Mosby's 2014 Nursing Drug Reference (135 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(dye-fen-ox′ee-late/a′troe-peen)
Lomotil, Lonox
(dye-fen-ox′in/a′troe-peen)
Motofen
Func. class.:
Antidiarrheal
Chem. class.:
Phenylpiperidine derivative opiate agonist
diphenoxylate/atropine
difenoxin/atropine (US)
Do not confuse:
Lomotil
/LaMICtal/LamISIL/Lanoxin/Lasix/Ludomil
Inhibits gastric motility by acting on mucosal receptors responsible for peristalsis
Acute nonspecific and acute exacerbations of chronic functional diarrhea
Children <2 yr, hypersensitivity, pseudomembranous colitis, severe electrolyte imbalances, diarrhea associated with organisms that penetrate intestinal mucosa
Precautions:
Pregnancy (C), breastfeeding, hepatic disease, ulcerative colitis, severe hepatic disease, substance abuse, dehydration
Calculator
•
Adult: PO
5 mg qid titrated to patient response needed, max 8 tabs/day
• Child 2-12 yr: PO
(liquid only) 0.3-0.4 mg/kg/day in 4 divided doses
•
Adult: PO
2 tabs then 1 tab after each loose stool or q3-4hr prn, max 8 tabs/day
Available forms:
Diphenoxylate/atropine:
tabs 2.5 mg with atropine 0.025 mg; liquid 2.5 mg with atropine 0.025 mg/5 ml;
difenoxin/atropine:
tabs 1 mg difenoxin/0.025 atropine
•
For 48 hr only; if no response, product should be discontinued
CNS:
Dizziness, drowsiness, light-headedness, headache
, fatigue, nervousness, insomnia, confusion
EENT:
Burning eyes, blurred vision
GI:
Nausea, vomiting, dry mouth, epigastric distress
, constipation,
paralytic ileus, toxic megacolon
MISC:
Anaphylaxis, angioedema
RESP:
Respiratory depression
PO:
Onset 40-60 min, peak 2 hr, duration 3-4 hr, terminal half-life 12-14 hr, metabolized in liver to active metabolite; excreted in urine and feces
•
Do not use with MAOIs; hypertensive crisis may occur
Increase:
action of alcohol, opioids, barbiturates, other CNS depressants, anticholinergics
Decrease:
GI motility, possible toxic megacolon—amantadine, antimuscarinics, amoxapine, diphenhydrAMINE, cloZAPine, clemastine, cyclobenzaprine, loperamide, maprotiline, phenothiazines, tricyclics, disopyramide, OLANZapine
•
Electrolytes (potassium, sodium, chlorine) if receiving long-term therapy
•
Bowel pattern before; for rebound constipation after termination of medication; bowel sounds
•
Response after 48 hr; if none, product should be discontinued
•
Abdominal distention, toxic megacolon;
may occur in ulcerative colitis
•
Hepatic studies if receiving long-term therapy
•
Therapeutic response: decreased diarrhea
•
To avoid OTC products unless directed by prescriber (may contain alcohol); not to use alcohol or CNS depressants
•
Not to exceed recommended dose
•
That product may be habit forming
•
Not to engage in hazardous activities; that drowsiness may occur; not to use for longer than 48 hr for acute diarrhea
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(dye-peer-id′a-mole)
Persantine
Func. class.:
Coronary vasodilator, antiplatelet agent
Chem. class.:
Nonnitrate
Inhibits adenosine uptake, which produces coronary vasodilation; increases oxygen saturation in coronary tissues, coronary blood flow; acts on small resistance vessels with little effect on vascular resistance; may increase de
velopment of collateral circulation; decreases platelet aggregation by the inhibition of phosphodiesterase (an enzyme)
Prevention of transient ischemic attacks, inhibition of platelet adhesion to prevent myocardial reinfarction, thromboembolism, with warfarin in prosthetic heart valves, prevention of coronary bypass graft occlusion with aspirin; IV form used to evaluate CAD; used as alternative to exercise with thallium myocardial perfusion imaging to evaluate CAD
Unlabeled uses:
Cardiomyopathy, MI prophylaxis, proteinuria, TIA, valvular heart disease
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, hypotension
Calculator
•
Adult: PO
75-100 mg qid in combination with aspirin or warfarin
•
Adult: IV
570 mcg/kg
•
Adult: PO
225-400 mg/day max 400 mg/day
Available forms:
Tabs 25, 50, 75 mg; inj 10 mg/2 ml
•
On empty stomach: 1 hr before meals or 2 hr after; give with 8 oz water for better absorption
•
IV after diluting to at least 1:2 ratio using D
5
W, 0.45% NaCl, or 0.9% NaCl to a total vol of 20-50 ml; give over 4 min; do not give undiluted
•
Inject thallium 201 within 5 min after product infusion
•
Do not admix
CNS:
Headache, dizziness, weakness, fainting, syncope;
IV: transient cerebral ischemia, weakness
CV:
Postural hypotension;
IV:
MI
GI:
Nausea, vomiting
, anorexia, diarrhea
INTEG:
Rash
, flushing
RESP:
IV:
Bronchospasm
PO:
Peak 1.25 hr, duration 6 hr, therapeutic response may take several months, metabolized in liver, excreted in bile, undergoes enterohepatic recirculation, protein binding 91%-99%, terminal half-life 12 hr
•
Prevention of coronary vasodilation: theophylline
Increase:
digoxin effect—digoxin
Increase:
bleeding risk—NSAIDs, cefamandole, cefoTEtan, cefoperazone, plicamycin, valproic acid, salicylates, sulfinpyrazole, anticoagulants, thrombolytics
•
B/P, pulse during treatment until stable; take B/P lying, standing; orthostatic hypotension is common
•
Cardiac status: chest pain; what aggravates, ameliorates condition
•
Storage at room temp
•
Therapeutic response: decreased platelet adhesion
•
That medication is not a cure; may have to be taken continuously in evenly spaced doses only as directed
•
To avoid hazardous activities until stabilized on medication; dizziness may occur
•
To rise slowly from sitting or lying to prevent orthostatic hypotension
•
Not to use alcohol or OTC medications unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert