Mosby's 2014 Nursing Drug Reference (17 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(a-kam-pro′sate)
Campral
Func. class.:
Alcohol deterrent
Chem. class.:
Synthetic amino acid neurotransmitter analog
Not completely understood; in vitro data suggest it has affinity for type A and type B GABA receptors, lowers neuronal excitability, centrally mediated
Alcohol abstinence management
Black Box Warning:
Hypersensitivity to this product or sulfites, creatinine clearance ≤30 ml/min
Precautions:
Pregnancy (C), breastfeeding, infants, children, ethanol intoxication, renal impairment, depression, suicidal ideation, driving or operating machinery, geriatric patients
Calculator
• Adult: PO
666 mg tid
• Adult: PO
CCr 30-50 ml/min 333 mg tid; CCr <30 ml/min do not use
Available forms:
Del-rel tabs 333 mg
•
Without regard to food; do not crush, chew, break delayed-release tab
•
Use only after alcohol is stopped
CNS:
Anxiety, depression, dizziness, headache, insomnia, paresthesias, suicidal ideation, tremor, abnormal thoughts, chills, drowsiness
CV:
Palpitations, hypertension, peripheral edema
EENT:
Rhinitis, pharyngitis, abnormal vision
GI:
Anorexia, constipation, diarrhea, dry mouth, abdominal pain, flatulence, nausea, vomiting, taste change, weight gain
GU:
Impotence
INTEG:
Rash, pruritus, increased sweating
MISC:
Infection, flulike syndrome
MS:
Back pain, myalgias, arthralgia
RESP:
Dyspnea, bronchitis
Peak 3-8 hr, half-life 20-33 hr
Increase:
LFTs, blood glucose, bilirubin, uric acid
Decrease:
Hgb/Hct, platelets
•
Mental status: depression, abnormal thinking, suicidal thoughts/behaviors, length of alcohol use, date of discontinuing alcohol use
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B/P baseline and periodically
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Storage at room temperature
•
Therapeutic response: Continued alcohol abstinence
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To notify prescriber of depression, abnormal thoughts, suicidal thoughts/behaviors
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To take without regard to food; not to break, crush, chew delayed release tabs
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To notify prescriber if pregnancy is planned or suspected, to use effective contraception
•
Not to engage in hazardous activities until effect is known
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ay-car′bose)
Precose
Func. class.:
Oral antidiabetic
Chem. class.:
α-Glucosidase inhibitor
Do not confuse:
Precose
/preCare
Delays digestion/absorption of ingested carbohydrates by inhibiting α-glucosidase, results in smaller rise in postprandial blood glucose after meals; does not increase insulin production
Type 2 diabetes mellitus, alone or in combination with a sulfonylurea, metformin
Unlabeled uses:
Adjunct in type 1 diabetes mellitus
Breastfeeding, hypersensitivity, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, ileus, colonic ulceration, partial intestinal obstruction, chronic intestinal disease, serum creatinine >2 mg/dl, CCr <25 ml/min
Precautions:
Pregnancy (B), children, renal/hepatic disease
Calculator
• Adult >60 kg (132 lb): PO
25 mg tid initially, with 1st bite of meal; maintenance dose may be increased to 50-100 mg tid; dosage adjustment at 4-8 wk intervals, individualized
• Adult <60 kg (132 lb): PO
max 50 mg tid
• Adult: PO
50 mg tid with meals × 2 wk, then 100 mg tid with meals
Available forms:
Tabs 25, 50, 100 mg
•
With 1st bite of each meal 3 ×/day
GI:
Abdominal pain, diarrhea, flatulence
Poor systemic absorption, peak 1 hr, duration 2-4 hr, metabolized in GI tract, excreted as intact product in urine, half-life 2 hr
Increase:
acetaminophen toxicity—acetaminophen combined with alcohol
Increase or decrease:
glycemic control—androgens, lithium, bortezomib, quinolones
Decrease:
effect of digoxin
•
Do not use with gatifloxacin
Increase:
hypoglycemia—sulfonylureas, insulin, MAOIs, salicylates, fibric acid derivatives, bile acid sequestrants, ACE inhibitors, angiotensin II receptor antagonists, beta blockers
Decrease:
effect, increase hyperglycemia—digestive enzymes, intestinal absorbents, thiazide diuretics, loop diuretics, corticosteroids, estrogen, progestins, oral contraceptives, sympathomimetics, isoniazid, phenothiazines; protease inhibitors, atypical antipsychotics, carbonic anhydrase inhibitors, cycloSPORINE, tacrolimus, baclofen
Increase:
hypoglycemia—chromium, garlic, horse chestnut
Increase:
ALT, AST
Decrease:
calcium, vit B
6
, Hgb, Hct
•
Hypoglycemia
(weakness, hunger, dizziness, tremors, anxiety, tachycardia, sweating), hyperglycemia; even though product does not cause hypoglycemia, if
patient is on sulfonylureas or insulin, hypoglycemia may be additive; if hypoglycemia occurs, treat with dextrose, or, if severe, with IV glucose or glucagon
•
For stress, surgery, or other trauma that may require change in dose
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Monitor AST, ALT q3mo × 1 yr and periodically thereafter; if elevated, dose may need to be reduced or discontinued, usually increased with doses ≥300mg/day; A1c q3mo, monitor serum glucose, 1 hr PP throughout treatment
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GI side effects for tolerability/compliance
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Storage in tight container in cool environment
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Therapeutic response: improved signs/symptoms of diabetes mellitus (decreased polyuria, polydipsia, polyphagia; clear sensorium, absence of dizziness, stable gait)
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The symptoms of hypo/hyperglycemia, what to do about each
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That medication must be taken as prescribed; explain consequences of discontinuing medication abruptly; that insulin may need to be used for stress, including trauma, surgery, fever
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To avoid OTC medications and herbal supplements unless approved by health care provider
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That diabetes is a lifelong illness; that the diet and exercise regimen must be followed; that this product is not a cure
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To carry emergency ID and a glucose source; to avoid sugar, because sugar is blocked by acarbose
•
That blood glucose monitoring is required to assess product effect
•
To avoid breastfeeding if using acarbose with other antidiabetics
•
That GI side effects may occur
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert