Mosby's 2014 Nursing Drug Reference (279 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(na-byoo′me-tone)
Func. class.:
Nonsteroidal antiinflammatory
Chem. class.:
Acetic acid derivative
Metabolite inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflammatory, antipyretic
Osteoarthritis, rheumatoid arthritis, acute or chronic treatment
Pregnancy (D) 3rd trimester; hypersensitivity to this product or aspirin, iodides, NSAIDs
Black Box Warning:
Perioperative pain with CABG surgery
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, bleeding/GI/cardiac/renal disorders, hepatic dysfunction, asthma, bone marrow suppression, lupus (SLE), ulcerative colitis, blood dyscrasias
Black Box Warning:
MI, stroke, GI bleeding
Calculator
• Adult:
PO
1 g as single dose or divided bid; max 2 g/day if needed
• Adult:
PO
CCr 31-49 ml/min, 750 mg daily, max 1 g/day; CCr <30 ml/min 500 mg daily
Available forms:
Tabs 500, 750 mg
•
With food or antacids
CNS:
Dizziness, headache, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, nervousness
EENT:
Tinnitus
CV:
Tachycardia, peripheral edema, palpitations, dysrhythmias,
CHF, MI, stroke
GI:
Nausea, anorexia, vomiting, diarrhea, jaundice,
cholestatic hepatitis,
constipation, flatulence, cramps, dry mouth, peptic ulcer, gastritis,
ulceration, perforation, bleeding
GU:
Nephrotoxicity, dysuria, hematuria, oliguria, azotemia,
cystitis
HEMA:
Blood dyscrasias
INTEG:
Purpura, rash, pruritus, sweating, photosensitivity
RESP:
Dyspnea, pharyngitis,
bronchospasm
SYST:
Anaphylaxis, angioneurotic edema
PO:
Peak 2½-4 hr; protein binding >99%; half-life 24 hr; metabolized in liver to active metabolite; excreted in urine (metabolites), breast milk
Increase:
bleeding risk—anticoagulants, thrombolytics, valproic acid, cefamandole, cefoTEtan, cefoperazone, plicamycin, clopidogrel, eptifibatide, ticlopidine, SSRIs, SNRIs
Increase:
hematologic toxicity—antineoplastics, radiation
Increase:
GI reactions—salicylates, NSAIDs, alcohol, potassium, corticosteroids
Increase:
toxicity, effect of—lithium, methotrexate
Decrease:
effect of diuretics, antihypertensives
Increase:
bleeding time, potassium, BUN, AST, ALT, LDH, alk phos, creatinine
Decrease:
CCr, blood glucose, Hct, Hgb
Black Box Warning:
Cardiac status: CV thrombotic events, MI, stroke; may be fatal, not to be used in perioperative pain after CABG
Black Box Warning:
GI status: ulceration, bleeding, perforation; may be fatal
•
Pain:
frequency, intensity, characteristics; relief of pain after taking product
•
Asthma, aspirin sensitivity, or nasal polyps; increased hypersensitivity reactions
•
Renal, hepatic studies: BUN, creatinine, AST, ALT, Hgb, LDH, blood glucose, WBC, platelets; CCr before treatment, periodically thereafter
•
Audiometric, ophthalmic exam before, during, after treatment
•
For eye, ear problems: blurred vision, tinnitus; may indicate toxicity
•
Storage at room temp
•
Therapeutic response: decreased pain and stiffness in joints
•
To avoid alcoholic beverages and aspirin
To report blurred vision, ringing, roaring in ears; may indicate toxicity
•
To avoid driving, other hazardous activities if dizziness, drowsiness occur
To report change in urine pattern, increased weight, edema, increased pain in joints, fever, blood in urine; indicates nephrotoxicity
•
That therapeutic effects may take up to 1 mo
•
To take with a full glass of water and food or antacids to enhance absorption; to sit upright for 30 min
•
To report dark stools; may indicate GI bleeding
•
To use sunscreen, wear protective clothing if in the sun
•
To report use to all health care providers, to avoid all other products unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(nay-doe′lole)
Corgard
Func. class.:
Antihypertensive, antianginal
Chem. class.:
β-Adrenergic receptor blocker
Do not confuse:
Corgard
/Cognex/Coreg
Nadolol
/Mandol
Long-acting, nonselective β-adrenergic receptor blocking agent, blocks β
1
in the heart and β
2
in the lungs, uterus, and circulatory system; mechanism is similar to that of propranolol
Chronic stable angina pectoris, mild to moderate hypertension
Unlabeled uses:
Tachydysrhythmias, anxiety, tremors, esophageal varices (rebleeding only), prophylaxis of migraine headaches, portal hypertension
Hypersensitivity to this product, cardiac failure, cardiogenic shock, 2nd/3rd degree heart block, bronchospastic disease, sinus bradycardia, CHF, COPD
Precautions:
Pregnancy (C), breastfeeding, diabetes mellitus, renal disease, hyperthyroidism, peripheral vascular disease, myasthenia gravis, major surgery, nonallergic bronchospasm
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult:
PO
40 mg/day, increase by 40-80 mg q3-7days; maintenance 40-240 mg/day for angina, 40-320 mg/day for hypertension
• Geriatric:
PO
20 mg/day, may increase by 20 mg until desired dose
• Adult:
PO
CCr 31-50 ml/min, give q24-36hr; CCr 10-30 ml/min, give q24-48hr; CCr <10 ml/min, give q40-60hr
• Adult:
PO
80-240 mg/day × 2-18 mo
Available forms:
Tabs 20, 40, 80 mg
•
With 8 oz water, check apical pulse prior to use, if <60 bpm, withhold; call prescriber
•
Give without regard to food
CNS:
Depression, dizziness,
fatigue
, lethargy, paresthesias, headache,
weakness
, insomnia, memory loss, nightmares
CV:
Bradycardia,
hypotension
,
CHF,
palpitations,
AV block,
chest pain, peripheral ischemia, flushing, edema, vasodilation, conduction disturbances
EENT:
Blurred vision, dry eyes, nasal congestion
ENDO:
Hyperglycemia, hypoglycemia
GI:
Nausea, vomiting, diarrhea, colitis, constipation, cramps, dry mouth, flatulence, hepatomegaly,
pancreatitis,
taste distortion
GU:
Impotence
, decreased libido
HEMA:
Agranulocytosis, thrombocytopenia
INTEG:
Rash, pruritus, fever, alopecia
RESP:
Dyspnea, respiratory dysfunction,
bronchospasm,
cough, wheezing,
pulmonary edema,
pharyngitis,
laryngospasm
PO:
Onset variable, peak 3-4 hr, duration 17-24 hr; half-life 20-24 hr; not metabolized; excreted in urine (unchanged), bile, breast milk; protein binding 30%
•
Do not use with MAOIs; bradycardia may occur
•
Peripheral ischemia: ergots
Increase:
bradycardia—digoxin
Increase:
hypotension, bradycardia—cloNIDine, EPINEPHrine
Increase:
hypotensive effects—other hypotensive agents, phenothiazines
Decrease:
β-blocking effect—thyroid hormones
Decrease:
antihypertensive effect—NSAIDs
Increase:
serum potassium, serum uric acid, ALT, AST, alk phos, LDH, blood glucose, cholesterol, ANA, triglycerides
•
B/P, pulse, respirations during beginning therapy; orthostatic hypotension may occur
•
Weight daily; report gain of 5 lb
•
I&O ratio, CCr if kidney damage diagnosed; crackles, jugular venous distention, fatigue, dyspnea
•
Pain:
duration, time started, activity being performed, character
•
Headache, lightheadedness, decreased B/P; may indicate a need for decreased dosage
Black Box Warning:
Abrupt discontinuation: can result in MI, myocardial ischemia, ventricular dysrhythmias, severe hypertension; withdraw slowly by tapering
•
Therapeutic response: decreased B/P, heart rate, symptoms of angina
•
That product may mask signs of hypoglycemia or alter blood glucose in diabetics
•
To avoid OTC products unless prescriber approves
•
To avoid hazardous activities if dizziness occurs
•
Hypertension:
to comply with complete medical regimen; to report weight gain of >5 lb, swelling, unusual bruising, bleeding
•
To rise slowly to prevent orthostatic hypotension
•
About how and when to check B/P, pulse; to hold dose, contact prescriber if pulse ≤60 bpm, systolic B/P <90 mm Hg
Black Box Warning:
Not to discontinue abruptly, may cause life-threatening cardiac changes