Mosby's 2014 Nursing Drug Reference (277 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
CNS:
Drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia,
seizures
CV:
Palpitations,
bradycardia,
change in B/P,
shock, cardiac arrest,
chest pain, hypo/hypertension, edema,
tachycardia
EENT:
Tinnitus, blurred vision, miosis, diplopia
GI:
Nausea, vomiting, anorexia, constipation, cramps, biliary tract pressure
GU:
Urinary retention
HEMA:
Thrombocytopenia
INTEG:
Rash, urticaria, bruising, flushing, diaphoresis, pruritus
RESP:
Respiratory depression, respiratory arrest, apnea
PO:
Onset variable, peak variable, duration variable
IM:
Onset 1/2 hr, peak 50-90 min, duration 3-7 hr
SUBCUT:
Onset 15-20 min, peak 50-90 min, duration 3-5 hr
IV:
Peak 20 min
RECT:
Peak 1/2-1 hr, duration 4-5 hr
Intrathecal:
Onset rapid, duration ≤24 hr
Metabolized by liver, crosses placenta; excreted in urine, breast milk; half-life 1½-2 hr
•
Unpredictable reaction, avoid use: MAOIs
Increase:
effects with other CNS depressants—alcohol, opiates, sedative/hypnotics, antipsychotics, skeletal muscle relaxants
Decrease:
morphine action—rifampin
Increase:
anticholinergic effect—corkwood
Increase:
CNS depression—chamomile, hops, kava, St. John’s wort, valerian
Decrease:
morphine effect—cranberry juice (excessive amounts), oats
Increase:
amylase
•
Pain:
location, type, character; give dose before pain becomes severe
•
Bowel status; constipation common, use stimulant laxative if needed
•
I&O ratio; check for decreasing output; may indicate urinary retention
•
B/P, pulse, respirations (character, depth, rate)
•
CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
Abrupt discontinuation:
gradually taper to prevent withdrawal symptoms; decrease by 50% q1-2days; avoid use of narcotic antagonists
•
Allergic reactions: rash, urticaria
Black Box Warning:
Accidental exposure:
if Duramorph or Infumorph gets on skin, remove contaminated clothing, rinse affected area with water
•
Respiratory dysfunction:
depression, character, rate, rhythm; notify prescriber if respirations are <12/min; accidental overdose has occurred with high-potency oral sols
•
Storage in light-resistant container at room temp
•
Assistance with ambulation
•
Safety measures: side rails, night-light, call bell within easy reach
•
Gradual withdrawal after long-term use
•
Therapeutic response; decrease in pain intensity
•
To change position slowly; orthostatic hypotension may occur
•
To report any symptoms of CNS changes, allergic reactions
•
That physical dependency may result from long-term use
•
To avoid use of alcohol, CNS depressants
•
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
Naloxone (Narcan) 0.2-0.8 mg IV, (caution with opioid-tolerant individuals) O
2
, IV fluids, vasopressors
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
Avelox, Avelox IV
Func. class.:
Antiinfective
Chem. class.:
Fluoroquinolone
Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; DNA gyrase inhibitor
Acute bacterial sinusitis:
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis;
acute bacterial exacerbation of chronic bronchitis:
S. pneumoniae, H. influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Staphylococcus aureus, M. catarrhalis;
community-acquired pneumonia:
S. pneumoniae, H. influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, M. catarrhalis;
uncomplicated skin/skin-structure infections:
S. aureus, Streptococcus pyogenes;
complicated intraabdominal infections including polymicrobial infections:
E. coli, Bacterioides fragilis, S. anginosus, S. constellatus, Enterococcus faecalis, Proteus mirabilis, Clostridium perfringens, Bacteroides thetaiotaomicron, Peptostreptococcus
sp; complicated skin, skin-structure infections caused by methicillin-susceptible:
S. aureus, E. coli, K. pneumoniae, Enterobacter cloacae
Hypersensitivity to quinolones
Precautions:
Pregnancy (C), breastfeeding, children, hepatic/cardiac/renal/GI disease, epilepsy, uncorrected hypokalemia, prolonged QT interval; patients receiving class IA, III antidysrhythmics; seizure disorder
Black Box Warning:
Tendon pain, rupture; tendinitis
Calculator
• Adult:
PO/IV
400 mg q24hr × 10 days
• Adult:
PO/IV
400 mg q24hr × 5 days
• Adult:
PO/IV
400 mg q24hr × 7-14 days
• Adult:
PO/IV
400 mg q24hr × 7 days
• Adult:
IV
400 mg/day × 5-14 days
• Adult:
PO/IV
400 mg/day × 7-21 days
Available forms:
Tabs 400 mg; inj premix 400 mg/250 ml
•
4 hr before or 8 hr after antacids, zinc, iron, calcium
•
Without regard to food
•
Store at room temperature
•
Discontinue primary IV while administering moxifloxacin, give over 60 min
•
Do not give SUBCUT, IM
•
Available as premixed sol; may be diluted at ratios from 1:10 to 10:1; do not refrigerate; give by direct inf or through Y-type inf set; do not add other medications to sol or inf through same IV line at same time
•
Do not refrigerate
•
Flush line with compatible sol before and after use
•
Do not admix
Solution compatibilities:
0.9% NaCl, D
5
, D
10
, LR, sterile water for inj
CNS:
Headache
, dizziness, fatigue, insomnia, depression,
restlessness
,
seizures,
confusion,
increased intracranial pressure,
peripheral neuropathy,
pseudotumor cerebri
CV:
Prolonged QT interval, dysrhythmias, torsades de pointes,
tachycardia
EENT:
Blurred vision, tinnitus, taste changes
GI:
Nausea, diarrhea
, increased ALT, AST, flatulence, heartburn,
vomiting
, oral candidiasis, dysphagia,
pseudomembranous colitis
INTEG:
Rash
, pruritus, urticaria, photosensitivity, flushing, fever, chills
MS:
Tremor, arthralgia, tendinitis,
tendon rupture,
myalgia
SYST:
Anaphylaxis, Stevens-Johnson syndrome
Excreted in urine as active product, metabolites; parent product excreted in urine (20%), feces (25%); terminal half-life PO 12-16 hr, IV 8-15 hr
Increase:
moxifloxacin serum levels—probenecid
Increase:
warfarin, cycloSPORINE effect
Increase:
seizure risk—NSAIDs
Black Box Warning:
Increase:
tendon rupture—corticosteroids
Decrease:
moxifloxacin absorption—magnesium antacids, aluminum hydroxide, zinc, iron, sucralfate, calcium, enteral feeding, didanosine
•
CNS symptoms: headache, dizziness, fatigue, insomnia, depression, seizures
•
Renal, hepatic studies: BUN, creatinine, AST, ALT
•
I&O ratio, urine pH <5.5 is ideal
Allergic reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis:
fever, flushing, rash, urticaria, pruritus, sore throat, fatigue, ulcers, other lesions; keep EPINEPHrine, emergency equipment nearby for anaphylaxis
Black Box Warning:
Tendon pain, rupture, tendinitis; if tendon becomes inflamed, product should be discontinued, more common in Achilles tendon
Cardiac status:
prolonged QT or use of products that increase QT prolongation
Pseudomembranous colitis:
assess for diarrhea, abdominal pain, fever, fatigue, anorexia; possible anemia, elevated WBC, low serum albumin; stop product; usually either vancomycin or IV metroNIDAZOLE given
•
Increased fluids to 3 L/day to avoid crystallization in kidneys
•
Therapeutic response: decreased pain, C&S; absence of infection
Black Box Warning:
To notify prescriber of tendon pain, inflammation; stop drug
•
Not to take any products containing magnesium or calcium (such as antacids), iron, or aluminum with this product or 4 hr before or 8 hr after
•
That photosensitivity may occur; to avoid sunlight or use sunscreen to prevent burns
•
To use frequent rinsing of mouth, sugarless candy or gum for dry mouth
•
To take as prescribed; not to double or miss doses
•
If dizziness occurs, to ambulate, perform activities with assistance
•
To complete full course of product therapy
•
To contact prescriber if abnormal heart rhythm or seizures occur