Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (288 page)
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Cardiac status: rate, rhythm, quality; postural hypotension, dysrhythmias
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Nutritional status: liver, yeast, legumes, organ meat, lean poultry; fat in diet
Hepatotoxicity:
clay-colored stools, itching, dark urine, jaundice; hepatic studies: AST, ALT, bilirubin, uric acid, alk phos; blood glucose before and during treatment
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CNS symptoms: headache, paresthesias, blurred vision
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Niacin deficiency:
nausea, vomiting, anemia, poor memory, confusion, dermatitis
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Hyperlipidemia:
for lipid, triglyceride, cholesterol level; obtain diet history
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Therapeutic response: decreased lipids, warm extremities, absence of numbness in extremities
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That flushing and increase in feelings of warmth will occur several hr after taking product (PO); after 2 wk of therapy, these side effects diminish
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To remain recumbent if postural hypotension occurs; to rise slowly to prevent orthostatic hypotension
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To abstain from alcohol if product is prescribed for hyperlipidemia
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To avoid sunlight if skin lesions are present
Hepatotoxicity:
to report clay-colored stools, anorexia, yellow eyes or skin, dark urine
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(nye-card′i-peen)
Cardene IV, Cardene SR
Func. class.:
Calcium channel blocker, antianginal, antihypertensive
Chem. class.:
Dihydropyridine
Do not confuse:
niCARdipine
/NIFEdipine
Cardene
/Cardizem
Cardene SR
/Cardizem SR
Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, peripheral vascular smooth muscle; dilates coronary vascular arteries; increases myocardial oxygen delivery in patients with vasospastic angina
Chronic stable angina pectoris, hypertension
Sick sinus syndrome, 2nd-/3rd-degree heart block; hypersensitivity to this product or dihydropyridine; advanced aortic stenosis
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, CHF, hypotension, hepatic injury, renal disease
Calculator
• Adult:
PO
20 mg tid initially; may increase after 3 days (range 20-40 mg tid) or 30 mg bid
SUS REL;
may increase to 60 mg bid or
IV
5 mg/hr; may increase by 2.5 mg/hr q15min; max 15 mg/hr
• Adult:
PO
20 mg tid; may be adjusted q3days; may use 20-40 mg tid
• Adult:
PO
adjust based on response
• Adult:
PO
20 mg bid
Available forms:
Caps 20, 30 mg; sus rel caps 30, 45, 60 mg; inj 2.5 mg/ml, premixed 20 mg/200 ml, 40 mg/200 ml
•
Do not break, crush, chew, or open sus rel cap
•
Without regard to meals
•
Dilute each 25 mg/240 ml of compatible sol (0.1 mg/ml), give slowly, titrate to patient response, change IV site q12hr
•
Stable at room temp for 24 hr
Solution compatibilities:
D
5
W, D
5
/0.45% NaCl, D
5
/0.9% NaCl
Y-site compatibilities:
Alemtuzumab, amikacin, aminophylline, aztreonam, bivalirudin, butorphanol, calcium gluconate, CARBOplatin, caspofungin, ceFAZolin, ceftizoxime, chloramphenicol, cimetidine, CISplatin, clindamycin, cytarabine, DAPTOmycin, dexmedetomidine, diltiazem, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin hydrochloride, enalaprilat, EPINEPHrine, epirubicin, erythromycin, esmolol, famotidine, fenoldopam, fentaNYL, gentamicin, hydrocortisone, HYDROmorphone, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mechlorethamine, methylPREDNISolone, metroNIDAZOLE, midazolam, milrinone, morphine, nafcillin, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, palonosetron, penicillin G potassium, potassium chloride/phosphate, quinupristin/dalfopristin, ranitidine, rocuronium, tacrolimus, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, vinCRIStine, voriconazole, zoledronic acid
CNS:
Headache, dizziness
, anxiety, depression, confusion, paresthesia, somnolence,
flushing
CV:
Edema, bradycardia, hypotension, palpitations,
pulmonary edema,
chest pain, tachycardia, increased angina,
arrhythmias, CHF
GI:
Nausea, vomiting, gastric upset, constipation,
hepatitis,
abdominal cramps, dry mouth, sore throat
GU:
Nocturia, polyuria
INTEG:
Rash, inf site discomfort,
Stevens-Johnson syndrome
OTHER:
Blurred vision, flushing, sweating, SOB, impotence
Metabolized by liver, excreted in urine 60%, feces 35%
PO:
Onset 30 min, peak 1-2 hr, duration 8 hr
PO-SR:
Onset unknown, peak 2-6 hr, duration 10-12 hr, half-life 2-5 hr
Increase:
effects of digoxin, neuromuscular blocking agents, theophylline, other antihypertensives, nitrates, alcohol, quiNIDine
Increase:
niCARdipine effects—cimetidine
Increase:
toxicity risk—cycloSPORINE, prazosin, carBAMazepine, quiNIDine, propranolol
Decrease:
antihypertensive effect—NSAIDs, rifampin
Increase:
effect—ginkgo, ginseng, hawthorn
Decrease:
effect—ephedra, melatonin, St. John’s wort, yohimbe
Increase:
hypotensive effect—grapefruit juice
Increase:
LFTs
Decrease:
potassium (IV), phosphate, platelets
Cardiac status: B/P often, pulse, respiration, ECG during long-term treatment
•
Anginal pain:
intensity, location, duration; alleviating, precipitating factors
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Potassium, renal, hepatic studies periodically
CHF:
weight gain, crackles, jugular venous distention, dyspnea, I&O
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Hypertension:
decreasing B/P; assess salt in diet, smoking, exercise, weight, monitor B/P often
•
Therapeutic response: decreased anginal pain, decreased B/P
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To avoid hazardous activities until stabilized on product, dizziness is no longer a problem
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To limit caffeine consumption; to avoid alcohol products, to take without regard to food, avoid high-fat foods, to swallow sus rel product whole
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To avoid OTC products, grapefruit juice unless directed by prescriber
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Hypertension:
comply in all areas of medical regimen: diet, exercise, stress reduction, product therapy
To notify prescriber of irregular heartbeat, SOB, swelling of feet and hands, pronounced dizziness, constipation, nausea, hypotension, change in severity/pattern/incidence of angina
Defibrillation, β-agonists, IV calcium, diuretics, atropine for AV block, vasopressor for hypotension