Mosby's 2014 Nursing Drug Reference (189 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTfospropofol (Rx)
(fos-proe′poe-fol)
Lusedra
Func. class.:
General anesthetic
Produces dose-dependent CNS depression by activation of GABA receptor
Induction or maintenance of anesthesia as part of balanced anesthetic technique; sedation in mechanically ventilated patients
Hypersensitivity to product
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, respiratory depression, severe respiratory disorders, cardiac dysrhythmias, labor/delivery, renal disease, hyperlipidemia
Calculator
• Adult <65 (healthy), >90 kg:
577.5
IV BOL,
may give supplemental doses up to max of 140 mg, give no more frequently than q4min; 61-89 kg 6.5 mg/kg (max 577.5 mg)
IV BOL
may give supplemental doses up to 1.6 mg/kg/dose (max 140 mg/dose; give no more frequently than q4min); <60 kg 385 mg
IV BOL,
may give supplemental doses up to max 105 mg/dose, give no more frequently than q4min
• Adult: <65 yr (severe systemic disease), ≥90 kg
437.5 mg
IV BOL,
give supplemental doses up to max 105 mg/dose, give no more frequently than q4min; 61-89 kg 4.875 mg/kg (max 437.5 mg) give supplemental doses of 75% of standard dose/up to 1.2 mg/kg/dose (max 105 mg/dose) give no more frequently than q4min; <60 kg 297.5
IV BOL,
give supplemental doses up to max 70 mg/dose, give no more frequently than q4min
• Geriatric ≥90 kg:
IV BOL
437.5 then supplemental doses up to max 105 mg; give no more frequently than q4min; 61-89 kg,
IV BOL
give 75% standard dosing regimen (4.875 mg/kg), give no more frequently than q4min (max 105 mg/dose)
Available forms:
Inj 1050 mg/30 ml
•
Visually inspect for particulate matter and discoloration
•
Each vial is single patient/single use
•
Draw from vial, discard unused portion
•
Do not mix with other drugs prior to use
•
Give by IV BOL in free-flowing peripheral IV line of D
5
W, 5% dextrose/0.2% NaCl, 5% dextrose/0.45% NaCl D
5
LR, LR, 0.45% NaCl, NS, 5% dextrose/0.45% NaCl/20 mEq KCI; do not mix with other fluids, flush line with NS before and after administration
•
No filtration needed
•
Give only with resuscitative equipment available
•
Only qualified persons trained in anesthesia should administer
CNS:
Involuntary movement, headache, jerking, fever, dizziness, shivering, tremor, confusion, somnolence, paresthesia, agitation, abnormal dreams, euphoria, fatigue,
increased intracranial pressure, impaired cerebral flow, seizures
CV:
Bradycardia, hypotension
, hypertension, PVC, PAC, tachycardia, abnormal ECG, ST segment depression,
asystole, bradydysrhythmias
EENT:
Blurred vision, tinnitus, eye pain, strange taste, diplopia
GI:
Nausea, vomiting, abdominal cramping
, dry mouth, swallowing, hypersalivation,
pancreatitis
GU:
Urine retention, green urine, cloudy urine, oliguria
INTEG:
Flushing, phlebitis, hives, burning/stinging at inj site
, rash, pain of extremities
MS:
Myalgia
RESP:
Apnea,
cough, hiccups
, dyspnea, hypoventilation, sneezing, wheezing, tachypnea, hypoxia, respiratory acidosis
Onset 15-30 sec, rapid distribution, half-life 1-8 min, terminal half-life .81-.88 hr; 70% excreted in urine; metabolized in liver by conjugation to inactive metabolites, 95%-99% protein binding
Do not use within 10 days of MAOIs
Increase:
CNS depression—alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants, inhalational anesthetics
Increase:
fospropofol effect—St. John’s wort
Increase:
LFTs, bilirubin
•
Inj site: phlebitis, burning, stinging
•
ECG
for changes: PVC, PAC, ST segment changes; monitor VS
•
CNS changes: movement, jerking, tremors, dizziness, LOC, pupil reaction
•
Allergic reactions: hives
•
Respiratory depression,
character, rate, rhythm; notify prescriber if respirations are <10/min; hypoxemia detectable by pulse oximetry
•
Storage of unopened vials at room temp
•
Therapeutic response: induction of anesthesia
•
That this medication will cause dizziness, drowsiness, sedation
Discontinue product; administer vasopressor agents or anticholinergics, artificial ventilation
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(froh-vah-trip′tan)
Frova
Func. class.:
Antimigraine agent
Chem. class.:
5-HT
1
-Receptor agonist
Binds selectively to the vascular 5-HT
1B
, 5-HT
1D
receptor subtypes; exerts antimigraine effect; binds to benzodiazepine receptor sites, causes vasoconstriction in cranium
Acute treatment of migraine with/without aura
Hypersensitivity, angina pectoris, history of MI, documented silent ischemia, Prinzmetal’s angina, ischemic heart disease; concurrent ergotamine-containing preparations; uncontrolled hypertension; basilar or hemiplegic migraine; ischemic bowel disease; peripheral vascular disease, severe hepatic disease, prophylactic migraine treatment
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, post
menopausal women, men >40 yr, risk factors for CAD, hypercholesterolemia, obesity, diabetes, impaired hepatic function, seizure disorder
Calculator
• Adult:
PO
2.5 mg; a 2nd dose may be taken after ≥2 hr; max 3 tabs (7.5 mg/day)
Available form:
Tabs 2.5 mg
•
Swallow tabs whole; do not break, crush, or chew
•
With fluids
•
2 days/wk or less; rebound headache may occur
CNS:
Hot/cold sensation
, paresthesia,
dizziness
, headache, fatigue, insomnia, anxiety, somnolence,
seizures
CV:
Flushing
, chest pain, palpitation
GI:
Dry mouth, dyspepsia, abdominal pain, diarrhea, vomiting, nausea
MS:
Skeletal pain
Onset of pain relief 2-3 hr, terminal half-life 25-29 hr, protein binding 15%, metabolized liver by CYP1A2
Increase:
frovatriptan levels—CYP1A2 inhibitors (cimetidine, ciprofloxacin, erythromycin), estrogen, propranolol, oral contraceptives
Increase:
toxicity—SSRIs, other serotonin agonists (dextromethorphan, traMADol, antidepressants)
•
Migraine symptoms:
aura, unable to view light; ingestion of tyramine-containing foods (pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artificial sweeteners, chocolate, caffeine, which may precipitate these types of headaches
•
B/P; signs, symptoms of coronary vasospasms
•
For stress level, activity, recreation, coping mechanisms
•
Quiet, calm environment with decreased stimulation from noise, bright light, excessive talking
•
Therapeutic response: decrease in frequency, severity of migraine
•
To report any side effects to prescriber
•
To use contraception while taking product; to inform prescriber if pregnant or planning to become pregnant
•
To consult prescriber if breastfeeding