Mosby's 2014 Nursing Drug Reference (244 page)

• Adult:
SUBCUT
0.6 mg/day × 1 wk, then increase to 1.2 mg/day, max 1.8 mg/day

Increase:
hypoglycemic reactions—angiotensin II receptor antagonists, ACE inhibitors, other antidiabetics, β-blockers, dexfenfluramine, fenfluramine, disopyramide, FLUoxetine, fibric acid derivatives, mecasermin, MAOIs, octreotide, pegvisomant, salicylates

Increase:
hyperglycemic reactions—protease inhibitors, phenothiazines, baclofen, atypical antipsychotics, corticosteroids, cycloSPORINE, tacrolimus, carbonic anhydrase inhibitors, dextrothyroxine, diazoxide, phenytoin, fosphenytoin, ethotoin, isoniazid, INH, niacin, nicotine, estrogens, progestins, oral contraceptives, growth hormones, sympathomimetics

Increase or decrease:
hypoglycemic reactions—androgens, bortezomib, quinolones, cloNIDine, alcohol, lithium, pentamidine

Increase or decrease:
effects of—torvastatin, acetaminophen, griseofulvin

Black Box Warning:

Thyroid C-cell tumors; monitor during treatment

• 
Hypoglycemic reactions
that may occur soon after meals: hunger, sweating, weakness, dizziness, tremors, restlessness, tachycardia

• 
Hypersensitivity to this product

• 
Serum glucose, A1c, CBC during treatment

• 
Stress:
those diabetic patients exposed to stress, surgery, fever, infections may require insulin administration temporarily

 
Serious skin reactions:
angioedema, pancreatitis, secondary thyroid malignancy

• 
Storage: do not store pen with needle attached; avoid direct heat and sunlight; discard 30 days after first use; after first use may be stored at room temp or refrigerated, do not freeze

• 
Therapeutic response: stable and improved serum glucose, A1C, weight loss

• 
About symptoms of hypo/hyperglycemia, what to do for each; to have glucagon emergency kit available; to carry a carbohydrate source at all times

• 
About side effects associated with therapy, such as nausea and vomiting; that upward dose titration can be delayed or ignored, depending on tolerance

• 
That diabetes is a lifelong illness; that product does not cure disease and must be continued on a daily basis

• 
To carry emergency ID with prescriber’s phone number and medications taken

• 
To continue with other recommendations: diet, exercise, hygiene

• 
To test blood glucose using a blood glucose meter

• 
To avoid other medications, herbs, supplements unless approved by prescriber

 
To report serious skin effects, abdominal pain with nausea/vomiting

• 
Provide patient with written instructions if self-administration is ordered

• Child 6-12 yr:
PO
30 mg/day, may increase by 10-20 mg/day at weekly intervals, max 70 mg/day

• 
Give daily in
AM

• 
Without regard to meals

• 
Caps: may take whole or opened and contents dissolved in water

Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists

Increase:
lisdexamfetamine effect—acetaZOLAMIDE, antacids, sodium bicarbonate, urinary alkalinizers

Increase:
CNS effect—haloperidol, tricyclics, phenothiazines, modafinil, meperidine, PHENobarbital, phenytoin

Increase:
CNS stimulation—melatonin

Decrease:
absorption of phenytoin

Decrease:
lisdexamfetamine effect—ascorbic acid, ammonium chloride, urinary acidifiers

Decrease:
effect of—adrenergic blockers, antidiabetics

• 
Serotonin syndrome: St. John’s wort

Increase:
stimulant effect—khat, melatonin, green tea, guarana

Decrease:
stimulant effect—eucalyptus

Increase:
amine effect—caffeine

• 
VS, B/P; product may reverse antihypertensives; check patients with cardiac disease often

• 
CBC, urinalysis; in diabetes: blood glucose; insulin changes may be required because eating may decrease

• 
Height, growth rate in children; growth rate may be decreased

• 
Mental status: mood, sensorium, affect, stimulation, insomnia, irritability

 
Serotonin syndrome, neuroleptic malignant syndrome:
increased heart rate, shivering, sweating, dilated pupils, tremors, high B/P, hyperthermia, headache, confusion; if these occur, stop product, administer serotonin antagonist if needed; at least 2 wk should elapse between discontinuation of serotonergic agents and start of product

• 
Tolerance or dependency:
increased amount of product may be used to get same effect; will develop after long-term use

• 
Overdose: pain, fever, dehydration, insomnia, hyperactivity

Black Box Warning:

Before giving this product, identify presence of substance abuse; high potential for abuse

• 
Gum, hard candy, frequent sips of water for dry mouth

• 
Therapeutic response: increased CNS stimulation, decreased drowsiness

• 
Seizures:
product may decrease seizure threshold; those with a seizure disorder should notify prescriber if seizure occurs

• 
To decrease caffeine consumption (coffee, tea, cola, chocolate); may increase irritability, stimulation

• 
To avoid OTC preparations unless approved by prescriber

• 
To taper product over several weeks; depression, increased sleeping, lethargy may occur

• 
To avoid alcohol ingestion

• 
To avoid breastfeeding

• 
To avoid hazardous activities until stabilized on medication

• 
To get needed rest; patient will feel more tired at end of day

• 
To use as part of a comprehensive treatment program

Black Box Warning:

Serious CV effects may occur from increasing dose