Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (256 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(me-man′teen)
Ebixa
, Namenda, Namenda XR
Func. class.:
Anti-Alzheimer agent
Chem. class.:
NMDA receptor antagonist
Antagonist action of CNS NMDA receptors that may contribute to the symptoms of Alzheimer’s disease
Moderate to severe dementia in Alzheimer’s disease
Unlabeled uses:
Vascular dementia, acquired pendular nystagmus
Children, hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, renal disease, GU conditions that raise urine pH, seizures, severe hepatic disease, renal failure
Calculator
• Adult:
PO
5 mg/day, may increase dose in 5-mg increments ≥1 wk intervals; recommended target dose of 20 mg/day as 10 mg bid; × R 7 mg q day increase in 7 mg increments ≥ q wk to 28 mg/day
Available forms:
Tabs 5, 10 mg; tab titration pak 5, 10 mg; oral sol 2 mg/ml (10 mg/5 ml); cap ext rel 7, 14, 21, 28 mg
•
Can be taken without regard to meals
•
Twice a day if dose >5 mg
•
Dosage adjusted to response no more than q1wk
•
Ext rel caps:
do not crush, chew, divide; swallow whole or open and sprinkle on applesauce
•
Oral sol
using device provided; remove dosing syringe, green cap, plastic tube from plastic; attach tube to green cap; open cap by pushing down on cap, turning counterclockwise; remove unscrewed cap; carefully remove seal from bottle, discard; insert plastic tube fully into bottle, screw green cap tightly onto bottle by turning cap clockwise; keeping bottle upright on table, remove lid; with plunger fully depressed, insert tip of syringe into cap; while holding syringe, gently pull up on plunger; remove syringe; invert syringe, slowly press plunger to level that removes large air bubbles; keep plunger in inverted position; few small air bubbles may be present
CNS:
Dizziness, confusion
, somnolence, headache, hallucinations,
stroke
CV:
Hypertension,
heart failure, CHF
GI:
Vomiting, constipation
HEMA:
Anemia
INTEG:
Rash
MISC:
Back pain, fatigue, pain
RESP:
Coughing, dyspnea
Rapidly absorbed PO, 44% protein binding, very little metabolism, 57%-82% excreted unchanged in urine, terminal elimination half-life 60-80 hr
•
May alter levels of both products: hydrochlorothiazide, triamterene, cimetidine, quiNIDine, ranitidine, nicotine
Increase:
effect—levodopa, some ergots
Decrease:
clearance of memantine—products that make urine alkaline (sodium bicarbonate, carbonic anhydrase inhibitors)
•
Alzheimer’s dementia:
affect, mood, behavioral changes; hallucinations, confusion, attention, orientation, memory
•
Assistance with ambulation during beginning therapy; dizziness may occur
•
Therapeutic response: decrease in confusion, improved mood, maintenance of function, even with no improvement in symptoms
•
To report side effects: restlessness, psychosis, visual hallucinations, stupor, LOC; may indicate overdose
•
To use product exactly as prescribed; that product not a cure, to avoid alcohol, nicotine
•
To use oral sol dispenser
•
To avoid OTC, herbal products unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTmeperidine (Rx)
(me-per′i-deen)
Demerol, Meperitab
Func. class.:
Opioid analgesic
Chem. class.:
Phenylpiperidine derivative
Do not confuse:
meperidine
/HYDROmorphone/meprobamate/morphine
Demerol
/Dilaudid/Desyrel/Demulen
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Moderate to severe pain preoperatively, postoperatively
Unlabeled uses:
Obstetric/regional analgesic, acute severe headache/migraine, shaking chills induced by IV amphotericin B or postoperative shivering
Hypersensitivity, severe respiratory insufficiency
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, addictive personality, increased intracranial pressure, MI (acute), severe heart disease, respiratory depression, renal/hepatic disease, seizure disorder, abrupt discontinuation, chronic pain
Calculator
• Adult:
PO/SUBCUT/IM
50-150 mg q3-4hr prn;
CONT INF
15-35 mg/hr as
PCA
10 mg then 1- to 5-mg incremental dose; lockout interval 6-10 min
• Child:
PO/SUBCUT/IM
1-1.8 mg/kg q3-4hr prn, max 100 mg q4hr
• Adult:
SUBCUT/IM
50-100 mg given when contractions regularly spaced, repeat q1-3hr prn
• Adult:
IM/SUBCUT
50-100 mg 30-90 min before surgery
• Child:
IM/SUBCUT
1-2.2 mg/kg 30-90 min before surgery, max 100 mg
•
Avoid or modify dose
Available forms:
Inj 10, 25, 50, 75, 100 mg/ml; tabs 50, 100 mg; oral sol 50 mg/5 ml
•
May give with food or milk to decrease GI irritation
•
Oral liquid:
dilute in 4 oz water
•
Patient should remain recumbent for 1 hr after IM/SUBCUT route
•
With antiemetic for nausea, vomiting
•
When pain beginning to return; determine dosage interval by patient response
•
In gradually decreasing dose after long-term use; withdrawal symptoms may occur
•
Inject IM into large muscle mass; IM preferred route for multiple inj
•
Dilute to conc of 10 mg/ml with sterile water for inj or NS
•
Inject slowly ≤25 mg/min
•
Have emergency equipment and opiate antagonist on hand
•
Dilute to conc of 1 mg/ml
•
Infuse using inf pump
Syringe compatibilities:
Butorphanol, chlorproMAZINE, cimetidine, dimenhyDRINATE, diphenhydrAMINE, droperidol, fentaNYL, glycopyrrolate, hydrOXYzine, ketamine, metoclopramide, midazolam, pentazocine, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, scopolamine
Y-site compatibilities:
Amifostine, amikacin, atenolol, aztreonam, bumetanide, ceFAZolin, cefotaxime, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephapirin, cisatracurium, cladribine, clindamycin, diltiazem, diphenhydrAMINE, DOBUTamine, DOPamine, DOXOrubicin HCL, doxycycline, droperidol, erythromycin, famotidine, filgrastim, fluconazole, fludarabine, gallium, gentamicin, granisetron, hydrocortisone, insulin (regular), kanamycin, labetalol, lidocaine, methyldopate, melphalan, metoclopramide, metoprolol, metroNIDAZOLE, moxalactam, ondansetron, oxacillin, oxytocin, PACLitaxel, penicillin G potassium, piperacillin, potassium chloride, propofol, propranolol, ranitidine, remifentanil, sargramostim, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tobramycin, vancomycin, verapamil, vinorelbine
•
Use controlled inf device; implantable controlled micro inf device used for highly concentrated inf, monitor for several days after implantation
•
Filling of inf reservoir should only be done by those fully qualified
•
To prevent pain, depletion of reservoir should be avoided
CNS:
Drowsiness, dizziness, confusion, headache, sedation, euphoria
,
increased intracranial pressure, seizures,
serotonin syndrome
CV:
Palpitations, bradycardia, hypotension, change in B/P, tachycardia (IV)
EENT:
Tinnitus, blurred vision, miosis, diplopia, depressed corneal reflex
GI:
Nausea, vomiting, anorexia, constipation, cramps, biliary spasm, paralytic ileus
GU:
Urinary retention, dysuria
INTEG:
Rash, urticaria, bruising, flushing, diaphoresis, pruritus
RESP:
Respiratory depression
SYST:
Anaphylaxis
Metabolized by liver (to active/inactive metabolites), excreted by kidneys; crosses placenta, excreted in breast milk; half-life 3-4 hr; toxic by-product accumulation can result from regular use or renal disease; protein binding 65%-75%
PO:
Onset 15 min, peak 1/2-1 hr, duration 2-4 hr, absorption 50%
SUBCUT/IM:
Onset 10 min, peak 1/2-1 hr, duration 2-4 hr, well absorbed
IV:
Onset 5 min, duration 2 hr
May cause fatal reaction: MAOIs, procarbazine
Increase:
serotonin syndrome, neuroleptic malignant syndrome, SSRIs, SNRIs, serotonin-receptor agonists
Increase:
effects with other CNS depressants, alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants
Increase:
adverse reactions—protease inhibitor antiretrovirals
Decrease:
meperidine effect—phenytoin
Increase:
CNS depression—St. John’s wort
Increase:
amylase, lipase
•
Pain:
location, type, character; give product before pain becomes extreme; reassess after 60 min (IM, SUBCUT, PO) and 5-10 min (IV)
•
Renal function prior to initiating therapy; poor renal function can lead to ac
cumulation of toxic metabolite and seizures
•
I&O ratio; check for decreasing output; may indicate urinary retention
•
For constipation; increase fluids, bulk in diet; give stimulant laxatives if needed
•
CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reactions with chronic or high-dose use
•
Allergic reactions: rash, urticaria
Respiratory dysfunction:
depression, character, rate, rhythm; notify prescriber if respirations are <12/min
•
CNS stimulation: with chronic or high doses
•
Storage in light-resistant container at room temp
•
Therapeutic response: decrease in pain
•
To report any symptoms of CNS changes, allergic reactions
•
That physical dependency may result from extended use, use should be short term only
•
That drowsiness, dizziness may occur
•
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
•
To make position changes slowly; orthostatic hypotension can occur
•
To avoid OTC medications, alcohol unless directed by prescriber
Naloxone (Narcan) 0.2-0.8 mg IV, caution in physically dependent patients, O
2
, IV fluids, vasopressors