Mosby's 2014 Nursing Drug Reference (132 page)

Increase:
toxicity—azole antifungals, macrolides, tetracyclines, ritonavir

Increase:
hypercalcemia, hypomagnesemia, digoxin toxicity—thiazides, parenteral calcium

Increase:
hypokalemia, digoxin toxicity—diuretics, amphotericin B, carbenicillin, ticarcillin, corticosteroids

Increase:
digoxin levels—propantheline, quiNIDine, verapamil, amiodarone, anticholinergics, diltiazem, NIFEdipine, indomethacin

Increase:
bradycardia—β-adrenergic blockers, antidysrythmics

Increase:
cardiac dysrhythmia risk—sympathomimetics

Decrease:
digoxin absorption—antacids, kaolin/pectin, cholestyramine, metoclopramide

Decrease:
digoxin level—thyroid agents, cholestyramine, colestipol, metoclopramide, aMILoride

Decrease:
product effect—St. John’s wort

Increase:
CPK

• 
Apical pulse for 1 min before giving product; if pulse <60 in adult or <90 in infant, take again in 1 hr; if <60 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral loading dose

• 
Electrolytes: potassium, sodium, chloride, magnesium, calcium; renal function studies: BUN, creatinine; blood studies: ALT, AST, bilirubin, Hct, Hgb before initiating treatment and periodically thereafter

• 
Monitor product levels; therapeutic level 0.5-2 ng/ml

• 
Therapeutic response: decreased weight, edema, pulse, respiration, crackles; increased urine output; serum digoxin level (0.5-2 ng/ml)

• 
Not to stop product abruptly; about all aspects of product; to take exactly as ordered; how to monitor heart rate

• 
To avoid OTC medications, herbal remedies because many adverse product interactions may occur; not to take antacid at same time

•
 
To notify prescriber of loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression, toxicity

• 
About the toxic symptoms of this product; when to notify prescriber

• 
To maintain a sodium-restricted diet as ordered

• 
To use one brand consistently

•
Adult and child: IV
dose (mg) = dose ingested (mg) × 0.8/1000 × 38- or 40-mg vial

• Adult and child: IV
dose = dose ingested (mg)/0.5 × 38- or 40-mg vial

• Adult and child: IV
SDC (ng/ml) × kg of weight/100 × 38- or 40-mg vial

• Adult and child >20 kg: IV
228 mg (6 vials)

• Infant and child <20 kg: IV
38 mg (1 vial)

•
Adult: IV
380 mg (10 vials)

•
Adult: IV
760 mg (20 vials)

• 
Adult: ID
9.5 mcg

• 
Test doses proven to be ineffective in the general population; only use test dose in those with known allergies or those previously treated with digoxin immune FAB

• 
For test dose
dilute 0.1 ml of reconstituted product (9.5 mg/ml) in 9.9 ml sterile isotonic saline, inj 0.1 ml (1:100 dilution) ID and observe for wheal with erythema; read in 20 min

• 
For scratch test,
place 1 gtt of sol on skin, make a scratch through the drop with a sterile needle; read in 20 min

• 
After diluting 38 mg/4 ml of sterile water for inj 10 mg/ml mix; may be further diluted with normal saline; sol should be clear, colorless

• 
By bolus if cardiac arrest is imminent or IV over 30 min using a 0.22-μm filter

Interference:
immunoassay digoxin

•
 
Hypokalemia:
ST depression, flat
T
waves, presence of
U
wave, ventricular dysrhythmia; potassium levels may decrease rapidly

•
 
CHF:
dyspnea, crackles, peripheral edema, B/P, volume overload

• 
Storage of reconstituted sol for up to 4 hr in refrigerator

•
 
Do not freeze DigiFab

• 
Therapeutic response: correction of digoxin toxicity; check digoxin levels 0.5-2 ng/ml; digitoxin level 9-25 ng/ml

• 
About the purpose of medication; to report delayed hypersensitivity: fever, chills, itching, swelling, dyspnea

•
Adult: PO
30 mg qid, increasing dose gradually to 180-360 mg/day in divided doses or (SR) 60-120 mg bid; may increase to 240-360 mg/day or 120 or 180 mg
EXT REL
(LA, CD, XT, XR products)
PO
daily

• 
Adult: IV BOL
0.25 mg/kg over 2 min initially then 0.35 mg/kg may be given after 15 min; if no response, may give
CONT INF
5-15 mg/hr for up to 24 hr

•
Adult: PO
or 120-240 mg
(EXT REL once-daily dosing)
daily or 60-120 mg bid
(SUS REL twice-daily dosing)

• Adolescent/child/infant >7 mo: IV BOL
0.25 mg/kg over 5 min then
CONT IV INF
0.11 mg/kg/hr

• 
Grind 16 90-mg diltiazem regular rel tab into fine powder

• 
In separate container, mix 60 ml Ora-Sweet and 60 ml Ora-Plus

• 
Add small amount of sol to powder to form paste, add geometric amounts of base to achieve desired vol, place in amber container

Y-site compatibilities:
Albumin, amikacin, amphotericin B, aztreonam, bumetanide, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, cefTRIAXone, cefuroxime, cimetidine, ciprofloxacin, clindamycin, digoxin, DOBUTamine, DOPamine, doxycycline, EPINEPHrine, erythromycin, esmolol, fentaNYL, fluconazole, gentamicin, hetastarch, HYDROmorphone, imipenem-cilastatin, labetalol, lidocaine, LORazepam, meperidine, metoclopramide, metroNIDAZOLE, midazolam, milrinone,
morphine, multivitamins, niCARdipine, nitroglycerin, norepinephrine, oxacillin, penicillin G potassium, pentamidine, piperacillin, potassium chloride, potassium phosphates, ranitidine, sodium nitroprusside, theophylline, ticarcillin, ticarcillin/clavulanate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vecuronium

Increase:
effect, toxicity—theophylline

Increase:
effects of β-blockers, digoxin, lithium, carBAMazepine, cycloSPORINE, anesthetics, HMG-CoA reductase inhibitors, benzodiazepines, lovastatin, methylPREDNISolone

Increase:
effects of diltiazem—cimetidine

•
 
CHF:
dyspnea, weight gain, edema, jugular venous distention, rales; monitor I&O ratios daily, weight

• 
Angina:
location, duration, alleviating factors, activity when pain starts

•
 
Dysrhythmias:
cardiac status: B/P, pulse, respiration, ECG and intervals PR, QRS, QT; if systolic B/P <90 mm Hg or HR <50 bpm, hold dose, notify prescriber

• 
Storage in tight container at room temp

• 
Therapeutic response: decreased anginal pain, decreased B/P

• 
How to take pulse, B/P before taking product; that a record or graph should be kept

• 
To avoid hazardous activities until stabilized on product, dizziness is no longer a problem

• 
To limit caffeine consumption; to avoid grapefruit juice

• 
To avoid OTC products unless directed by prescriber

• 
About the importance of complying with all areas of medical regimen: diet, exercise, stress reduction, product therapy

• 
To change position slowly

 
To report dizziness, SOB, palpitations

•
 
Not to discontinue abruptly