Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (291 page)
Defibrillation, atropine for AV block, vasopressor for hypotension
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(nye-loe′ti-nib)
Tasigna
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Protein-tyrosine kinase inhibitor
Inhibits BCR-ABL tyrosine kinase created in patients with chronic myeloid leukemia (CML)
Chronic phase/accelerated phase Philadelphia-chromosome–positive CML that is resistant or intolerant to imatinib
Pregnancy (D), breastfeeding, hypersensitivity
Black Box Warning:
Hypokalemia, hypomagnesemia, QT prolongation
Precautions:
Children, females, geriatric patients, active infections, anemia, cardiac disease, bone marrow suppression, cholestasis, diabetes, gelatin hypersensitivity, infertility, galactose-free diet, lactase deficiency, neutropenia, pancreatitis, thrombocytopenia
Black Box Warning:
Hepatic disease
Calculator
• Adult:
PO
400 mg q12hr, continue until disease progression or unacceptable toxicity
• Adult:
PO
Reduce to 400 mg/bid
• Adult:
PO
Reduce dose to 300 mg/day
• QTcF >480 msec:
Withhold dose
• Anc 1 × 109/l or platelets <50 × 109/l:
Withhold dose
• Adult:
PO
(Child-Pugh A/B/C) newly diagnosed CML 200 mg bid, then escalation to 300 mg bid initially
Available forms:
Caps 150, 200 mg
•
Do not break, crush, or chew caps; if whole capsule cannot be swallowed, disperse capsule contents in 1 tsp. applesauce
•
Without regard to meals; separate doses by 12 hr; make-up dose should not be taken if dose is missed
CNS:
Headache, dizziness, fatigue, fever, flushing, paresthesia
CV:
QT prolongation,
palpitations,
torsades de pointes,
AV block
GI:
Nausea
,
hepatotoxicity, vomiting, dyspepsia,
anorexia, abdominal pain
, constipation,
pancreatitis,
diarrhea, xerostomia
HEMA:
Neutropenia, thrombocytopenia, anemia, pancytopenia
INTEG:
Rash
, alopecia, erythema
META:
Hyperamylasemia, hyperbilirubinemia, hyperglycemia, hyperkalemia, hypocalcemia, hyponatremia, hypomagnesemia
MISC:
Diaphoresis, anxiety
MS:
Arthralgia, myalgia, back or bone pain, muscle cramps
RESP:
Cough, dyspnea
SYST:
Bleeding, tumor lysis syndrome
Protein binding 98%, metabolized by CYP3A4, plasma levels 3 hr, elimination half-life 17 hr
•
Product interactions are numerous
•
Do not use with phenothiazines, pimozide, ziprasidone
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl; CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
Increase:
hepatotoxicity—acetaminophen
Increase:
concentrations—ketoconazole, itraconazole, erythromycin, clarithromycin
Increase:
plasma concentrations of sim-vastatin, calcium channel blockers
Increase:
plasma concentration of warfarin; avoid use with warfarin, use low-molecular-weight anticoagulants instead
Decrease:
concentrations—dexamethasone, phenytoin, carBAMazepine, rifampin, PHENobarbital
Decrease:
concentration—St. John’s wort
Increase:
plasma concentrations—grapefruit juice
•
Tumor lysis syndrome:
maintain hydration, correct uric acid before use with this product
Black Box Warning:
QT prolongation
can occur; monitor ECG, left ventricular ejection fraction (LVEF) at baseline periodically; hypertension, assess for chest pain, palpitations, dyspnea
Black Box Warning:
Hepatotoxicity:
monitor LFTs before treatment and monthly; if liver transaminases >5 × IULN, withhold until transaminase levels return to <2.5 × IULN
•
Myelosuppression:
CBC, differential, platelet count; for bleeding: epistaxis, rectal, gingival, upper GI, genital and wound bleeding;
tumor-related hemorrhage may occur rapidly
•
ANC and platelets; if ANC <1 ×10
9
/L and/or platelets <50 ×10
9
/L, stop until ANC >1.5 ×10
9
/L and platelets >75 ×10
9
/L
•
Electrolytes:
calcium, potassium, magnesium, sodium; lipase, phosphate; hypokalemia, hypomagnesemia should be corrected before use
•
Storage at 59° F-86° F (15° C- 30° C)
•
Therapeutic response: decrease in progression of disease
•
To report adverse reactions immediately: SOB, bleeding
•
About reason for treatment, expected results
•
That many adverse reactions may occur
•
To avoid persons with known upper respiratory tract infections; immunosuppression is common
•
To watch for signs, symptoms of low potassium or magnesium
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(nye-sole′dih-peen)
Sular
Func. class.:
Calcium channel blocker, antihypertensive
Chem. class.:
Dihydropyridine
Do not confuse:
nisoldipine
/NIFEdipine/niMODipine
Inhibits calcium ion influx across the cell membrane, thereby resulting in the dilation of peripheral arteries
Essential hypertension, alone or in combination with other antihypertensives
Unlabeled uses:
Variant (Prinzmetal’s) angina, stable angina pectoris
Hypersensitivity to this product or dihydropyridines; sick sinus syndrome; 2nd-/3rd-degree heart block; aortic stenosis
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, CHF, hypotension <90 mm Hg systolic, hepatic injury, renal disease, acute MI, unstable angina, CAD, cardiogenic shock
Calculator
• Adult:
PO
17 mg/day initially, may increase by 8.5 mg/wk, usual dose 17-34 mg/day, max 34 mg/day
• Geriatric/hepatic dose:
PO
8.5 mg/day, increase based on patient response
• Adult:
PO
17-34 mg/day, max 34 mg/day
• Adult:
PO
8.5 mg/day
Available forms:
Ext rel tabs 8.5, 17, 20, 25.5, 30, 34, 40 mg
•
Swallow whole; do not break, crush, or chew
•
Once daily as whole tablet; avoid high-fat foods, grapefruit juice
CNS:
Headache, fatigue, drowsiness, dizziness, anxiety, depression, nervousness, insomnia, lightheadedness, paresthesia, tinnitus, psychosis, somnolence, ataxia, confusion, malaise, migraine, flushing
CV:
Dysrhythmia, edema,
CHF,
hypotension, palpitations,
MI, pulmonary edema,
tachycardia, syncope, AV block, angina, chest pain, ECG abnormalities
GI:
Nausea, vomiting, diarrhea, gastric upset, constipation, increased LFTs, dry mouth, dyspepsia, dysphagia, flatulence
GU:
Nocturia, hematuria, dysuria
HEMA:
Anemia, leukopenia,
petechiae
INTEG:
Rash, pruritus
MISC:
Sexual difficulties, cough, nasal congestion, SOB, wheezing, epistaxis, dyspnea, gingival hyperplasia, chills, fever, gout, sweating
Metabolized by liver, excreted in urine, peak 6-12 hr, protein binding 99%, half-life 7-12 hr
Increase:
effects of β-blockers, antihypertensives, digoxin
Increase:
nisoldipine level—CYP3A4 inhibitors, cimetidine, ranitidine, azole antifungals
Decrease:
nisoldipine effect—CYP3A4 inducers, hydantoins
Increase:
B/P—ephedra, melatonin
Decrease:
B/P—hawthorn
Decrease:
nisoldipine effect—St. John’s wort, ginseng, ginkgo biloba
Increase:
nisoldipine level—high-fat foods
Increase:
hypotensive effect—grapefruit juice
•
Cardiac status: B/P, pulse, respiration, ECG before treatment and periodically
•
CHF:
weight gain, jugular venous distention, edema, crackles, I&O ratios
•
Angina:
frequency, severity of attacks, if angina worsens, report immediately
•
Therapeutic response: decreased B/P
•
To avoid hazardous activities until stabilized on product, dizziness is no longer a problem
•
To report nausea, dizziness, swelling, SOB, palpitations, severe headache
•
To avoid OTC products unless directed by prescriber; to avoid grapefruit juice
•
About the importance of complying with all areas of the medical regimen: diet, exercise, stress reduction, product therapy
•
To rise slowly to prevent orthostatic hypotension
•
If dose is missed, to take as soon as remembered; not to double dose
•
How to perform B/P monitoring at home
Defibrillation, atropine for AV block, vasopressor for hypotension