Mosby's 2014 Nursing Drug Reference (174 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Ferretts, Ferrimin, Ferro-Sequels, Hemocyte, Palafer
, Walgreens Finest Iron
Apo-Ferrous Gluconate, Ferate, Walgreens Gold Seal Ferrous Gluconate
Apo-Ferrous Sulfate, Equaline Ferrous Sulfate, Leader Ferrous Sulfate, Slow Release Iron, Walgreens Gold Seal Ferrous Sulfate
Slow Fe
OTC
)
(kar′bo-nil)
ICAR Pediatric, Iron Chews
(
OTC
)
iFerex, Niferex, Nu-Iron
Func. class.:
Hematinic
Chem. class.:
Iron preparation
Replaces iron stores needed for red blood cell development as well as energy and O
2
transport and use; fumarate contains 33% elemental iron; gluconate, 12%; sulfate, 20%; iron, 30%; ferrous sulfate exsiccated
Iron deficiency anemia, prophylaxis for iron deficiency in pregnancy, nutritional supplementation
Sideroblastic anemia, thalassemia, hemosiderosis/hemochromatosis
Precautions:
Pregnancy (B) (ferric gluconate complex), (C) (iron dextran, oral products), anemia (long term), ulcerative colitis/regional enteritis, peptic ulcer disease, hemolytic anemia, cirrhosis, sulfite sensitivity
Black Box Warning:
Accidental exposure
Calculator
• Adult:
PO
200-325 mg tid
• Child:
PO
3 mg/kg/day (elemental iron) tid-qid
• Infant:
PO
10-25 mg/day (elemental iron) in 3-4 divided doses, max 15 mg/day
• Adult:
PO
50-100 mg elemental iron tid
• Child:
PO
3 mg/kg/day in divided doses
• Adult:
PO
0.75-1.5 g/day in divided doses tid
• Child 6-12 yr:
PO
3 mg/kg/day in divided doses
• Adult:
PO
300-600 mg/day in divided doses
• Adult:
PO
100-200 mg tid
• Child:
PO
4-6 mg/kg/day in 3 divided doses (severe iron deficiency)
Available forms:
Fumarate:
tabs 63, 195, 200, 324, 325 mg; chewable tabs 100 mg; cont rel tabs 300 mg; oral susp 100 mg/5 ml, 45 mg/0.6 ml;
gluconate:
tabs 300, 320, 325 mg; caps 86, 325,
435 mg; film-coated tabs 300 mg; elix 300 mg/5 ml;
sulfate:
tabs 195, 300, 325 mg; enteric-coated tabs 325 mg; ext rel tabs, time-rel caps, 525 mg;
dried:
tabs 200 mg; ext rel tabs 160 mg; ext rel caps 160 mg;
iron polysaccharide:
tabs 50 mg; caps 150 mg; sol 100 mg/5 ml
•
Swallow tabs whole; do not break, crush, or chew unless labeled as chewable
•
Between meals for best absorption; may give with juice; do not give with antacids or milk, delay at least 1 hr; if GI symptoms occur, give after meals even if absorption is decreased; eggs, milk products, chocolate, caffeine interfere with absorption
•
Liquid
through plastic straw to avoid discoloration of tooth enamel; dilute thoroughly
•
At least 1 hr before bedtime; corrosion may occur in stomach; ferrous gluconate is less irritating of GI tract than ferrous sulfate
•
For <6 mo for anemia
GI:
Nausea, constipation, epigastric pain, black and red tarry stools
, vomiting, diarrhea
INTEG:
Temporarily discolored tooth enamel and eyes
SYST:
Hypersensitivity reactions (Ferrlecit)
PO:
Excreted in feces, urine, skin, breast milk; enters bloodstream; bound to transferrin; crosses placenta
Increase:
action of iron preparation—ascorbic acid, chloramphenicol
Decrease:
absorption of penicillamine, levodopa, methyldopa, fluoroquinolones,
L
-thyroxine, tetracycline
Decrease:
absorption of iron preparations—antacids, H
2
-antagonists, proton pump inhibitors, cholestyramine, vit E
Decrease:
absorption—dairy products, caffeine, eggs
False positive:
occult blood
•
Blood studies: Hct, Hgb, reticulocytes, bilirubin before treatment, at least monthly; iron studies (Iron, TIBC, ferritin)
Toxicity:
nausea, vomiting, diarrhea (green then tarry stools), hematemesis, pallor, cyanosis, shock, coma
•
Elimination; if constipation occurs, increase water, bulk, activity
•
Nutrition:
amount of iron in diet (meat, dark green leafy vegetables, dried beans, dried fruits, eggs)
•
Cause of iron loss or anemia, including salicylates, sulfonamides, antimalarials, quiNIDine
•
Storage in tight, light-resistant container
•
Therapeutic response: improvement in Hct, Hgb, reticulocytes; decreased fatigue, weakness
•
That iron will turn stools black or dark green
•
Accidental exposure:
to keep out of reach of children, pets; iron poisoning may occur if increased beyond recommended level
•
Not to substitute 1 iron salt for another; that elemental iron content differs (e.g., 300 mg ferrous fumarate contains about 100 mg elemental iron; 300 mg ferrous gluconate contains only about 30 mg elemental iron)
•
To avoid reclining position for 15-30 min after taking product to avoid esophageal corrosion
•
To follow a diet high in iron; to avoid taking iron, dairy products, calcium
supplements, and vit C together because they compete for absorption
Induce vomiting; give eggs, milk until lavage can be done
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(fess′oh-ter-oh-deen)
Toviaz
Func. class.:
Overactive bladder product
Chem. class.:
Muscarinic receptor antagonist
Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Overactive bladder (urinary frequency, urgency), urinary incontinence
GI obstruction, ileus, pyloric stenosis, urinary retention, gastric retention, hypersensitivity, closed-angle glaucoma
Precautions:
Pregnancy (C), breastfeeding, children, renal/hepatic disease, urinary tract obstruction, ambient temperature increase, autonomic neuropathy, constipation, contact lenses, hazardous activity, GERD, gastroparesis, myasthenia gravis, prostatic hypertrophy, toxic megacolon, ulcerative colitis, possible cross-sensitivity with tolterodine
Calculator
• Adult and geriatric:
PO EXT REL
4 mg/day, may increase to 8 mg/day based on response, max 4 mg/day in those taking potent CYP3A4 inhibitors
• Adult:
PO
EXT REL CCr <30 ml/min, max 4 mg/day in severe renal impairment
Available forms:
EXT REL TABS
4, 8 mg
•
Do not break, crush, or chew ext rel product
•
Give without regard to meals
CV:
Chest pain, angina,
QT prolongation
EENT:
Xerophthalmia
GI:
Nausea, vomiting
, abdominal pain, constipation, dry mouth
GU:
Dysuria, urinary retention
INTEG:
Rash,
angioedema
MISC:
Peripheral edema, insomnia
MS:
Back pain
RESP:
Cough
SYST:
Infection
Peak 5 hr, rapidly absorbed, protein binding 50%, excreted in urine/feces, half-life 7 hr
Increase:
action of fesoterodine—CYP3A4 inhibitors (antiretroviral protease inhibitors, macrolide antiinfectives, azole antifungals)
Increase:
anticholinergic effect—antimuscarinics, anticholinergics
Increase:
urinary frequency—diuretics
Decrease:
fesoterodine—caffeine, green tea, guarana
Increase:
fesoterodine level—grapefruit juice
Decrease:
fesoterodine level—cola, coffee, tea
•
Urinary patterns:
distention, nocturia, frequency, urgency, incontinence
•
Allergic reactions:
rash; if this occurs, product should be discontinued
•
Storage at room temp; protect from moisture
•
Therapeutic response: absence of urinary frequency, urgency, incontinence
•
Not to drink liquids before bedtime
•
About the importance of bladder maintenance