Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (300 page)
(oh-mah-lye-zoo′mab)
Xolair
Func. class.:
Antiasthmatic
Chem. class.:
Monoclonal antibody
Recombinant DNA-derived humanized IgG murine monoclonal antibody that selectively binds to IgE to limit the release of mediators in the allergic response
Moderate to severe persistent asthma
Unlabeled uses:
Seasonal allergic rhinitis, food allergy
Hypersensitivity to hamster protein
Black Box Warning:
Hypersensitivity to this product
Precautions:
Pregnancy (B), breastfeeding, children <12 yr, acute attacks of asthma, lymphoma, nephrotic disease, bronchospasm, neoplastic disease, status asthmatics
Calculator
• Adult/adolescent/child ≥12 yr:
SUBCUT
150-375 mg × 2-4 wk, divide inj into 2 sites if dose >150 mg; dose is adjusted based on IgE levels, significant changes in body weight
Available forms:
Powder for inj, lyophilized 202.5 mg (150 mg/1.2 ml after reconstitution)
•
Reconstitute using 1.4 ml sterile water for inj (150 mg/1.2 ml or 125 mg/ml); gently swirl to dissolve; allow vial to stand and q5min gently swirl for 5-10 sec to dissolve, some vials may take ≥20 min, do not use if contents do not dissolve within 40 min, should be clear or slightly opalescent; use large-bore needle to withdraw medication; replace needle with small-bore needle
•
Given q2-4wk; product is viscous; if >150 mg is given, divide into 2 sites; inj may take 5-10 sec to administer
CV:
Heart failure,
cardiomyopathy, hypotension
HEMA:
Serious systemic eosinophilia
INTEG:
Pruritus, dermatitis, inj site reactions, rash
MISC:
Earache, dizziness, fatigue, pain,
malignancies
, viral infections,
anaphylaxis, thrombocytopenia,
headache
MS:
Arthralgia, fracture, leg, arm pain
RESP:
Sinusitis, upper respiratory infections, pharyngitis, pulmonary hypertension,
bronchospasm
Slowly absorbed, peak 7-8 days, half-life 26 days, degradation by liver, excretion in bile
•
Use cautiously with live virus vaccines
Increase:
IgE
•
Asthma:
respiratory rate, rhythm, depth; auscultate lung fields bilaterally; notify prescriber of abnormalities; monitor pulmonary function tests; serum IgE (may increase and continue for 1 year)
•
Inj site reactions:
inflammation, edema, redness, warmth at site; may occur within 60 min of inj, may decrease with repeated dosing
Black Box Warning:
Anaphylaxis, allergic reactions:
rash, urticaria, inability to breathe, edema of throat; product should be discontinued; have emergency equipment available, observe for 2 hr, reaction can occur ≤24 hr
•
Therapeutic response: ability to breathe more easily
•
That improvement will not be immediate
•
Not to stop taking or decrease current asthma medications unless instructed by prescriber
•
To avoid live virus vaccines while taking this product
Black Box Warning:
To report signs of allergic reaction
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
, Rx)
(oh-mep′ray-zole)
Good Sense Omeprazole, Losec
, PriLOSEC, PriLOSEC OTC
Func. class.:
Antiulcer, proton pump inhibitor
Chem. class.:
Benzimidazole
Do not confuse:
PriLOSEC
/Prinivil/PROzac/predniSONE
Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cells; characterized as gastric acid pump inhibitor because it blocks the final step of acid production
Gastroesophageal reflux disease (GERD), severe erosive esophagitis, poorly responsive systemic GERD, pathologic hypersecretory conditions (Zollinger-Ellison syndrome, systemic mastocytosis, multiple endocrine adenomas); treatment of active duodenal ulcers with/without antiinfectives for
Helicobacter pylori
Unlabeled uses:
NSAID-induced ulcer prophylaxis, stress gastritis prophylaxis
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children
Calculator
• Adult:
PO
20 mg/day × 4-8 wk; associated with
H. pylori
40 mg q
AM
and clarithromycin 500 mg tid on days 1-14 then 20 mg/day on days 15-28
• Adult:
PO
(del rel cap/del rel susp) 20 mg/day × 4-8 wk
• Adult:
PO
60 mg/day; may increase to 120 mg tid; daily doses >80 mg should be divided
• Adult:
PO
40 mg/day 4-8 wk
• Geriatric:
PO
≤20 mg/day
• Adult:
PO
1 del rel tab (20 mg)/day before
AM
meal with glass of water
Available forms:
Del rel caps 10, 20, 40 mg; del rel tabs 20 mg; granules for oral susp 2.5, 10 mg (del rel)
•
Swallow caps whole; do not crush or chew; caps may be opened and sprinkled over applesauce
•
Before eating, usually in the
AM
, separate with other medications
•
Oral susp powder:
give on empty stomach ≥1 hr before food; if there is NG or enteral feeding tube, do not feed 3 hr before or 1 hr after giving product: contents of packet should be mixed with 1-2 tbls water, add 20 ml water for NG tube; for oral, stir well, drink, add more water, and drink
CNS:
Headache, dizziness, asthenia
CV:
Chest pain, angina, tachycardia, bradycardia, palpitations, peripheral edema,
heart failure
EENT:
Tinnitus, taste perversion
GI:
Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid regurgitation
, abdominal swelling, anorexia, irritable colon, esophageal candidiasis, dry mouth,
hepatic failure
GU:
UTI, urinary frequency, increased creatinine,
proteinuria, hematuria,
testicular pain, glycosuria
HEMA:
Pancytopenia, thrombocytopenia, neutropenia, leukocytosis,
anemia
INTEG:
Rash
, dry skin, urticaria, pruritus, alopecia
META:
Hypoglycemia, increased hepatic enzymes, weight gain, hypomagnesemia, hyponatremia, vit B12 deficiency
MISC:
Back pain
, fever, fatigue, malaise
RESP:
Upper respiratory infections, cough
, epistaxis,
pneumonia
SYST:
Angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis
Bioavailabity 30%-40%; peak 1/2-3½ hr; half-life 1/2-1 hr; protein binding 95%; eliminated in urine as metabolites and in feces; in geriatric patients, elimination rate decreased, bioavailability increased; metabolized by CYP2C19 enzyme system
Increase:
bleeding—warfarin
Increase:
serum levels of diazepam, phenytoin, flurazepam, triazolam, cycloSPORINE, disulfiram, digoxin
Decrease:
effect of iron salts, ketoconazole, cyanocobalamin, calcium carbonate, ampicillin, indinavir, gefitinib
Increase:
alk phos, AST, ALT, bilirubin, gastrin
•
GI system:
bowel sounds q8hr, abdomen for pain, swelling, anorexia, blood in stools
•
Electrolyte imbalances:
hyponatremia; hypomagnesemia in patients using product (3 mo-1 yr); if hypomagnesemia occurs, use of magnesium supplements may be sufficient, if severe, discontinue product
•
Hepatic enzymes:
AST, ALT, alk phos during treatment;
blood studies:
CBC, differential during treatment, blood dyscrasias may occur; vit B12 in long-term treatment
Serious skin reactions:
toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, exfoliative dermatitis; fever, sore throat, fatigue, thin ulcers, lesions in mouth, lips; discontinue product, some serious skin disorders may be fatal
•
Therapeutic response: absence of epigastric pain, swelling, fullness, bleeding: decreased GERD, esophagitis symptoms
•
To report severe diarrhea; black, tarry stools; abdominal cramps/pain; or continuing headache; product may have to be discontinued
•
That, if diabetic, hypoglycemia may occur
•
To avoid hazardous activities because dizziness may occur
•
To avoid alcohol, salicylates, NSAIDs; may cause GI irritation
•
To take as directed, even if feeling better; to take missed dose as soon as remembered; not to double; PriLOSEC OTC takes up to 4 days for full effect