Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (25 page)
(a-lis′kir-en)
Tekturna
Func. class.:
Antihypertensive
Chem. class.:
Direct renin inhibitor
Renin inhibitor that acts on the renin-angiotensin system (RAS)
Hypertension, alone or in combination with other antihypertensives
Hypersensitivity
Black Box Warning:
Pregnancy (D) 2nd, 3rd trimester
Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children, geriatric patients, angioedema, aortic/renal artery stenosis, cirrhosis, CAD, dialysis, hyper/hypokalemia, hyponatremia, hypotension, hypovolemia, renal/hepatic disease, surgery, diabetes, seizures
Calculator
• Adult: PO
150 mg/day, may increase to 300 mg/day if needed, max 300 mg/day
Available forms:
Tabs 150, 300 mg
•
Do not use with a high-fat meal
•
Daily with a full glass of water, titrate up to achieve correct dose
•
Do not discontinue abruptly, correct electrolyte/volume depletion before treatment
CV:
Orthostatic hypotension, hypotension
CNS:
Headache, dizziness
GI:
Diarrhea
GU:
Renal stones, increased uric acid
INTEG:
Rash
META:
Hyperkalemia
MISC:
Angioedema,
cough
Poorly absorbed, bioavailability 2.3%, peak 1-3 hr, steady state 7-8 days, 91% excreted unchanged in the feces, half-life 24 hr
•
Do not use ACE inhibitors, angiotensin II receptor antagonists in diabetes mellitus
Increase:
potassium levels—ACE inhibitors, angiotensin II receptor antagonists, potassium supplements, potassium-sparing diuretics
Increase:
hypotension—other antihypertensives, diuretics
Increase:
aliskiren levels—atorvastatin, itraconazole, ketoconazole, cyclosporine; concurrent use is not recommended
Decrease:
levels of warfarin
Decrease:
absorption—high-fat meal
Increase:
uric acid, CPK, BUN, serum creatinine, potassium
Decrease:
Hct, Hgb
•
Renal studies: uric acid, serum creatinine, BUN may be increased; potassium, hyperkalemia may occur
Allergic reactions: angioedema
may occur (swelling of face; trouble breathing, swallowing)
•
Daily dependent edema in feet, legs; weight, B/P, orthostatic hypotension
•
Diabetes:
identify the use of ACE inhibitors, angiotensin II receptor antagonists, do not use aliskiren
•
Storage in tight container at room temp
•
Therapeutic response: decrease in B/P
•
About the importance of complying with dosage schedule even if feeling better; that if dose is missed, take as soon as possible; that if it is almost time for the next dose, take only that dose; do not double dose
Black Box Warning:
To notify if pregnancy is planned or suspected; if pregnant, product will need to be discontinued, pregnancy (D) 2nd/3rd trimester, (C) 1st trimester
•
How to take B/P and normal reading for age group
•
Not to use OTC products including herbs, supplements unless approved by prescriber
•
To report to prescriber immediately: dizziness, faintness, chest pain, palpitations, uneven or rapid heart beat, headache, severe diarrhea, swelling of tongue or lips, trouble breathing, difficulty swallowing, tightening of the throat
•
Not to operate machinery or perform hazardous tasks if dizziness occurs
•
To avoid faintness; to rise slowly
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(al-oh-pure′i-nole)
Aloprim, Zyloprim
Func. class.:
Antigout drug, antihyperuricemic
Chem. class.:
Xanthene oxidase inhibitor
Do not confuse:
Zyloprim
/Zovirax
Inhibits the enzyme xanthine oxidase, reducing uric acid synthesis
Chronic gout, hyperuricemia associated with malignancies, recurrent calcium oxalate calculi, uric acid calculi
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, renal/hepatic disease
Calculator
• Adult: PO
600-800 mg/day in divided doses for 2-3 days; start up to 1-2 days before chemotherapy;
IV INF
200-400 mg/m
2
/day, max 600 mg/day 24-48 hr before chemotherapy, may be divided at 6-, 8-, 12-hr intervals
• Child 6-10 yr: PO
300 mg/day, adjust dose after 48 hr
• Child
<
6 yr: PO
150 mg/day, adjust dose after 48 hr
• Child:
IV INF
200 mg/m
2
/day, initially as a single dose or divided q6-12hr
• Adult: PO
200-300 mg/day in a single dose or divided bid-tid, max 300 mg/dose, 800 mg/day
• Adult and child
>
10 yr: PO
600-800 mg/day × 2-3 days
• Adult: PO
100 mg/day, increase weekly based on uric acid levels, max 800 mg/
day; maintenance dose 100-200 mg bid-tid
• Adult: PO
400-600 mg/day in a single dose or divided bid-tid, max 800 mg/day, doses >300 mg should be given in divided doses
• Adult: PO/IV
CCr 81-100 ml/min 300 mg/day; CCr 61-80 ml/min 250 mg/day; CCr 41-60 ml/min 200 mg/day; 21-40 ml/min 150 mg/day; CCr 10-20 ml/min 100-200 mg/day; CCr 3-9 ml/min 100 mg/day or 100 mg every other day; CCr <3 ml/min 100 mg q24hr or longer or 100 mg every 3rd day
Available forms:
Tabs, scored 100, 300 mg; powder for inj 500 mg/vial
•
With meals to prevent GI symptoms; may crush, add to foods or fluids
•
1-2 days before antineoplastic therapy
•
Reconstitute 30-ml vial with 25 ml of sterile water for inj; dilute to desired conc (≤6 mg/ml) with 0.9% NaCl for inj or D
5
for inj; begin inf within 10 hr
Y-site compatibilities:
Acyclovir, aminophylline, amphotericin B lipid complex, anidulafungin, argatroban, atenolol, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, caspofungin, ceFAZolin, cefoperazone, cefotetan, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, CISplatin, cyclophosphamide, DACTINomycin, DAUNOrubicin citrate liposome, dexamethasone, dexmedetomidine, docetaxel, DOXOrubicin liposomal, enalaprilat, etoposide, famotidine, fenoldopam, filgrastim, fluconazole, fludarabine, fluorouracil, furosemide, gallium, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, granisetron hydrochloride, heparin, hydrocortisone phosphate, hydrocortisone succinate, HYDROmorphone, ifosfamide, linezolid injection, LORazepam, mannitol, mesna, methotrexate, metroNIDAZOLE, milrinone, mitoxantrone, morphine, nesiritide, octreotide, oxytocin, PACLitaxel, pamidronate, pantoprazole, pemetrexed, piperacillin, piperacillin-tazobactam, plicamycin, potassium chloride, ranitidine, sodium acetate, sulfamethoxazole-trimethoprim, teniposide, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, vancomycin, vasopressin, vinBLAStine, vinCRIStine, voriconazole, zidovudine, zoledronic acid
CNS:
Headache
, drowsiness, neuritis, paresthesia
GI:
Nausea, vomiting, anorexia, malaise
, metallic taste, cramps, peptic ulcer, diarrhea
HEMA:
Agranulocytosis, thrombocytopenia, aplastic anemia, pancytopenia, leukopenia, bone marrow suppression, eosinophilia
INTEG:
Dermatitis, pruritus, purpura, erythema, rash,
Stevens-Johnson syndrome
MISC:
Myopathy, arthralgia, hepatomegaly,
cholestatic jaundice, renal failure, exfoliative dermatitis
Protein binding <1%, half-life 1-2 hr
PO:
Peak 1.5 hr; excreted in feces, urine
IV:
Peak up to 30 min
Increase:
kidney stone formation—ammonium chloride, vit C, potassium/sodium phosphate
Increase:
rash—ampicillin, amoxicillin, avoid concurrent use
Increase:
action of oral anticoagulants, oral antidiabetics, theophylline
Increase:
hypersensitivity, toxicity—ACE inhibitors, thiazides
Increase:
bone marrow depression—antineoplastics (mercaptopurine, azaTHIOprine)
Increase:
xanthine nephropathy, calculi—rasburicase
•
For gout:
joint pain, swelling; may use with NSAIDs for acute gouty attacks; uric acid levels q2wk; uric acid levels should be ≤6 mg/dl, effect may take several wk
•
CBC, AST, BUN, creatinine before starting treatment, periodically
•
I&O ratio; increase fluids to 2 L/day to prevent stone formation and toxicity
•
For rash, hypersensitivity reactions, discontinue allopurinol
•
Therapeutic response: decreased pain in joints, decreased stone formation in kidneys, decreased uric acid levels
•
To take as prescribed; if dose is missed, take as soon as remembered; do not double dose; tabs may be crushed
•
To increase fluid intake to 2 L/day
•
To report skin rash, stomatitis, malaise, fever, aching; product should be discontinued
•
To avoid hazardous activities if drowsiness or dizziness occurs
•
To avoid alcohol, caffeine; will increase uric acid levels
•
To avoid large doses of vit C; kidney stone formation may occur
•
To reduce dairy products, refined sugars, sodium, meat if taking for calcium oxalate stones