Mosby's 2014 Nursing Drug Reference (148 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
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Appendix B
edetate calcium
disodium (Rx)
(ee′de-tate)
Calcium Disodium Versenate
Func. class.:
Heavy metal antagonist (antidote)
Do not confuse:
edetate calcium disodium
/edetate disodium
Lead poisoning, acute lead encephalopathy
Hypersensitivity, anuria, poisoning of other metals, severe renal disease, hepatitis
Black Box Warning:
Child <3 yr
Calculator
• Adult/adolescent:
IV INF
500 mg/m
2
over 1 hr or
IM
• Child:
IV INF
500 mg/m
2
over 1 hr or
IM
as single dose or 2 divided doses
• Adult/adolescent/child/infant:
IM/IV
1500 mg/m
2
as
IV INF
over 12-24 hr in combination with dimercaprol
IM,
give 1st dose ≥4 hr after initial dimercaprol, when urine flow established
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ef-ah-veer′enz)
Sustiva
Func. class.:
Antiretroviral
Chem. class.:
Nonnucleoside reverse transcriptase inhibitor (NNRTI)
Binds directly to reverse transcriptase and blocks RNA, DNA polymerase, thus causing a disruption of the enzyme’s site
HIV-1 in combination with at least 2 other antivirals
Unlabeled uses:
HIV prophylaxis
Pregnancy (D), hypersensitivity
Precautions:
Breastfeeding, children <3 yr, renal/hepatic disease, myelosuppression, depression, seizures
Calculator
Given in combination with protease inhibitor or nucleoside analog reverse transcriptase inhibitors (NARTIs)
• Adult and child >40 kg:
PO
600 mg/day at bedtime
• Child ≥3 yr, 32.5-39.9 kg:
PO
400 mg/day at bedtime
• Child ≥3 yr, 25-32.4 kg:
PO
350 mg/day at bedtime
• Child ≥3 yr, 20-24.9 kg:
PO
300 mg/day at bedtime
• Child ≥3 yr, 15-19.9 kg:
PO
250 mg/day at bedtime
• Child ≥3 yr, 10-14.9 kg:
PO
200 mg/day at bedtime
Available forms:
Caps 50, 100, 200 mg; 600-mg tabs
•
Give on empty stomach; give at bedtime to decrease CNS side effects
•
Caps may be opened, added to grape jelly to disguise peppery taste
CNS:
Fatigue, impaired cognition, insomnia, abnormal dreams, depression, headache, dizziness, anxiety, drowsiness
GI:
Diarrhea
, abdominal pain,
nausea
, hyperlipidemia, constipation, increased LFTs
GU:
Hematuria, kidney stones
INTEG:
Rash,
erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
Peak 3-5 hr, well absorbed, metabolized by liver; terminal half-life 52-76 hr; >99% protein binding, excreted in urine, feces; concentrations higher in females and those of African, Asian, and Hispanic descent
•
Avoid use with boceprevir, delavirdine, rilpivirine; dosage change may be needed if given with telaprevir
•
Do not give together with benzodiazepines, ergots, midazolam, triazolam, CISapride
Increase:
CNS depression—alcohol, antidepressants, antihistamines, opioids
Increase:
levels of both products—ritonavir, estrogens, anticonvulsants
Increase:
levels of warfarin, statins (except pravastatin, fluvastatin)
Decrease:
levels of indinavir, amprenavir, lopinavir, oral contraceptives, nonoral contraceptives, ketoconazole, itraconazole, posaconazole, voriconazole, saquinavir, clarithromycin, methadone
Decrease:
efavirenz metabolism—CYP3A4 inhibitors (conivaptan, ambrisentan, sorafenib)
Decrease:
efavirenz effect—CYP3A4 inducers (carBAMazepine, rifamycins)
Decrease:
efavirenz level—St. John’s wort; do not use together
Increase:
absorption—high-fat foods
Increase:
ALT
False positive:
cannibinoids
•
Pregnancy:
Rule out pregnancy (D) before starting treatment; a type of contraception is needed, oral/nonoral contraceptives are decreased
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
•
Serious skin reactions:
Stevens-Johnson syndrome, toxic epidermal necrolysis
•
HIV:
Monitor CBC, blood chemistry, plasma HIV RNA, absolute CD4+/CD8+ cell counts/%, serum β
2
microglobulin, serum ICD+24 antigen levels, cholesterol, hepatic enzymes
•
Signs of toxicity:
severe nausea/vomiting, maculopapular rash
•
Therapeutic response: increased CD4 cell counts; decreased viral load; slowing progression of HIV
•
To take as prescribed; if dose is missed, to take as soon as remembered; not to double dose; to take with water, juice; to take on empty stomach at bedtime
•
To make sure health care provider knows all medications, supplements, OTC products taken
•
That, if severe rash occurs, to notify health care provider; that adverse reactions (rash, dizziness, abnormal dreams, insomnia) lessen after 1 mo
•
Not to breastfeed or become pregnant if taking this product; to use nonhormonal contraception because serious birth defects have occurred (pregnancy D)
•
To avoid hazardous activities if dizziness, drowsiness occur
•
That product does not cure disease but controls symptoms; that HIV can be transmitted to others even while taking this product; to continue with safe-sex practices
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(el-ee-trip′tan)
Relpax
Func. class.:
Antimigraine agent, abortive
Chem. class.:
5-HT
1
-1B/1D receptor agonist, triptan
Binds selectively to the vascular 5-HT
1
-receptor subtype; causes vasoconstriction in cranial arteries
Acute treatment of migraine with/without aura
Hypersensitivity, coronary artery vasospasm, peripheral vascular disease, hemiplegic/basilar migraine, uncontrolled hypertension; ischemic bowel, heart disease; severe renal/hepatic disease, acute MI, stroke, angina, CV disease
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, postmenopausal women, men >40 yr; risk factors of CAD, MI, or other cardiac disease; hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function
Calculator
• Adult:
PO
20 or 40 mg, may increase if needed, max 40 mg (single dose); may repeat in 2 hr if headache improves but returns, max 80 mg/24 hr
Available forms:
Tabs 20, 40 mg
•
Swallow tabs whole; do not break, crush, or chew, use with 8 oz of water
•
At beginning of headache; if headache returns, repeat dose after 2 hr of 1st dose if 1st dose is ineffective
CNS:
Dizziness
, headache, anxiety, paresthesia, asthenia, somnolence, flushing, fatigue, hot/cold sensation, chills, vertigo, hypertonia,
seizures, serotonin syndrome
CV:
Chest pain, palpitations, hypertension,
MI, sinus tachycardia, stroke, ventricular fibrillation/tachycardia, atrial fibrillation, AV block, bradycardia,
chest pressure syndrome,
coronary vasospasm
GI:
Nausea, dry mouth, vomiting
MS:
Weakness
, back pain
RESP:
Chest tightness, pressure
Onset of pain relief 2 hr, metabolized in the liver, 70% excreted in urine and feces
Increase:
plasma concentration of eletriptan—CYP3A4 inhibitors (clarithromycin, erythromycin, itraconazole, ketoconazole, nelfinavir, ritonavir), propranolol, ergots
Increase:
serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists
•
Migraine:
pain location, character, intensity, nausea, vomiting, aura; quiet, calm environment with decreased stimulation from noise, bright light, excessive talking
•
B/P; signs, symptoms of coronary vasospasms, geriatric patients may be at higher risk
•
Tingling, hot sensation, burning, feeling of pressure, numbness, flushing
•
Stress level, activity, recreation, coping mechanisms
•
Neurologic status: LOC, blurring vision, nausea, vomiting, tingling in extremities preceding headache
•
Ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artificial sweeteners, chocolate, caffeine, which may precipitate these types of headaches
•
Patients with CAD risk factors; 1st dose should be administered in prescriber’s office or medical facility
•
Therapeutic response: decrease in frequency, severity of migraine
•
To report any side effects to prescriber
•
To use contraception while taking product; to inform prescriber if pregnant or intending to become pregnant
•
To provide dark, quiet environment
•
That product does not prevent or reduce number of migraine attacks