Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (20 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
)
Actidose-Aqua, Actidose with Sorbitol, Charcoal Plus, Charcoal Plus DS, Charcocaps, EZ Char
Func. class.:
Antiflatulent; antidote
Do not confuse:
Actidose
/Actos
Binds poisons, toxins, irritants; increases adsorption in GI tract; inactivates toxins and binds until excreted
Poisoning, overdose
Unlabeled uses:
Diarrhea, flatulence
Hypersensitivity to this product, unconsciousness, semiconsciousness, cyanide poisoning, mineral acids, alkalis, gag reflex depression, ethanol intoxication, intestinal obstruction, absent bowel sounds
Precautions:
Pregnancy (C), hypersensitivity to quiNIDine, quiNINE
Calculator
Children should not get more than 1 dose of products that contain sorbitol
•
Tabs/caps should not be used for poisonings
• Adult/adolescents: PO
(activated charcoal aqueous susp) 5-10 × estimated weight of drug/chemical ingested or 50-100 g dose, may repeat q4-6hr as needed; (activated charcoal with sorbitol susp) 50 g as a single dose, do not use multiple dosing
• Child: PO
(activated charcoal aqueous susp) 1-2 g/kg/dose or 25-50 g dose, may repeat as needed q4-6hr
• Infant: PO
(activated charcoal aqueous susp) 1 g/kg/dose, may repeat as needed q4-6hr
• Adult: PO
(CharcoCaps) 520 mg (2 caps) after meals or prn, max 4.16 g (16 cap)/day
Available forms:
Powder 15, 25, 30, 40, 120, 240 g/container; oral susp 12.5 g/60 ml, 15 g/72 ml, 15 g/120 ml, 25 g/120 ml, 30 g/120 ml, 50 g/240 ml; 15 g/120 ml, 25 g/125 ml, 50 g/225 ml, 50 g/250 ml
•
Storage in tightly closed container to prevent absorption of gases
•
Use stool softener or laxative to lessen constipation unless sorbitol has been given
•
Give orally to those with intact gag reflexes, protected airways
•
After inducing vomiting unless vomiting contraindicated (i.e., cyanide or alkalis)
•
After mixing with water or fruit juice to form thick syrup; do not use dairy products, chocolate syrup to mix charcoal
•
Repeat dose if vomiting occurs soon after dose; give with a laxative to promote elimination
•
After spacing at least 2 hr before or after other products or absorption will be decreased
•
Do not use tabs, caps to treat overdose
NG route
•
Through nasogastric tube if patient unable to swallow
GI:
Nausea, black stools
, vomiting, constipation, diarrhea, abdominal pain
OTHER:
Pulmonary aspiration
PO:
Excreted in feces, not absorbed, excreted unchanged in feces
•
Inactivation of acetylcysteine
Decrease:
effects of acarbose, carBAMazepine, digoxin, ipecac, phenytoin, acetaminophen, barbiturates, furosemide, methotrexate, phenothiazine, salicylates, tricyclics; use for overdose
•
Respiration, pulse, B/P to determine charcoal effectiveness if taken for barbiturate/opiate poisoning; intact gag reflex, serum
•
Not used for all types of overdose
•
Therapeutic response: LOC alert (poisoning)
•
That stools will be black
•
How to prevent further poisonings
•
To drink 8 glasses of water to prevent constipation
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ay-sye′kloe-veer)
Zovirax
Func. class.:
Antiviral
Chem. class.:
Purine nucleoside analog
Do not confuse:
Zovirax
/Zyvox/Valtrex/Zostrix
Interferes with DNA synthesis by conversion to acyclovir triphosphate, thereby causing decreased viral replication
Mucocutaneous herpes simplex virus, herpes genitalis (HSV-1, HSV-2), varicella infections, herpes zoster, herpes simplex encephalitis
Unlabeled uses:
Bell’s palsy, prevention of CMV, Epstein-Barr virus, esophagitis, hairy leukoplakia, prevention of herpes labialis, herpes simplex, herpes simplex ocular prophylaxis, keratoconjunctivitis, pharyngitis, pneumonitis, prevention of postherpetic neuralgia, proctitis, stomatitis, tracheobronchitis, varicella prophylaxis
Hypersensitivity to this product, valacyclovir
Precautions:
Pregnancy (B), breastfeeding, renal/hepatic/neurologic disease, electrolyte imbalance, dehydration, hypersensitivity to famciclovir, ganciclovir, penciclovir, valganciclovir
Calculator
• Adult: PO
400 mg 3 ×/day for 5 days or 200 mg 5 ×/day × 5 days
• Adult and child >12 yr: IV INF
5 mg/kg over 1 hr q8hr × 7 days, use ideal body weight for patients with obesity
• Infant >3 mo/child <12 yr: IV INF
10 mg/kg q8hr × 7 day; if HIV infected 5-10 mg/kg q8hr (moderate to severe)
• Neonate: IV INF
10 mg/kg q8hr × 10 days, may use higher dose
• Adult: PO
200 mg q4hr (5 ×/day while awake) for 5 days to 6 mo depending on whether initial, recurrent, or chronic;
IV
5 mg/kg q8hr × 5 days
• Adult/child ≥12 yr:
top cover lesions q3hr 6 times/day
•Adult: IV
10 mg/kg over 1 hr q8hr × 10 days
• Child 3 mo-12 yr: IV
20 mg/kg q8hr × 10 days
• Child birth-3 mo: IV
10 mg/kg q8hr × 10 days
• Adult/child ≥12 yr:
top apply cream 5 ×/day for 4 days, start as soon as symptoms appear
• Adult: PO
800 mg q4hr while awake × 7-10 days;
IV
10 mg/kg q8hr × 7 days
• Adult/adolescent: PO
800 mg q4hr 5×/day for 7-10 days;
IV
10 mg/kg q8hr × 7 days
• Child
≥
12 yr: IV
10 mg/kg/dose q8hr × 7 days
• Infant/child <12 yr: IV
20 mg/kg/dose q8hr × 7-10 days
• Adult: PO
800 mg q4hr 5×/day × 7-10 days; start within 48-72 hr of rash onset
• Adult/adolescent/child >40 kg: PO
800 mg 4×/day × 5 days
• Child ≥2 yr and ≤40 kg: PO
20 mg/kg/dose (max 800 mg) 4×/day × 5 days
• Adult and child
>
12 yr: IV
5 mg/kg q8hr × 7 days
• Infant >3 mo/child <12: IV
10 mg/kg q8hr × 7 days
• Adult and child: PO/IV
CCr >50 ml/min 100% dose q8hr, CCr 25-50 ml/min 100% dose q12hr, CCr 10-25 ml/min 100% dose q24hr, CCr 0-10 ml/min 50% dose q24hr
• Adult/child ≥12 yr: PO
600-800 mg every day × 8-12 mo
•Adult: IV
500 mg/m
2
q8hr
• Adult and adolescent: IV
5-10 mg/kg q8hr × 2-7 days or
PO
200 mg q4hr 5×/day × 7-10 days or 400 mg 3-5 ×/day × ≥10 days
• Child 6 mo-12 yr: IV
1000 mg/day in 3-5 divided doses × 7-14 days
• Adult and adolescent: PO
400 mg bid up to 12 mo
• Child: PO
800-1000 mg/day in 2-5 divided doses, max 80 mg/kg/day
Available forms:
Caps 200 mg; tabs 400, 800 mg; powder for inj 500, 1000 mg; sol for inj 50 mg/ml; oral susp 200 mg/5 ml; ointment/cream 5%
•
Do not break, crush, or chew caps
•
May give without regard to meals, with 8 oz of water
•
Shake susp before use
•
Increase fluids to 3 L/day to decrease crystalluria; most critical during first 2 hr after IV
•
Reconstitute with 10 ml compatible sol/500 mg or 20 mg/1 g of product, conc of 50 mg/ml, shake, further dilute in 50-125 ml compatible sol; use within 12 hr; give over at least 1 hr (constant rate) by inf pump to prevent nephrotoxicity; do not reconstitute with sol containing benzyl alcohol in neonates
•
Use finger cot or glove to cover all lesions completely, do not get in eye, wash hands after use
Solution compatibilities:
D
5
W, LR, or NaCl (D
5
0.9% NaCl, 0.9% NaCl) sol
Y-site compatibilities:
Alemtuzumab, alfentanil, allopurinol, amikacin, aminophylline, amphotericin B cholesteryl, amphotericin B liposome, ampicillin, anidulafungin, argatroban, atracurium, bivalirudin, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, cefazolin, cefonicid, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, cefTRIAXone, cefuroxime, cephapirin, chloramphenicol, cholesteryl sulfate complex, cimetidine, clindamycin, dexamethasone sodium phosphate, dimenhyDRINATE, DOXOrubicin, doxycycline, erythromycin, famotidine, filgrastim, fluconazole, gallium, gentamicin, granisetron, heparin, hydrocortisone sodium succinate, hydromorphone, imipenem/cilastatin, LORazepam, magnesium sulfate, melphalan, methylPREDNISolone sodium succinate, metoclopramide, metroNIDAZOLE, multivitamin, nafcillin, oxacillin, paclitaxel, penicillin G potassium, PENTobarbital, perphenazine, piperacillin, potassium chloride, propofol, ranitidine, remifentanil, sodium bicarbonate, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vasopressin, voriconazole, zidovudine
CNS:
Tremors, confusion, lethargy, hallucinations,
seizures,
dizziness, headache, encephalopathic changes
EENT:
Gingival hyperplasia
GI:
Nausea, vomiting, diarrhea, increased ALT/AST, abdominal pain, glossitis, colitis
GU:
Oliguria, proteinuria, hematuria,
vaginitis, moniliasis,
glomerulonephritis, acute renal failure,
changes in menses, polydipsia
HEMA:
Thrombotic thrombocytopenia purpura, hemolytic uremic syndrome
(immunocompromised patients)
INTEG:
Rash, urticaria, pruritus, pain or phlebitis at IV site, unusual sweating, alopecia,
Stevens-Johnson syndrome
MS:
Joint pain, leg pain, muscle cramps
Distributed widely; crosses placenta; CSF concentrations are 50% plasma; protein binding 9%-33%
PO:
Absorbed minimally, onset unknown, peak 1.5-2 hr, terminal half-life 2.5-3.3 hr
IV:
Onset immediate, peak immediate, duration unknown, half-life 20 min-3 hr (terminal); metabolized by liver, excreted by kidneys as unchanged product (95%)
Increase:
CNS side effects; zidovudine
Increase:
levels, toxicity—probenecid
Increase:
nephrotoxicity—aminoglycosides
Increase:
concentrations of—entecavir, pemetrexed, tenofovir
Decrease:
action of—hydantoins, valproic acid
Increase:
BUN, creatinine
•
Signs of infection, anemia
•
Toxicity
: any patient with compromised renal system because product is excreted slowly with poor renal system function; toxicity may occur rapidly
•
Hepatic, renal studies: AST, ALT; urinalysis, protein, BUN, creatinine, CCr, watch for increasing BUN and serum creatinine or decreased CCr; I&O ratio; report hematuria, oliguria, fatigue, weakness; may indicate
nephrotoxicity;
check for protein in urine during treatment
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued
•
Skin eruptions: rash, urticaria, itching
•
Allergies before treatment, reaction of each medication; place allergies on chart in bright red letters
•
Neurologic status with herpes encephalitis
•
Storage at room temp for up to 12 hr after reconstitution; if refrigerated, sol may show a precipitate that clears at room temp; yellow discoloration does not affect potency
•
Adequate intake of fluids (2 L) to prevent deposits in kidneys, more likely to occur with rapid administration or in dehydration
•
Therapeutic response: absence of itching, painful lesions; crusting and healed lesions; decreased symptoms of chickenpox; healing, decreased pain with herpes zoster
•
To take as prescribed; if dose is missed, take as soon as remembered up to 1 hr before next dose; do not double dose
•
That product may be taken orally before infection occurs; product should be taken when itching or pain occurs, usually before eruptions
•
That sexual partners need to be told that patient has herpes because they can become infected; condoms must be worn to prevent reinfections
•
Not to touch lesions to avoid spreading infection to new sites
•
That product does not cure infection, just controls symptoms and does not prevent infecting others
•
That product must be taken in equal intervals around the clock to maintain blood levels for duration of therapy
•
To seek dental care during treatment to prevent gingival hyperplasia
•
That women with genital herpes are more likely to develop cervical cancer; to keep all gynecologic appointments
Discontinue product, hemodialysis, resuscitate if needed