Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (169 page)
HIGH ALERTfactor IX complex
(human) (Rx)
AlphaNine SD, Bebulin, BeneFIX, Mononine, Profilnine SD
Func. class.:
Hemostatic
Chem. class.:
Factors II, VII, IX, X
Causes an increase in blood levels of clotting factors II, VII, IX, X; factor IX (human) has IX activity
Hemophilia B (Christmas disease), factor IX deficiency, anticoagulant reversal, control of bleeding in patients with factor VIII inhibitors, reversal of overdose of anticoagulants in emergencies
Hypersensitivity to mouse or hamster protein, DIC, mild factor IX deficiency
Precautions:
Pregnancy (C), neonates/infants, hepatic disease, elective surgery
Calculator
• Adult and child:
IV
establish 25% of normal factor IX or 60-75 units/kg then 10-20 units/kg/day 1-2×/wk
• Adult and child:
IV
25-40 units/kg 2×/wk
• Adult and child:
IV
75 units/kg, repeat after 12 hr
• Adult and child:
IV
20-50 units/kg
• Adult and child:
IV
0.5 units/kg × weight (kg) × desired factor IX increase (% of normal); repeat q4-6hr if needed
Use only Alpha-Nine, Alpha-Nine SD
• Adult and child:
IV
dose to increase factor IX level to 20%-30% in one dose
• Adult and child:
IV
dose to increase factor IX to 30%-50% as daily inf
• Adult and child:
IV
dose to increase factor IX to 15%-25% (20-30 units/kg), repeat after 24 hr if needed
• Adult and child:
IV
dose to increase factor IX to 25%-50% (75 units/kg) q18-30hr × ≤10 days
Available forms:
Inj (number of units noted on label)
•
Hepatitis B vaccine before administration
•
IV after warming to room temp ≤3 ml/min, with plastic syringe only; do not admix
•
After dilution with provided diluent, 50 units/ml or 25 units/ml; do not exceed 10 ml/min; decrease rate if fever, headache, flushing, tingling occur
•
After cross-matching if patient has blood type A, B, AB to determine incompatibility with factor
•
Allow vials of concentrate/diluent to warm to room temp
•
After removing flip-top cap from vial, wipe top of vial with alcohol swab; allow to dry
•
Peel back cover from vial adapter package; do not remove
•
Place vial adapter over vial; press firmly until it snaps; attach plunger rod to diluent syringe and break plastic tip cap from diluent syringe
•
Lift package away from adapter and connect diluent syringe; depress plunger; swirl contents
CNS:
Headache, dizziness, malaise, paresthesia,
lethargy, chills, fever, flushing
CV:
Hypotension
, tachycardia,
MI
,
venous thrombosis, pulmonary embolism
GI:
Nausea, vomiting, abdominal cramps, jaundice,
viral hepatitis
HEMA:
Thrombosis, hemolysis, AIDS, DIC
INTEG:
Rash, flushing,
urticaria
, inj site reactions
RESP:
Bronchospasm
IV:
Half-life factor IX: 22 hr; rapidly cleared from plasma
•
Incompatible with protein products
Increase:
thrombosis risk—aminocaproic acid; do not administer
Decrease:
effect of warfarin
•
Blood studies: coagulation factor assays by % normal: 5% prevents spontaneous hemorrhage, 30%-50% for surgery, 80%-100% for severe hemorrhage; APTT, clotting inhibitor titers, D-dimer, factor IX, VII concentration, fibrin degradation products, fibrinogen, platelets, PT, thrombin time
•
Increased B/P, pulse
•
For bleeding q15-30min; immobilize and apply ice to affected joints
•
I&O; if urine becomes orange or red, notify prescriber
•
Allergic or pyrogenic reaction:
fever, chills, rash, itching, slow inf rate if not severe
DIC:
bleeding, ecchymosis, hypersensitivity, changes in coagulation tests
•
For tingling sensation; if present, reduce rate
•
Storage of reconstituted sol for 3 hr at room temp or for ≤2 yr with refrigeration (powder); check expiration date
•
Therapeutic response: prevention of hemorrhage
•
To report any signs of bleeding: gums, under skin, urine, stools, emesis; calf pain, joint pain, yellowing of eyes/skin
•
About the risk for viral hepatitis, AIDS; to be tested q2-3mo for HIV, although low risk
•
That immunization for hepatitis B may be given first
•
To carry emergency ID identifying disease; to avoid salicylates, NSAIDs; to inform other health professionals of condition
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(fam-cy′clo-veer)
Famvir
Func. class.:
Antiviral
Chem. class.:
Guanosine nucleoside
Inhibits DNA polymerase and viral DNA synthesis by conversion of this guanosine nucleoside to penciclovir
Treatment of acute herpes zoster (shingles), genital herpes; recurrent mucocutaneous herpes simplex virus (HSV) in patients with HIV; initial episodes of herpes genitalis; herpes labialis in the immunocompromised
Unlabeled uses:
Bell’s palsy, herpes labialis prophylaxis, postherpetic neuralgia prophylaxis
Hypersensitivity to this product, penciclovir, acyclovir, ganciclovir, valacyclovir, valganciclovir
Precautions:
Pregnancy (B), breastfeeding, renal disease
Calculator
• Adult:
PO
500 mg q8hr for 7 days
• Adult:
PO
CCr ≥60 ml/min, 500 mg q8hr; CCr 40-59 ml/min, 500 mg q12hr; CCr 20-39 ml/min, 500 mg q24hr; CCr <20 ml/min, 250 mg q24hr
• Adult:
PO
125 mg q12hr × 5 days
• Adult:
PO
40-59 ml/min 500 mg bid; CCr 20-39 ml/min 500 q day; CCr <20 ml/min 250 mg q day
• Adult:
PO
250 mg q12hr up to 1 yr
• Adult:
PO
CCr 20-39 ml/min, 125 mg q12hr × 5 days; CCr <20 ml/min, 125 mg q24hr × 5 days
• Adult:
PO
125 mg bid × 5 days or 1000 mg bid for 1 day; begin treatment at 1st sign of recurrence; immunocompetent herpes labialis 1500 mg as a single dose
• Adult:
PO
250 mg bid for up to 1 yr
• Adult:
PO
250 mg tid × 7-10 days
• Adult:
PO
750 mg tid × 7 days with predniSONE
• Adult:
PO
500 mg q8hr × 7 days, preferably within 48 hr of onset
• Adult/adolescent:
PO
500 mg tid × 7-10 days
Available forms:
Tabs 125, 250, 500 mg
•
Without regard to meals
•
As soon as diagnosed; for herpes zoster within 72 hr
CNS:
Headache, fatigue, dizziness
, paresthesia, somnolence, fever
GI:
Nausea, vomiting, diarrhea, constipation, abdominal pain, anorexia
GU:
Decreased sperm count
INTEG:
Pruritus
MS:
Back pain, arthralgia
RESP:
Pharyngitis, sinusitis
Bioavailability 77%, 20% protein binding, 73% excreted via kidneys, terminal plasma half-life 2-3 hr
Decrease:
renal excretion—theophylline, probenecid, digoxin
Decrease:
metabolism—cimetidine
•
Herpes zoster:
number, distribution of lesions; burning, itching, pain, which are early symptoms of herpes infection; assess daily during therapy
•
Renal studies: urine CCr; BUN before and during treatment if decreased renal function; dose may have to be lowered
•
Bowel pattern before, during treatment; diarrhea may occur
•
Posttherapeutic neuralgia during and after treatment
•
Therapeutic response: decreased size, spread of lesions
•
How to recognize beginning infection
•
How to prevent spread of infection; that this medication does not prevent spread to others; that condoms should be used
•
About the reason for medication, expected results
•
That women with genital herpes should have yearly Pap smears; that cervical cancer is more likely