Read Mosby's 2014 Nursing Drug Reference Online

Authors: Linda Skidmore-Roth

Mosby's 2014 Nursing Drug Reference (185 page)

Canada only Side effects:
italics
= common;
bold
= life-threatening
Nurse Alert

folic acid (vit B
₉) (
OTC
)

(foe′lik a′sid)

Equaline Folic Acid, Folacin, Vitamin B
₉, Walgreens Gold Seal Folic Acid

Func. class.:
Vit B complex group, water-soluble vitamin

ACTION:

Needed for erythropoiesis; increases RBC, WBC, platelet formation with megaloblastic anemias

USES:

Megaloblastic or macrocytic anemia caused by folic acid deficiency; hepatic disease, alcoholism, hemolysis, intestinal obstruction, pregnancy to reduce risk for neural tube defects

Unlabeled uses:
Reduce risk for heart disease, stroke, methotrexate toxicity prophylaxis

CONTRAINDICATIONS:

Hypersensitivity

Precautions:
Pregnancy (A), anemias other than megaloblastic/macrocytic anemia, vit B
₁₂deficiency anemia, uncorrected pernicious anemia

DOSAGE AND ROUTES
Calculator

RDA

• Adult and child ≥14 yr:
PO
400 mcg

• Adult (pregnant/lactating):
PO
600 mcg/day

• Child 9-13 yr:
PO
300 mcg

• Child 4-8 yr:
PO
200 mcg

• Child 1-3 yr:
PO
150 mcg

• Infant 6 mo-1 yr:
PO
80 mcg

• Neonate/infant <6 mo:
PO
65 mcg

Megaloblastic/macrocytic anemia due to folic acid or nutritional deficiency

• Pregnant/lactating:
PO
800-1000 mcg

Therapeutic dose

• Adult and child:
PO/IM/SUBCUT/IV
up to 1 mg/day

Maintenance dose

• Adult and child >4 yr:
PO/IM/SUBCUT/IV
0.4 mg/day

• Pregnant and lactating:
PO/IM/SUBCUT/IV
0.8-1 mg/day

• Child <4 yr:
PO/IM/SUBCUT/IV
up to 0.3 mg/day

• Infant:
PO/IM/SUBCUT/IV
up to 0.1 mg/day

Prevention of neural tube defects during pregnancy

• Adult:
PO
0.6 mg/day

Prevention of megaloblastic anemia during pregnancy

• Adult:
PO/IM/SUBCUT
up to 1 mg/day during pregnancy

Tropical sprue

• Adult:
PO
3-15 mg/day

Available forms:
Tabs 0.1, 0.4, 0.8, 1, 5 mg; inj 5, 10 mg/ml

Administer:

SUBCUT route

•
Do not inject intradermally

IM route

•
Inject deeply in large muscle mass, aspirate

Direct IV route

•
Direct undiluted ≤5 mg/1 min or more

Continuous IV INF route

•
May be added to most IV sol or TPN

Y-site compatibilities:
Alfentanil, aminophylline, ascorbic acid injection, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bumetanide, calcium gluconate, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, cimetidine, clindamycin, cyanocobalamin, cycloSPORINE, dexamethasone, digoxin, diphenhydrAMINE, DOPamine, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, erythromycin, esmolol, famotidine, fentaNYL, fluconazole, furosemide, ganciclovir, glycopyrrolate, heparin, hydrocortisone, hydrOXYzine, imipenem-cilastatin, indomethacin, insulin (regular), ketorolac, labetalol, lidocaine, LR, magnesium sulfate, mannitol, meperidine, methicillin, methylPREDNISolone, metoclopramide, metoprolol, mezlocillin, midazolam, moxalactam, multiple vitamins injection, naloxone, nitroglycerin, nitroprusside, ondansetron, oxacillin, oxytocin, penicillin G potassium/sodium, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, potassium chloride, procainamide, propranolol, ranitidine, Ringer’s, ritodrine, sodium bicarbonate, succinylcholine, SUFentanil, theophylline, ticarcillin, ticarcillin-clavulanate, TPN, trimetaphan, urokinase, vancomycin, vasopressin

SIDE EFFECTS

CNS:
Confusion, depression, excitability, irritability

GI:
Anorexia, nausea

INTEG:
Pruritus, rash, erythema

RESP:
Bronchospasm

SYST:
Anaphylaxis (rare)

PHARMACOKINETICS

PO:
Peak 1/2-1 hr, bound to plasma proteins, excreted in breast milk, metabolized by liver, excreted in urine (small amounts)

INTERACTIONS

Increase:
need for folic acid—estrogen, hydantoins, carBAMazepine, glucocorticoids

Decrease:
folate levels—methotrexate, sulfonamides, sulfaSALAzine, trimethoprim

Decrease:
phenytoin levels, fosphenytoin, may increase seizures

NURSING CONSIDERATIONS

Assess:

•
Megaloblastic anemia: fatigue, dyspnea, weakness

•
Hgb, Hct, reticulocyte count

•
Nutritional status: bran, yeast, dried beans, nuts, fruits, fresh vegetables, asparagus

•
Products currently taken: estrogen, carBAMazepine, glucocorticoids, hydantoins; these products may cause increased folic acid use by body and con
tribute to a deficiency if taking other neurotoxic products

Perform/provide:

•
Storage in light-resistant container

Evaluate:

•
Therapeutic response: increased weight, oriented, well-being; absence of fatigue; increase in reticulocyte count within 5 days of beginning treatment, absence of neural tube defect

Teach patient/family:

•
To take product exactly as prescribed; that periodic lab work is required

•
To alter nutrition to include high–folic-acid foods: organ meats, vegetables, fruit

•
That urine will turn bright yellow

•
To notify prescriber of allergic reaction

•
To avoid breastfeeding

Canada only Side effects:
italics
= common;
bold
= life-threatening
Nurse Alert

HIGH ALERT
fondaparinux (Rx)

(fon-dah-pair′ih-nux)

Arixtra

Func. class.:
Anticoagulant, antithrombotic

Chem. class.:
Synthetic, selective factor Xa inhibitor

Do not confuse:
Arixtra
/Anti-Xa

ACTION:

Acts by antithrombin III (ATIII)-mediated selective inhibition of factor Xa; neutralization of factor Xa interrupts blood coagulation and inhibits thrombin formation; does not inactivate thrombin (activated factor II) or affect platelets

USES:

Prevention/treatment of deep venous thrombosis, PE in hip and knee replacement, hip fracture or abdominal surgery

Unlabeled uses:
Acute coronary syndrome

CONTRAINDICATIONS:

Hypersensitivity to this product; hemophilia, leukemia with bleeding, peptic ulcer disease, hemorrhagic stroke, surgery, thrombocytopenic purpura, weight <50 kg, severe renal disease (CCr <30 ml/min), active major bleeding, bacterial endocarditis

Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, alcoholism, hepatic disease (severe), blood dyscrasias, heparin-induced thrombocytopenia, uncontrolled severe hypertension, subacute bacterial endocarditis, acute nephritis, mild to moderate renal disease

Black Box Warning:

Spinal/epidural anesthesia, lumbar puncture

DOSAGE AND ROUTES
Calculator

Deep venous thrombosis/PE

• Adult <50 kg:
SUBCUT
5 mg/day × ≥5 days until INR 2-3; may give warfarin within 72 hr of fondaparinux

• Adult 50-100 kg:
SUBCUT
7.5 mg/day × ≥5 days until INR 2-3; may give warfarin within 72 hr of fondaparinux

• Adult >100 kg:
SUBCUT
10 mg/day × ≥5 days until INR 2-3; may give warfarin within 72 hr of fondaparinux

Prevention of deep venous thrombosis

• Adult:
SUBCUT
2.5 mg/day given 6 hr after surgery; continue for 5-9 days; for hip surgery, up to 32 days; for abdominal surgery, up to 24 days

Coronary artery thrombosis prophylaxis/acute coronary syndrome (unlabeled)

• Adult:
SUBCUT
2.5 mg until hospital discharge or ≤8 days with standard treatment

Renal disease

• Adult:
SUBCUT
CCr <30 ml/min, do not use

Available forms:
Inj 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml, 10 mg/0.8 ml prefilled syringes

Administer:

•
Alone; do not mix with other products or solutions; cannot be used interchangeably (unit to unit) with other anticoagulants

•
For 5-9 days

•
Only after screening patient for bleeding disorders

SUBCUT route

•
SUBCUT only; do not give IM; do not give <6 hr after surgery

•
Check for discolored sol or sol with particulate; if present, do not give

•
Administer 6-8 hr after surgery; administer to recumbent patient, rotate inj sites (left/right anterolateral, left/right posterolateral abdominal wall)

•
Wipe surface of inj site with alcohol swab, twist plunger cap and remove, remove rigid needle guard by pulling straight off needle; do not aspirate, do not expel air bubble from surface

•
Insert whole length of needle into skinfold held with thumb and forefinger

•
When product is injected, a soft click may be felt or heard

•
Give at same time each day to maintain steady blood levels; observe inj site

•
Avoid all IM inj that may cause bleeding

Administer only this product when ordered; not interchangeable with heparin

SIDE EFFECTS

CNS:
Fever
, confusion, headache, dizziness,
insomnia

GI:
Nausea, vomiting
, diarrhea, dyspepsia,
constipation
, increased AST, ALT

GU:
UTI, urinary retention

HEMA:
Anemia
, minor bleeding, purpura, hematoma,
thrombocytopenia, major bleeding (intracranial, cerebral, retroperitoneal hemorrhage), postoperative hemorrhage, heparin-induced thrombocytopenia

INTEG:
Increased wound drainage, bullous eruption, local reaction—
rash
, pruritus, inj site bleeding

META:
Hypokalemia

OTHER:
Hypotension, pain,
edema

PHARMACOKINETICS

Rapidly, completely absorbed; peak steady state 3 hr; distributed primarily in blood; does not bind to plasma proteins except 94% to ATIII; metabolism unknown; eliminated unchanged in urine within 72 hr with normal renal function; terminal half-life 17-21 hr

INTERACTIONS

Increase:
bleeding risk—salicylates, NSAIDs, abciximab, eptifibatide, tirofiban, clopidogrel, dipyridamole, quiNIDine, valproic acid

Drug/Herb

Increase:
bleeding risk—feverfew, garlic, ginger, ginkgo, ginseng, green tea, horse chestnut, kava

NURSING CONSIDERATIONS

Assess:

Black Box Warning:

Monitor patients who have received epidural/spinal anesthesia or lumbar puncture for neurological impairment

•
Blood studies (CBC, anti-Xa, Hgb/Hct, prothrombin time, platelets, occult blood in stools), thrombocytopenia may occur; if platelets <100,000/mm
³, treatment should be discontinued; renal studies: BUN, creatinine

•
For bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria; decreased Hct, notify prescriber

•
For risk of hemorrhage if coadministering with other products that may cause bleeding

•
For hypersensitivity: rash, fever, chills; notify prescriber

Perform/provide:

•
Storage at 77° F (25° C); do not freeze

Evaluate:

•
Therapeutic response: prevention of DVT

Teach patient/family:

•
To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor

•
To report any signs of bleeding: gums, under skin, urine, stools

•
To avoid OTC products containing aspirin, NSAIDs