Mosby's 2014 Nursing Drug Reference (171 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(feb-ux′oh-stat)
Uloric
Func. class.:
Antigout drug, antihyperuricemic
Chem. class.:
Xanthene oxidase inhibitor
Inhibits the enzyme xanthine oxidase, thereby reducing uric acid synthesis; more selective for xanthine oxidase than allopurinol
Chronic gout, hyperuricemia
Hypersensitivity
Precautions:
Pregnancy (C), breast-feeding, children, renal/hepatic/cardiac/neoplastic disease, stroke, MI, organ transplant, Lesch-Nyhan syndrome
Calculator
• Adult:
PO
40 mg daily, may increase to 80 mg daily if uric acid levels are >6 mg/dl after 2 wk of therapy
Available forms:
Tabs 40, 80 mg
•
Without regard to meals or antacids; may crush and add to foods or fluids
•
A few days before antineoplastic therapy
CNS:
Weakness, flushing
CV:
MI, atrial fibrillation, atrial flutter, AV block,
bradycardia, hypo/hypertension, palpitations,
sinus tachycardia, stroke,
angina
EENT:
Retinopathy, cataracts, epistaxis
GI:
Nausea, vomiting, anorexia
, constipation, diarrhea, dyspepsia, hematemesis, hepatitis, hepatomegaly, weight gain/loss, cholecystitis, cholelithiasis, melena
GU:
Renal failure, urinary urgency/frequency/incontinence, nephrolithiasis, hematuria
HEMA:
Thrombocytopenia, anemia, pancytopenia, leukopenia, bone marrow suppression
INTEG:
Rash
MISC:
Arthralgia, gout flare
Peak 1-1.5 hr; excreted in feces, urine; half-life 5-8 hr; protein binding 99.2%
Increase:
toxicity—azaTHIOprine
Increase:
xanthine nephropathy, calculi—rasburicase, antineoplastics
Increase:
myelosuppression—mercaptopurine, theophylline
•
Hyperuricemia:
uric acid levels q2wk; uric acid levels should be ≤6 mg/dl, flares may occur during first 6 wk of treatment
•
CBC, AST, BUN, creatinine before starting treatment, periodically
•
Renal disease:
I&O ratio; increase fluids to 2 L/day to prevent stone formation and toxicity
•
For rash, hypersensitivity reactions; discontinue
•
Gout:
joint pain, swelling; may use with NSAIDs for acute gouty attacks and gout flare (first 6 wk)
•
Therapeutic response: decreased pain in joints, decreased stone formation in kidneys, decreased uric acid levels
•
That tabs may be crushed
•
To take as prescribed; if dose is missed, to take as soon as remembered; not to double dose
•
To increase fluid intake to 2 L/day unless contraindicated
•
To avoid alcohol, caffeine because they will increase uric acid levels
•
To report cardiovascular events to prescriber immediately
•
Gout:
That flares may occur during first 6 wk of treatment
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(fe-loe′-di-peen)
Plendil
, Renedil
Func. class.:
Antihypertensive, calcium channel blocker, antianginal
Chem. class.:
Dihydropyridine
Do not confuse:
Plendil
/pindolol/Pletal/PriLOSEC/Prinivil
Inhibits calcium ion influx across cell membrane, resulting in the inhibition of the excitation and contraction of vascular smooth muscle
Essential hypertension alone or with other antihypertensives
Unlabeled uses:
Hypertension in adolescents and children, angina pectoris; Prinzmetal’s angina (vasospastic)
Hypersensitivity to this product or dihydropyridines, sick sinus syndrome, 2nd- or 3rd-degree heart block, hypotension <90 mm Hg systolic
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, CHF, hepatic injury, renal disease
Calculator
• Adult:
PO
5 mg/day initially; usual range 2.5-10 mg/day; max 10 mg/day; do not adjust dosage at intervals of <2 wk
• Geriatric:
PO
2.5 mg/day
• Adult:
PO
2.5-5 mg, max 10 mg/day
• Adolescent and child:
PO
2.5 mg initially, titrate upward, max 10 mg/day
Available forms:
Ext rel tabs 2.5, 5, 10 mg
•
Swallow whole; do not break, crush, or chew ext rel products
•
Once daily with light meal; avoid grapefruit juice
CNS:
Headache
, fatigue, drowsiness, dizziness, anxiety, depression, nervousness, insomnia, light-headedness, paresthesia, tinnitus, psychosis, somnolence, flushing
CV:
Dysrhythmia,
edema
,
CHF,
hypotension, palpitations,
MI, pulmonary edema,
tachycardia, syncope, AV block, angina
GI:
Nausea, vomiting, diarrhea, gastric upset, constipation, increased LFTs, dry mouth
GU:
Nocturia, polyuria
HEMA:
Anemia
INTEG:
Rash, pruritus
MISC:
Flushing, sexual difficulties, cough, nasal congestion, SOB, wheezing, epistaxis, respiratory infection, chest pain,
angioedema,
gingival hyperplasia
Peak plasma levels 2.5-5 hr, highly protein bound >99%, metabolized in liver, 0.5% excreted unchanged in urine, elimination half-life 11-16 hr
Increase:
bradycardia, CHF—β-blockers, digoxin, phenytoin, disopyramide
Increase:
toxicity, hypotension—nitrates, alcohol, quiNIDine, zileuton, miconazole, diltiazem, delavirdine, quinupristin, dalfopristin, conivaptan, cycloSPORINE, cimetidine, clarithromycin, antiretroviral protease inhibitors, other antihypertensives, MAOIs, ketoconazole, erythromycin, itraconazole, propranolol
Decrease:
antihypertensive effects—NSAIDs, carBAMazepine, barbiturates, phenytoin
Increase:
antihypertensive effect—ginseng, ginkgo, hawthorn
Decrease:
antihypertensive effect—ephedra, St. John’s wort
Increase:
felodipine level—grapefruit juice
•
CHF:
I&O, weight daily; weight gain, crackles, dyspnea, edema, jugular venous distention
•
Cardiac status: B/P, pulse, respiration; ECG periodically
•
Angina pain:
location, duration, intensity; ameliorating, aggravating factors
•
Therapeutic response: decreased B/P, decreased anginal attacks, increased activity tolerance
•
To avoid hazardous activities until stabilized on product, dizziness no longer a problem
•
To avoid OTC products, alcohol unless directed by prescriber; to limit caffeine consumption
•
About the importance of complying with all areas of medical regimen: diet, exercise, stress reduction, product therapy
•
That tablets may appear in stools but are insignificant
•
To report dyspnea, palpitations, irregular heart beat, swelling of extremities, nausea, vomiting, severe dizziness, severe headache
•
To change positions slowly to prevent orthostatic hypotension
•
To obtain correct pulse; to contact prescriber if pulse <50 bpm
Atropine for AV block, vasopressor for hypotension