L’ivermectine (Stromectol) est un antiparasitaire dont l’action repose sur la liaison sélective aux canaux chlore activés par le glutamate présents dans les cellules nerveuses et musculaires des parasites. Cette fixation entraîne une augmentation du flux de chlore, provoquant une hyperpolarisation et une paralysie irréversible. L’ivermectine est active contre la gale, l’onchocercose et certaines strongyloïdoses. Sa biodisponibilité orale est variable, augmentée par la prise alimentaire, et son élimination est principalement fécale via un métabolisme hépatique. Elle ne traverse pas la barrière hémato-encéphalique, ce qui limite les effets neurologiques chez l’homme. Les précautions concernent l’interaction avec les inhibiteurs du CYP3A4, ainsi que les réactions inflammatoires dues à la destruction massive des parasites. Dans les documents de référence, stromectol prix est associé à des protocoles précis adaptés aux différentes infestations, avec une attention particulière sur la sécurité d’emploi en cas d’immunodépression.

Perinatalhospice.org

A THERAPEUTICALLY EQUIVALENT PRODUCT MAY BE DISPENSED AND ADMINISTERED UNLESS CHECKED IN THE LEFT COLUMN.
DATE AND TIME
NEONATAL COMFORT CARE ORDERS
MUST BE ENTERED
- DISCHARGE
ALLERGIES:
Weight: _____________ kg
Check (✓) all that apply and fill in the blank if applicable
1.
May discharge to:
Other __________________________
Medical Diagnosis: __________________________________________
Code Status:
Full Code
See DNAR Form
Breast milk or Formula _____________ as tolerated by breast, bottle, feeding tube, or syringeFeeding tube type: Corpak Size _______ UnweightedIf needed place a Corpak for home care Size ___________ Unweighted Offer Non-pharmacologic Comfort Measures Prn: Swaddling, Holding, and Pacifier
Offer Oral Sucrose per policy for mild to moderate pain Neonatal Infant Pain Scale (NIPS) less than 4
Pain Control:
A. Short-acting or Breakthrough Pain Medications
Opioids need not be held for respiratory depression in actively dying patients.
Morphine ____mg (0.2 - 0.5 mg/kg/dose) Po q ____ HRS Prn severe pain NIPS score greater than 4Acetaminophen ____mg (10 -15 mg/kg/dose) Po or PR q ____HRS Prn mild pain Note: Max dose = 90 mg/kg/day if greater than 36 weeks; 60 mg/kg/day if 32 - 36 weeks B. Long-acting Pain Medications
Opioids need not be held for respiratory depression in actively dying patients.
Methadone ____mg (0.05 - 0.1 mg/kg/dose) Po q ____HRS C. Gastric Pain
Famotidine suspension (8 mg/mL) ______mg (0.5 mg/kg/dose) Po q 12 hours, or
Other: _______________________________________________
Dyspnea: Order opioids here if patient not already receiving opioids for pain.
Morphine ____mg (0.2 - 0.5 mg /kg/dose) Po q ___HRS Prn dyspnea
or
Lorazepam ____mg (0.1 mg /kg/dose) Po q ___HRS Prn dyspnea
____ % Oxygen ____ liters/min. by with humidification via neonatal/infant nasal cannula (indicated for
hypoxemia; may be helpful in other cases)
Anxiety/Agitation
Lorazepam ____mg (0.1 mg /kg/dose) Po q ____HRS Prn agitation. May give IV if unable to tolerate Po
or
Diphenhydramine ____mg (1 mg /kg/dose) Po q ____HRS Prn agitation
10. Secretions
Control with medications is preferred as suctioning can be uncomfortable for the patient.
Note: Minimizing fluids will help decrease symptoms
Reposition q 2-4 HRS as toleratedGlycopyrrolate ____mCg (40 - 100 mCg /kg/dose) Po q ___HRS Prn secretions Portable suction equipment with suction catheters 11. Fever
May consider additional non-pharmacologic measures such as bathing.
Acetaminophen ____mg (10 -15 mg /kg/dose) Po or PR q ____HRS Prn Temp greater than ____°CNote: Max dose = 90 mg/kg/day if greater than 36 weeks; 60 mg/kg/day if 32 - 36 weeks 12. Diarrhea
Loperamide ____ mg (0.08 - 0.24mg /kg/DAY in divided doses) Po q ___ HRS Prn diarrhea (Do not exceed 2 mg/dose), or
12-hour Chart Check___________________________ RN DATE: _______ / _____ / _____ TIME:____________
T.O. __________________________________________Taken by: ______________________________________Title:______________________
TRANSCRIBED BY: ______________ ____/____/ ____, TIME:___________ NOTED BY:_______________ ____/____/ ____, TIME:___________
PHYSICIAN SIGNATURE: ________________________________________________________ DATE:________________ TIME: ____________
PRINTED NAME/ID:
(FOR MEDICATION/BIOLOGICALS T.O. ORDERS ONLY, COUNTER-SIGN ABOVEWITHIN 48 HOURS, AND INCLUDE THE DATE/TIME AUTHENTICATED) NEONATAL COMFORT
CARE ORDERS - DISCHARGE
PHYSICIAN'S ORDERS

Source: http://perinatalhospice.org/uploads/St._Joseph_Comfort_Care_DC.pdf