Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (208 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(hye-oh-sye′a-meen)
Anaspaz, Colidrops, Colytrol Pediatric, Cystospaz-M, ED-SPAZ, HyoMax, HyoMax SL, Hyosyne, Levisin SL, NuLev, Oscimin, Spasdel, Symax
Func. class.:
Anticholinergic/antispasmodics
Chem. class.:
Belladonna alkaloid
Inhibits muscarinic actions of acetylcholine at postganglionic parasympathetic neuroeffector sites; reduces rigidity, tremors, hyperhidrosis of parkinsonism
Treatment of peptic ulcer disease in combination with other products; other GI disorders, other spastic disorders, IBS, urinary incontinence
Hypersensitivity to anticholinergics, closed-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, GI atony, toxic megacolon, prostatic hypertrophy, urinary tract obstruction
Precautions:
Pregnancy (C), geriatric patients, hyperthyroidism, dysrhythmias, CHF, ulcerative colitis, hypertension, hiatal hernia, renal/hepatic disease, urinary retention, CAD
Calculator
• Adult/adolescent/child
≥
12 yr:
PO/SL
0.125-0.25 mg q4hr;
EXT REL
0.375-0.75 mg q12hr
• Adult:
IM/SUBCUT/IV
0.25-0.5 mg in a single dose or 2-4×/day q6hr
• Geriatric:
Max 1.5 mg/day in divided doses or max 4 biphasic tabs
• Child 2-12 yr:
PO
SL 0.0625-0.125 q4hr
Available forms:
Tabs 0.125, 0.15 mg; ext rel caps 0.375 mg; sol 0.125 mg/ml; elix 0.125 mg/5 ml; sol for inj 0.5 mg/ml; SL tab 0.125 mg; tab, biphasic 0.125, 0.375 mg; orally disintegrating tab 0.125 mg
•
Do not break, crush, or chew ext rel caps
•
1/2 hr before meals for better absorption
•
Decreased dose to geriatric patients; metabolism may be slowed
•
Use undiluted, inject slowly
CNS:
Confusion, stimulation in geriatric patients
, headache, insomnia, dizziness, drowsiness, anxiety, weakness, hallucination
CV:
Palpitations
, tachycardia
EENT:
Blurred vision
, photophobia, mydriasis, cycloplegia, increased ocular tension
GI:
Dry mouth, constipation, paralytic ileus
, heartburn, nausea, vomiting, dysphagia, absence of taste
GU:
Urinary hesitancy, retention
, impotence
INTEG:
Urticaria, rash, pruritus, anhidrosis, fever, allergic reactions
PO:
Duration 4-6 hr, metabolized by liver, excreted in urine, half-life 3.5 hr
Increase:
anticholinergic effect—amantadine, tricyclics, MAOIs, H
1
-antihistamines
Decrease:
hyoscyamine effect—antacids
Decrease:
effect of phenothiazines, levodopa, ketoconazole
•
VS, cardiac status: checking for dysrhythmias, increased rate, palpitations
•
I&O ratio; check for urinary retention or hesitancy
•
GI complaints: pain, nausea, vomiting, anorexia
•
Storage in tight container protected from light
•
Increased fluids, bulk, exercise to decrease constipation
•
Therapeutic response: absence of epigastric pain, bleeding, nausea, vomiting
•
To avoid driving, other hazardous activities until stabilized on medication
•
To avoid alcohol or other CNS depressants; they will enhance sedating properties of this product
•
To avoid hot environments because heat stroke may occur; that product suppresses perspiration
•
To use sunglasses when outside to prevent photophobia; that product may cause blurred vision
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (C)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(eye-ban′dro-nate)
Boniva
Func. class.:
Bone-resorption inhibitor, electrolyte modifier
Chem. class.:
Bisphosphonate
Inhibits bone resorption, apparently without inhibiting bone formation and mineralization; absorbs calcium phosphate crystals in bone and may directly block dissolution of hydroxyapatite crystals of bone; more potent than other products
Osteoporosis and prophylaxis
Unlabeled uses:
Hypercalcemia of malignancy, osteolytic metastases, Paget’s disease, osteoporosis (treatment/prevention) in those taking anastrozole
Achalasia, esophageal stricture, hypocalcemia, intraarterial administration, renal failure, hypersensitivity to bisphosphonates
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, anemia, chemotherapy, coagulopathy, dental disease, diabetes mellitus, dysphagia, GI/renal disease, GERD, hypertension, infection, multiple myeloma, phosphate hypersensitivity, vit D deficiency
Calculator
• Adult: PO
2.5 mg/day or 150 mg/mo;
IV BOL
3 mg q3mo
• Adult: PO
2.5 mg/day or 150 mg/mo
• Adult: IV
2 mg as a single dose
• Postmenopausal women: PO
150 mg/mo
• Adult: IV
6 mg over 1 hr × 3 days, repeat q4wk
• Adult: IV INF
2-4 mg over 2 hr
• Adult: PO
CCr <30 ml/min, avoid use
Available forms:
Tabs 2.5, 150 mg; sol for inj 1 mg/ml
•
Give early
AM
with a glass of water; if monthly, give on same day of each month
•
Use single-dose prefilled syringe; discard unused portion; give over 15-30 sec; give q3mo, do not use if discolored or contains particulates
CNS:
Fever, insomnia, dizziness, headache
CV:
Hypertension,
atrial fibrillation
EENT:
Ocular pain/inflammation, uveitis
GI:
Constipation, nausea, vomiting, diarrhea, dyspepsia
INTEG:
Rash, inj site reaction
META:
Hypomagnesemia, hypophosphatemia, hypocalcemia
, hypercholesterolemia
MS:
Bone pain, myalgia, osteonecrosis of the jaw
Half-life 5-60 hr, 86%-99% protein binding; taken up mainly by bones, primarily in areas of high bone turnover; eliminated primarily by kidneys
Increase:
neurotoxicity—aminoglycosides, cycloSPORINE, tacrolimus, NSAIDs, radiopaque contrast agents, vancomycin
Increase:
hypocalcemia—loop diuretics
Decrease:
ibandronate effect—calcium/vit D/iron/aluminum/magnesium salts; separate by 1 hr
•
Do not take with food, calcium
Increase:
cholesterol
Decrease:
Alk phos, magnesium, calcium, phosphate
•
Osteoporosis:
before and during treatment; DEXA scan for bone mineral density, correct electrolyte imbalances (calcium, magnesium, phosphate) before starting therapy
•
Atrial fibrillation
•
Dental health:
before dental extraction, give antiinfectives, osteonecrosis of the jaw may occur
•
Blood studies: electrolytes, creatinine/BUN, vit D: correct deficiencies prior to treatment
•
For bone pain; use analgesics; may begin within 24 hr or even years after treatment; pain usually subsides after treatment is discontinued
•
Storage at room temp
•
Therapeutic response: increased bone mineral density
•
To report hypercalcemic relapse:
nausea, vomiting, bone pain, thirst, unusual muscle twitching, muscle spasms, severe diarrhea, constipation
•
To continue with dietary recommendations, including calcium, vit D
•
To obtain an analgesic from provider for bone pain
•
That, if nausea, vomiting occur, small, frequent meals may help
•
To report vision symptoms: blurred vision, edema, inflammation
•
To report if pregnancy is planned or suspected or if planning to breastfeed, pregnancy (C)
•
To exercise regularly, stop smoking, decrease alcohol intake
•
To take PO first thing in
AM
at least 60 min before other medications, food, beverages, to take monthly dose on same day
•
To sit upright for ≥60 min after PO