Mosby's 2014 Nursing Drug Reference (201 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
OTC
, Rx)
(gwye-fen′e-sin)
Alfen, Altarussin, Balminil
, Bidex, Diabetic Tussin, Elix Sure EX, Equaline Non-Drowsy Tussin, Equate Tussin Cough, Good Sense Mucus Relief, Good Sense Tussin Chest Congestion, Guaifenesin NR, Guiatuss, Humibid, Iophen NR, Liquibid, Miltuss EX, Mucinex, Mucinex Children’s Mucus Relief, Mucinex Junior Strength, Naldecon Senior EX, Organ-1NR, Organidin NR, Q-Tussin, Robafen, Scot-Tussin Expectorant, Siltussin DAS, Siltussin SA, Top Care Children’s Mucus Relief, Top Care Tussin Chest Congestion Solution, Wal-Tussin Expectorant, XPect
Func. class.:
Expectorant
Increases the volume and reduces the viscosity of secretions in the trachea and bronchi to facilitate secretion removal
Productive and nonproductive cough
Hypersensitivity; chronic, persistent cough
Precautions:
Pregnancy (C), breastfeeding, CHF, asthma, emphysema, fever
Calculator
• Adult and adolescent:
PO
200-400 mg q4hr;
EXT REL
600-1200 mg q12hr, max 2.4 g/day
• Child 6-11 yr:
PO
100-200 mg q4hr;
EXT REL
600 mg q12hr, max 1.2 g/day
• Child 2-5 yr:
PO
50-100 mg q4hr; max 600 mg/day; ext rel 300 mg q12hr, max 600 mg/day
Available forms:
Tabs 200, 400 mg; oral sol 100 mg/5 ml; ext rel tabs 600, 1200 mg; syrup 100 mg/5 ml; oral granules 50, 100 mg/packet
•
Do not break, crush, chew ext rel tabs
CNS:
Drowsiness, headache, dizziness
GI:
Nausea, anorexia, vomiting, diarrhea
Half-life 1 hr, excreted in urine (metabolites)
•
Cough:
type, frequency, character, including sputum; fluids should be increased to 2 L/day
•
Storage at room temp
•
Increased fluids, room humidification to liquefy secretions
•
Therapeutic response: productive cough, thinner secretions
•
To avoid driving, other hazardous activities if drowsiness occurs (rare)
•
To avoid smoking, smoke-filled room, perfumes, dust, environmental pollutants, cleansers
•
To consult health provider if cough lasts >7 days
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(hal-oh-pehr′ih-dol)
Haldol Decanoate
Haldol
Func. class.:
Antipsychotic, neuroleptic
Chem. class.:
Butyrophenone
Do not confuse:
haloperidol
/Halotestin
Depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmission produced by DOPamine at synapse; exhibits strong α-adrenergic, anticholinergic blocking action; mechanism for antipsychotic effects unclear
Psychotic disorders, control of tics, vocal utterances in Gilles de la Tourette’s syndrome, short-term treatment of hyperactive children showing excessive motor activity, prolonged parenteral therapy in chronic schizophrenia, organic mental syndrome with psychotic features, hiccups (short-term), emergency sedation of severely agitated or delirious patients, ADHD
Unlabeled uses:
Nausea, vomiting during surgery; autism; migraine
Children <3 yr, hypersensitivity, blood dyscrasias, coma, brain damage, bone marrow depression, alcohol and barbiturate withdrawal states, Parkinson’s disease, angina, epilepsy, urinary retention, closed-angle glaucoma
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, seizure disorders, hypertension, pulmonary/cardiac/hepatic disease, QT prolongation, torsade de pointes
Black Box Warning:
Increased mortality in elderly patients with dementia-related psychosis
Calculator
• Adult:
IM/IV
(lactate) 2-10 mg, may repeat q1hr, convert to
PO
as soon as possible,
PO
should be 150% of total parenteral dose required
• Child 6-12 yr:
IM/IV
(lactate) (unlabeled) 1-3 mg q4-8hr, max 0.15 mg/kg/day, switch to
PO
as soon as possible
• Adult:
IM
(decanoate) 50-100 mg q4wk, max 100 mg for 1st inj
• Child 3-12 yr:
PO/IM
0.05-0.15 mg/kg/day
• Adult and adolescent:
PO
0.5-2 mg bid-tid, increase until desired response occurs
• Child 3-12 yr or weighing 15-40 kg:
PO
0.25-0.5 mg/day in 2-3 divided doses, increase by 0.25-0.5 mg q5-7days, max 0.15 mg/kg/day
• Child 3-12 yr:
PO
0.25-0.5 mg/day in 2-3 divided doses, may increase by 0.025-0.5 mg q5-7days; maintenance 0.01-0.03 mg/kg/day as a single dose
• Child:
PO
0.04 mg/kg/day or 1-3 mg/day, max 4 mg/day
• Adult:
PO/IM
(lactate) 5 mg at onset, may repeat once
Available forms:
Tabs 0.5, 1, 2, 5, 10, 20 mg;
lactate:
oral sol 2 mg/ml; inj 5 mg/ml,
decanoate:
50 mg/ml, 100 mg/ml
•
Reduced dose to geriatric patients
•
Antiparkinsonian agent if EPS occurs
•
Avoid use with CNS depressants
•
Oral liquid:
use calibrated device; do not mix in coffee or tea
•
PO with food or milk
•
Avoid skin contact with oral suspension or solution—may cause contact dermatitis
•
IM inj into large muscle mass, use 21G, 2-in needle; give no more than 3 ml/inj site; patient should remain recumbent for 30 min
•
Give undiluted for psychotic episode at 5 mg/min
•
Only use lactate for IV
•
Dilute in 30-50 ml of D
5
W, give over 30 min
Y-site compatibilities:
Amifostine, amsacrine, cisatracurium, cladribine, DOXOrubicin liposome, filgrastim, fludarabine, granisetron, LORazepam, melphalan, milrinone, PACLitaxel, palonosetron, pamidronate, pancuronium, propofol, remifentanil, riTUXimab, rocuronium, tacrolimus, teniposide, thiotepa, tigecycline, tirofiban, TPN, trastuzumab, vecuronium, vinCRIStine, vinorelbine, voriconazole, zoledronic acid
CNS:
EPS: pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, headache
,
seizures, neuroleptic malignant syndrome,
confusion
CV:
Orthostatic hypotension
, hypertension,
cardiac arrest,
ECG changes,
tachycardia, QT prolongation, sudden death, torsades de pointes
EENT:
Blurred vision, glaucoma, dry eyes
GI:
Dry mouth, nausea, vomiting, anorexia, constipation
, diarrhea, jaundice, weight gain,
ileus, hepatitis
GU:
Urinary retention, dysuria, urinary frequency, enuresis, impotence, amenorrhea, gynecomastia
INTEG:
Rash
, photosensitivity, dermatitis
RESP:
Laryngospasm,
dyspnea,
respiratory depression
SYST:
Risk for death (dementia)
Metabolized by liver; excreted in urine, bile; crosses placenta; enters breast milk; protein binding 92%; terminal half-life 12-36 hr (metabolites)
PO:
Onset erratic, peak 2-6 hr, half-life 24 hr
IM:
Onset 15-30 min, peak 15-20 min, half-life 21 hr
IM (Decanoate):
Peak 4-11 days, half-life 3 wk
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs
Increase:
QT prolongation—class IA, III antidysrhythmics, tricyclics, amoxapine, maprotiline, phenothiazines, pimozide, risperiDONE, sertindole, ziprasidone, β-blockers, chloroquine, cloZAPine, dasatinib, dolasetron, droperidol, dronedarone, flecainide, halogenated/local anesthetics, lapatinib, methadone, erythromycin, telithromycin, troleandomycin, octreotide, ondansetron, palonosetron, pentamidine, propafenone, ranolazine, SUNItinib, tacrolimus, vardenafil, vorinostat, usually with IV use
Increase:
oversedation—other CNS depressants, alcohol, barbiturate anesthetics
Increase:
toxicity—EPINEPHrine, lithium
Increase:
both drugs effects—β-adrenergic blockers, alcohol
Increase:
anticholinergic effects—anticholinergics
Decrease:
effects—lithium, levodopa
Decrease:
haloperidol effects—PHENobarbital, carBAMazepine
Increase:
LFTs
•
Prolactin, CBC, urinalysis, ophthalmic exam before and during prolonged therapy
Black Box Warning:
Dementia, affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances, risk for death in dementia-related psychosis
•
B/P standing, lying; take pulse, respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg
•
Dizziness, faintness, palpitations, tachycardia on rising
•
EPS
including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
Neuroleptic malignant syndrome/serotonin syndrome:
hyperthermia, muscle rigidity, altered mental status, increased CPK, seizures, hypo/hypertension, tachycardia; notify prescriber immediately
•
Constipation, urinary retention daily; if these occur, increase bulk, water in diet
•
Abrupt discontinuation:
do not withdraw abruptly, taper
•
QT prolongation:
more common with IV use at high doses; monitor ECG in those with CV disease
•
Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program, fainting is possible; patient should not stand still for long periods
•
Sips of water, sugarless candy, gum for dry mouth
•
Storage in tight, light-resistant container
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia, reorganization of patterns of thought, speech; improvement in specific behaviors
•
That orthostatic hypotension occurs often; to rise from sitting or lying position gradually; to remain lying down after IM inj for at least 30 min
•
To avoid hazardous activities until stabilized on medication and effects are known
•
To avoid abrupt withdrawal of this product because EPS may result; to withdraw slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber, serious product interactions may occur; to avoid use with alcohol, increased drowsiness may occur
•
About EPS and necessity of meticulous oral hygiene because oral candidiasis may occur
•
To report impaired vision, jaundice, tremors, muscle twitching
Activated charcoal, lavage if orally ingested; provide an airway; do not induce vomiting