Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (203 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
globulin (HBIG) (Rx)
HepaGam B, Hyper HEP B S/D, Nabi-HB
Func. class.:
Immune globulin
Provides passive immunity to hepatitis B
Prevention of hepatitis B virus in exposed patients, including passive immunity in neonates born to HBsAg-positive mother, prevention of hepatitis B recurrence after liver transplant in HBsAg-positive patients
Hypersensitivity to immune globulins, coagulation disorders
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, hemophilia, active infection, IgA deficiency
Calculator
• Adult and child:
IM
0.06 ml/kg (usual 3-5 ml) within 7 days of exposure; repeat 28 days after exposure if patient wishes to not receive hepatitis B vaccine
• Neonate:
IM
0.5 ml within 12 hr of birth
• Adult:
IV
(HepaGam B only) 20,000 international units concurrent with grafting transplanted liver, then 20,000 international units/day on days 1-7, then 20,000 international units q2wk starting on day 14, then 20,000 international units/mo starting with mo 4
Available forms:
Inj 1-, 4-, 5-ml vials; neonatal syringe 0.5 ml; HepaGam B sol for inj 312 units/ml; Hyper HEP B S/D 217 units/ml
•
After rotating vial; do not shake
•
Only with EPINEPHrine 1:1000 on unit to treat laryngospasm
•
In deltoid for better absorption (adult)
•
Calculate volume needed for each 20,000 international-unit dose using measured potency of each lot; HBIG potency stamped on label
•
Promptly use after vial entered; discard unused product
•
Give at 2 ml/min through separate IV line, use inf pump, decrease to 1 ml/min if inf-related event occurs, patient becomes uncomfortable
•
Do not use HyperHEP B BS/D or Nabi-HB IV
CNS:
Headache, dizziness, fever
GI:
Nausea, vomiting
INTEG:
Soreness at inj site, urticaria, erythema, swelling
SYST:
Induration,
anaphylaxis, angioedema
•
Do not use within 3 mo of hepatitis B immune globulin, MMR, varicella, or rotavirus vaccines even after discontinuing product
•
History of allergies, skin conditions (eczema, psoriasis, dermatitis), reactions to vaccinations
•
Skin reactions: rash, induration, urticaria
Anaphylaxis:
inability to breathe, bronchospasm, hypotension, wheezing, diaphoresis, fever, flushing
•
Can be used with hepatitis B vaccine in cases of direct contact
•
Written record of immunization
•
Prevention of hepatitis B
•
That discomfort may occur at site
•
To report any rash, wheezing, inability to breathe immediately
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(hye-dral′a-zeen)
Apresoline
Func. class.:
Antihypertensive, direct-acting peripheral vasodilator
Chem. class.:
Phthalazine
Do not confuse:
hydrALAZINE
/hydrOXYzine
Apresoline
/allopurinol
Vasodilates arteriolar smooth muscle by direct relaxation; reduction in blood pressure with reflex increases in heart rate, stroke volume, cardiac output
Essential hypertension; severe essential hypertension
Unlabeled uses:
CHF
Hypersensitivity to hydrALAZINEs, mitral valvular rheumatic heart disease, CAD
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, CVA, advanced renal disease, hepatic disease, SLE, dissecting aortic aneurysm
Calculator
• Adult:
PO
10 mg qid 2-4 days, then 25 mg for rest of 1st wk, then 50 mg qid individualized to desired response, max 300 mg/day
• Child:
PO
0.75-1 mg/kg/day in 2-4 divided doses, max 25 mg/dose, increase over 3-4 wk to max 7.5 mg/kg/day or 200 mg, whichever is less
• Adult:
IV BOL
10-20 mg q4-6hr, administer
PO
as soon as possible;
IM
10-50 mg q4-6hr
• Child:
IV BOL
0.1-0.6 mg/kg q4hr;
IM
0.1-0.6 mg/kg q4-6hr, max 1.7-3.5 mg/kg/day
• Adult:
PO
10-25 mg tid, max 75 mg tid
Available forms:
Inj 20 mg/ml; tabs 10, 25, 50, 100 mg
•
Give with meals (PO) to enhance absorption
•
Do not admix, switch to PO as soon as possible
•
No dilution needed, inject deeply in large muscle, aspirate
•
IV undiluted; give through
Y
-tube or 3-way stopcock, give each 10 mg over ≥1 min
•
To recumbent patient, keep recumbent for 1 hr after administration
Y-site compatibilities:
Alemtuzumab, anidulafungin, argatroban, atenolol, bivalirudin, bleomycin, DACTINomycin, DAPTOmycin, dexrazoxone, diltiazem, DOCEtaxel, etoposide, fludarabine, gatifloxacin, gemcitabine, granisetron, HYDROmorphone, IDArubicin, irinotecan, leucovorin, linezolid, mechlorethamine, metroNIDAZOLE, milrinone, mitoXANtrone, octreotide, oxaliplatin, PACLitaxel, palonosetron, pancuronium, potassium chloride, tacrolimus, teniposide, thiotepa, tirofiban, vecuronium, vinorelbine, vitamin B/C, voriconazole
Solution compatibilities:
D
5
LR, D
5
W, D
10
W, D
10
LR, 0.45% NaCl, 0.9% NaCl, Ringer’s, LR
CNS:
Headache, tremors, dizziness, anxiety
, peripheral neuritis, depression, fever, chills
CV:
Palpitations, reflex tachycardia, angina
,
shock,
rebound hypertension, orthostatic hypotension
GI:
Nausea, vomiting, anorexia, diarrhea
, constipation, paralytic ileus
GU:
Urinary retention, glomerulonephritis, hematuria
HEMA:
Leukopenia, agranulocytosis,
anemia,
thrombocytopenia
INTEG:
Rash, pruritus, urticaria
MISC:
Nasal congestion, muscle cramps,
lupuslike symptoms
, flushing, edema, dyspnea
Half-life 3-7 hr, metabolized by liver, 12%-14% excreted in urine, protein binding 89%
PO:
Onset 20-30 min, peak 1-2 hr, duration 2-4 hr
IM:
Onset 10-30 min, peak 1 hr, duration 2-6 hr
IV:
Onset 5-30 min, peak 10-80 min, duration 2-6 hr
Increase:
severe hypotension—MAOIs
Increase:
tachycardia, angina—sympathomimetics (EPINEPHrine, norepinephrine)
Increase:
hypotension—other antihypertensives, alcohol, levodopa, thiazide diuretics
Increase:
effects of β-blockers
Decrease:
hydrALAZINE effects—NSAIDs, estrogens
Decrease:
Hgb, WBC, RBC, platelets, neutrophils
Positive:
ANA titer
•
Cardiac status: B/P q5min × 2 hr, then q1hr × 2 hr, then q4hr; pulse, jugular venous distention q4hr
•
Electrolytes, blood studies: potassium, sodium, chloride, carbon dioxide, CBC, serum glucose, LE prep, ANA titer before, during treatment; assess for fever, joint pain, rash, sore throat (lupuslike symptoms); notify prescriber
•
Weight daily, I&O
•
Edema in feet, legs daily, skin turgor, dryness of mucous membranes for hydration status
•
Crackles, dyspnea, orthopnea
•
IV site for extravasation, rate
•
Mental status: affect, mood, behavior, anxiety; check for personality changes
•
Therapeutic response: decreased B/P
•
To take with food to increase bioavailability (PO)
•
To avoid OTC preparations unless directed by prescriber
•
To notify prescriber if chest pain, severe fatigue, fever, muscle or joint pain occurs
•
To rise slowly to prevent orthostatic hypotension
•
To notify prescriber if pregnancy is suspected
Administer vasopressors, volume expanders for shock; if PO, lavage or give activated charcoal, digitalization