Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (130 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
dicyclomine (Rx)
(dye-sye′kloe-meen)
Bentyl, Bentylol
, Formulex, Lomine
Func. class.:
Gastrointestinal anticholinergic
Treatment of peptic ulcer disease in combination with other products; infant colic, urinary incontinence, IBS
Hypersensitivity to anticholinergics, closed-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, GI atony, toxic megacolon, dementia
Calculator
•
Adult: PO
10-20 mg tid-qid;
IM
20 mg q4-6hr; max 160 mg/day
• Child >2 yr: PO
10 mg tid-qid
• Child 6 mo-2 yr: PO
5 mg tid-qid
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(dye-dan′oh-seen)
ddl, Videx Pediatric Powder, Videx EC
Func. class.:
Antiretroviral
Chem. class.:
Nucleoside reverse transcriptase inhibitor (NRTI)
Nucleoside analog incorporating into cellular DNA by viral reverse transcriptase, thereby terminating the cellular DNA chain
HIV-1 infection in combination with at least 2 other antiretrovirals
Unlabeled uses:
HIV prophylaxis
Hypersensitivity, lactic acidosis, pancreatitis, phenylketonuria
Precautions:
Pregnancy (B), breastfeeding, children, renal disease, sodium-restricted diets, elevated amylase, preexisting peripheral neuropathy, hyperuricemia, gout, CHF, noncirrhotic portal hypertension
Black Box Warning:
Hepatic disease, lactic acidosis, pancreatitis
Calculator
• Adult/adolescent/child ≥6 yr and ≥60 kg: PO EXT REL CAP
400 mg/day; if used with tenofovir, reduce to 250 mg/day
• Adult/adolescent/child ≥6 yr and 25 kg to <60 kg: PO EXT REL CAP
250 mg/day; if used with tenofovir, reduce to 200 mg/day
• Adolescent 20 kg to <25 kg: PO EXT REL CAP
200 mg/day
•
Adult ≥60 kg: PO ORAL SOL
200 mg bid or 400 mg/day; if used with tenofovir, reduce to 250 mg/day
• Adult <60 kg: PO ORAL SOL
125 mg bid or 250 mg/day; if used with tenofovir, reduce to 200 mg/day
• Adolescent/child/infant >8 mo: PO ORAL SOL
120 mg/m
2
every 12 hr, max adult dosing
• Infant <8 mo/neonate ≥2 wk: PO ORAL SOL
100 mg/m
2
every 12 hr
•
Adult: PO
CrCl ≥60 ml/min: No change
• Adult/adolescent ≥60 kg: PO
CCr 30–59 ml/min: reduce oral sol to 100 mg every 12 hr or 200 mg every 24 hr; reduce EXT-REL caps to 200 mg/day; CCr 10–29 ml/min: reduce oral sol to 150 mg every 24 hr; reduce EXT-REL caps to 125 mg/day; CCr <10 ml/min: reduce oral sol to 100 mg every 24 hr; reduce EXT-REL caps to 125 mg/day
• Adult/adolescent <60 kg: PO
CCr 30–59 ml/min: reduce oral sol to 75 mg every 12 hr or to 150 mg every 24 hr; reduce EXT-REL caps to 125 mg/day; CCr 10–29 ml/min: reduce oral sol to 100 mg every 24 hr; reduce EXT-REL caps to 125 mg/day; CCr <10 ml/min: reduce oral sol to 75 mg every 24 hr; EXT-REL caps are not recommended
• Adult/adolescent >60 kg:
Give 100 mg oral sol or 125 mg EXT-REL CAPS every 24 hrs
• Adult/adolescent <60 kg:
Give 75 mg oral sol every 24 hr, EXT-REL CAPS are not recommended
Available forms:
Powder for oral sol 10 mg/ml; del rel caps 125, 200, 250, 400 mg
•
Pediatric powder for oral sol after preparation by pharmacist; dilution required using purified USP water then antacid (10 mg/ml), refrigerate, shake before use
•
On an empty stomach ≥30 min before or 2 hr after meals
•
Adjust dose with renal impairment
CNS:
Peripheral neuropathy, seizures,
confusion,
anxiety
, hypertonia, abnormal thinking, asthenia,
insomnia
,
CNS depression,
pain, dizziness, chills, fever
CV:
Hypertension, vasodilation, dysrhythmia, syncope,
CHF,
palpitation
EENT:
Ear pain, otitis, photophobia, visual impairment, retinal depigmentation, optic neuritis
GI:
Pancreatitis,
diarrhea, nausea
, vomiting,
abdominal pain
, constipation, stomatitis, dyspepsia, liver abnormalities, flatulence, taste perversion, dry mouth, oral thrush, melena, increased ALT/AST, alk phos, amylase,
hepatic failure,
noncirrhotic portal hypertension
GU:
Increased bilirubin, uric acid
HEMA:
Leukopenia, granulocytopenia, thrombocytopenia, anemia
INTEG:
Rash, pruritus
, alopecia, ecchymosis, hemorrhage, petechiae, sweating
MS:
Myalgia, arthritis, myopathy, muscular atrophy
RESP:
Cough, pneumonia, dyspnea, asthma, epistaxis, hypoventilation, sinusitis
SYST:
Lactic acidosis, anaphylaxis
PO:
Peak 0.67 hr, del rel 2 hr; elimination half-life 1.62 hr; extensive metabolism thought to occur; administration within 5 min of food will decrease absorption (50%); excreted urine, feces
Increase:
didanosine level—allopurinol, tenofovir
Increase:
side effects from magnesium, aluminum antacids
Increase:
pancreatitis risk—stavudine
Decrease:
absorption—ketoconazole, dapsone
Decrease:
concentrations of fluoroquinolones, other antiretrovirals, itraconazole, tetracyclines
Decrease:
didanosine level—methadone
•
Do not use with these products PO: gatifloxacin, gemifloxacin, grepafloxacin, levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, sparfloxacin, trovafloxacin
•
Any food decreases rate of absorption 50%, do not use with food
•
Do not use with acidic juices
Black Box Warning:
Pancreatitis:
do not use in those with symptoms of pancreatitis; may be dose related in advanced HIV, alcoholism, history of pancreatitis
•
Peripheral neuropathy:
tingling or pain in hands and feet, distal numbness; onset usually occurs 2-6 mo after beginning treatment, may persist if product not discontinued
Black Box Warning:
Lactic acidosis, severe hepatomegaly, pancreatitis:
abdominal pain, nausea, vomiting, elevated hepatic enzymes; product should be discontinued because condition can be fatal
•
Children by dilated retinal exam q6mo to rule out retinal depigmentation
•
CBC, differential, platelet count monthly; notify prescriber of results; alk phos, monitor amylase; viral load, CD4 count
•
Renal studies: BUN, serum uric acid, urine CCr before, during therapy
•
Temp may indicate beginning infection
•
Hepatic studies before, during therapy (bilirubin, AST, ALT) as needed, monthly
•
Clean up of powdered products; use wet mop or damp sponge
•
Storage of tabs, caps in tightly closed bottle at room temp; store oral sol after dissolving at room temp ≤4 hr
•
Therapeutic response: absence of infection; symptoms of HIV
•
To avoid use with alcohol, not to take with food
•
To report numbness/tingling in extremities
•
To take on an empty stomach; not to take dapsone at same time as ddI; not to mix powder with fruit juice; chew tab or crush and dissolve in water; to drink powder immediately after mixing
•
To report signs of
infection:
increased temp, sore throat, flulike symptoms
•
To report signs of
anemia:
fatigue, headache, faintness, SOB, irritability
•
To report
bleeding;
to avoid use of razors, commercial mouthwash
•
That hair may be lost during therapy (rare); that a wig or hairpiece may make patient feel better
•
That product does not cure, only controls symptoms