Mosby's 2014 Nursing Drug Reference (241 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Increases electrical stimulation threshold of ventricle, His-Purkinje system, which stabilizes cardiac membrane, decreases automaticity
Ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, digoxin toxicity, cardiac catheterization
Unlabeled uses:
Attenuation of intracranial pressure increased during intubation/endotracheal tube suctioning
Hyper-sensitivity to amides, severe heart block, supraventricular dysrhythmias, Adams-Stokes syndrome, Wolff-Parkinson-White syndrome
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, renal/hepatic disease, CHF, respiratory depression, malignant hyperthermia, myasthenia gravis, weight <50 kg
Calculator
• Adult:
IV BOL
50-100 mg (1-1.5 mg/kg) 25-50 mg/min, repeat q3-5min, max 300 mg in 1 hr; begin
IV INF; IV INF
1-4 mg/min (20-50 mcg/kg/min);
IM
200-300 mg (4.3 mg/kg) in deltoid muscle, may repeat after 1-11/2 hr if needed
Available forms:
IV INF
0.2% (2 mg/ml), 0.4% (4 mg/ml), 0.8% (8 mg/ml); IV ad 4% (40 mg/ml), 10% (100 mg/ml), 20% (200 mg/ml);
IV dir
1% (10 mg/ml), 2% (20 mg/ml);
IM
10% 300 mg/ml
•
IM inj in deltoid; aspirate to avoid intravascular administration; check IV site daily for infiltration or extravasation
•
Bolus undiluted (1%, 2% only), give ≤50 mg/1 min or dilute 1 g/250-500 ml D
5
W; titrate to patient response; use inf pump; pediatric inf 120 mg lidocaine/100 ml D
5
W; 1-2.5 ml/kg/hr = 20-50 mcg/kg/min; use only 1%, 2% sol for IV bol
Y-site compatibilities:
Alemtuzumab, alteplase, amikacin, aminophylline, amiodarone, argatroban, atropine, aztreonam, bivalirudin, bumetanide, calcium chloride/gluconate, ceFAZolin, cefotaxime, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, clindamycin, cycloSPORINE, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOPamine, doxycycline, enalaprilat, EPINEPHrine, eptifibatide, ertapenem, erythromycin,
esmolol, etomidate, famotidine, fenoldopam, fentaNYL, fluconazole, furosemide, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, imipenem/cilastatin, inamrinone, insulin, isoproterenol, ketorolac, labetalol, levofloxacin, linezolid, LORazepam, magnesium sulfate, meperidine, methylPREDNISolone sodium succinate, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, morphine, nafcillin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, palonosetron, penicillin G potassium, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, quinupristin/dalfopristin, ranitidine, remifentanil, sodium bicarbonate, streptokinase, tacrolimus, theophylline, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, vancomycin, vasopressin, verapamil, vitamin B complex with C, voriconazole, warfarin
CNS:
Headache, dizziness
, involuntary movement, confusion, tremor, drowsiness, euphoria,
seizures,
shivering
CV:
Hypotension, bradycardia
,
heart block, CV collapse, arrest
EENT:
Tinnitus, blurred vision
GI:
Nausea, vomiting, anorexia
HEMA:
Methemoglobinemia
INTEG:
Rash, urticaria, edema, swelling, petechiae, pruritus
MISC:
Febrile response, phlebitis at inj site
RESP:
Dyspnea,
respiratory depression
Half-life 8 min, 1-2 hr (terminal); metabolized in liver; excreted in urine; crosses placenta
IM:
Onset 5-15 min, duration 1½ hr
IV:
Onset 2 min, duration 20 min
Increase:
cardiac depression, toxicity—amiodarone, phenytoin, procainamide, propranolol
Increase:
hypotensive effects—MAOIs, antihypertensives
Increase:
neuromuscular blockade—neuromuscular blockers, tubocurarine
Increase:
lidocaine effects—cimetidine, beta blockers, protease inhibitors, ritonavir
Decrease:
lidocaine effects—barbiturates, ciprofloxacin, voriconazole
Decrease:
effect of—cycloSPORINE
Increase:
CPK
ECG continuously to determine increased PR or QRS segments; if these develop, discontinue or reduce rate; watch for increased ventricular ectopic beats, may have to rebolus; B/P
•
Blood levels:
therapeutic level, 1.5-5 mcg/ml
•
I&O ratio, electrolytes (potassium, sodium, chlorine)
Malignant hyperthermia:
tachypnea, tachycardia, changes in B/P, increased temp
•
Respiratory status:
rate, rhythm, lung fields for crackles, watch for respiratory depression; lung fields, bilateral crackles may occur with CHF; increased respiration, pulse; product should be discontinued
•
CNS effects:
dizziness, confusion, psychosis, paresthesias, convulsions; product should be discontinued
•
Therapeutic response: decreased dysrhythmias
•
About the use of automatic lidocaine injection device if ordered for personal use
•
To report signs of toxicity
O
2
, artificial ventilation, ECG; administer DOPamine for circulatory depression, diazepam or thiopental for seizures; decrease product if needed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(lin′a-glip′tin)
Tradjenta
Func. class.:
Antidiabetic
Chem. class.:
Didipeptidyl peptidase-4 inhibitor
Slows the inactivation of incretin hormones. Concentrations of the active, intact hormones are increased, thereby increasing and prolonging the action of these hormones. Incretin hormones are released by the intestine throughout the day, and levels are increased in response to a meal
Type 2 diabetes mellitus
Hypersensitivity to linagliptin
, type 1 diabetes mellitus, diabetic ketoacidosis (DKA)
Precautions:
Pregnancy (category B), breastfeeding, adolescents or children <18 yr, debilitated physical condition, malnutrition, uncontrolled adrenal insufficiency, pituitary insufficiency, hypo/hyperthyroidism, diarrhea, gastroparesis, GI obstruction, ileus, female hormonal changes, high fever, severe psychological stress, uncontrolled hypercortisolism
Calculator
• Adult:
PO
5 mg daily; when used with a sulfonylurea or insulin; a lower dose of the sulfonylurea may be necessary to minimize the risk of hypoglycemia
Available forms:
Tab 5 mg
•
Once daily; may give without regard to food
CNS:
Headache
EENT:
Nasopharyngitis
ENDO:
Hypoglycemia, hyperuricemia
GI:
Body weight loss,
pancreatitis
INTEG:
Hypersensitivity reactions, urticaria,
angioedema, exfoliative dermatitis
MISC:
Arthralgia, back pain
RESP:
Bronchial hyperreactivity (with
bronchospasm
), nasopharyngitis, cough
Extensively distributed in the tissues, protein binding is concentration-dependent, a weak to moderate inhibitor of CYP3A4, plasma terminal half life of >100 hr; effective half-life 12 hr, 90% excreted unchanged, 85% excreted via the enterohepatic system (80%) or in urine (5%) within 4 days of dosing, rapidly absorbed, peak in 1.5 hr; bioavailability 30%
•
Increased hypoglycemia: sulfonylureas, beta blockers, ACE inhibitors, angiotensin II receptor antagonists, disopyramide, guanethidine, cloNIDine, octreotide, fenfluramine, dexfenfluramine, fibric acid derivatives, monoamine oxidase inhibitors (MAOIs), FLUoxetine, salicylates
•
Increased masking of the signs and symptoms of hypoglycemia: reserpine
•
Increased need for dosing change: cisapride, metoclopramide, tegaserod, androgens, alcohol, lithium, quinolones
Decrease:
hypoglycemic effect—dextrothyroxine, bumetanide, furosemide, ethacrynic acid, torsemide, estrogens, progestins, oral contraceptives, thyroid hormones, glucocorticoids, glucagon, carbonic anhydrase inhibitors, phenytoin, fosphenytoin, or ethotoin; atypical antipsychotics (ARIPiprazole, cloZAPine, OLANZapine, QUEtiapine, risperiDONE,
and ziprasidone), phenothiazine, niacin (nicotinic acid), triamterene, thiazide diuretics
Decrease:
effect of linagliptin—CYP3A4 inducers (topiramate, rifabutin, pioglitazone, OXcarbazepine, carBAMazepine, nevirapine, modafinil, metyrapone, etravirine, efavirenz, bosentan, barbiturates, aprepitant, fosaprepitant
Decrease:
linagliptin effect—St. John’s wort
Increase:
uric acid
•
Hypo/hyperglycemia:
reaction may occur after meals, for severe hypoglycemia use IV Dextrose
•
Monitor blood glucose, A1c, during treatment to determine diabetes control
•
CBC baseline and periodically during treatment, report decreased blood counts
•
Storage at room temperature
•
Improving blood glucose level, A1c; decreasing polydipsia, polyphagia, polyuria, clear sensorium, absence of dizziness
•
About the symptoms of hypo/hyperglycemia and what to do about each; to have glucagon emergency kit available, to carry sugar packets
•
That product must be continued on a daily basis, about the consequences of discontinuing product abruptly; to take only as directed
•
To avoid OTC products unless approved by prescriber
•
That diabetes is a life-long illness, that product will not cure diabetes
•
That all food in diet plan must be eaten to prevent hypoglycemia
•
To carry emergency ID with prescriber, condition and medications taken
•
To immediately report skin disorders, swelling, difficulty breathing, or severe abdominal pain