Mosby's 2014 Nursing Drug Reference (178 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(floo-kon′a-zole)
Diflucan
Func. class.:
Antifungal, systemic; azole
Chem class:
Triazole
Do not confuse:
Diflucan
/Diprivan
Inhibits ergosterol biosynthesis, causes direct damage to fungal membrane phospholipids
Oropharyngeal candidiasis, chronic mucocutaneous candidiasis; sys
temic, vaginal, urinary candidiasis; cryptococcal meningitis; prevention of candidiasis in bone marrow transplant in those who receive chemotherapy and/or radiation therapy; cystitis, fungal prophylaxis, peritonitis, pneumonia, pyelonephritis
Unlabeled uses:
Prophylaxis, systemic candidiasis in very-low-birthweight premature infants, blastomycosis, chemotherapy-induced neutropenia, coccidioidomycosis cryptococcosis prophylaxis, endocarditis, endophthalmitis, histoplasmosis infectious arthritis, myocarditis, osteomyelitis, pericarditis
Hypersensitivity to this product or azoles, pregnancy (D)
Precautions:
Breastfeeding, renal/hepatic disease, torsades de pointes
Calculator
• Adult:
PO
150 mg as a single dose
• Adult:
PO/IV
50-400 mg initially then 200 mg/day for 4 wk
• Child:
6-12 mg/kg/day
• Adult:
PO/IV
200 mg initially then 100 mg/day for ≥2 wk
• Child:
PO/IV
6 mg/kg initially then 3 mg/kg/day for ≥2 wk
• Adult:
PO/IV
200 mg on 1st day, then 100 mg daily × ≥3 wk and for ≥2 wk after resolution of symptoms
• Child:
PO/IV
6 mg/kg on 1st day, then 3 mg/kg × ≥3 wk and for ≥2 wk after resolution of symptoms
• Adult:
PO/IV
400 mg on 1st day, then 200 mg daily × 10-12 wk after CSF culture negative
• Child/infants/neonates ≥14 days:
PO/IV
12 mg/kg on 1st day, then 6-12 mg/kg daily × 10-12 wk after CSF culture negative, max 600 mg/day
• Neonates 0-14 days:
PO/IV
12 mg/kg on 1st day, then 6-12 mg/kg q72hr × 10-12 wk after CSF culture negative
• Adult:
PO/IV
400 mg/day
• Adult:
PO/IV
CCr ≤50 ml/min, after loading dose, give 50% of usual dose
Available forms:
Tabs 50, 100, 150, 200 mg; inj 2 mg/ml; powder for oral susp 50, 200 mg/ml
•
Tap bottle to loosen powder, add 24 ml distilled or purified water to bottles with 0.35 or 1.4 g drug, shake well, conc 50 or 200 mg/5 ml, respectively
•
Shake oral susp before each use
•
After diluting according to package directions; run at ≤200 mg/hr; do not use plastic containers in connections; check for bag leaks
•
Use inf pump; check for extravasation and necrosis q2hr
•
Do not use if cloudy or precipitated
•
Do not admix; do not refrigerate
Y-site compatibilities:
Acyclovir, aldesleukin, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefepime, cefmetazole, cefonicid, cefoperazone, cefoTEtan, cefOXitin, cefpirome, cefTAZidime, ceftizoxime, ceftobiprole, cephalothin, cephapirin, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, diltiazem, dimenhyDRINATE, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubi
cin liposomal, doxycycline, droperidol, drotrecogin alfa, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fludarabine, fluorouracil, folic acid, foscarnet, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, IV immune globulin, inamrinone, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, lansoprazole, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins injection, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phenytoin, phytonadione, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sargramostim, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, temocillin, teniposide, theophylline, thiotepa, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Headache,
seizures
CV:
QT prolongation, torsades de pointes
GI:
Nausea, vomiting, diarrhea, cramping, flatus, increased AST, ALT,
hepatotoxicity
HEMA:
Agranulocytosis, eosinophilia, leukopenia, neutropenia, thrombocytopenia
INTEG:
Stevens-Johnson syndrome, angioedema, anaphylaxis, exfoliative dermatitis, toxic epidermal necrolysis
Peak 2-4 hr, bioavailability (PO) >90%, excreted unchanged in urine 80%, metabolized by CYP3A enzyme system at dose >200 mg/day, elimination half-life 30 hr
Increase:
hypoglycemia—oral antidiabetics
Increase:
anticoagulation—warfarin
Increase:
plasma concentrations—cycloSPORINE, phenytoin, theophylline, rifabutin, tacrolimus, sirolimus
Increase:
myopathy, rhabdomyolysis risk—lovastatin, simvastatin
Increase:
effect of zidovudine, methadone, SUFentanil, alfentanil, buprenorphine, saquinavir, fentaNYL, ergots
Decrease:
effect of oral contraceptives, calcium channel blockers
•
Infection:
clearing of CSF and other culture during treatment, obtain C&S baseline and throughout treatment, product may be started as soon as culture is taken
Hepatotoxicity:
increasing AST, ALT, periodically alk phos, bilirubin; for renal status: BUN, creatinine
•
Storage protected from moisture and light; diluted sol stable 24 hr; do not freeze
•
Therapeutic response: decreasing oral candidiasis, fever, malaise, rash; negative C&S for infection organism
•
That long-term therapy may be needed to clear infection
•
That medication may be taken with food to reduce GI effects
•
To notify prescriber of nausea, vomiting, diarrhea, jaundice, anorexia, clay-colored stools, dark urine
•
To use alternative method of contraception while taking this product, pregnancy (D)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
fludarabine (Rx)
(floo-dar′a-been)
Fludara, Oforta
Func. class.:
Antineoplastic, antimetabolite
Chronic lymphocytic leukemia, non-Hodgkin’s lymphoma
Pregnancy (D), breastfeeding, hypersensitivity
Black Box Warning:
Hemolytic anemia, bone marrow suppression, coma, seizures, visual disturbances
Calculator
• Adult:
IV
25 mg/m
2
over 30 min × 5 days, may repeat q28days; reconstitute with 2 ml of sterile water for inj; dissolution should occur in <15 sec, adjust dose based on toxicity;
PO
40 mg/m
2
× 5 days q28days
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert