Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (217 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(in-doe-meth′a-sin)
Indocin, Nu-Indo
Func. class.:
Nonsteroidal antiinflammatory product (NSAID), antirheumatic
Chem. class.:
Acetic acid derivative
Do not confuse:
Indocin
/Endocet/minocin/Vicodin
Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic
RA, ankylosing spondylitis, osteoarthritis, bursitis, tendinitis, acute gouty arthritis; closure of patent ductus arteriosus in premature infants (IV)
Unlabeled uses:
Bone pain, headache, heterotopic ossification, juvenile rheumatoid arthritis, pericarditis
Pregnancy (D) 3rd trimester, neonates, aortic coarctation, bleeding salicylate/NSAID hypersensitivity, ulcer disease
Black Box Warning:
Perioperative pain in CABG
Precautions:
Pregnancy (B) 1st trimester, breastfeeding, children, bleeding disorders, GI disorders, cardiac disorders, depression, renal/hepatic disease, asthma, diabetes, acute bronchospasm, ulcerative colitis, seizures, Parkinson’s disease
Black Box Warning:
Stroke, GI bleeding, MI
Calculator
• Adult: PO
25-50 mg bid-tid; max 200 mg/day;
EXT REL
75 mg/day, may increase to 75 mg bid
• Adult: PO
50 mg tid; use only for acute attack then reduce dose
Longer or repeated treatment courses may be necessary for very premature infants
• Infant <2 days: IV
0.2 mg/kg then 0.1 mg/kg × 2 doses after 12, 24 hr
• Infant 2-7 days: IV
0.2 mg/kg then 0.2 mg/kg × 2 doses after 12, 24 hr
• Infant >7 days: IV
0.2 mg/kg then 0.25 mg/kg × 2 doses after 12, 24 hr
Available forms:
Caps 25, 50 mg; ext rel caps 75 mg; inj 1-mg vial; supp 50 mg; oral susp 5 mg/ml
•
Do not break, crush, or chew sus rel cap or reg caps
•
With food to decrease GI symptoms and prevent ulcerations
•
Shake susp; do not mix with other liquids
•
After reconstituting 1-2 mg/ml or more NS or sterile water for inj without preservative; infuse over 20-30 min, avoid extravasation; do not inj/inf via umbilical catheter to avoid dramatic shift in cerebral blood flow
Y-site compatibilities:
Furosemide, insulin (regular), potassium chloride, sodium bicarbonate, sodium nitroprusside
CNS:
Dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression,
headache
CV:
Tachycardia, peripheral edema, palpitations, dysrhythmias, hypertension,
CV thrombotic events, MI, stroke
EENT:
Tinnitus, hearing loss, blurred vision
GI:
Nausea
, anorexia,
vomiting
, diarrhea, jaundice,
cholestatic hepatitis,
constipation
, flatulence, cramps, dry mouth, peptic ulcer,
ulceration, perforation, GI bleeding
GU:
Nephrotoxicity: dysuria, hematuria, oliguria, azotemia
HEMA:
Blood dyscrasias,
prolonged bleeding
INTEG:
Purpura, rash, pruritus, sweating
PO:
Onset 1-2 hr; peak 3 hr; duration 4-6 hr; metabolized in liver, kidneys; excreted in urine 60%, feces 33%; crosses placenta; excreted in breast milk; 99% protein binding; half-life 1 hr 1st pass, 2.6-11.2 hr 2nd pass
Increase:
hyperkalemia—potassium-sparing diuretics
Increase:
toxicity—lithium, methotrexate, cycloSPORINE, zidovudine, probenecid
Increase:
effect of—digoxin, penicillamine, phenytoin, aminoglycosides
Increase:
bleeding risk—anticoagulants, abciximab, cefamandole, cefoperazone, cefoTEtan, clopidogrel, eptifibatide, plicamycin, ticlopidine, tirofiban, valproic acid, thrombolytics, aspirin, SSRIs, SNRIs
Decrease:
effect of—antihypertensives
•
Arthritis symptoms:
ROM, pain, swelling before and 2 hr after treatment
Black Box Warning:
Cardiac disease, CV, thrombotic events (MI, stroke) before administration, not to be used in perioperative pain in CABG surgery
•
Patent ductus arteriosus: respiratory rate, character, heart sounds
•
Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb before treatment, periodically thereafter; if renal function has decreased, do not give subsequent doses
•
Eye/ear problems: blurred vision, tinnitus; may indicate toxicity; audiometric, ophthalmic exam before, during, after treatment if patient receiving long-term therapy
•
Confusion, mood changes, hallucinations, especially among geriatric patients
•
Asthma, nasal polyps, aspirin sensitivity, may develop hypersensitivity to indomethacin
Black Box Warning:
GI bleeding/perforation: chronic use can lead to GI bleeding, use cautiously in those with a history of active GI disease
Black Box Warning:
MI, stroke: may be greater with longer-term use and those with CV risk factors
•
Storage at room temp
•
Therapeutic response: decreased pain, stiffness, swelling in joints; ability to move more easily
•
To report blurred vision, ringing, roaring in ears; may indicate toxicity
•
To avoid driving, other hazardous activities if dizziness, drowsiness occurs
•
To report change in urine pattern, increased weight, edema, increased pain in joints, fever, blood in urine; may indicate nephrotoxicity
•
To report mood changes: anxiety, depression
•
That therapeutic antiinflammatory effects may take up to 1 mo
•
To avoid alcohol, NSAIDs, salicylates because bleeding may occur
•
To report use to all health care providers
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(in-fliks′ih-mab)
Remicade
Func. class.:
Biologic response modifiers
Chem. class.:
Tumor necrosis factor modifiers
Do not confuse:
Remicade
/Renacidin/inFLIXimab/riTUXimab
Monoclonal antibody that neutralizes the activity of tumor necrosis factor alpha (TNFα) found in Crohn’s
disease; decreased infiltration of inflammatory cells
Crohn’s disease, fistulizing (moderate to severe); RA, given with methotrexate; plaque psoriasis, ankylosing spondylitis, ulcerative colitis, psoriasis
Unlabeled uses:
Psoriatic arthritis, Behçet’s syndrome, uveitis, juvenile arthritis
Hypersensitivity to murines, moderate to severe CHF (NYHA class III/IV)
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, COPD, hepatotoxicity, hemalologic abnormalities, hepatitis B, Guillain-Barré syndrome, seizures, multiple sclerosis
Black Box Warning:
Infection, neoplastic disease, TB
Calculator
• Adult/adolescent/child ≥6 yr: IV INF
5 mg/kg initially then at 2 wk, 6 wk, q8wk thereafter; may increase to 10 mg/kg/dose if needed (adults)
• Adult: IV
3 mg/kg initially then at 2 wk, 6 wk, q8wk thereafter; max 10 mg/kg/dose
Available forms:
Powder for inj 100 mg
•
Pretreat with diphenhydrAMINE, acetaminophen, predniSONE if a reaction is inf related
•
Give immediately after reconstitution; reconstitute each vial with 10 ml sterile water for inj; further dilute total dose/250 ml of 0.9% NaCl inj to a total conc of 0.4-4 mg/ml; use 21G or smaller needle for reconstitution; direct sterile water at glass wall of vial; gently swirl; do not shake; may foam; allow to stand for 5 min, give within 3 hr
•
Give over ≥2 hr, use polyethylene-lined inf with in-line, sterile, low-protein-bind filter
•
Do not admix
CNS:
Headache, dizziness, depression, vertigo, fatigue, anxiety, fever
,
seizures,
chills, flulike symptoms
, demyelinating disease
CV:
Chest pain, hypo/hypertension,
tachycardia,
CHF,
acute coronary syndrome
GI:
Nausea, vomiting, abdominal pain, stomatitis, constipation, dyspepsia, flatulence
GU:
Dysuria, urinary frequency
HEMA:
Anemia, leukopenia, thrombocytopenia, pancytopenia
INTEG:
Rash, dermatitis, urticaria
, dry skin, sweating, flushing, hematoma, pruritus, keratoderma blenorrhagicum
MS:
Myalgia, back pain, arthralgia
RESP:
URI, pharyngitis, bronchitis, cough, dyspnea, sinusitis
SYST:
Anaphylaxis, fatal infections, sepsis, malignancies, immunogenicity, Stevens-Johnson syndrome, toxic epidermal necrolysis
Distributed to vascular compartment, half-life 9.5 days
Increase:
infections neutropenia—TNF blockers (abatacept, anakinra, golimumab, rilonacept), avoid concurrent use
•
Do not administer live vaccines concurrently
•
For RA, ROM, pain
•
GI symptoms: nausea, vomiting, abdominal pain
•
Periodic blood counts (CBC), ANA titer, LFTs
•
CV status: B/P, pulse, chest pain
Allergic reaction, anaphylaxis:
rash, dermatitis, urticaria, dyspnea, hypotension, fever, chills; discontinue if severe, administer EPINEPHrine, corticosteroids, antihistamines; assess for allergies to murine proteins before starting therapy
Black Box Warning:
Fatal infections: discontinue if infection occurs, do not administer to patients with active infection; identify TB before beginning treatment; a TB test should be obtained; if present, TB should be treated before patient receives product; exercise caution when switching from 1 DMARD to another
•
Report suspected adverse reactions to the FDA (1-800-FDA-1088)
Black Box Warning:
For neoplastic disease in those <18 yr, including hepatosplenic T-cell lymphoma, usually occurs in those with inflammatory bowel disease
•
Refrigerated storage, do not freeze
•
Therapeutic response: absence of fever, mucus in stools
•
Infusion reaction should be reported immediately
•
If infection occurs, notify prescriber immediately
•
Not to breastfeed while taking this product
•
To notify prescriber of GI symptoms, hypersensitivity reactions, heart symptoms
•
Not to operate machinery, drive if dizziness, vertigo occur
•
To avoid live virus vaccinations, bring up to date before use