Mosby's 2014 Nursing Drug Reference (222 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(i-pra-troe′pee-um)
Atrovent HFA
Func. class.:
Anticholinergic, bronchodilator
Chem. class.:
Synthetic quaternary ammonium compound
Do not confuse:
Atrovent
/Alupent
Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, thereby resulting in decreased cGMP and bronchodilation
COPD; rhinorrhea (nasal spray)
Hypersensitivity to this product, atropine, bromide, soybean or peanut products
Precautions:
Breastfeeding, children <12 yr, angioedema, heart failure, surgery, acute bronchospasm, bladder ob
struction, closed-angle glaucoma, prostatic hypertrophy, urinary retention, pregnancy (B)
Calculator
• Adult: INH
2 sprays (17 mcg/spray) 3-4×/day, max 12
INH
/24 hr;
SOL
500 mcg (1 unit dose) given 3-4×/day by nebulizer; nasal spray: 2 sprays (42 mcg/spray) 3-4×/day
• Child 5-11 yr: INH
4-8 inhalations q20min as needed for ≤3 hr (asthma, unlabeled);
NEB
250-500 mcg q20min as needed for ≤3 hr (asthma, unlabeled)
• Adult/child ≥6 yr: INTRANASAL
2 sprays (43 mcg)/nostril bid or tid
• Child 5-12 yr: INTRANASAL
2 sprays (0.03%) in each nostril 3×/day
Available forms:
Aerosol 17 mcg/actuation; nasal spray 0.03%, 0.06%; sol for inh 0.0125%, 0.02%
•
Use sol in nebulizer with a mouthpiece rather than a face mask
•
Priming pump initially requires 7 actuations of pump; priming again is not necessary if used regularly, tilt head backward after dose
CNS:
Anxiety, dizziness, headache
, nervousness
CV:
Palpitation
EENT:
Dry mouth, blurred vision, nasal congestion
GI:
Nausea, vomiting, cramps
INTEG:
Rash
RESP:
Cough, worsening of symptoms
,
bronchospasms
Half-life 2 hr, does not cross blood-brain barrier
Increase:
toxicity—other bronchodilators (INH)
Increase:
anticholinergic action—phenothiazines, antihistamines, disopyramide
Increase:
anticholinergic effect—belladonna
Increase:
bronchodilator effect—green tea (large amts), guarana
•
Palpitations; if severe, product may have to be changed
•
Tolerance over long-term therapy; dose may have to be increased or changed
•
Atropine sensitivity; patient may also be sensitive to this product
•
Respiratory status: rate, rhythm, auscultate breath sounds prior to and after administration
•
Storage at room temp
•
Hard candy, frequent drinks, sugarless gum to relieve dry mouth
•
Therapeutic response: ability to breathe adequately
•
That compliance is necessary with number of inhalations/24 hr or overdose may occur; about spacer device for geriatric patients; that max therapeutic effects may take 2-3 mo
•
To shake before using
•
About the correct method of inhalation; how to clean equipment daily
•
Patients should prime the inhaler before using for the first time by releasing 2 test sprays into the air, away from the face
•
Each inhaler has 200 actuations or sprays
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(er-be-sar′tan)
Avapro
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin II receptor blocker (Type AT
1
)
Do not confuse:
Avapro
/Anaprox
Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT
1
receptor found in tissues
Hypertension, alone or in combination; nephropathy in type 2 diabetic patients; proteinuria
Unlabeled uses:
Heart failure
Hypersensitivity
Black Box Warning:
Pregnancy (D) 2nd/3rd trimester
Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children <6 yr, geriatric patients, hypersensitivity to ACE inhibitors; hepatic/renal disease; renal artery stenosis
Calculator
• Adult: PO
150 mg/day; may be increased to 300 mg/day, volume-depleted patients: start with 75 mg/day
• Adult: PO
maintenance dose 300 mg/day, start 75 mg/day
Available forms:
Tabs 75, 150, 300 mg
•
Without regard to meals
•
May be used with other antihypertensives, diuretic
CNS:
Dizziness
, anxiety, headache, fatigue
CV:
Hypotension
GI:
Diarrhea, dyspepsia
HEMA:
Thrombocytopenia
MISC:
Edema, chest pain, rash, tachycardia, UTI,
angioedema,
hyperkalemia
RESP:
Cough, upper respiratory tract infection
, sinus disorder, pharyngitis, rhinitis
Peak 1.5-2 hr, extensively metabolized, half-life 11-15 hr, highly bound to plasma proteins, excreted in urine and feces, protein binding 90%
Increase:
hyperkalemia: potassium-sparing diuretics, potassium salt substitutes, ACE inhibitors
Increase:
irbesartan level—CYP2C9 inhibitors (amiodarone, delavirdine, fluconazole, FLUoxetine, fluvastatin, fluvoxaMINE, imatinib, sulfonamides, sulfinpyrazone, voriconazole, zafirlukast)
Decrease:
antihypertensive effect—NSAIDs
Increase:
antihypertensive effect—black cohosh, goldenseal, hawthorn, kelp
Increase or decrease:
antihypertensive effect—astragalus, cola tree
Decrease:
antihypertensive effect—guarana, khat, licorice, yohimbe
•
Hypotension:
for severe hypotension, place in supine position and give IV infusion of NS, drug may be continued after B/P is restored
•
B/P, pulse q4hr; note rate, rhythm, quality
•
Baselines of renal/hepatic studies before therapy begins; periodically monitor LFTs, total/direct bilirubin
•
Skin turgor, dryness of mucous membranes for hydration status; edema in feet, legs daily
•
Therapeutic response: decreased B/P
•
To comply with dosage schedule, even if feeling better; that max therapeutic effects may take 2-3 mo, to take without regard to food
•
That product may cause dizziness, fainting, lightheadedness
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
Black Box Warning:
To notify prescriber if pregnancy is suspected; discontinue if pregnant; pregnancy (D) 2nd/3rd trimester, (C) 1st trimester