Mosby's 2014 Nursing Drug Reference (253 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mec-a′sir-men)
Increlex
Func. class.:
Biologic response modifier; insulin-like growth factor
Stimulates growth; IGF-1 is the principal hormonal mediator of statural growth; GH binds to its receptor in the liver and other tissues
Growth failure in children with severe primary insulin-like growth factor-1 (IGF-1) deficiency (primary IGFD) or with growth hormone (GH) gene deletion who have developed neutralizing antibodies to GH
Unlabeled uses:
ALS
Hypersensitivity, benzyl alcohol, closed epiphyses, active/suspected neoplasia, IV use
Precautions:
Pregnancy (C), breastfeeding, children <2 yr, diabetes mellitus, hypothyroidism, lymphoid tissue hypertrophy, increased intracranial pressure, malnutrition, scoliosis, sleep apnea
Calculator
• Child ≥2 yr:
SUBCUT
0.04-0.08 mg/kg (40-80 mcg/kg) bid; if well tolerated for 1 wk, may increase by 0.04 mg/kg/dose, max 0.12 mg/kg bid
Available forms:
Inj 10 mg/ml
•
Give within 20 min of meal or snack, do not give if unable to eat or if vomiting
•
Rotate inj site; use sterile, disposable syringe/needles; use small-volume syringe for accurate measurement; if using syringe (units), convert to mg/kg (weight [kg] × dose [mg/kg] × 1 ml/mg × 100 units/1 ml = units/injection)
•
Do not double dose if a dose is missed
CNS:
Headache,
seizures,
dizziness, cardiac valvulopathy,
increased intracranial pressure
CV:
Cardiac murmur
EENT:
Ear pain, otitis media, abnormal tympanometry, papilledema, visual impairment, tonsillar hypertrophy
ENDO:
Hypoglycemia, ketosis, hypothyroidism, hypercholesterolemia, hypertriglyceridemia
INTEG:
Pruritus, urticaria,
anaphylaxis, angioedema
GI:
Vomiting, nausea
HEMA:
Thymus hypertrophy
MISC:
Bruising, lipohypertrophy, inj site reaction
MS:
Arthralgia, joint pain, slipped upper femoral epiphysis
RESP:
Snoring,
apnea
SYST:
Antibodies to growth hormone, secondary malignancy
Bioavailability almost 100%, metabolized in liver/kidney, half-life 5.8 hr
Increase:
hypoglycemia—antidiabetics, corticosteroids
Decrease:
growth suppression possible—psychostimulants
•
Monitor preprandial glucose at beginning of treatment and until well tolerated
•
By funduscopic exam at beginning and periodically during treatment
•
Allergic reactions;
if present, interrupt treatment and notify prescriber
•
Growth rate of child at intervals during treatment
•
Serious skin disorders:
angioedema, anaphylaxis
•
Storage in refrigerator before opening, avoid freezing; after opening, stable for 30 days after initial vial entry, store in refrigerator; do not use if particulate matter is present, avoid direct light, do not use after expiration date
•
Therapeutic response: growth in children
•
That treatment may continue for years; that regular assessments are required
•
To avoid hazardous activities, driving within 2-3 hr of dosing
•
About correct administration, needle disposal
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
, Rx)
(mek′li-zeen)
Antivert, Bonamine
, Bonine, Dramamine Less Drowsy Formula, Medivert, Travel Sickness, Wal-Dram II
Func. class.:
Antiemetic, antihistamine, anticholinergic
Chem. class.:
H
1
-receptor antagonist, piperazine derivative
Acts centrally by blocking chemoreceptor trigger zone, which in turn acts on vomiting center
Vertigo, motion sickness
Hypersensitivity to cyclizines
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, closed-angle glaucoma, prostatic hypertrophy, hepatic/renal disease
Calculator
• Adult/adolescent:
PO
25-100 mg/day in divided doses
• Adult/adolescent:
PO
25-50 mg 1 hr before traveling, repeat dose q24hr prn
Available forms:
Tabs 12.5, 25, 50 mg; chew tabs 25 mg; caps 25, 30 mg
•
May give without regard to food
•
Chew tab:
give without regard to water or may be swallowed whole with water
•
Lowest possible dose for geriatric patients; anticholinergic effects
CNS:
Drowsiness
, fatigue, restlessness, headache, insomnia
CV:
Hypotension
EENT:
Dry mouth, blurred vision
GI:
Nausea, anorexia, constipation, increased appetite
GU:
Urinary retention
SYST:
Anaphylaxis
PO:
Onset 1 hr, duration 8-24 hr, half-life 6 hr
Increase:
sedation—CYP2D6, inhibitors
Increase:
anticholinergic effects—other antihistamines, atropine, antidepressants, phenothiazines
Increase:
effect of alcohol, opioids, other CNS depressants
False negative:
allergy skin testing (allergen extracts)
•
Vertigo/motion sickness:
nausea, vomiting after 1 hr; assess vertigo periodically
Signs of toxicity of other products, masking of symptoms of disease: brain tumor, intestinal obstruction
•
Observe for drowsiness, dizziness, level of consciousness
•
Therapeutic response: absence of dizziness, vomiting
•
That a false-negative result may occur with skin testing for allergies; that these procedures should not be scheduled for ≤4 days after discontinuing use
•
To avoid hazardous activities, activities requiring alertness because dizziness may occur; to request assistance with ambulation
•
To avoid alcohol, other depressants; not to breastfeed