Mosby's 2014 Nursing Drug Reference (250 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(loo-ras′i-done)
Latuda
Func. class.:
Atypical antipsychotic
Chem. class.:
Benzoisothiazol derivative
May modulate central dopaminergic and serotonergic activity; high affinity for dopamine-D2 receptors, serotonin 5-HT2A receptors; partial agonist at serotonin 5-HT1A receptor
Schizophrenia
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, abrupt discontinuation, ambient temperature increase, breast cancer, cardiac disease, dehydration, diabetes, ketoacidosis, driving, operating machinery, dysphagia, heart failure, hematologic/hepatic/renal disease, hypotension, hypovolemia, MI, infertility, obesity, Parkinson’s disease, seizures, strenuous exercise, stroke, substance abuse, suicidal ideation, syncope, tardive dyskinesia
Black Box Warning:
Dementia: antipsychotics (e.g., as lurasidone) not approved for treatment of dementia-related psychosis in geriatric patients; may increase risk of death in this population
Calculator
• Adult:
PO
40 mg/day, range 40-160 mg/day; for those receiving CYP3A4 inhibitors (max 80 mg/day), do not use with strong CYP3A4 inducers/inhibitors
• Adult:
PO
Child-Pugh class B/C; CCr ≥10 ml/min, ≤50 ml/min, max 40 mg/day
Available forms:
Tabs 40, 80 mg
•
Give with meal of ≥350 calories
CNS:
Agitation, akathisia, anxiety, dizziness, drowsiness, fatigue, hyperthermia, insomnia, dystonic reactions;
neuroleptic malignant syndrome (rare),
pseudoparkinsonism, restlessness,
seizures, suicidal ideation,
syncope, tardive dyskinesia, vertigo
CV:
Angina,
AV block, bradycardia,
hypertension, orthostatic hypotension,
sinus tachycardia, stroke
EENT:
Blurred vision
ENDO:
Diabetes mellitus, ketoacidosis, hyperglycemia, hyperprolactinemia
GI:
Abdominal pain, diarrhea, dyspepsia, nausea, vomiting, gastritis, weight gain/loss
GU:
Amenorrhea, breast enlargement, dysmenorrhea, impotence, dysuria, renal failure
HEMA:
Agranulocytosis, anemia, leucopenia, neutropenia
INTEG:
Pruritus, rash
MS:
Back pain, dysarthria;
rhabdomyolysis (rare)
SYST:
Angioedema
99% protein binding; excreted 80% in feces, 9% in urine; elimination half-life 18 hr; 9-19% absorbed; peak 1-3 hr, steady state 7 days
Increase:
lurasidone effect—strong CYP3A4 inhibitors; do not use concurrently
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs
Increase:
sedation—other CNS depressants, alcohol
•
Schizophrenia:
hallucinations, delusions, agitation, social withdrawal; monitor orientation, behavior, mood prior to and periodically during therapy
•
Neuroleptic malignant syndrome (rare):
fever, dyspnea, tachycardia, seizures, sweating, hypo/hypertension, muscle stiffness, pallor; report immediately
•
Blood dyscrasias:
CBC periodically; blood dyscrasias may occur
•
Serious cardiac symptoms:
AV block, stroke, bradycardia may occur
•
EPS:
restlessness, difficulty speaking, loss of balance, pill rolling, masklike face, shuffling gait, rigidity, tremors, muscle spasms; monitor before and periodically during therapy; report tardive dyskinesia immediately
Black Box Warning:
Dementia:
this product is not approved for geriatric patients with dementia-related psychosis
•
Weight gain, hyperglycemia, metabolic changes in diabetes
•
Storage at room temp, protection from moisture
•
Therapeutic response: decreasing hallucinations, delusions, agitation, social withdrawal
•
About reason for treatment, expected results
•
That lab work will be needed regularly
•
To avoid hazardous activities until response is known
•
To avoid OTC products unless approved by prescriber
•
To report fast heartbeat, extra beats
•
To report EPS symptoms, blood dyscrasias: sore throat, fever, unusual bleeding/bruising
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
globulin (anti-thymocyte, equine) (Rx)
Atgam
Func. class.:
Immune globulins—immunosuppressant
Produces immunosuppression by inhibiting the function of lymphocytes (T)
Renal organ transplants to prevent rejection, aplastic anemia
Unlabeled uses:
Immunosuppressant in liver, bone marrow, heart, and other organ transplants; stem-cell transplant preparations
Hypersensitivity to this product or equine/leporine protein; acute viral illness
Precautions:
Pregnancy (C), breastfeeding, children, severe renal/hepatic disease, leukopenia, thrombocytopenia
Black Box Warning:
Infection, neoplastic disease
Calculator
• Adult/child:
IV
10-15 mg/kg/day × 14 days then every other day for 14 days if needed up to 21 total
• Adult:
IV
15 mg/kg/day × 7-14 days then every other day × 14 days for total of 21 doses in 28 days
• Adult:
IV
10-20 mg/kg/day × 8-14 days then every other day for ≤21 total doses
Available forms:
Inj 50 mg equine gamma globulin/ml
•
Do not infuse <4 hr; usually given over 4-8 hr
•
Use 0.2-1 micron in-line filter
•
Skin testing must be completed before treatment; use intradermal inj of 0.1 ml of a 1:1000 dilution (5 mcg horse IgG) in 0.9% NaCl; if wheal or rash >10 mm or both, use caution during inf
•
Dilute in saline sol before inf; invert IV bag so undiluted product does not contact air inside; conc should not be >1 mg/ml; do not shake
•
Keep emergency equipment nearby for severe allergic reaction
CNS:
Fever, chills, headache, dizziness, weakness, faintness,
seizures
CV:
Chest pain, hypo/hypertension, tachycardia
GI:
Diarrhea, nausea, vomiting, epigastric pain,
GI bleeding
INTEG:
Rash, pruritus, urticaria, wheal
SYST:
Anaphylaxis
CNS:
Fever, chills, headache,
seizures,
lightheadedness, encephalitis, postviral encephalopathy
CV:
Bradycardia, myocarditis, irregularity
GI:
Nausea, LFTs abnormality
HEMA:
Thrombocytopenia, leukopenia
MS:
Backache
RESP:
Dyspnea, pulmonary edema
Onset rapid, half-life 5-7 days
•
Infection:
if infection occurs, evaluation will be needed to continue therapy
•
Renal studies: BUN, creatinine at least monthly during treatment, for 3 mo after treatment
•
Hepatic studies: alk phos, AST, ALT, bilirubin
•
CBC with differential
•
Therapeutic response: absence of rejection; hematologic recovery (aplastic anemia)
•
To report fever, chills, sore throat, fatigue, since serious infections may occur
•
To use contraceptive measures during treatment, for 12 wk after therapy
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert