Ofatumumab, a fully human anti-CD20 monoclonal antibody, in biological-naive, rheumatoid arthritis patients with an inadequate response to methotrexate: a randomised, double-blind, placebo-controlled clinical trial Peter C Taylor, 1 Emilia Quattrocchi, 2 Stephen Mallett, 2 Regina Kurrasch, 3 Jørgen Petersen, 4 David J Chang 3 ▶ An additional supplementary ABSTRACT
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Perfect Touch Home Health Care, Inc.
PATIENT SERVICES HANDBOOK
During the initial phase of care, the Perfect Touch Home Health Care, Inc. registered nurses
will visit you
for times a week.
The following services are available, should your plan of care indicate such services:
Home Health Aide will visit you _ times a week.
Physical Therapy will evaluate you and then visit you times a week.
Occupational Therapy will evaluate you and then visit you times a week.
Speech Therapy will evaluate you and then visit you times a week.
A Dietician will evaluate you and then visit you additional times.
A Medical Social Worker will evaluate you and then visit you additional times.
During your care, your input will help Perfect Touch Home Health Care, Inc. establish your
further plan of care.
Patient services are provided without regard to race, color, creed, sex, disability (mental or
physical), religion, sexual preference or place of national origin.
This book contains information regarding: • Home Care Services • Your Rights and Responsibilities • Your Right to Make Decisions about Medical Treatment • Helpful information: o Medication Tips o Infection Control in the Home o Equipment Safety Tips o Safety in Your Home o Earthquake Safety Tips o What To Do In a Disaster o Area Resources o Emergency Phone Numbers o Drug Classification o Food and Drug Interaction Guide Description of Services Dear Patient, Our agency provides nursing, physical therapy, speech therapy, occupational therapy, social services and home health aide services to patients in their homes. These services can only be provided through your doctor's orders and are paid for by your insurance carrier as long as you meet the appropriate eligibility guidelines. A brief description of these guidelines are as follows: (Please note, these guidelines do not guarantee payment for services, and for detailed information you should review your individual policy): Medicare Medicare will only pay for services as long as: 1) you are homebound, (that means that it must take a taxing and considerable effort on your part to leave your home) 2) skilled services are medically necessary on an intermittent or part-time basis; 3) you remain under a physician's care while receiving services. Medi-Cal/IMS Medi-Cal and IMS will pay for limited services if: 1) hands-on skilled care is provided; 2) you are homebound; 3) the care is medically necessary.
Eligibility guidelines depend on the carrier and an individual's policy. Pre-authorization is usually required and is completed by our office staff. It is our goal to assist you back to recovery and a normal independent way of life as soon as possible. As you recover, the services of our staff will decrease. Before you accept our services, you must receive a copy of two forms, "Patient's Bill of Rights and Responsibilities" and "Your Right to Make Decisions About Medical Treatment", and be informed of our agency's policy regarding resuscitation. This means that if necessary, our staff will provide CPR or contact 911 unless instructed otherwise by you. If you do not want our staff to perform resuscitation measures, you must contact your physician, obtain an order, and complete a legal document known as an Advanced Directive. This may be in the form of a Durable Power of Attorney for Health Care, A Declaration Pursuant to the Natural Death Act, a living will, or a Do Not Resuscitate Directive. Please be advised that if Home Health Aide services are provided, they are to assist you with your personal needs related to your medical condition. Please do not ask them to perform the following tasks: • Change linens, prepare meals, grocery shop, or wash dishes for ANYONE OTHER THAN YOU, THE PATIENT. • Move furniture, wash windows, walls, floors or any heavy housekeeping chores • Drive anyone in their car or drive another car for the patient These tasks are allowable for patients only: dusting, vacuuming, sweeping, damp mopping, dishes, laundry, linens, and cleaning the bathroom. We hope these suggestions will aid you in understanding our services. You may contact our office from 9:30 am to 5:30 pm, Monday – Friday. After hours, Saturdays and Sundays, and on holidays leave your message with our answering service. The Registered Nurse On-Call will get back to you as soon as possible. Thank you for choosing our agency. We hope you will find our service satisfactory, and wish you a speedy recovery. PATIENT RIGHTS AND RESPONSIBILITIES
As a patient, you have the right to:
• Be fully informed of your rights and responsibilities and receive this notice before the initiation of care. • Be treated with respect, consideration of dignity and individuality, including privacy in treatment, care for personal needs, and respect of property. • Exercise your rights (or your family's or guardian's rights) and voice grievances regarding care or lack of respect for your property without fear of reprisal or discrimination in any way, for any reason. • Be fully informed of services available in the agency under the terms of your contract with Medicare, Medi-Cal, and/or insurance, and any costs you may incur, and to be taught about your illness so that you and/or your family can understand and help in your recovery and care. • Be informed, in advance, about the care to be furnished, and any changes in your care to • Be advised, in advance, of the disciplines that will furnish your care, and the proposed frequency of visits and to be assured that the personnel who provide the care are qualified through education and experience. • Participate in planning your care or treatment and in planning changes in the care or treatment, and to be fully informed by your physician (unless medically contraindicated), your illness, additional diagnosis and prognosis; that you may refuse treatment at any time and to be informed of the consequences of that refusal; and that you may participate of refuse experimental research, or clinical trials. • Be assured of confidentiality in treatment of personal and medical records and to approve or refuse their release to any individual outside the agency, except in the case of transfer to another health facility or as required by law or third party payment contract. • Be informed within a reasonable time or anticipated termination of service. • Be informed of change in payer source in writing no later than 30 calendar days from the date the home health agency becomes aware of the change. • Receive information on completing advance directives including a description of the applicable state law.
As a patient, you have the responsibility to:
• Sign the required consents prior to care being given or received. • Provide the agency with complete and accurate health and insurance information. • Remain under a doctor's care while receiving agency services. • Treat agency staff and other personnel with respect and consideration. • Notify the agency when you cannot keep appointments. • Accept the consequences of refusal of treatment or choice of non-compliance. • Participate in the planning of your care. • Provide a safe environment for the agency staff. • Provide the agency with a copy of advance directives if you have one. YOUR RIGHT TO MAKE DECISIONS ABOUT MEDICAL TREATMENT
This section explains your rights to make health That's why it is helpful if you say in advance what care decisions and how you can plan what should you want to happen if you can't speak for yourself. be done when you can't speak for yourself. There are several kinds of "advance directives" that you can use to say what you want and who you A federal law requires us to give you this want to speak for you. information. We hope this information will help increase your control over your medical treatment. One kind of advance directives under California law lets you name someone to make health care WHO DECIDES ABOUT MY
decisions when you can't. This form is called a TREATMENTS?
Durable Power of Attorney for Health Care. Your doctor will give you information and advice about treatment. You have the right to choose. You WHAT IF I'M TOO SICK TO DECIDE?
can say "Yes" to treatments you want. You can say If you can's make treatment decisions, your doctor "No" to any treatment you don't want- even if the will ask your closest available relative or friend to treatment might keep you alive longer. help decide what is best for you. Most of the time, that works. But sometime everyone doesn't agree HOW DO I KNOW WHAT I WANT?
about what to do. Your doctor must tell you about your medical condition and about what different treatments can That's why it is helpful if you say in advance what do for you. Many treatments have "side effects." you want to happen if you can't speak for yourself. Your doctor must offer you information about There are several kinds of "advance directives" that serious problems that medical treatment is likely to you can use to say what you want and who you want to speak for you. Often, more than one treatment might help you- One kind of advance directives under California and people have different ideas about which is best. law lets you name someone to make health care Your doctor can tell you which treatments are decisions when you can't. This form is called a available to you, but your doctor can't choose for Durable Power of Attorney for Health Care. you. That choice depends on what is important to WHO CAN FILL OUT THIS FORM?
You can, if you are 18 years or older and of sound WHAT IF I'M TOO SICK TO DECIDE?
mind. You do not need a lawyer to fill out. If you can's make treatment decisions, your doctor will ask your closest available relative or friend to WHO CAN I NAME TO MAKE
help decide what is best for you. Most of the time MEDICAL TREATMENT DECISIONS
that works. But sometime everyone doesn't agree WHEN I'M UNABLE TO DO SO?
about what to do. You can choose an adult relative or friend you trust as your "agent" to speak for you when you're too sick to make your own decisions. HOW DOES THIS PERSON KNOW
ARE THERE OTHER LIVING WILLS I
THAT I WOULD WANT?
After to choose someone, talk to that person about Instead of using the Declaration in the Natural what you want. You can also write down in the Death Act, you can use any of the available living Durable Power of Attorney For Health Care when will forms. You can use a Durable Power of you would or wouldn't want the medical treatment. Attorney For Health Care form without naming an Talk to your doctor about what you want and give agent, or you can just write down your wishes on a your doctor a copy of the form. Give another copy piece of paper. You doctors and family can use to the person named as your agent, and take a copy what you write in deciding about your treatment, with you when you go into a hospital or other but living wills that don't meet the requirements of treatment facility. the Natural Death Act don't give as much legal protection for your doctors if a disagreement arises Sometimes treatment decisions are hard to make about following your wishes. and it truly helps your family and your doctors if they know what you want. The Durable Power of WHAT IF I CHANGE MY MIND?
Attorney For Health Care also gives them legal You can change or revoke any of these documents protection when they follow your wishes. at any time as long as you can communicate your WHAT IF I DON'T HAVE ANYBODY TO
MAKE DECISIONS FOR ME?
DO I HAVE TO FILL OUT ONE OF
You can use another kind of advance directive to THESE FORMS?
write down your wishes about treatment. This is No, you don't have to fill out any of these forms if often called a "living will" because it takes effect you don't want to. You can just talk with your while you are still alive, but have become unable to doctors and ask them to write down what you've speak for yourself. said in your medical chart. And you can talk with your family, but people will be more clear about The California Natural Death Act lets you sign a your treatment wishes if you write them down. living will called a Declaration. Anyone 18 years or Your wishes are more likely to be followed if you older and of sound mind can sign one. write them down. When you sign a Declaration it tells your doctors WILL I STILL BE TREATED IF I DON'T
that you don't want any treatment that would only FILL OUT THESE FORMS?
prolong your dying. All life-sustaining treatment Absolutely. You will still get medical treatment. would be stopped if you were terminally ill and We just want you to know that if you become too your death was expected soon, or if you were sick to make decisions, someone else will have to permanently unconscious. You would receive make them for you. Remember that: treatment to keep you comfortable, however. • A Durable Power of Attorney for Health Care The doctors must follow your wishes about limiting lets you name someone to make treatment treatment or turn your care over to another doctor decisions for you. That person can make most who will. Your doctors are also legally protected medical decisions-not just those about life- when they follow your wishes. sustaining treatment-when you can't speak for yourself. Besides naming an agent, you can also use the form to say when you would and wouldn't want particular kinds of treatment. • If you don't have someone you want to name to It is your responsibility to provide a copy of your make decisions when you can't, you can sign a advance directive to the agency so that it can be Natural Death Act Declaration. This kept with your records. If you have any questions Declaration says that you do not want life about any of these forms, please talk to your prolonging treatment if you are terminally ill or doctor, your nurse, or call our office. Ask for a permanently unconscious. social worker to visit you and further explain these HOW CAN I GET MORE INFORMATION
ABOUT ADVANCE DIRECTIVES?
The California Consortium on Patient Self- Ask your doctor, nurse or social worker to get more Determination prepared the preceding text, which information for you. has been adopted by the California Department of Health Services to implement Public Law 101-508. All of us at our agency want our patients to understand their rights to make medical treatment decisions. We comply with California laws and court decisions on advance directives. We do not condition the provision of care or otherwise discriminate against anyone based on whether or not you have executed an advance directive. We have formal policies to ensure that your wishes about treatment will be followed. Information Regarding Your Medication Regimen
Your doctor has prescribed medication to help you Don't stop taking your medication unless your treat your condition. This medication will help you doctor tells you to. Do not self-prescribe or self- only if you take it correctly. Here's how: HOW TO FILL YOUR PRESCRIPTION
Make sure you shake the liquid medicine bottles effectively before taking. Have your prescription filled at the pharmacy you ordinarily use. That way, the pharmacist can keep a HOW TO STORE YOUR MEDICATION
complete record of your medications. Tell him if you are allergic to any medications. Keep your medication in its original container or in a properly labeled prescription bottle. If you are If you need to refill your prescription, don't wait taking more than one medication, don't store them until the last minute. Refill it before you run out of together in a pill box or container. medication. There should be no disruption in your Store your medication in a cool, dry place or as directed by your pharmacist. Don't keep in the HOW TO TAKE YOUR MEDICATION
bathroom medicine cabinet where heat and humidity may cause it to lose its effectiveness. Take your medication in a well lit room. Double Some medications require refrigeration. Please read check the label to make sure you are taking the right medication at the right time. If you don't understand the directions, call your pharmacist or If you have children, make sure your medication containers have childproof caps. Always keep the containers beyond the reach of children. If you forget to take a dose or several doses, don't take two or more doses together. Instead, contact Wash your hands before taking your medications to your doctor or pharmacist for directions. avoid contamination. At Home Infection Control
Infections can be a major health hazard. An 7. Soiled disposable products (dressings, infection is a disease that results when germs diapers) should be placed in a heavy plastic invade and grow in the body. Some infections can bag, fastened securely and placed in the cause a short illness while others can be very serious. The infections may involve a body part or the whole body. Patients and caregivers need to 8. Used needles and syringes can be placed protect themselves from infections. You can help into a rigid walled containers (empty prevent infections by practicing the following bleach bottle), sealed securely and disposed of in the trash for trash pick-up. 1. Hand washing is the one most important 9. Damp mop uncarpeted floors at least once procedure to prevent the spread of a. Wash your hands before and after 10. Bathroom surfaces: sink, toilet, toilet seat and floor should be cleaned routinely. A b. Wash your hands before preparing disinfectant, bathroom cleaner or a solution of water and detergent is used. c. Wash your hands before eating d. Wash your hands after using the 11. Special precautions to prevent infection in your particular condition will be discussed, e. Use liquid soap in the bathroom as necessary, by the nurse at your home 2. Each family member should use his or her own towels, washcloths, toothbrush, 12. Notify the nurse or physician if the patient drinking glass, and other personal care develops any of the following signs or symptoms: fever, pain or tenderness, fatigue, loss of appetite, nausea, vomiting, 3. Wash cooking and eating utensils with hot diarrhea, rash, sore on mucous membranes, soapy water after they have been used. redness or swelling of a body part, and discharge or drainage from any area of the 4. Clean cooking and eating surfaces with soap and water of a disinfectant. 13. Clean up spills of blood or urine with a 5. Do not leave food sitting out and 10% bleach solution (mix 1 part of bleach uncovered. Close all food containers. to 10 parts of water daily). Throw away Refrigerate foods that will spoil. Keep hot unused bleach solution at the end of the food hot and cold food cold. 6. Soiled bed linens should be changed 14. Whenever possible, the family should wear immediately. Soiled linens should be disposable gloves when in contact with the washed in hot water using a detergent. patient's blood, would drainage, feces, Wash separately from other laundry. urine, open areas of the skin, or other 15. Clean utility gloves with hot soapy water; then disinfect the gloves with a 10% solution of bleach. Throw away and replace cracked gloves. 16. Cover you mouth and nose when coughing or sneezing to prevent the spread of germs. Turn your head to avoid droplets from coughs or sneezes. HOSPITAL BED
• Always keep wheels locked. Unlock only • When ready to ambulate stand a few minutes with the walker to steady your • Always maintain side rails up and locked • Walking surface should be dry, clean and well lighted. Removing throw rugs will • Electric beds may malfunction or a power failure may cause the bed to remain in one position. Always know how to use the • When walking do not look at your feet- manual hand crank look straight ahead. • A bedridden person should always have a • Wear supportive, flat soled, non-skid way to summon help. Provide patient with shoes. Avoid high heels and slip-on shoes. a call bell or other emergency response • Attach a light weight bag or basket to your walker to safely carry small items. • Unplug electric beds before washing the mattress or framework. CANES AND CRUTCHES
• Avoid walking on slippery, wet or uneven surfaces. Removing throw rugs will • Always lack the wheelchair brakes before making transfers to or from your chair or • Make sure the rubber tip on the cane/crutch end is without cracks or tears and that it fits • If you are unable to place both feet flat on the floor do not lean forward in the wheelchair-you may fall. • Crutches should have padded underarm • Prolonged sitting in the wheelchair may cause pressure sores to develop. Establish a • Always look straight ahead while walking routine of shifting your weight from side to with a cane, do not look at your feet. side, up and down, if possible. The armrest of the wheelchair may be padded to help Always get up slowly from a sitting position and cushion and relieve pressure to arms. assess if you feel dizzy or off balance. While standing breathe slowly. If dizziness should persist, sit down and call for assistance. Oxygen Therapy
• NO SMOKING IN YOUR HOME! • OXYGEN IS NOT TO BE USED AROUND A SPACE HEATER OR STOVE! • Keep an all purpose fire extinguisher in • Electric blankets and electric heating pads may be a potential hazard • Use only water-soluble lubricating jelly if needed. Do not use products that contain oil or alcohol, as they flammable. • Clean your cannula or mask every eight hours with a wet cloth. • Oxygen tubing should not be covered by bed linen, clothing or furniture. • Oxygen tank systems should be kept upright and always turned off when not in use. • Oxygen containers should never be put in the truck of the car. • Equipment may be wiped clean with household detergent and warm water. SAFETY IN YOUR HOME
Tips for Staying Independent
Falls or other injuries could leave you unable to Do you have an emergency exit plan? live on your own. It is our hope that the following Once a fire starts, it spreads rapidly. Since you may information will enable you to make your home not have much time to get out and there may be a safer and more comfortable. Removing potential lot of confusion, it is important that everyone hazards and making things easier to do can help knows what to do. you stay independent. Check Smoke Detectors
Having an Emergency Plan
Do you have smoke detectors installed in your Listed on the back page of this booklet you will find local emergency numbers. If numbers for your If the answer is no, we urge you to purchase smoke particular area are not listed, space is provided for detectors for your own personal safety. Not: Some you to include those numbers. local fire departments or local government agencies will provide assistance in acquiring or installing Remember RACE:
smoke detectors. R= REMOVE patient and family from immediate
Many home fire injuries and deaths are caused by danger. Develop a fire escape plan for your home smoke and toxic gases, rather than the fire itself. and determine one place for all family members to Smoke detectors provide an early warning and can meet outside in a safe place away from the fire. wake you in the event of a fire. A= ACTIVATE – call 911. Remember to give your You may want to consider Carbon Monoxide
detectors for your home safety. C= CONTAIN the fire, if possible, by closing all
At least one smoke detector should be placed near doors. Remember your own safety first and do not bedrooms, either on the ceilings or 6-12 inches place yourself in danger. below the ceiling on the wall. Place smoke detectors away from air vents. E= EXTINGUISH the fire if possible, if not,
evacuate the area. Again, do not place yourself in Are your smoke detectors currently in proper
Check the batteries on a regular basis. Getting Rid of Hazards
Check Areas Around Beds
Hazards that can cause fires, falls and other injuries Are lamps or light switches within easy reach of
in the home are easy to overlook.
At the time, they're often easy to fix. Lamps located close to each bed will enable people Checking each room for safety hazards can help getting up at night to see where they are going. you prevent injuries. Rearrange furniture closer to switches or move lamps close to beds. Install night lights Check all rugs, runners and mats
Are all small rugs and runners slip-resistant?
Is there a telephone close to your bed?
In case of an emergency it is important to be able to Estimates that in 1982, over 2,500 people age 65 reach the telephone without getting out of the bed. and over were treated in hospital emergency rooms for injuries that resulted from tripping over rugs Are ash trays, smoking materials, or other fire
and runners. Falls are also the most common cause sources (heaters, hot plates, teapots, etc.) located
of fatal injury to older people. away from beds or bedding?
Burns are a leading cause of accidental death • Remove rugs and runners that tend to slide. among seniors. Smoking in bed is a major • Apply double-faced adhesive carpet tape or contributor to this problem. Don't smoke in bed or rubber matting to the backs of rug and have hot liquids or other heat sources near the bed. • Purchase rugs with slip-resistant backing Is anything covering your electric blanket when
• Check rugs and mats periodically to see if the backing needs to be replaced. "Tucking in" electric blankets, or placing additional coverings on top of them can cause Place rubber matting under rugs. Rubber excessive heat buildup that can start a fire. Don't matting can be cut to the size of the rug. set electric blankets so high that they could burn Note: Over time adhesive on tape can wear away. Rugs with slip-resistant backing also become less Do you ever sleep with a heating pad that is
effective as they are washed. Periodically check turned on?
rugs and mats to see if new tape or backing is Never go to sleep with a heating pad if it is turned on, because it can cause serious burns, even at relatively low settings. Check Bathtub and Shower Areas
Electric cords that run under carpeting may cause fire. Remove cords from under furniture or Are bathtubs and showers equipped with non-
carpeting. Replace damaged or frayed cords. skid mats, abrasive strips or surfaces that are
Are cords attached to the walls or base boards
Wet, soapy tile or porcelain surfaces are especially with nails or staple?
slippery and may contribute to falls. Apply textured Nails or staples can damage cords, presenting fire strips or appliqués on the floors of tubs and and shock hazards. Remove nails, staples, etc. showers. Use non-skid mats in the tub or shower Check wiring for damage. Use tape to attach cords and on the bathroom floor. If you are unsteady on to walls or floors. your feet, use a stool with non-skid tips as a seat while showering or bathing. Do extension cords carry more than their
proper load than indicated by the ratings label
Grab bars can help you get into and out of your tub on the cord and the appliance?
or shower, and can help prevent falls. Check Overloading extension cords may cause fires. existing bars for strength and stability and repair if Standard 18 gauge extension cords can carry 1250 watts. If an extension cord is needed, use one having a sufficient amp or wattage rating. If the Attach grab bars, through the tile, to structural rating on the cord is exceeded because of the power supports in the wall, or install bars specifically requirements of one or more appliances being used designed to attach to the sides of the bathtub. If you on the cord, change the cord to a higher rated one are not sure how it is done, get someone who is or unplug some appliances. qualified to assist you. Are heaters that come with a 3-prong plug being
Check ALL Electrical / Telephone Cords
used in a 3-prong outlet or with a properly
Are lamp, extension and telephone cords placed
The grounding feature provided by a 3-hole out of the flow of traffic?
receptacle or an adapter for a 2-hole receptacle is a Cords stretched across walkways may cause safety feature designed to lessen the risk of shock. someone to trip. Arrange furniture so that outlets Never defeat the grounding feature. If you do not are available for lamps and appliances without the have a 3-hole outlet, use an adapter to connect the use of an extension cord, place it on the floor heater's 3-prong plug. Make sure the adapter against a wall where people cannot trip over it. ground wire or tab is attached to the outlet. Move the phone so that telephone cords will not lie
where people walk.
Are cords out from beneath furniture and rugs
Furniture resting on cords can damage them,
creating fire and shock hazards.
Are small stoves and heaters placed where they
loose steps and cracked or uneven paving. Keep can be knocked over, and away from furnishings pathways and steps free of hoses, newspapers and
and flammable materials, such as curtains or
Heaters can cause fires or serious burns if they During an Earthquake
cause you to trip or if they are knocked over. Relocate heaters away from passageways and • If you are indoors get under a table, a desk flammable materials. or bed, or brace yourself in a strong doorway. Watch for falling, flying and If your home has space heating equipment, such
sliding objects. Stay away from windows. as kerosene heater, a gas heater or an LP gas
• If you are outdoors move to an open area heater, do you understand the installation and
away from building, trees, power poles, operating instructions thoroughly?
brick or block walls and other objects that Unvented heaters should be used with room doors open or window slightly open to provide • If you are in an automobile, stop and stay ventilation. The correct fuel, as recommended by in it until the shaking stops. Avoid stopping the manufacturer, should always be used. Vented near trees and power lines, on or under heaters should have proper venting, and the venting system should be checked frequently. Improper • If you are in a high rise building get under venting is the most frequent cause of carbon a desk until the shaking stops. Do not use monoxide poisoning and older consumers are at the elevator to evacuate. Use the stairs. • If you're in a store get under a table, or any sturdy object, or in a doorway. Avoid Check Entrances and Stairs
stopping under anything that could fall. Do not dash for the exit. Choose your exit Are entrances safe?
Put bright lights over front and back doors, or
install motion sensor lights that come on when you
approach. Replace dim or burned out lights along
pathways and halls. Oil or replace locks and
handles that don't turn easily or are hard to grasp.
Install dead bolt locks on outside doors. Mark keys
so they are easy to identify.
Are stairs and pathways clear?
Put nonskid strips on the outer edge of steps, or
paint the edges white. Repair handrails that aren't
sturdy. Replace handrails that don't run the full
length of the stairs. Repair broken or
If you must evacuate:
• Check neighbors for injury • Turn on radio and listen for advisories. • Prominently post a message indicating Locate light source, if necessary. where you can be found. • Do not touch downed power lines or • Take with you: objects touched by downed power 1. Medicines and first aid kit 2. Flashlight, radio and batteries • Clean up potentially harmful material. 3. Important papers and cash • Check to see that sewage lines are intact 4. Food, sleeping bags/blankets before continued flushing of toilets. 5. Extra clothing • Check house, roof, chimney for damage. 6. Make arrangements for pets • Check Emergency supplies. • Do not use phone except for genuine After a disaster:
• Do not go sightseeing. • Put on heavy shoes immediately to avoid • Be prepared for after shocks. injury from stepping on glass or other • Open closets and cupboards carefully. • Cooperate with public safety officials. Be • Check for injuries and give first aid prepared to evacuate when necessary. • Check for fires and fire hazards 1. Sniff for gas leaks, starting at the hot water heater. If you smell gas or
suspect a leak, turn off the main gas
valve, open windows and carefully
leave the house. Do not turn lights on
or off, or light matches or do anything
that might make sparks. Note: Do not
shut off gas unless an emergency
exists. If time permits call the gas
company or a qualified plumber. DO
NOT turn it back on until the gas
company or plumber has checked it
2. If water leaks are suspected shut off water at main valve. 3. If damage to electrical system is suspected (frayed wires, sparks, or the smell of hot insulation) turn off system at main circuit breaker of fuse box. FOOD AND DRUG INTERACTION GUIDE
FOOD AND DRUG INTERACTION GUIDE
GASTROINTESTINAL PREPARATION Take ½ hour before meals. May cause drowsiness. Avoid alcoholic beverages. Belladonna (Donnatal) Take ½ hour before meals. Diphenoxlate (Lomotil) Avoid alcohol or other depressants such as tranquilizers and sedatives. Hyoscyamine Sulfate Same as atropine above. Propantheline Bromide Take ½ hour before meals. (Probanthine) Metoclopramide (Reglan) Take ½ hour before meals. May cause drowsiness so avoid alcoholic beverages. Cimetidine (Tagamet) Take with or immediately after a meal. Bethanechol (Urecholine) Take on a empty stomach 1 hour before or 2 hours after meals. Dioctyl Sodium Sulfosuccinate (Colace) Take with 8 oz. of water. Take with 8 oz. of water with meals. (Effersyllium, Metamucil) Iron (Fergon, Feosol) Take on an empty stomach with water. If stomach upset occurs, take after meal or with food. Do not take simultaneously with tetracycline or antacids. Potassium Chloride May cause stomach upset. Take after meals or with food and a glass of water. ORAL HYPOGLYCEMICS Chlorpropamide (Diabinese) Take with milk or food. Avoid alcoholic beverages. May cause stomach upset. Tolbutamide (Orinase) Take with milk or food. Avoid alcoholic beverages. May cause stomach upset. May cause stomach upset. Take ½ hour before meals. Avoid (DiaBeta, Micronase) alcoholic beverages. CARDIOVASCULAR DRUGS Methyldopa (Aldomet) Avoid natural licorice. (Most licorice in this country is artificial and not harmful, but imported licorice candy and flavoring from Europe is often natural). Propranolol (Inderal) Take with food for best results. If being used for high blood pressure, avoid foods high in sodium or Tyramine. Nitrates (Isordil, Sorbitrate) Avoid alcoholic beverages. Take on an empty stomach 1 hour before or 2 hours after meals. Digoxin (Lanoxia) Take oral doses after morning meal. Avoid antacids, cough, cold, allergy and appetite suppressants. Dipyridamole (Persantine) Take 1 hour before meals with a full glass of water. Take with food. May cause stomach upset. (Quinaglute, Quinora) Take with milk or food. May cause stomach upset. Include high potassium foods in diet (see below). Furosemide (Lasix) Take with milk or food with 8 oz. of water. Include high potassium foods in Diet (see below). Spironolactone (Aldactone) Take with milk or food. May cause stomach upset. Take with milk or food. May cause stomach upset. Include high potassium (Diuril, Hydrodiuril) foods in diet (see below). HIGH POTASSIUM FOODS ASA (Aspirin, Empirin) May cause stomach upset. Take with milk or food. Take on an empty stomach. Causes drowsiness. Avoid alcoholic beverages. (Morphine, Codeine, Demerol) Phenazopyridine (Pyridium) Take ½ hour before meals with a full glass of water. For best results, take on an empty stomach (1 hour before meals or (Ceclor, Keflex) 2 hours after meals). If stomach irritation occurs, take with food or milk. Same as cephalosporins (Chloromcetin) Erythromycin Base (E-mycin, Erytab, Eryc) Take on an empty or immediately before meals. Stearate Estolate (Liosone) Absorption unaffected by food. (EES, Pedlamycin) Absorption unaffected by food. Metronidazole (Flagyl) May cause stomach upset. Take with food. Nausea and vomiting may occur if taken with alcoholic beverages. Nitrofurantoin (Furadantin, Macrodantin) May cause stomach upset. For best results, take with milk or food. Penicillins and Derivatives Take on an empty stomach, 1 hour before meals or 2 hours after meals. (Pen G, Pen Vee K, Pentids, Take with a full glass of water. Ampicillin, Amoxicillin) Avoid citrus foods, juices and carbonated beverages. Tetracycline (Achromycin) Avoid milk and milk products. For best results, take on an empty stomach, 1 hour before meals or 2 hours after meals. ANTI DEPRESSANTS MAO INHIBITORS Isocarboxazid (Marplan) Avoid foods high in Tyramine. Tranylcypromine (Pamate) Avoid foods high in Tyramine. Phenelzine (Nardil) Avoid foods high in Tyramine. FOODS HIGH IN TYRAMINE May cause stomach upset. Take with food and water. Side effects are increased by caffeine containing foods such as coffee, tea, cocoa and chocolate. Avoid alcoholic beverages. Avoid foods high in Vitamin K: beef (Coumadin, Dicoumarol) liver, oils, green leafy vegetables (kale, brussel sprouts, cabbage, collards, spinach). Avoid taking with salicylates. May cause stomach upset, take with food. May cause drowsiness. Do not take concurrently with alcoholic beverages. Chloral Hydrate (Noctec) Take with milk or food. May cause stomach upset. May cause stomach upset, take with milk or food. May decrease the therapeutic effects of aspirin, requiring dosage adjustment, if taken together. Lithium Carbonate May cause drowsiness. Do not take with alcoholic beverages. Take (Lithan, Eskalith) after meals or with food or milk. Maintain adequate fluid and salt intake. May cause drowsiness. Do not take with alcoholic beverages. (Antivert, Bonine, Marezine) Barbiturates (Phenobarbital) May cause drowsiness. Do not take with alcoholic beverages or medications containing antihistamines. Phenytoin (Dilantin) Take with food to increase absorption and reduce stomach irritation. Avoid alcoholic beverages. Prednisolone (Delta-Cortef) Take with milk or food. May cause stomach upset. Prednisone (Deltasone) Take with milk or food. May cause stomach upset. Albuterol (Proventil) Take with milk or food. May cause stomach upset. Take with milk or food. May cause stomach upset. Avoid excessive protein. Take on an empty stomach with 8 oz. of water. Avoid brussel sprouts, cabbage, cauliflower, kale, greens, rutabaga, soybeans and turnips. Alprazolam (Xanax) Take with milk or food. Avoid alcoholic beverages. May cause stomach upset. This pamphlet has been prepared for you by the Food & Nutrition management Services and Pharmacy Management Services. It contains information about some common interactions that may occur between food and drugs that you take. It does not attempt to discuss all possible food-drug interactions, nor does it list possible drug-drug interactions. For information regarding drug-drug interactions, you should consult your Pharmacist or Physician. If you have questions regarding information in this pamphlet, contact your Physician, Pharmacist or Registered Dietitian at your hospital. REORDER #30
Food and Nutrition Management Services
6151 W. Century Blvd., Suite #916, Los Angeles, CA 90045
DRUG CLASSIFICATION SHEET
1. Drug classification: ADRENERGICS
Vasoconstrictor, vasodilator, nasal decongestant, bronchodilator, decreased insulin output and increased heart action. Side Effects:
Nausea/vomiting, lack of appetite, cramps, insomnia anxiety, dizziness, pallor, flushing and chest pain. Glaucoma, arrhythmias, severe hypertension; enhanced by antihistamines. 2. Drug classification: ADRENOCORTICAL STEROIDS
Simulates secretion of hormones from the adrenal gland; inhabits inflammation. Side Effects:
Nausea/vomiting, headaches, hypertension, weakness, rash, congestive heart failure, compression fractures and poor wound healing. Congestive heart failure, kidney disease; enhanced by salicylates. 3. Drug classification: ANALGESICS
Decrease impulses to control nervous system and alleviates pain. Side Effects:
Nausea/vomiting, lack of appetite, dry mouth and constipation. Epilepsy, asthma, hepatic disease, respiratory diseases, gastro-intestinal disorders, pregnancy; do not use with alcohol. 4. Drug classification: Acts on smooth muscle, relaxes and dilates coronary vessels, stops anginal pain. Side Effects:
Nausea/vomiting, rash, erythema, abdominal pain, tachycardia, hypotension, headache and dizziness. Hypersensitivity, pregnancy, children. 5. Drug classification: Acts as an anti-inflammatory Side Effects:
Nausea/vomiting, abdominal pain, flatulence, rash, loss of hair, congestive heart failure, hypertension and pericarditis. Hypersensitivity, gastro-intestinal problems, renal disease, hepatic disease, pregnancy. 6. Drug classification: Slow and strengthens the beat of the heart muscle. Side Effects:
Loss of appetite, nausea/vomiting, diarrhea, abdominal pain, bitter taste in mouth and weakness. Aortic stenosis, congestive heart failure and heart block. 7. Drug classification: ANTIBIOTICS
Inhibits growth of micro-organisms, controls infection. Side Effects:
Nausea/vomiting, diarrhea, loss of appetite, increased BUN, protein in urine, vaginitis, hematuria, anemia, dermatitis and photosensitivity. Hypersensitivity, blood disease; enhanced by other antibiotics, oral Anticoagulants and aspirin. 8. Drug classification: Suppresses Vitamin K, decreases clotting property of blood. Side Effects:
Nausea/vomiting, diarrhea, hemorrhage, low white count, gastro-intestinal bleeding, rash, loss of hair and blood in urine. Bleeding disorders, hepatic or renal disease, pregnancy, postpartum. 9. Drug classification: Decrease intestinal motility; relaxes muscles. Side Effects:
Nausea/vomiting, heartburn, constipation, urinary retention, nervousness, headache, rash, drowsiness and blurred vision. Muscle, hepatic and renal diseases, glaucoma; enhanced by many drugs. 10. Drug classification: Decreases seizure activity. Side Effects:
Nausea/vomiting, diarrhea, slurred speech, confusion, dizziness, insomnia, nervousness and fatigue. Hepatic and renal disease, heart block and blood diseases. 11. Drug classification: Stimulates Beta cells in pancreas to produce and release insulin; regulates blood sugar. Side Effects:
Hepatic toxicity, allergic reaction, rash and weak. Hypersensitivity, renal or hepatic disease. 12. Drug classification: Decreases depression. Side Effects:
Orthostatic hypotension, hypertension, arrhythmias, headache, anxiety, dry mouth, nausea/vomiting, diarrhea, constipation, lack of appetite, decreased sexual drive, rash and edema. Myocardial infarction, hepatic or renal disease, glaucoma; death may result when used with MAO inhibitors; Phenothiazines inhibit the metabolism of this drug. 13. Drug classification: ANTI-EMETIC
Blocks chemoreceptor trigger zone, which in turn acts on vomiting center. Side Effects:
Restlessness, headache, dizziness, anorexia, diarrhea, constipation, dry mouth, palpitations. Hypersensitivity, shock, children (parenterally), coma, seizure, encephalopathy, bone marrow depression. 14. Drug classification: Completes with histamine, antihistamine. Side Effects:
Nausea/vomiting, diarrhea, stomach pain, lack of appetite, constipation, dizziness, nervousness, insomnia, headache, rash, blurred vision, ringing in the ears and confusion. Asthma, glaucoma, prostate hypertrophy, coma; enhanced by depressants and alcohol; use with caution in seizure patients. 15. Drug classification: Relaxes vascular, smooth muscles, actions vary with drug; lowers blood pressure. Side Effects:
Nausea/vomiting, diarrhea, constipation, liver disorders, peptic ulcers, sedation, weakness, orthostatic hypotension, anemia and rash. Pregnancy, lactation, hypersensitivity, myocardial infarcations, children; use cautiously in renal, cardiac, neuro, elderly or CVA patients. 16. Drug classification: Decreases cell replication. Side Effects:
Nausea/vomiting, diarrhea, lack of appetite, loss of hair, rash, blood diseases, liver and bowel problems. Hepatic or renal disease, hypersensitivity, radiation therapy, low blood count; Do not use with radiation. 17. Drug classification: Decreases effects of Parkinson's disease. Side Effects:
Nausea/vomiting, loss of appetite, weakness, anxiety, insomnia, orthostatic hypotension, hand tremors, palpitations, hallucinations and urinary incontinence. Glaucoma, psychosis; use cautiously with tricyclic antidepressants. 18. Drug classification: Decreases temperature. Side Effects:
Nausea/vomiting, diarrhea, gastro-intestinal bleeding, heartburn, loss of appetite, rash, increases prothrombin time, ringing in ears, dizziness and headaches. Hypersensitivity, gastro-intestinal bleeding, bleeding disorder, Vitamin K deficiency, pregnancy; use cautiously in gout, allergies, cardiac or renal disease, pulmonary disease. 19. Drug classification: Stimulates response to dilate bronchial tubes and increase conduction of the heart; assists with more controlled breathing. Side Effects:
Nausea/vomiting, loss of appetite, gastro-intestinal bleeding, restlessness, anxiety, headache, palpitations and fast pulse. Renal or hepatic disease and myocardial infarction. 20. Drug classification: CARDIAC GLYCOSIDES
Increases force of heart beat and the refractory period in the heart; strengthens the heart and slows the pulse. Side Effects:
Nausea/vomiting, diarrhea, loss of appetite, cramps, headache, drowsiness, confusion and visual disturbances. Ventricular tachycardia and fibrillation; do not use with antihistamines, anticonvulsants, barbituates and hypoglycamic agents. 21. Drug classification: Causes vasoconstriction with a fall in blood pressure; slows heart rate, increases salivation, sweating, gastro-intestinal and genital-urinary tone and movement. Side Effects:
Vision problems, headache, nervousness, dizziness, rash; if taken internally, nausea/vomiting, diarrhea and frequency of urination. Eye abrasions, asthma, diabetes, eye inflammation, cardiac disease. 22. Drug classification: DIURETICS
Decreases water reabsorption in the kidney by increasing sodium loss which leads to water loss in the body. Side Effects:
Frequency of urination, hematuria, vomiting, diarrhea, hepatic failure, flushing, lethargy and orthostatic hypotension. Severe renal disease, COPD, pregnancy, infants, lactation, electrolyte imbalance. 23. Drug classification: ELECTROLYTE REPLENISHERS
Replaces electrolytes. Side Effects:
Nausea/vomiting, diarrhea, decreased blood pressure, arrhythmias, confusion, tingling of extremities, weakness, paralysis, gastro-intestinal problems. Use cautiously in renal or cardiac disease, dehydration, severe burns, hyperkalemia; do not administer with Spironolactone, Triamterene or salt substitutes. 24. Drug classification: ESTROGENS
Increases actions of the reproductive hormones. Side Effects:
Headaches, dizziness, depression, libido changes, lethargy, thrombophlebitis, hypertension, edema, visual changes, GI effects (i.e. nausea/vomiting, abdominal cramps, bowel changes, appetite changes) changes in menstrual flow, jaundice, electrolyte imbalance, rash, breast tenderness, leg cramps. Thombophlebitis, undiagnosed abnormal genital bleeding. 25. Drug classifications: LAXATIVES
Retains water and adds fats; lubricates and irritates the mucosa. Side Effects:
Cramps, electrolyte imbalance, rash and nausea/vomiting. Intestinal obstruction, lower abdominal pain and fecal impaction. 26. Drug classification: MUSCLE RELAXANTS
Interferes with nerve impulses in the muscles. Side Effects:
Headache, dizziness, lethargy, uncoordination, nausea/vomiting and hypotension. Myasthenia gravis, cardiac disease, infants; enhanced by alcohol. 27. Drug classification: Suppresses ovulation, forms a thick cervical mucous. Side Effects:
Headache, dizziness, depression, hypertension, lethargy, thrombophlebitis, edema, nausea/vomiting, abdominal cramps, changes menstrual flow, jaundice, hyperglycemia, libido changes, rash, breast tenderness, enlargement or secretions. Thromboembolic disorders, breast cancer, undiagnosed vaginal bleeding, Hepatic disease. 28. Drug classification: Side Effects:
Nausea/vomiting, diarrhea, lack of appetite, headache, dizziness, hypotension, circulatory or respiratory depression, rash, edema, confusion. Hypersensitivity, severe hepatic and renal disease 29. Drug classification: THYROID HORMONES
Replaces thyroid hormone. Side Effects:
Palpitations, arrhythmias, angina, headache, tremors, insomnia, nervousness, loss of appetite and weight loss. Nephrosis, hyperthyroidism, thryotoxicosis, may increase effect of anticoagulants and insulin. 30. Drug classification: Produces a calming effect. Side Effects:
Confusion, headache, agitation, over sedation, dizziness, insomnia, weakness, constipation, loss of appetite, decreased sex drive, blurred vision and urinary retention. Glaucoma, children under 6, psychosis, pregnancy. Do not use with alcohol or Central nervous system depressants; antacids and food decrease absorption rate; potentiated by Phenothiazines, MAO inhibitors, antidepressants and central nervous system depressants. 31. Drug classification: Dilates skeletal muscle and increases blood flow. Side Effects:
Nausea/vomiting, abdominal distension, hypotension, fast pulse and dizziness. Pregnancy, lactation; use with caution in cardio disease, myocardial infarctions.
Perfect Touch Home Health Care, Inc. 7250 Beverly Blvd., Suite 205 Los Angeles, CA 90048-4126 FIRE DEPARMENT, POLICE AND SHERIFF EMERGENCY CALLS ONLY:
Fire & Rescue, Police, Sheriff and Highway Patrol, Ambulance and Paramedics TELECOMMUNICATIONS DEVICES FOR THE DEAF
(TDD) EMERGENCY CALLS
LLAMADAS EMERGENCIA APARTATO DE TELLECOMMUNICACIONES PARA LOS SORDOS (TDD) BAUDOT MODE ONLY: DIAL 911
Press the space bar until someone answers. BAUDOT APATOS SOLEMENTE: MARQUE 911
Oprima la barra espaciadora hasta que alguien le conteste. EMERGENCY PHONE NUMBERS
Physician: _ Pharmacy: Ambulance: _
Other important phone numbers:
PATIENT RESOURCES/EMERGENCY NUMBERS
Your Home Health Care Agency is: Perfect Touch Home Health Care, Inc.
Perfect Touch Home Health Care, Inc. staff is proud to have the opportunity to provide home
health services to you. The following information will help you understand how to call for help
in urgent or emergency situations.
IN CASE OF A DISASTER
Remain in a safe place. Turn your radio dial to KISS RADIO LA at 102.7 or 1150 AM or call (818) 845-1027 or (818) 520-1027.
While receiving your services, someone from Perfect Touch Home Health Care, Inc. will be contacting you. THE AGENCY IS NOT AN EMERGENCY CARE FACILITY.
Emergencies are referred to acute care facilities. EMERGENCY NUMBERS
Paramedic, Fire, Police, Ambulance Companies
Empire Trans Med American Red Cross Child Abuse Hotline Department of Aging (City) Department of Aging (County) Department of Health Services (Home Health Hotline) National Institute of Aging Legal Aid Foundation LA info Line for Community Services/Resources Mayor's Office for the Disabled (Info: Handicap Stickers) Medicare Hotline Social Security Office PATIENT RESOURCES
MEDICAL SERVICES (Physical, Mental, Pharmacies) –
Medical Information (Health Center Referral)
National Institute for Drug Abuse Nursing Home Information and Referral Service Pharmacy 24 Hour CVS Referral Line Fair Housing Council HUB User (Info on Elderly & Handicapped Housing) Emergency Shelter Food Stamp Application Information Line Salvation Army – LA Transportation Authority (information on Bus/Rail)
These referral sources are given to the patient/caregiver for emergencies. Perfect Touch
Home Health Care, Inc. has 24-hour on-call availability by calling (323) 852-1959.
with injectables > The mission of the Physicians Coalition for Injectable Safety is to provide the public with unbiased and necessary information on injectable cosmetic treatments, appropriate injectors and where to safely access cosmetic medical procedures. Our goal is to eradicate the practice of unqualified persons providing injections, to promote treatment supervised by properly qualified and trained, board-certified doctors and to promote only the use of US FDA-approved, appropriately administered products.