metered dose pumps from your physician. This needs to be filled at the University Hospital Pharmacy as other pharmacies do not carry these pumps.

2. The sterile pumps you get will be empty. These are for use when you return to your home.

3. While you are an outpatient in the Iowa City area, you will need to pick up a new bottle of nasal amphotericin from pharmacy each week.

4. The nasal amphotericin expires in one week, and needs to be refilled at that time.

5. To administer the amphotericin, first remove the cap and prime the pump by depressing the nasal actuator several times. When doing this, direct the spray into a tissue or into the air.

6. Administer the prescribed dose as ordered. Use firm, quick depressions of the actuator. If possible, inhale as the spray is administered.

7. Clean the nasal actuator tip and the rim of the cap with a sterile alcohol wipe after each use and replace the cap.

8. Return the bottle of intranasal amphotericin to the refrigerator. Keep the bottle in the refrigerator between doses.

9. If nasal irritation had been a problem while you were an inpatient, your physician may order you to use beclomethasone nasal spray along with the amphotericin nasal spray. This is an anti-inflammatory drug that will help decrease irritation and inflammation that may be caused from the amphotericin.

10. Notify your physician if you develop nose bleeds, oozing, nasal congestion, or irritation.

11. If you skip a dose because of a nose bleed or irritation, please notify your physician.

12. If you forget to take a dose, take it as soon as you remember.

13. When you leave Iowa City for your hometown, arrangements will be made for you to continue the nasal amphotericin with the help of a local pharmacy or home health care agency. Make certain that you have enough empty sterile pumps to take home with you.

14. If you experience any trouble obtaining your amphotericin, please inform your physician.

Intranasal Amphotericin Guidelines (Pre-Drawn, 50 mg/10cc) - PBMT

Equipment:

One unopened sterile disposable metered-dose pump/bottle

10-20cc syringe with pre-drawn Amphotericin dilution

Alcohol pad

Procedure:

1. Remove the pump/bottle from the sealed package. Inspect first to be sure the sterility seal is intact. The pump and bottle are already assembled.

2. Carefully unscrew the pump from the bottle, leaving the bottle in an upright position. Do not let the pump's sipping tube touch the work surface. Hold in hand if necessary, making sure the sipping tube is not touched.

3. Remove the cover from the amphotericin filled syringe and carefully inject the 10cc or 20cc into the 20cc capacity bottle.

4. Place the empty syringe aside and carefully screw the pump onto the bottle. Avoid touching the threaded portion of the bottle or the inside of the pump. Screw on tightly to avoid leaks.

5. Prime the pump of the amphotericin filled pump/bottle. Hold the unit in an upright position. Remove the dust cover from the nasal tip actuator, and place on a clean surface. Using quick, firm strokes, depress the actuator of the pump 3-5 times, directing the resulting mist into the air or preferably into a tissue held 2-3 inches above the tip.

6. Clean the rim of the dust cap with a sterile alcohol pad and place the cover back on the pump's nasal actuator tip.

7. The medication expires after 7-days. Discard pump/bottle and fill new pump bottle.

8. Administer amphotericin intranasally as previously instructed.

9. Store the pump/bottle in the refrigerator between uses. (The pump/bottle may be removed 30-60 minutes before use if the cold Amphotericin mist causes more irritation than room temperature solution. Do not heat the bottle under hot water or in a microwave.)

10. If the pump/bottle breaks within the 7-days and the medication is not contaminated, the contents may be transferred to a new pump/bottle. Maintain sterility.

Itraconazole (Sporanox)

Type of Drug:

Antifungal

Use:

Used to treat fungal infections resistant to amphotericin-B by disrupting fungal cell membranes.

How Supplied:

100 mg capsules.

Special Instructions:

1. Should be taken with food. Pepsi/Coke may also help absorption of the drug.

2. No antacids (i.e., ranitidine, cimetidine, carafate, amphogel) should be taken two hours before or after the dose.

3. The following may occur and should be reported at your next clinic visit: headache, nausea, edema, heartburn, dizziness.

4. The following may occur and should be reported to your physician as soon as possible: abdominal pain, rash, continued headache, continued dizziness.

5. If you miss a dose, take it as soon as possible. If it is near the time for the next dose, skip the missed dose and take the next dose as scheduled.

Ketoconazole

Type of Drug:

Antifungal, anti-infective

Use:

Ketoconozole is used to prevent or treat fungal infections of the mouth (thrush).

How Supplied:

200 mg tablets

Special Instructions:

1. If you notice an increase in white plaques or sores in your mouth, contact your physician.

2. The following may occur and should be reported to your physician as soon as possible: dark urine, stomach pain, unusual tiredness or weakness, changes in skin or eye color such as yellowing or rash, repeated nausea, vomiting or diarrhea.

3. If any of the following occur, report the occurrence at your next clinic visit: dizziness, increased sensitivity of eyes to light, drowsiness, problems with sleeping.

4. If you miss a dose, try to make it up that day. If this is not possible, skip the missed dose and continue normal schedule.

Lasix (Furosemide)

Type of Drug:

Diuretic, anti-hypertensive

Use:

Lasix is used to eliminate excess fluid or edema. Lasix may also be used to decrease high blood pressure.

How Supplied:

20 mg, 40 mg, 80 mg, tablets, 10 mg per ml injection, and liquid form

Special Instructions:

1. Contact your physician if the following occurs: repeated nausea, vomiting or diarrhea; skin rash; hives; muscle cramps; weakness; fatigue; dizziness.

2. Lightheadedness when getting up from a lying or sitting position may occur. Getting up more slowly and gradually may prevent this. If dizziness persists contact your physician.

3. Lasix will cause an increase in the amount and frequency of urination.

4. The liquid form should be given only with the syringes provided.

5. Lasix causes the loss of potassium in addition to the reduction of fluid. The following foods are high in potassium and should be included in the diet: orange and other citrus juices; tomato juice; almonds and peanut butter; apricots, bananas, peaches, raisins or prunes.

6. If you miss a dose take it as soon as possible. If it is less than eight hours before your next dose, skip the missed dose and continue on your regular schedule. Never double doses unless instructed by your physician.

Leucovorin (Folinic Acid)

Type of Drug:

Vitamin

Use:

Leucovorin is used to protect the bone marrow from the effects of bactrim (septra) which suppresses the marrow.

How Supplied:

5 mg, 25 mg, tablets

Special Instructions:

1. Leucovorin does not usually cause any side effects or problems.

2. If the following occur contact your physician immediately: skin rash or hives; repeated nausea or vomiting; wheezing.

3. While you are taking bactrim (septra), do not stop taking leucovorin unless instructed by your physician.

4. If you miss a dose take it as soon as possible. If it is near the time of your next dose, skip the missed dose and continue on your regular schedule. Do not double the dose without your physician's instruction.

Magnesium Oxide

Type of Drug:

Magnesium Supplement

Use:

Magnesium oxide is used as a supplement for those whose magnesium intake is inadequate.

How Supplied:

140 mg capsules

Special Instructions:

1. If the following occurs, report to your physician as soon as possible: excessive thirst; feeling of warmth; sedation; confusion; muscle weakness.

2. If the following occurs, report the occurrence to your physician at your next clinic visit: diarrhea; nausea; vomiting.

3. Signs of low magnesium include irritability, tremors or shaking, twitching, muscle cramps, increased heart rate, and change in behavior.

4. If you miss a dose of magnesium oxide and remember within 2 hours, take the dose right away, then resume the regular schedule.

If you do not remember until several hours past the missed dose, skip the dose and resume your regular schedule. Never take double doses unless otherwise instructed.

Metolazone (Diulo, Zaroxolyn)

Type of Drug:

Diuretic, anti-hypertensive

Use:

Metolazone is used to eliminate excess fluid or edema. Metolazone may also be used to decrease high blood pressure.

How Supplied:

2.5 mg, 5 mg, tablets

Special Instructions:

1. Contact your physician if the following occurs: repeated nausea, vomiting or diarrhea, skin rash/hives, muscle cramps, weakness.

2. Metolazone will cause an increase in the amount and frequency of urination.

3. Metolazone causes the loss of potassium in addition to the reduction of fluid. The following foods are high in potassium and should be included in the diet: citrus juices, almonds, peanut butter, apricots, bananas, peaches, raisins, and prunes.

4. If you miss a dose, take it as soon as possible. If it is less than eight hours before your next dose, skip the missed dose and continue on your regular schedule. Never take double doses unless instructed by your physician.

Metronidazole (Flagyl)

Type of Drug:

Antibacterial, antiprotozoal

Use:

Used in the treatment of anaerobic bacterial infections.

How Supplied:

250 mg, 500 mg, tablets

Special Instructions:

1. May be taken with food to lessen GI irritation.

2. The following may occur and should be reported at your next clinic visit: diarrhea, nausea, vomiting, headache, lightheadedness, discoloration of urine (red brown).

3. The following may occur and should be reported to your physician as soon as possible: continued dizziness, numbness or weakness in hands and feet, rash, blurred vision or eye pain.

4. If you miss a dose, take it as soon as possible. If it is near the time for the next dose, skip the missed dose and take the next dose as scheduled.

5. Avoid any alcoholic beverages or medication containing alcohol (some cough syrups & cold preparation contain alcohol).

Nystatin

Type of Drug:

Antifungal

Use:

Nystatin is used to prevent or treat fungal infections of the mouth (thrush).

How Supplied:

Liquid

Special Instructions:

1. Do routine oral care. After applying Nystatin to gums, inside cheeks, and lips, hold in mouth for one minute before swallowing. Nystatin can be applied with a toothette or can be swished.

2. Do not eat or drink anything for at least 20 minutes after taking Nystatin.

3. If you notice an increase in white plaques or sores in your mouth, contact your physician.

4. If the following occur, contact your physician: repeated nausea, vomiting, diarrhea, or stomach pain.

5. If you miss a dose, try to make it up that day; if this is not possible, skip the missed dose and continue normal schedule.

Peridex

Type of Drug:

Antibacterial mouthwash

Use:

Peridex is used to prevent or treat bacterial infections of the mouth.

Special Instructions:

1. Do routine mouth care and use your Nystatin or Clotrimazole (antifungal agent). Wait 20 minutes.

2. Rinse your mouth with Peridex by swishing and spitting.

3. If you are unable to swish, use a toothette to swab the Peridex into your mouth.

4. DO NOT swallow Peridex. It is a mouth wash intended to be swished only. (However, it is important to know that if you do swallow some, it is not harmful to you.)

5. Peridex may cause a discoloration of your teeth and gums. This is temporary and can be removed with a routine dental cleaning.

Potassium

Type of Drug:

Electrolyte

Use:

Potassium supplements are used for those who do not have enough potassium in their daily diet or lose potassium as a result of certain medications.

How Supplied:

20 mEq tablets, 8 mEq, 10 mEq, sustained release tablets/capsules, and liquid form

Special Instructions:

1. If any of the following occur contact your physician as soon as possible: numbness or tingling in hands, feet or lips; unusual tiredness or weakness; shortness of breath or difficulty breathing; confusion or unexplained anxiety; repeated vomiting or diarrhea.

2. If any of the following occur, report the occurrence at your next Clinic visit: diarrhea; nausea or vomiting; stomach pain or discomfort.

3. Take potassium with food or directly after meals to decrease stomach upset.

4. The liquid form should be taken with or diluted in at least 4 oz. of cold water or juice to decrease stomach upset.

5. Allow fizzing to stop before taking dissolved medicine.

6. If you miss a dose of potassium and remember within two hours, take the dose right away, then resume the regular schedule. If you do not remember until several hours past the missed dose, skip the dose and resume your regular schedule. Never double doses unless otherwise instructed.

7. Potassium comes in several different forms. If you do not like the kind you are taking, ask your nurse or physician if you can try another form.

Prednisone (Methylprednisolone)

Type of Drug:

Corticosteroid

Use:

Prednisone is used to prevent and treat graft-versus-host disease.

How Supplied:

1 mg, 2.5 mg, 5 mg (scored), 10 mg (scored), 20 mg (scored), 50 mg (scored), liquid form, and IV methylprednisolone (see next page).

Special Instructions:

1. Use a calendar to keep track if you have alternating doses.

2. It is very important to keep close track of Prednisone doses. Your physician may change these frequently and it is important that you know the correct dose.

3. The following may occur and should be reported at your next Clinic visit: fluid retention; increased appetite; weight gain; muscle or joint pain.

4. If the following occur contact your physician immediately: skin rash or hives; muscle cramping or weakness; abdominal distention; shortness of breath; persistent headache.

5. Prednisone reduces the body's ability to fight infection. Avoidance of ill persons is important. Even if your white count is normal, Prednisone immunosuppresses you and makes you very susceptible to infections.

6. Report any sign of infection.

7. The dose of Prednisone should not be stopped or decreased without a physician's instruction.

8. If you miss a dose of Prednisone take it as soon as possible. If it is less than eight hours before your next scheduled dose, skip the missed dose and continue on your regular schedule. Contact your physician if you are unsure of what to do with a missed dose. Never double a dose without your physician's instruction.

9. If on high doses of steroids or IV doses, it is important to keep up with your exercise routine. Prednisone causes muscle wasting especially in your legs and may make you feel weak. Exercise will help you keep your activity level up.

IV Methylprednisolone
Methylprednisolone is the IV form of prednisone. Methylprednisolone is available in vials of 40 mg in 1 ml.

Draw up the amount noted on the 1 cc syringe which corresponds with the ordered dose. (Additional doses can be found below.)

Ranitidine (Zantac)

Type of Drug:

Anti-ulcer, gastric-acid secretion inhibitor

Use:

Ranitidine is used to decrease the amount of acid released by the stomach.

How Supplied:

150 mg tablets, and liquid form.

Special Instructions:

1. The following may occur and should be reported at your next clinic visit: headache; lightheadedness; constipation; nausea; abdominal pain.

2. If the following occurs contact your physician as soon as possible: persistent headache or dizziness; repeated nausea or vomiting; skin rash; unusual weakness.

3. It may take a few days for ranitidine to relieve stomach pain. Continue to take ranitidine even when you feel better unless your physician tells you to stop.

4. If you miss a dose take it as soon as possible. If it is near the time for the next dose, skip the missed dose, and take the next dose as scheduled.

5. Ranitidine can occasionally cause a mild suppression of your bone marrow. If your counts are dropping, you may be taken off ranitidine.

6. If you are also taking carafate, it must be given one hour apart from ranitidine as it counteracts the effects of the drug.

Sodium Bicarbonate

Type of Drug:

Potent, rapid acting antacid

Use:

Sodium Bicarbonate reduces stomach acid by producing salt, water, and carbon dioxide which prevents acidosis (increases CO2). It is also used as a CO2 replacement.

How Supplied:

650 mg tablet, 1 Gram capsules.

Special Instructions:

1. Store away from heat and direct light.

2. The following may occur and should be reported at your next clinic visit: dry mouth, increased urination, nausea, vomiting, increased thirst, abdominal and muscle cramping.

3. If the following occur, contact your physician as soon as possible: repeated nausea, vomiting, headache, loss of appetite, or cramping.

4. If you miss a dose, take it as soon as possible. If it is near the time for the next dose, skip the missed dose and take the next dose as scheduled.

Spironolactone (Aldactone)

Type of Drug:

Potassium-sparing Diuretic

Use:

Spironolactone is used to help eliminate excess fluid or edema. Unlike other diuretics, such as Lasix, Spironolactone will not cause the body to lose potassium.

How Supplied:

25 mg, 100 mg tablets.

Special Instructions:

1. Contact your physician if the following occurs: repeated nausea, vomiting or diarrhea; confusion; numbness in hands, feet or lips; unusual tiredness or weakness; skin rash.

2. If you experience stomach upset, you may take Spironolactone with meals or with milk.

3. Store away from heat, moisture or direct light.

4. If you miss a dose, take as soon as possible. However, if it is almost time (less than 8 hours) for your next dose, skip the missed dose and continue on your regular schedule. Never double doses unless instructed by your physician.

Suprax (Cefixime)

Type of Drug:

Cephalosporin antibiotic

Use:

Broad spectrum antibiotic used primarily for otitis media (ear infections) and organisms resistant to penicillins and some cephalosporins.

How Supplied:

Available at outside pharmacy.

Special Instructions:

1. Common side effects include diarrhea, nausea and vomiting, skin rashes, and abdominal pain.

2. If you miss a dose, take it as soon as possible, then resume the regular schedule. However, if it is almost time for your next dose, skip the missed dose and resume your regular schedule. DO NOT double dose.

3. Suprax is contraindicated in patients with known allergy to the Cephalosporin group of antibiotics.

4. Shake well before using. Discard unused portion after 14 days. Do not refrigerate.

5. Absorption increases when taken with food.

Trimethoprim and Sulfamethoxazole (Bactrim, Cotrim, Septra)

Type of Drug:

Antibiotic

Use:

Used to prevent pneumocystis pneumonia.

How Supplied:

400/80 tablets, 800/160 double strength tablets and liquid form.

Special Instructions:

1. The following may occur and should be reported at your next clinic visit: decreased appetite; nausea; vomiting; diarrhea; headache.

2. The following may occur and should be reported to your physician as soon as possible: rash; repeated nausea, vomiting or diarrhea; persistent headache.

3. If you miss a dose take as soon as possible. If it is near the time for the next scheduled dose, make up the missed dose on the day following your last scheduled dose. Report the missed dose at your next clinic visit.

4. Take Leucovorin while you are taking Trimethoprim and Sulfamethoxazole unless instructed by your physician to do otherwise.

5. If your physician tells you to stop taking Bactrim, you should begin Pentamidine treatments within a month of that time. Ask your physician about this if he does not order it.

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