Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (150 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(en-fyoo′vir-tide)
Fuzeon
Func. class.:
Antiretroviral
Chem. class.:
Fusion Inhibitor
Inhibitor of the fusion of HIV-1 with CD4+ cells
Treatment of HIV-1 infection in combination with other antiretrovirals
Unlabeled uses:
HIV prophylaxis after occupational exposure
Breastfeeding, hypersensitivity
Precautions:
Pregnancy (B), children <6 yr, liver disease, myelosuppression, infections
Calculator
• Adult:
SUBCUT
90 mg (1 ml) bid
• Child 6-16 yr and <42.6 kg:
SUBCUT
2 mg/kg bid, max 90 mg bid; 11-15.5 kg 27 mg/0.3 ml bid; 15.6-20 kg 36 mg/0.4 ml
bid; 20.1-24.5 kg 45 mg/0.5 ml bid; 24.6-29 kg 54 mg/0.6 ml bid; 29.1-33.5 kg 63 mg/0.7 ml bid; 33.6-38 kg 72 mg/0.8 ml bid; 38.1-42.5 kg 81 mg/0.9 ml bid
• Adult:
SUBCUT
90 mg bid added to PEP regimen
Available forms:
Powder for inj, lyophilized 108 mg (90 mg/ml when reconstituted)
•
Reconstitute
vial with 1.1 ml sterile water for inj; tap and roll to mix; allow to stand until completely dissolved, may take up to 45 min; after dissolved, immediately
inject
or refrigerate up to 24 hr
•
Do not mix with other medications
•
SUBCUT: give bid, rotate sites; preferred sites: upper arm, anterior thigh, abdomen
CNS:
Anxiety, peripheral neuropathy, taste disturbance,
Guillain-Barré syndrome,
insomnia, depression
GI:
Abdominal pain, anorexia, constipation,
pancreatitis
GU:
Glomerulonephritis, renal failure
HEMA:
Thrombocytopenia, neutropenia
INTEG:
Inj site reactions
MISC:
Influenza, cough, conjunctivitis, lymphadenopathy, myalgia, hyperglycemia,
pneumonia,
rhinitis, fatigue, hypersensitivity
Peak 8 hr, terminal half-life 3.8 hr, well absorbed, undergoes catabolism, 92% protein binding
•
Signs of infection, inj site reactions
•
Glomerulonephritis/renal failure:
BUN, creatinine, renal failure may occur
•
Bowel pattern before, during treatment; if severe abdominal pain or constipation occurs, notify prescriber; monitor hydration
•
Skin eruptions, rash, urticaria, itching
•
Allergies before treatment, reaction to each medication
•
Immune reconstitution syndrome:
with combination theory
•
HIV:
CBC, blood chemistry, plasma HIV RNA, absolute CD4+/CD8+ cell counts/%, serum β
2
microglobulin, serum ICD+24 antigen levels, cholesterol
•
Therapeutic response: increased CD4 cell counts; decreased viral load; slowing progression of HIV-1 infection
•
To notify prescriber if pregnancy is suspected or if breastfeeding
•
That pneumonia may occur; to contact prescriber if cough, fever occur
•
That hypersensitive reactions may occur; rash, pruritus; to stop product, contact prescriber
•
That product is not a cure for HIV-1 infection but controls symptoms; HIV-1 can still be transmitted to others; that product is to be used in combination only with other antiretrovirals
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTenoxaparin (Rx)
(ee-nox′a-par-in)
Lovenox
Func. class.:
Anticoagulant, antithrombotic
Chem. class.:
Low-molecular-weight heparin (LMWH)
Do not confuse:
enoxaparin
/enoxacin
Lovenox
/Lotronex
Binds to antithrombin III inactivating factors Xa/IIa, thereby resulting in a higher ratio of anti-factor Xa to IIa
Prevention of DVT (inpatient or outpatient), PE (inpatient) in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non–Q-wave MI
Unlabeled uses:
Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, cerebral thromboembolism, percutaneous coronary intervention
Hypersensitivity to this product, benzyl alcohol, heparin, pork; active major bleeding, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, heparin-induced thrombocytopenia
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, low weight men (<57 kg), women (<45 kg), severe renal/hepatic disease, blood dyscrasias, severe hypertension, subacute bacterial endocarditis, acute nephritis, recent burn, spinal surgery, indwelling catheters
Black Box Warning:
Lumbar puncture, epidural anesthesia, spinal anesthesia
Calculator
• Adult:
SUBCUT
30 mg bid given 12-24 hr postop for 7-10 days until DVT risk is diminished
• Adult:
SUBCUT
40 mg/day started 9-15 hr preop or 30 mg q12hr started 12-24 hr postop, continued until DVT risk diminished or patient adequately on anticoagulant
• Adult:
SUBCUT
40 mg/day starting 24 hr prior to surgery × 7-10 days to prevent thromboembolic complications
• Adult:
SUBCUT
1 mg/kg q12hr (without PE, outpatient); 1 mg/kg q12hr or 1.5 mg/kg/day (with or without PE, inpatient); warfarin should be started within 72 hr, continued ≥5 days until INR is 2-3 (usually 7 days)
• Adult:
SUBCUT/IV
1 mg/kg q12hr until stable with aspirin 100-325 mg/day × ≥2 days
• Adult:
SUBCUT
<30 ml/min 30 mg/day (thrombosis prophylaxis)
Available forms:
Prefilled syringes/inj 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml, 100 mg/1 ml, 120 mg/0.8 ml, 150 mg/ml; multidose vials 100 mg/ml (3 ml)
•
Only after screening patient for bleeding disorders
•
Do not mix with other products or inf fluids
Only this product when ordered; not interchangeable with heparin or other LMWHs
•
At same time each day to maintain steady blood levels
•
Avoid all IM inj that may cause bleeding
•
Prepare in a sterile environment using aseptic technique
•
Dilution may be stored for up to 4 wk in glass vial at room temp, up to 2 wk in TB syringes with rubber stoppers at room temp or refrigerated
•
Do not give IM; begin 1 hr prior to surgery; do not aspirate; rotate sites; do not expel bubble from syringe before administration
•
To recumbent patient, give SUBCUT; rotate inj sites (left/right anterolateral, left/right posterolateral abdominal wall)
•
Insert whole length of needle into skin fold held with thumb and forefinger
•
If withdrawing from multidose vial, use TB syringe for proper measurement
•
Prefilled syringes (30, 40 mg) not graduated; do not use for partial doses
•
Do not administer if particulate is present
•
Use multidose vial for IV administration; use TB syringe, other graduated sy
ringe to measure dose; give IV BOL through IV line, flush after
CNS:
Fever, confusion
GI:
Nausea
HEMA:
Hemorrhage, hypochromic anemia, thrombocytopenia, bleeding
INTEG:
Ecchymosis, inj site hematoma
META:
Hyperkalemia in renal failure
SYST:
Edema, peripheral edema
SUBCUT:
90% absorbed, maximum antithrombin activity (3-5 hr), elimination half-life 4½ hr, excreted in urine
Increase:
enoxaparin action—anticoagulants, salicylates, NSAIDs, antiplatelets, thrombolytics
Increase:
AST, ALT
Decrease:
platelet count
•
Blood studies (Hct/Hgb, CBC, coagulation studies, platelets, occult blood in stools), anti-factor Xa (should be checked 4 hr after inj); thrombocytopenia may occur
•
Renal studies: BUN/creatinine baseline and periodically
•
Bleeding:
gums, petechiae, ecchymosis, black tarry stools, hematuria; notify prescriber
Black Box Warning:
Neurologic symptoms in patients who have received spinal anesthesia
•
Storage at 77° F (25° C); do not freeze
•
Therapeutic response: prevention of DVT
•
To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor
•
To report any signs of bleeding: gums, under skin, urine, stools
•
To avoid OTC products containing aspirin unless approved by prescriber
Protamine SO
4
1% sol; dose should equal dose of enoxaparin