Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (182 page)
See
Appendix B
See
Appendix B
(floo′ta-mide)
Euflex
Func. class.:
Antineoplastic, hormone
Chem. class.:
Antiandrogen
Interferes with androgen uptake in the nucleus or androgen activity in target tissues; arrests tumor growth in androgen-sensitive tissue (i.e., prostate gland)
Metastatic prostatic carcinoma, stage D
2
in combination with LHRH agonistic analogs (leuprolide), B
2
-C in combination with goserelin and radiation
Pregnancy (D), hypersensitivity
Black Box Warning:
Severe hepatic disease
Precautions:
G6PD deficiency, hemoglobinopathy, lactase deficiency, polycystic ovary syndrome, tobacco smoking
Calculator
• Adult:
PO
250 mg q8hr for a daily dosage of 750 mg
Available forms:
Caps 125, 250
mg
•
Do not break, crush, chew caps
•
Give without regard to food with a full glass of water
•
Use cytotoxic handling procedures
CNS:
Hot flashes
, drowsiness, confusion, depression, anxiety, paresthesia
GI:
Diarrhea, nausea, vomiting
, increased levels in hepatic studies,
hepatitis,
anorexia,
hepatotoxicity, abdominal pain, cholestasis, hepatic necrosis/failure
GU:
Decreased libido, impotence, gynecomastia
HEMA:
Hemolytic anemia, leukopenia, thrombocytopenia
INTEG:
Irritation at site, rash, photosensitivity
MISC:
Edema, neuromuscular and pulmonary symptoms, hypertension, secondary malignancy
Rapidly and completely absorbed; excreted in urine and feces as metabolites; half-life 6 hr, geriatric half-life 8 hr; 94% protein binding, peak 2 hr
Increase:
PT—warfarin
Decrease:
flutamide action—LHRH analog (leuprolide)
Increase:
LFTs, BUN, creatinine
Decrease:
WBC, platelets
Black Box Warning:
Severe hepatic disease:
AST, ALT, alk phos, which may be elevated; if LFTs elevated, product may need to be discontinued; monitor CBC, bilirubin, creatinine
•
CNS symptoms, including drowsiness, confusion, depression, anxiety
•
Therapeutic response: decrease in prostatic tumor size, decrease in spread of cancer
•
To report side effects: decreased libido, impotence, breast enlargement, hot flashes, diarrhea
Black Box Warning:
Hepatotoxicity:
to report nausea, vomiting, yellow eyes or skin, dark urine, clay-colored stools; hepatotoxicity may be the cause
•
Notify of yellow, green urine discoloration
•
Avoid sun exposure, tanning beds
•
To use contraception during treatment; pregnancy category (D)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(floo-tic′a-sone)
Flonase, Flovent HFA, Flovent Diskus, Veramyst (nasal spray)
Func. class:
Corticosteroids, inhalation; antiasthmatic
Decreases inflammation by inhibiting mast cells, macrophages, and leukotrienes; antiinflammatory and vasoconstrictor properties
Prevention of chronic asthma during maintenance treatment in those requiring oral corticosteroids; nasal symptoms of seasonal/perennial, allergic/nonallergic rhinitis
Unlabeled uses:
COPD
Hypersensitivity to this product or milk protein, primary treatment in status asthmaticus
Precautions:
Pregnancy (C), breastfeeding, active infections, glaucoma, diabetes, immunocompromised patients
Calculator
• Adult and child ≥12 yr:
INH
88-660 mcg bid (in those previously taking bronchodilators alone);
INH
88-220 mcg bid, max 440 mcg bid (in those previously taking inhaled corticosteroids);
INH
440 mcg bid, max 880 mcg
bid (in those previously taking oral corticosteroids)
• Child 4-11 yr:
INH
88 mcg bid
• Adult and child ≥12 yr:
INH
100 mcg bid, max 500 mcg (in those previously taking bronchodilators alone);
INH
100-250 mcg bid, max 500 mcg bid (in those previously taking inhaled corticosteroids);
INH
500-1000 mcg bid, max 1000 mcg bid (in those previously taking oral corticosteroids)
• Child 4-11 yr:
INH
Initially 50 mcg bid, max 100 mcg bid (in those previously taking bronchodilators alone or inhaled corticosteroids)
• Adult:
nasal 2 sprays initially, in each nostril daily or 1 spray bid, when controlled, lower to 1 spray in each nostril daily
• Adolescent/child >4 yr:
nasal 1 spray in each nostril daily, may increase to 2 sprays in each nostril daily, when controlled lower to 1 spray in each nostril daily
• Adult/child ≥12 yr:
nasal 2 sprays in each nostril daily
• Child 2-11 yr:
nasal 1 spray in each nostril daily
Available forms:
Oral inhalation aerosol 44, 110, 220 mcg; oral inhalation powder 50, 100, 250 mcg; nasal spray (Veramyst) 27.5 mcg/actuation, (Flonase) 50 mcg/actuation
•
Give at 1-min intervals; if a bronchodilator aerosol spray is used, use bronchodilator first, wait 5-15 min, then use fluticasone
•
Decrease dose to lowest effective dose after desired effect; decrease dose at 2-4 wk intervals
•
Shake well, prime before 1st use, release 4 sprays into air away from face, prime using 1 spray if not used for ≥7 days; when the counter reads 000, discard; clean inhaler daily in warm water, dry; do not share inhaler with others
•
In general, child <4 yr requires a face mask with spacer/VHC device for delivery; allow 3-5 INH per actuation; do not use spacer with Flovent Diskus
•
Before initial use, remove the diskus foil pouch and throw away the foil pouch; the diskus will be in the closed position. Fill in the “Pouch opened” and “Use by” dates in the blank lines on the label; the “Use by” date for Flovent Diskus 50 mcg is 6 wk from the date the pouch is opened; the “Use by” date for Diskus 100 mcg and 250 mcg is 2 months from the date the pouch is opened
•
Open the diskus by holding in one hand and using the thumb of the other to push the thumb grip away as far as it will go until the mouthpiece shows and snaps into place
•
Hold the diskus in a level, flat position with the mouthpiece toward the patient and slide the lever away from the patient as far as it will go until it clicks. The number on the dose counter will count down by 1; the diskus is now ready to use
•
Before inhaling the dose, have patient breathe out as much as possible while holding the diskus level and away from the mouth. The patient should never breathe out into the mouthpiece
•
Instruct the patient to put the mouthpiece to the lips and breathe in through the mouth quickly and deeply through the diskus. Remove the diskus from the mouth, hold breath for about 10 sec, and breathe out slowly
•
After taking a dose, close the diskus by sliding the thumb grip back as far as it will go. The diskus will click shut. The lever automatically returns to its original position
•
The counter displays how many doses are left. The counter number counts
down each time the patient uses the diskus After 55 doses (23 doses from the sample pack), numbers 5 to 0 are red to warn that there are only a few doses left
•
After use, patient should rinse mouth with water and spit out the water, not swallow it
•
To avoid the spread of infection, do not use the inhaler for more than one person
•
Prime before first use
•
Shake well before each use
•
Rinse tip after use, dry with tissue
CNS:
Fever, headache, nervousness, dizziness, migraines, numbness in fingers
EENT:
Pharyngitis
, sinusitis, rhinitis, laryngitis, hoarseness, dry eyes, cataracts, nasal discharge, epistaxis
GI:
Diarrhea, abdominal pain, nausea, vomiting,
oral candidiasis
, gastroenteritis
GU:
UTI
INTEG:
Urticaria, dermatitis
META:
Hyperglycemia, growth retardation in children, cushingoid features
MISC:
Influenza,
eosinophilic conditions, angioedema, Churg-Strauss syndrome, anaphylaxis, adrenal insufficiency (high doses),
bone mineral density reduction
MS:
Osteoporosis, muscle soreness, joint pain
RESP:
Upper respiratory infection
, dyspnea, cough, bronchitis,
bronchospasm
Absorption 30% aerosol, 13.5% powder; protein binding 91%; metabolized in liver after absorption in lung; half-life 7.8 hr; <5% excreted in urine and feces
Oral INH:
Onset 24 hr, peak several days, duration 1-2 wk
Increase:
fluticasone levels—CYP3A4 inhibitors (ketoconazole, itraconazole), darunavir, nelfinavir, ritonavir, amprenavir, fosamprenavir, atazanavir, delavirdine, saquinavir
Increase:
tendonitis, tendon rupture—quinolones
Decrease:
effects of growth hormones—mecasermin
Increase:
urine/serum glucose
•
Respiratory status:
lung sounds, pulmonary function tests during, for several months after change from systemic to inhalation corticosteroids
•
Withdrawal symptoms from oral corticosteroids: depression, pain in joints, fatigue
Adrenal insufficiency:
nausea, weakness, fatigue, hypotension, hypoglycemia, anorexia; may occur when changing from systemic to inhalation corticosteroids; may be life-threatening; adrenal function tests periodically: hypothalamic–pituitary–adrenal axis suppression in long-term treatment
•
Growth rate in children; blood glucose, serum potassium for all patients
•
Therapeutic response: decreased severity of asthma
•
To use bronchodilator 1st, before using inhalation, if taking both
•
Not to use for acute asthmatic attack; acute asthma may require oral corticosteroids
•
To avoid smoking, smoke-filled rooms, those with URIs, those not immunized against chickenpox or measles
•
To rinse mouth after inhaled product to decrease risk of oral candidiasis