Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (110 page)
12
)
(
OTC
, Rx)
(sye-an-oh-koe-bal′a-min)
Anacobin
, Bedoz, Cyanabin, Cyanoject, Cyomin, Ener-B
OTC
, Rx)
LA-12, Nascobal, Neuroforte-R, Vitamin B
12
Func. class.:
Vit B
12
, water-soluble vitamin
Needed for adequate nerve functioning, protein and carbohydrate metabolism, normal growth, RBC development, cell reproduction
Vit B
12
deficiency, pernicious anemia, vit B
12
malabsorption syndrome, Schilling test, increased requirements with pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, renal/hepatic disease, nutritional supplementation
Hypersensitivity, optic nerve atrophy
Precautions:
Pregnancy (A), breastfeeding, children
Calculator
• Adult:
PO
Up to 1000 mcg/day
SUBCUT/IM
30-100 mcg/day × 1 wk, then 100-200 mcg/mo
• Adult and child:
IM
1000 mcg in 1 dose
• Child:
PO
Up to 1000 mcg/day
SUBCUT/IM
30-50 mcg/day × 2 wk, then 100 mcg/mo;
NASAL
500 mcg q wk
• Adult:
SUBCUT/IM
30-50 mcg/day × 5-10 days then 100-200 mcg/mo
• Child:
SUBCUT/IM
30-50 mcg/day × 5-10 days then 30-50 mcg/mo
Available forms:
Cyanocobalamin:
tabs 25, 50, 100, 250, 500, 1000, 5000 mcg; ext rel tabs 100, 200, 500, 1000 mcg; lozenges 100, 250, 500 mcg; nasal jel 500 mcg/spray; inj 100, 1000 mcg/ml;
hydroxocobalamin:
inj 1000 mcg/ml
•
With fruit juice to disguise taste; immediately after mixing
•
With meals if possible for better absorption; large doses should not be used because most is excreted
•
By IM inj for pernicious anemia for life unless contraindicated
•
Avoid use within 1 hr of hot fluids, food
•
IV route not recommended but may be admixed in TPN solution
Additive compatibilities:
Ascorbic acid, chloramphenicol, hydrocortisone, metaraminol, vit B/C
Solution compatibilities:
Dextrose/Ringer’s or LR combinations, dextrose/saline combinations, D
5
W, D
10
W, 0.45% NaCl, Ringer’s or LR sol
Y-site compatibilities:
Alfentanil, amikacin, aminophylline, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bretylium, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, cefamandole, ceFAZolin, cefmetazole, cefonicid,
cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, clindamycin, dexamethasone, digoxin, diphenhydrAMINE, DOBUTamine, DOPamine, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, erythromycin, esmolol, famotidine, fentaNYL, fluconazole, folic acid, furosemide, ganciclovir, gentamicin, glycopyrrolate, heparin, hydrocortisone, hydrOXYzine, imipenem-cilastatin, indomethacin, insulin (regular), isoproterenol hydrochloride, ketorolac, labetalol, lidocaine, magnesium, mannitol, meperidine, metaraminol, methicillin, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, mezlocillin, miconazole, midazolam, minocycline, morphine, moxalactam, multiple vitamins injection, nafcillin, nalbuphine, naloxone, netilmicin, nitroglycerin, nitroprusside, norepinephrine, ondansetron, oxacillin, oxytocin, papaverine, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, ritodrine, sodium bicarbonate, succinylcholine, SUFentanil, theophylline, thiamine, ticarcillin, ticarcillin-clavulanate, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, verapamil, vitamin B complex with C
CNS:
Flushing, optic nerve atrophy
CV:
CHF,
peripheral vascular thrombosis,
pulmonary edema
GI:
Diarrhea
INTEG:
Itching, rash, pain at inj site
META:
Hypokalemia
SYST:
Anaphylactic shock
Gastric intrinsic factor must be present for absorption to occur; stored in liver, kidneys, stomach; 50%-90% excreted in urine; crosses placenta; excreted in breast milk
Increase:
absorption—predniSONE
Decrease:
absorption—aminoglycosides, anticonvulsants, colchicine, chloramphenicol, aminosalicylic acid, potassium preparations, cimetidine
Decrease:
vit B
12
absorption—goldenseal
False positive:
intrinsic factor
•
For vit B
12
deficiency: red, beefy tongue; psychosis; pallor; neuropathy
•
GI function: diarrhea, constipation
•
Potassium levels during beginning treatment in megaloblastic anemia; q6mo in pernicious anemia; folic acid, plasma vit B
12
(after 1 wk), reticulocyte counts
•
Nutritional status: egg yolks, fish, organ meats, dairy products, clams, oysters: good sources of vit B
12
•
For pulmonary edema, worsening of CHF in cardiac patients
•
Protection from light, heat
•
Therapeutic response: decreased anorexia, dyspnea on exertion, palpitations, paresthesias, psychosis, visual disturbances
•
That treatment must continue for life for pernicious anemia
•
To eat a well-balanced diet
•
To avoid contact with persons with infection; that infections are common
Discontinue product
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sye-kloe-ben′za-preen)
Amrix, Fexmid, Flexeril
Func. class.:
Skeletal muscle relaxant, central acting
Chem. class.:
Tricyclic amine salt
Do not confuse:
cyclobenzaprine
/cyproheptadine
Reduces tonic muscle activity at the brain stem; may be related to antidepressant effects
Adjunct for relief of muscle spasm and pain in musculoskeletal conditions
Unlabeled uses:
Fibromyalgia
Children <12 yr, acute recovery phase of MI, dysrhythmias, heart block, CHF, hypersensitivity, intermittent porphyria, thyroid disease, QT prolongation
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, renal/hepatic disease, addictive personality
Calculator
• Adult/adolescent ≥15 yr:
PO
5 mg tid × 1 wk, max 30 mg/day × 3 wk
• Adult:
EXT REL
15 mg/day, max 30 mg/day × 3 wk
• Geriatric:
PO
5 mg tid
• Adult (mild hepatic disease):
PO
5 mg, titrate slowly
• Adult:
PO
10 mg at bedtime, titrated up
Available forms:
Tabs 5, 10 mg; ext rel tab 15, 30 mg
•
Without regard to meals, give with food for GI symptoms
•
Do not crush, break, chew ext rel cap
CNS:
Dizziness, weakness, drowsiness
, headache, tremor, depression, insomnia, confusion, paresthesia, nervousness
CV:
Postural hypotension, tachycardia,
dysrhythmias
EENT:
Diplopia, temporary loss of vision
GI:
Nausea
, vomiting, hiccups, dry mouth, constipation, hepatitis
GU:
Urinary retention, frequency, change in libido
INTEG:
Rash, pruritus, fever, facial flushing, sweating
PO:
Onset 1 hr, peak 3-8 hr, duration 12-24 hr, half-life 1-3 days, metabolized by liver, excreted in urine, crosses placenta, excreted in breast milk
•
Do not use within 14 days of MAOIs, tramadol
Increase:
QT interval—Class IA/III antidysrhythmics, and other products that increase QT interval
Increase:
CNS depression—alcohol, tricyclics, opiates, barbiturates, sedatives, hypnotics
Increase:
CNS depression—kava
•
Pain:
location, duration, mobility, stiffness at baseline, periodically
•
Allergic reactions:
rash, fever, respiratory distress
•
Severe weakness, numbness in extremities
•
Storage in tight container at room temp
•
Assistance with ambulation if dizziness, drowsiness occur, especially for geriatric patients
•
Therapeutic response: decreased pain, spasticity; muscle spasms of acute, painful musculoskeletal conditions generally short term; long-term therapy seldom warranted
•
Not to discontinue medication abruptly; that insomnia, nausea, headache, spasticity, tachycardia will occur; that product should be tapered off over 1-2 wk
•
Not to take with alcohol, other CNS depressants
•
To avoid hazardous activities if drowsiness, dizziness occur
•
To avoid using OTC medication (cough preparations, antihistamines) unless directed by prescriber
•
To use gum, frequent sips of water for dry mouth
Administer activated charcoal; use anticonvulsants if indicated; monitor cardiac function