Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (19 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(a-se-teel-sis′tay-een)
Acetadote, Mucomyst
Func. class.:
Mucolytic; antidote—acetaminophen
Chem. class.:
Amino acid
L
-cysteine
Do not confuse:
acetylcysteine
/acetylcholine
Mucomyst
/Mucinex
Decreases viscosity of secretions by breaking disulfide links of mucoproteins; serves as a substrate in place of glutathione, which is necessary to inactivate toxic metabolites with acetaminophen overdose
Acetaminophen toxicity; bronchitis; cystic fibrosis; COPD; atelectasis
Unlabeled uses:
Prevention of contrast medium nephrotoxicity
Hypersensitivity, increased intracranial pressure, status asthmaticus
Precautions:
Pregnancy (B), breastfeeding, hypothyroidism, Addison’s disease, CNS depression, brain tumor, asthma, renal/hepatic disease, COPD, psychosis, alcoholism, seizure disorders, bronchospasms, asthma, anaphylactoid reactions, fluid restriction, weight <40 kg
Calculator
• Adult and child: PO
140 mg/kg, then 70 mg/kg q4hr × 17 doses to total of 1330 mg/kg;
IV
loading dose 150 mg/kg over 60 min (dilution 150 mg/kg in 200 ml of D
5
); maintenance dose 1: 50 mg/kg over 4 hr (dilution 50 mg/kg in 500 ml D
5
): maintenance dose 2: 100 mg/kg over 16 hr (dilution 100 mg/kg in 1000 ml D
5
)
• Adult and child: INSTILL
1-20 ml (10%-20% sol) q6-8hr prn or 3-5 ml (20% sol) or 6-10 ml (10% sol) tid or qid; nebulization (face mask, mouthpiece, tracheostomy) 1-10 ml of a 20% sol, or 2-20 ml of a 10% sol, q6-8hr; nebulization (tent, croupette) may require large dose, up to 300 ml/treatment
• Adult: PO
600 mg bid, given day before and day of administration of contrast media or
IV
150 mg/kg in 500 ml NS over 30 min before contrast, then 50 mg/kg in 500 ml NS over the next 4 hr;
IV BOL
1200 mg before contrast medium and 1200 mg
PO
bid for 48 hr (MI undergoing angioplasty)
Available forms:
Oral sol 10%, 20%; inj 20% (200 mg/ml)
•
Antidotal use:
give within 24 hr; dilute 10% or 20% sol to a 5% sol with diet soda, may use water if giving via gastric tube; dilution of 10% sol 1:1, 20% sol 1:3, store open undiluted solution refrigerated ≤96 hr
•
By syringe: 1-2 ml of 10%-20% sol up to q1hr
•
Decreased dose to geriatric patients; metabolism may be slowed
•
Only if suction machine is available
•
Before meals 1/2-1 hr for better absorption, to decrease nausea
•
20% sol diluted with NS or water for inj; may give 10% sol undiluted
•
Only after patient clears airway by deep breathing, coughing
•
21-hr regimen:
loading dose: dilute 150 mg/kg in 200 ml D
5
W; maintenance dose 1: dilute 50 mg/kg in 500 ml D
5
W; maintenance dose 2: dilute 100 mg/kg in 1000 ml D
5
W, give loading dose over 15 min, give maintenance dose 1 over 4 hr; give maintenance dose 2 over 16 hr, administer sequentially without time between doses
CNS:
Dizziness, drowsiness
, headache, fever, chills
CV:
Hypotension, flushing tachycardia
EENT:
Rhinorrhea
, tooth damage
GI:
Nausea
, stomatitis, constipation, vomiting, anorexia,
hepatotoxicity,
diarrhea
INTEG:
Urticaria, rash, fever, clamminess, pruritus
RESP:
Bronchospasm,
burning,
hemoptysis,
chest tightness, cough, dyspnea
MISC:
Anaphylaxis, angioedema
PO:
(antidote), peak 1-2 hr, duration 4 hr
INH/INSTILL:
Onset 5-10 min, peak 10 min, duration 1 hr
Excreted in urine, half-life 5.6 hr (adult), 11 hr (newborn)
IV:
Protein binding 83%
•
Do not use with iron, copper, rubber, nickel, activated charcoal
Increase:
effect—nitrates
•
Mucolytic use:
cough—type, frequency, character, including sputum
•
Rate, rhythm of respirations, increased dyspnea; sputum; discontinue if bronchospasm occurs
•
VS, cardiac status including checking for dysrhythmias, increased rate, palpitations
•
ABGs for increased CO
2
retention in asthma patients
•
Antidotal use:
LFTs, PT, BUN, creatinine, glucose, electrolytes, acetaminophen levels; inform prescriber if dose is vomited or vomiting is persistent
•
Nausea, vomiting, rash; notify prescriber if these occur
•
Storage in refrigerator; use within 96 hr of opening
•
Assistance with inhaled dose: bronchodilator if bronchospasm occurs; mechanical suction if cough insufficient to remove excess bronchial secretions
•
Therapeutic response: absence of purulent secretions when coughing, clear lung sounds (mucolytic use); absence of hepatic damage with acetaminophen toxicity
•
That foul odor and smell may be unpleasant
•
To clear airway for inhalation
•
That discoloration of sol after bottle is opened does not impair its effectiveness
•
To report vomiting because dose may need to be repeated
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a′kli-din′ee-um)
Tudorza Pressair
Func. class.:
Anticholinergic, bronchodilator
Chem. class.:
Synthetic quaternary ammonium compound
Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, thereby resulting in decreased cGMP and bronchodilation
Long-term maintenance treatment of bronchospasm in COPD, emphysema, chronic bronchitis, not indicated for initial treatment of acute episodes
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, milk sensitivity, contact lenses, narrow-angle glaucoma, neonates, ocular exposure, prostatic hypertrophy, bladder obstruction
Calculator
• Adults, including geriatric patients:
Oral inhalation 400 μg (1 actuation) bid; doses should be 12 hours apart
Available forms:
Powder for inhalation 400 μg/actuation
•
Before initial use, remove inhaler from pouch; remove the cap by squeezing the arrows marked on each side and pulling outward; instruct the patient to hold the inhaler with the mouthpiece facing patient but not inside the mouth; the green button should be facing straight up
•
Before placing the inhaler into the mouth, the green button should be pushed all the way down and then released; patient should not continue to hold it down. Once the green button is pressed, the control window changes from red to green, indicating that the medication is ready for inhalation. If the control window remains red, repeat the press-and-release actions until the control window is green
•
Before inhaling the dose, have patient breathe out completely away from the inhaler; patient should never breathe out into the inhaler
•
Instruct patient to put their lips tightly around the mouthpiece and to breathe in quickly and deeply through the mouth until a click sound is heard
•
The patient should remove the inhaler from the mouth and hold breath for as long as is comfortable, then breathe out slowly through the nose
•
The control window should turn red after the full dose has been inhaled. If it remains green after the dose is inhaled, the inhalation process should be repeated. If correct inhalation has not been achieved after several attempts, the doctor or health care professional should be contacted
•
Once the window has turned red, the protective cap should be placed back onto the inhaler by pressing it back onto the mouthpiece
•
The dose indicator displays how many doses are left. The first time the inhaler is used, the indicator displays the number 60. The indicator number counts down as the patient uses the inhaler
•
Discard inhaler when the marking “0” with red background shows in the middle of the dose indicator, the device locks out, after 45 days (whichever comes first); the inhaler does not need to be cleaned
CNS:
Anxiety, dizziness, headache
, nervousness
CV:
Palpitation
EENT:
Dry mouth, blurred vision, nasopharyngitis congestion
GI:
Nausea, vomiting, diarrhea
INTEG:
Rash
RESP:
Cough, worsening of symptoms
,
bronchospasm
Half-life 5-8 hr
Increase:
toxicity—other bronchodilators
•
Tolerance over long-term therapy; dose might have to be increased or changed
•
Respiratory status: rate, rhythm, auscultate breath sounds before and after administration, pulmonary function tests at baseline and periodically
•
Therapeutic response: Ability to breathe adequately
•
That compliance is necessary with number of inhalations/24 hr or overdose can occur; about spacer device for geriatric patients; that max therapeutic effects can take 2-3 mo
•
About the correct method of inhalation
•
To report any visual effects or urinary retention