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186 Cards in this Set
- Front
- Back
Tricyclics
|
Elevil, Tofranil, Norpramin
DEPRESSION budcat takes 2-6 weeks for effect |
|
MAOI
|
Marplan, Nardil, Parnate
DEPRESSION PHOBIAS ANXIETY Hypertensive crisis - caused when taken with trycyclics- DO NOT use with tricyclics - Tyramine precautions |
|
SSRI
|
Prozac, Paxil, Zoloft, Luvox, Celexa
depression, anxiety, panic, aggression, anorexia, OCD Serotonin Syndrome 2-4 weeks to take effect do NOT use with MAOI--> HTN crisis |
|
SSRI
|
Serotonin Syndrome
- rapid onset of altered mental status - agitation - myoclonus - hyperreflexia - fever, shivering - diaphoresis - ataxia - diarrhea * St. John's Wort |
|
Atypical
|
Desyrel
Remeron Effexor - takes 2-4 weeks to be effective |
|
Anti-anxiety side-Effects
|
sedation
drowsiness |
|
Antidepressant Side Effects
|
Anticholinergic effects
postural hypotension |
|
MAOI SE
|
hypertensive crisis
|
|
Lithium Side Effects
|
LFT
Blood Tests |
|
Phenothiazines
|
EPS
Tardive dyskinesia can be permanent if not assessed early |
|
Phenothiazines
|
photosensitivity
|
|
MAOI
|
require diet precautions- avoid tyramine rich foods
|
|
Antimanic/Mood Stabilizing Drugs
|
Lithium
Anticonvulsants Antipsychotics Sedatives |
|
Lithium
|
esp. Manic phase
weight gain, Hypothyroidism maintain .5-1.5 levels Sodium- keep sal usage consistent do NOT use with diuretics |
|
Valproic Acid (DEpakene)
|
Gi distress, Hepatotoxicity
Tremor, Sedation, dizzy administer with food serum levels: 50-125 |
|
Carbamazepine
|
Anticonvulsant
alternative to lithium dizziness, ataxia |
|
Atypical Antidepressents are also used for
|
Mania
|
|
antipsychotic Drugs
|
Phenothiazines ( typical)- treat positive only
Atypical- positive and negative |
|
Chlorpromazine
Fluphenazine Haloperidol Chlorprothixine Thiothixene |
Anti-psychotic ( phenothiazines)
|
|
Antipychotic Adverse Reactions
|
drowsiness
orthostatic hypotension EPS Anticholinergic Photosensitivity NMS |
|
EPS
|
Pseudo-Parkinsonism
Akathisia Dystonia Tardive Dyskinesia |
|
Haldol
|
severe EPS
can be given every 4 weeks (decanote) |
|
Orap
|
Tourete's Syndrome
|
|
Atypical Antipsychotics
|
Risperidone
Olanzapine Quetipine Aripiprazole Ziprasidone Clozapine |
|
Atypical Antipsychotics
|
treat positive and negative
fewer side effects |
|
Atypical Antipsychotics Adverse Reactions
|
RIsperdal- NMS, EPS
Zyprexia- drowsiness, dizzy Seroquel- EPS, anticholinergic Clozaril-AGRANULOCYTOSIS ( check WBC count) |
|
Parkinsonism
|
rigidity
shuffling gait pill-rolling tremors mask-like face |
|
Akithesia
|
inability to sit still
give Inderal |
|
Dystonia
|
limb and neck spasms
uncoordinated, jerky movements - give IM anticholinergics |
|
CAB protocol
|
for EPS symptoms
Cogentin, Artane Benadryl |
|
Tardive Dyskinesia
|
involuntary tongue/lip movements
blinking choreiform movements of limbs and trunk - PERMANENT side effect |
|
Photosensitivity
|
exposed skin turns blue
color changes in eyes- no vision impairment |
|
NMS
|
life-threatening emergency
high fever tachycardic stupor increased respirations sever muscle rigidity |
|
Serotonin Syndrome
|
confusion
disorientation autonomic dysfunction |
|
Anticholinergic Effects
|
BUDCAT
Bluured vision urinary retention dry mouth constipation A? tachycardia |
|
Antabuse
|
Aversion Therapy
SERVERE SE if alcohol consumed: NV, hypotension, headache, rapid pulse and respiration READ LABELS!!! |
|
Alcohol Withdrawal
|
Librium, Ativan
|
|
Opiate Withdrawal
|
watery eyes
runny nose dilated pupils anxiety insomnia tachycardia NVD |
|
Opiate OD
|
respiratory depression--arrest
circulatory depression--arrest unconsciousness---coma death |
|
Opiates Effect
|
physical and mental deterioration
rapid tolerance impaired judgement |
|
Cocaine Withdrawal
|
depression
fatigue disturbed sleep anxiety psychomotor agitation |
|
Cocaine OD
|
tachy
pupilary dilatation increased BP cardiac arryhtmias perpiration, chills NV |
|
Cocaine Effects
|
psychological dependence
tolerance within hours or days |
|
Amphetamines Withdrawal
|
DEpression
fatigue disturbed sleep |
|
Amphetamines OD
|
restlessness
tremors rapid respiration confusion assaultive behavior hallucinations panis |
|
Amphetamines Effect
|
Paranoid delusions
|
|
Hallucinogenics Withdrawal
|
NONE
|
|
Hallucinogenics OD
|
Panic
Psychosis |
|
Hallucinogenics Effect
|
flashabcks
impaired judgement |
|
BZA Withdrawal
|
tremors
agitation anxiety abdominal cramps grand mal seizures |
|
BZA OD
|
drowsiness
confusion hypotensoin coma--> death |
|
Chemically Dependent Client
|
Group therapy
support groups |
|
Alzheimer's Meds
|
Tacrine
Donepezil Rivastigmine Galantamine Concerta ( ER) Adderall |
|
AZ Adverse Reactions to Meds
|
Nausea and Diarrhea
Cognex: considerable GI distress and elevated liver enzymes |
|
AZ Teaching for Meds
|
NO anticholinergic meds!
not with severe liver impairment take with meals to avoid GI upset do NOT discontinue abruptly |
|
AZ Alternative meds
|
Atypical Antipsychotics
-Risperidone, Quietapine, Olanzapine not CLozaril bc of side effects Mood Stabilizers, Anti-anxiety as indicated |
|
Penicillin G
|
gram positive bacteria
- diarrhea, GI reactions - use with caution with allergies to cephalosporins -observe for 30 minutes following parenterla admin. -taken on an empty stomach -alters contraceptive effectiveness |
|
Ampicillin
|
Broad Spectrum
-rash (reactions) - contraindicated for those allergic to penicillin |
|
Tetracycline
|
Photosensitivty reaction
- decrease oral contraceptives - avoid antacids/milk -yellow/brown discoloration and growth retardation |
|
Adrenergics.Sympathomimetics
- Bronchodilators |
Epinephrine
Isoproteronol Albuterol Terbutaline levabuterol |
|
Adverse Reactions to Adrenergics/Sympathomimetics for Bronchodilation
|
Anxiety
increased HR NV Urinary retention |
|
Adrenergics/Sympathomimetics Nursing COnsiderations
|
- check HR
- monitor for urinary retention - proper use of inhaler -bronchodilator before steroid inhaler -may cause sleep disturbance |
|
Methylxanthines
|
Aminophylline/Theophylline
- GI distress, Sleeplessness, Cardiac Dysrhytmias, Hyperactivity : with food :avoid caffeine :therapeutic range: 10-20 :crosses placenta |
|
Corticosteroids
|
Prednisone
Solu-Medrol Beclomethasone Pulmicort Flovent Azmacort AeroBid |
|
Corticosteroids (Anti-Inflammatory)
|
Adverse Reacts:
- cardiac dysrhytmias with long term use Nursing: - instruct in proper use * see Endocrine Meds |
|
Anticholinergics for Bronchodilation and Rhinorhea control
|
Atrovent
- dry mouth, blurred vision, cough DO NOT EXCEED 12 DOSES in 24 HOURS! |
|
Combination Productsfor Asthma
|
Advair
|
|
Tuberculosis Meds
|
INH
Rifampin Ethambutol |
|
Isoniazid (INH)
|
Side Effects:
-NV -RARE- neurotoxicity, hepatotoxicity - administer with B6 -active TB patients -crosses BBB |
|
Rifampin
|
-possible orange urine
|
|
Nitrates
|
nitroglycerin
Isordil Imdur |
|
Nitrates Indications
|
Angina prophylaxis
acute attack reduces vascular resistance |
|
nitrates Adverse Reactions
|
HEADACHE
flushing dizziness weakness hypotension nausea |
|
Nitrates Nursing COnsiderations
|
- monitor relief
- client rests -monitor vitals - store in original container - replace NTG every 6 months |
|
Beta Blockers for Angina
|
Propanolol
Atenolol Nadolol |
|
Beta Blocker Indications
|
Angina prophylaxis
reduces o2 demand |
|
Beta Blcoker Adverse Reactions
|
fatigue
lethargy hallucinations impotence bradycardia hypotension Heart Failure Wheezing |
|
Beta Blockers Nursing Indications
|
Monitor APICAL heart rate
assess decreased BP DO NOT STOP ABRUPTLY |
|
Calcium Channel Blockers
|
Verapamil
Nifedipine Diltiazem |
|
CCB Indications
|
angina prophylaxis
|
|
CCB Adverse Reactions
|
Dizziness
hypotension headache syncope peripheral edema HYPOKALEMIA Dysrhythmia HF |
|
CCB Implications for Nurses
|
monitor Potassium ( hypokalemia)
swallow pills whole do not stop abruptly take 1 hour before meals or 2 hours after meals |
|
Anti-Lipid Meds
|
Bile Sequestrants
Statins Niacin |
|
Bile Sequestrants
|
Welchol
falulence, belching |
|
Statins
|
Lipitor, Zocor
- may elevate liver enzymes! - Rhabdomyalysis *monitor LFT every 6 months *avoid grapefruit juice *report muscle tenderness |
|
Niacin
|
*Flushing
- upper GI distress - give aspirin before to avoid flushing |
|
Meds for Acute Angina
|
Nitroglycerin
|
|
Not appropriate for Acute Angina
|
Digoxin
Atropine Propanolol |
|
Digoxin
|
increases the strength and contractility of the heart muscle
|
|
Atropine
|
increases HR
-Vagal nerve suppresion the Vagal nerve suppresses the heart rate |
|
Propanolol
|
LONGTERM management of angina
- controls vasoconstriction |
|
Ck-MB
|
onset: 2-4 hours
Peak: 12-20 hours returns: 48-72 hours |
|
Troponins
|
Onset: 1 hour post-injury
Peak: 10-24 hours Normal: 5-14 days |
|
MI drugs
|
MOrphine SUlfate
Nitroglycerin beta blockers CCB aspirin antiplatelet aggregates |
|
Fibrinolytic Therapy
( as soon as a positive troponin after MI) |
Streptokinase
Reteplase Alteplase |
|
Reteplase
|
fibrinolytic
- for coronary thrombus - can cause hypotension - obtain baseline PT, PTT, CBC - avoid needle punctures |
|
Alteplase
|
DVT, PE, Coronary thrombosis
- interacts with heparin-->increases risk for bleeding - does NOT work systemically |
|
Antihypertensive Pharm therapy side effects
|
IMpotence
insomnia |
|
Diuretics
|
Thiazides- K-wasting
Loop- K-wasting K-Sparring Combination |
|
Thiazides ( diuretics)
|
HCTZ
- decreases fluid volume HYPOKALEMIA sexual dysfunction *Postural Hypotension? *Caution with renal failure or taking lithium **Hypokalemia increases risk for Digitalis toxicity *Adminitster K supplements |
|
HYPOKALEMIA Symptoms
|
dry mouth
thirst weakness drowsiness lethargy muscles aches tachycardia |
|
Loop Diuretics
|
Furosemide, Bumetanide
- hypokalemia - sexual dysfunction * RAPID volume depletion and electrolyte depletion *same with thiazides |
|
Potassium Sparing Diuretics
|
Spironolactone
- Hyperkalemia - Gyencomastia **watch with NSAID or ACE use ** give after meals to decrease GI stress |
|
Anti-Hypertensives: Alpha Adrenergic Blockers
|
Prazosin
|
|
Carvedilol
|
decreases BP without reflex tachy/bradycardia
- Adverse Reactions:HF, Ventricular dysrhythmias orthostatic hypo Contrindications: HF Heart Block COPD * |
|
Beta Blockers for Anti-HTN
|
Metoprolol, Propanolol,
- blocks SNS - slower HR - lowers BP - reduces o2 consumption during MI *do not d/c abruptly *watch for SOB *masks symptoms of hypoglycemia |
|
Clonidine ( Catapres)
|
*watch for reboudn HTN
* caution with position changes - lowers BP |
|
Vasodilators
|
Hydralazine, Minoxidil
decreases BP by decreasing vascular resistance - headache, fluid retention *observe for peripheral edema |
|
Angiotensin II Antagonists
|
Losartan, Valsartan
-Adv. Rxn: hypotension, renal failure *monitor liver enzymes |
|
ACE-Inhibitors
|
Anti-HTN
"prils" - suppress RAAS *useful with diabetics Adv. Rxn: proteinuria, skn rash, cough *observe for ARF *routine renal function tests *remain in bed 3 hours after first dose |
|
CCB for anti-HTN
|
Diltiazem, Nifedipine, Verapamil
decreased conduction Adv. Rxn.: headache, constipation, tachy, HF *Limit caffeine *before meals *avoid grapefruit juice |
|
Anti-Coagulants
|
Heparin, Warfarin
|
|
Heparin Sodium
|
antagonist to thrombin
Adv.Rxn: hemorrhage, agranulocytosis, keukopenia, hepatitis *PTT *Antagonist: Protamine Sulfate |
|
WArfarin ( Coumadin)
|
Adv. Reaction:
- hemorrhage -agranulocytosis - leukopenia - hepatitis *PT *avoid sudden changes in Vitamin K input Antagonist: Vitamin K |
|
Antiplatelet Agents
|
Plavix, LMWH
|
|
Plaxiv ( Clopidogrel)
|
short term use after interventions
intolerant to aspirin Adv. Rxn: - Pancytopenia - Hemorrhage - GI irritation, bleed *monitor CBC |
|
LMWH (lovenox)
|
DVT prevention
- hemorrhage - GI irritation, bleeding *monitor for bleeding *subq *monitor CBC *use soft toothbrush |
|
Drugs that cause Dysrhythmias
|
Digoxin
Quinidine Caffeine Nicotine Alcohol |
|
Antiarrhythmics
|
Quinidine, Lidocaine, Inderal, Verapamil, Atropine
Digoxin, Epinephrine, Natrecor |
|
Propanolol for dysrhythmias
|
Supraventricular and ventricular tachy-dysrhythmias
*contraindicated in COPD and Athsma |
|
Amiodarone
|
Inotropic
ventricular dysrhythmias *wear suncreen and glasses outside- Photophobia |
|
Atropine for dysrhythmias
|
for bradycardia
Adv. Reaction: chest pain, urinary retention, dry mouth *monitor HR and rhythm, assess for chest pain *assess for urinary retention *avoid with use with glaucoma |
|
Digoxin
|
Atrial Fib
Supraventriculr dysrhythmias Adv. Rxn: bradycardia, dysrhythmias, anorexia, NVD, visual disturbances *report signs of toxicity (hypokalemia increases risk) *causes HYPERCALCEMIA |
|
Epinephrine
|
cardiac arrest
Adv. Rx,: tachy, HTN - impaired renal function--> toxicity *monitor BUN and creatine *monitor vitals |
|
Natrecor
|
ADHF
- hypotension is side effect *many drug-drug rxns *as diuress occurs, monito electrolytes (K) |
|
Wihhold digitalis if:
|
HR < 60 bpm
|
|
Digitalis
|
Side effects increased when hypokalemic
SLOWS the HR hold if: <60 or >120 |
|
Signs of DIgitalis Toxicity
|
bradycardia
tachycardia dysrythmias NV headache |
|
Antacids-
(Anti-ulcer) |
Maalox, Mylanta
- neutralizes stomach acid Adv. Rxn.: Constipation, DIarrhea, Drug Interactions *AFTER MEALS |
|
H2- Antagonists
(Anti-Ulcer) |
Zantac, Tagamet, Pepcid
- prophylactic tx *no smoking *expensive |
|
@ risk for developing ulcers
|
on corticosteroids
stressed |
|
Proton Pump INhibitors
(Anti-Ulcer) |
"prazole's"
- tx of erosive esophigitis Adv. rxn: - abdominal pain, hepatic damage, pancreatitis, gastroenteritis * BEFORE MEALS * do NOT CRUSH/CHEW |
|
Add'l Drugs (Anti-Ulcer)
|
Prokinetic Drugs
Antimetics Cough Suppressants Stool Softeners |
|
Meds that increase risk for PUD
|
Salicylates (aspirin)
NSAIDS ( ibuprofen) Corticosteroids in high doses Resperine (anti-HTN) Anticoagulants |
|
Drugs for Inflammatory Bowel DIseases
- Crohn's - UC |
Steroids
Anti-diarrheals sulfasalazine (azulfinide) |
|
LActulose (Cephulac)
- Encephalopathy |
decreases ammonia levels and bowel pH
Adv. Rxn: Diarrhea * observe for diarrhea *monitor ammonia levels |
|
Thyroid Storm Meds
|
Propylthiouracil (PTU)
Methimazole (Tapazole) Propanolol (indural)- decreases excessive sympathetic stimulation |
|
THyroid Ablation therapy
|
PTU/ Methimazole
- blcosk synthesis of t3/t4 - given over months - makes them euthyroid - given to prepare for thyroidectomy |
|
Radiation for THyroid
|
Iodine 131
- destroys thyroid cells - GI irritation ( vomiting-reactive) - on radiation precautions |
|
Thyroid Preparations
|
Synthroid
Cytomel Armour Thyroid |
|
Synthroid
|
increases metabolic rates
synthetic T4 Adv. Rxn: - anxiety, insomnia, tremors, tachy, palpitations, angina, dysrhythmias *check serum hormone levels *Check BP/pulse *Avoid foods with iodine *initiate cautiously in clients with cardiovascular disease |
|
Corticosteroids for Endocrine Disorders
|
Hydrocortisone, Prednisone, Dexamethasone
|
|
Corticosteroids
|
Hormone replacement
Severe rheumatoid arthritis autoimmune disorders |
|
Corticosteroids Adverse Reactions
|
impaired wound healing
abnormal fat deposition HYPERGLYCEMIA hirsutism moon face osteoporosis **symptoms of Cushing's if OD |
|
Corticosteroids Nursing IMplications
|
*wean slowly
monitor K, Glucose and Na (can become diabetic) Weigh dailiy ( report if 5 lb/week gained) give with antiulcer drugs or food monitor BP and pulse *Cushings syndrome symptoms teaching |
|
sudden withdrawal of corticosteroids =
|
Addison's disease
|
|
Addison Crisis meds
|
IV glucose
parenteral glucocorticoids - large fluid volum replacement |
|
More Addison Crisis
|
- rapid infusion of fluids
- IV glucose - PARENTERAL HYDROCORTISONE - Aldosterone replacement = Fludrocortison Acetate(Florinef) PO + Sodium Chloride ( salt) if Na deficit |
|
Take steroids with
|
meals to avoid GI upset
(if prolonged--call dr) |
|
Oral Hypoglycemics
|
Sulfonylureas (Glipizide)
Biguinides ( Metformin) Alpha-Glucosidase Inhibitors (Precose, Glyset) Thiozolidinedoines (Avandia, Actos) Meglitindes ( Prandin) Combo ( Glucovance) |
|
Sulfonylureas
|
"ide's"
- stimulates insulin release - glucose take up easier Adv. Rxn.: heartburn, constipation, agranulocytosis *given once daily with first meal *elderly or on Beta Blockers- hard to detect |
|
Metformin ( Glucophage)
|
-Biguinides
inhibit hepatic glucose production and increase sensitivity of peripheral tissue to insulin * ER tablets should be taken with evening meal *renal or Liver disease? *not with Iodine contrast media |
|
Avandia/Actose
|
Thiazolidinediones
- decreases insulin resistance *weight gain and incr. cholesterol *may precipitate HF |
|
Rapid Acting Insulin
|
Lispro/ Insulin Aspart
Onset: 15 minutes Peak: 2-4 hours *give within 15 minutes of a meal |
|
Short Acting Insulin
|
Regular (human)
Onset: 30-60 minutes Peak: 2-3 hours *CAN BE GIVEN IV |
|
Intermediate Acting INsulin
|
NPH, Humulin
Onset: 1-2 hours Peak: 6-12 hours Mixtures: rapid Acting with Regular Regular@ 30% NPH @ 70% |
|
Long Acting Insulin
|
Lantus
Onset: 1 hour Peak: none *give at bedtime basal insulin DO NOT MIX do not shake! Use with caution in NPO client |
|
Anemia-inducing drugs
|
Salicylates
Thiazides Diuretics *Lead exposure *insecticide exposure |
|
Blood Products
|
Packed RBC
frozen RBC Platelets FFP (fresh frozen plasma) Albumin |
|
Fe preparations
|
with meals to decrease gastric irritation
|
|
B12 and folic acid
|
ORALLY
*except pernicious anemia- parenteral |
|
Parenteral Iron
|
Z-track - prevents staining skin
use air bubble to avoid withdrawing med into subq do NOT use deltoid do NOT massage injection site |
|
Syphillis
|
Penicillin G
|
|
Gonorrhea
|
Ceftriaxone
|
|
Chalmydia
|
Tetracycline
|
|
Trichomoniasis
|
FLagyl
|
|
Candidiasis
|
Monistat
Clotrimazole Nystatin |
|
Herpes
|
Acyclovir
|
|
HPV
|
podophyllum
|
|
Oxytocin (pitocin)
|
Uterine Stimulant-
- for uterine antony AdvRxn: - afterpains inmultipara - HTN *after placenta delivery *may stimulate let-down milk reflex and flow of milk when engorged |
|
Methergine
|
for uterine antony ( a uterine stimulant)
AdvRnx: HTN *.2 mg --> .2 mg q4-6 *do not use if HTN or preeclamptic *take BP prior ( if higher than 140/90- HOLD- notify dr) |
|
Prostaglandin F2
(hemabate) |
uterine stimulant
- for uterine antony AdvRxn: headache, NV, fever, bronchospasm, wheezing *contrindicated for asthma *check temp every 1-2 hours *auscultate breath sounds frequently |
|
Prophylactic Eye Care
|
Erythromycin
*after 1 minute may wipe away excess - for tx of opthalmia neonatorum and Chalmydia conjuntivitis |
|
Silver NItrate
|
- gonorrhea exposure to eyes
ADVrxn: staining of skin red, puffy eyes *do NOT irrigate eyes after instillation *mandatory in the US |
|
Birth Analgesics
|
Meperidine
Fentanyl Morphine Sulfate |
|
Meperidine
Fentanyl Morphine Sulfate |
AdvRxn: respiratory depression, fetal narcosis, hypotension, itching, urinary retention
*do not admin if respirations < 12 *NARCAN |
|
Bisocodyl (dulcolax suppository)
|
constipation after delivery
AdvRxn: cramping *effective in 15 min- 1 hour |
|
Docusate Sodium (Colace)
|
for constipation
or painful defacation with 4th degree tear -abdominal cramping *encourage increased fluid intak *results within 1-3 days of continual use |
|
RhoGAM
|
prevention of isoimmunization with next pregnancy
*give to Rh- women @ 28 weeks (Rh- with a negative antibody titer) *with Rh + newborn *within 72 hours of delivery **is a blood product - checked by 2 nurses - syringe returned to lab - not given to mother with positive Indirect Coombs--she is already sensitized and has developed antibodies |
|
Rubella vaccine
|
Rubella titer <1:10
*before discharge *ok to breastfeed - informed consent **avoid pregnancy for 3 months |
|
Needs for RhoGAM
|
Rh- mom with Rh+ baby
Negative Direct Coomb's test (if positive) she is already sensitized |
|
Bisocodyl (dulcolax suppository)
|
constipation after delivery
AdvRxn: cramping *effective in 15 min- 1 hour |
|
Docusate Sodium (Colace)
|
for constipation
or painful defacation with 4th degree tear -abdominal cramping *encourage increased fluid intak *results within 1-3 days of continual use |
|
RhoGAM
|
prevention of isoimmunization with next pregnancy
*give to Rh- women @ 28 weeks (Rh- with a negative antibody titer) *with Rh + newborn *within 72 hours of delivery **is a blood product - checked by 2 nurses - syringe returned to lab - not given to mother with positive Indirect Coombs--she is already sensitized and has developed antibodies |
|
Rubella vaccine
|
Rubella titer <1:10
*before discharge *ok to breastfeed - informed consent **avoid pregnancy for 3 months |
|
Needs for RhoGAM
|
Rh- mom with Rh+ baby
Negative Direct Coomb's test (if positive) she is already sensitized |