Mosby's 2014 Nursing Drug Reference (149 page)

• Adult:
PO
50 mg/day, adjust dosage to maintain platelets at ≥50 × 10
⁹
, max 75 mg/day; 100 mg/day chronic hepatitis C

Black Box Warning:

Hepatic insufficiency, chronic hepatitis B virus (HPV)

• Adult:
PO
Caps 200 mg/day; oral sol 240 mg (24 ml)/day

• Adolescent/child >33 kg:
PO
Caps 200 mg/day;
child 3 mo-17 yr:
oral sol 6 mg/kg/day, max 240 mg (24 ml)

• Infants <3 mo:
PO oral sol
3 mg/kg daily, do not use caps

• Adult:
PO
Caps CCr 30-49 ml/min, 200 mg q48hr; oral sol 120 mg q24hr; caps CCr 15-29 ml/min, 200 mg q72hr; oral sol 80 mg q24hr; caps CCr <15 ml/min, 200 mg q96hr; oral sol 60 mg q24hr

• 
Give without regard to meals

• 
Oral cap and solution not interchangeable

• 
Storage (caps) at 25° C (77° F); (oral sol) refrigerated, use within 3 mo

Decrease:
emtricitabine level—interferons

• 
Renal/hepatic function tests: AST, ALT, bilirubin, amylase, lipase, triglycerides periodically during treatment

Black Box Warning:

Lactic acidosis, severe hepatomegaly with steatosis;
if lab reports confirm these conditions, discontinue treatment; may be fatal

Black Box Warning:

Hepatotoxicity:
do not use in those with risk factors such as alcoholism, discontinue if hepatotoxicity occurs

Black Box Warning:

Hepatitis B and HIV coinfection (unlabeled); perform HBV screening in any patient who has HIV to ensure appropriate treatment; avoid single-drug treatments in HBV

• 
Therapeutic response: decreased signs, symptoms of HIV; decreased viral load, increased CP4 counts

• 
That GI complaints resolve after 3-4 wk of treatment

• 
To report planned or suspected pregnancy; not to breastfeed while taking product

• 
That product must be taken at same time of day to maintain blood level

• 
That product will control symptoms but is not a cure for HIV; patient still infectious, may pass HIV virus on to others; that other products may be necessary to prevent other infections

• 
That changes in body fat distribution may occur

Black Box Warning:

Lactic acidosis: to notify prescriber immediately if fatigue, muscle aches/pains, abdominal pain, difficulty breathing, nausea, vomiting, change in heart rhythm occur

Black Box Warning:

Hepatotoxicity: to notify prescriber of dark urine, yellowing of skin/eyes, clay-colored stools, anorexia, nausea, vomiting

• Adult:
PO
2.5-5 mg/day, may increase or decrease to desired response, range 10-40 mg/day;
IV
0.625-1.25 mg q6hr over 5 min

• Child:
PO
0.08 mg/kg/day in 1-2 divided doses, max 0.58 mg/kg/day

• Child:
IV
5-10 mcg/kg/dose q8-24hr

• Adult:
PO
2.5-20 mg/day in 2 divided doses, max 40 mg/day in divided doses

• Adult:
PO
2.5 mg/day (CCr <30 ml/min), increase gradually;
IV
CCr >30 ml/min, 1.25 mg q6hr; CCr <30 ml/min, 0.625 mg as one-time dose, increase as per B/P

• Adult:
IV
1.25-5 mg q6hr

Y-site compatibilities:
Acyclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminophylline, amphotericin B liposome, anidulafungin, ascorbic acid,
atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bretylium, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, ceFAZolin, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, cimetidine, cisatracurium, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, dextran 40, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposome, doxycycline, ePHEDrine, EPINEPHrine, epirubicin, epoetin, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem-cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamin injection, nafcillin, nalbuphine, naloxone, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, papaverine, PEMEtrexed, penicillin G potassium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin-tazobactam, potassium chloride/phosphate, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxime, quinupristin-dalfopristin, ranitidine, remifentanil, ritodrine, riTUXimab, rocuronium, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, tetracycline, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zoledronic acid

Additive compatibilities:
DOBUTamine, DOPamine, heparin, meropenem, nitroglycerin, nitroprusside, potassium chloride

Increase:
hypersensitivity—allopurinol

Increase:
hypotension—diuretics, other antihypertensives, phenothiazines, nitrates, acute alcohol ingestion, general anesthesia

Increase:
potassium levels—salt substitutes, potassium-sparing diuretics, potassium supplements, cycloSPORINE, indomethacin

Increase:
levels of lithium, digoxin

Decrease:
effects of enalapril—antacids, rifampin

Increase:
ALT, AST, bilirubin, alk phos, glucose, uric acid

False positive:
ANA titer

• 
Bone marrow depression (rare):
neutrophils, decreased platelets; WBC with differential baseline, q3mo; if neutrophils <1000/mm
³
, discontinue treatment (recommended with collagen-vascular disease)

• 
Hypertension:
B/P, peak/trough level, orthostatic hypotension, syncope when used with diuretic, pulse q4hr; note rate, rhythm, quality

• 
Baselines of renal, hepatic studies before therapy begins and 1 wk into therapy; electrolytes: potassium, sodium, chloride during 1st 2 wk of therapy

• 
Skin turgor, dryness of mucous membranes for hydration status; edema in feet, legs daily

• 
Symptoms of CHF:
edema, dyspnea, wet crackles, weight gain, jugular venous distension, difficulty breathing

• 
Therapeutic response: decreased B/P

• 
Not to use OTC (cough, cold, or allergy) products unless directed by prescriber; to avoid potassium, salt substitutes

• 
To avoid sunlight or wear sunscreen for photosensitivity

• 
To comply with dosage schedule even if feeling better

• 
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, signs of angioedema

• 
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in blood pressure; to consult prescriber if these occur

• 
That product may cause dizziness, fainting; that lightheadedness may occur during 1st few days of therapy

• 
That product may cause skin rash, impaired perspiration or angioedema; to discontinue if angioedema occurs

• 
Not to discontinue product abruptly

• 
That CV adverse reactions may reoccur

• 
To rise slowly to sitting or standing position to minimize orthostatic hypotension

Black Box Warning:

To notify prescriber if pregnancy is planned or suspected; to use contraception during treatment; pregnancy (D)