Mosby's 2014 Nursing Drug Reference (320 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
OTC
)
Fleet Enema, Phospho-Soda
Func. class.:
Laxative, saline
Increases water absorption in the small intestine by osmotic action; laxative effect occurs by increased peristalsis and water retention
Constipation, bowel or rectal preparation for surgery, exam
Hypersensitivity, rectal fissures, abdominal pain, nausea, vomiting, appendicitis, acute surgical abdomen, ulcerated hemorrhoids, sodium-restricted diet, renal failure, hyperphosphatemia, hypocalcemia, hypokalemia, hypernatremia, Addison’s disease, CHF, ascites, bowel perforation, megacolon, imperforate anus
Black Box Warning:
GI obstruction, renal failure
Precautions:
Pregnancy (C)
Black Box Warning:
Colitis, geriatric hypovolemia, renal disease
Calculator
• Adult:
PO
20-30 ml (Phospho-Soda)
• Child:
PO
5-15 ml (Phospho-Soda)
• Adult and child
>
12 yr:
RECT
1 enema (118 ml)
• Child 2-12 yr:
RECT
1/2 enema (59 ml)
Available forms:
Enema 7 g phosphate/19 g biphosphate/118 ml; oral sol 18 g phosphate/48 g biphosphate/100 ml
•
Alone for better absorption; do not take within 1-2 hr of other products
CV:
Dysrhythmias, cardiac arrest,
hypotension,
widening QRS complex
GI:
Nausea, cramps
, diarrhea
META:
Electrolyte, fluid imbalances
Onset 30 min-3 hr, excreted in feces
•
Stools:
color, amount, consistency; bowel pattern, bowel sounds, flatulence, distention, fever, dietary patterns, exercise; cramping, rectal bleeding, nausea, vomiting; if these occur, product should be discontinued
•
Blood, urine electrolytes if product used often
•
Therapeutic response: decrease in constipation
•
Not to use laxatives for long-term therapy because bowel tone will be lost
•
That normal bowel movements do not always occur daily
•
Not to use in presence of abdominal pain, nausea, vomiting
•
To notify prescriber if constipation unrelieved or if symptoms of electrolyte imbalance occur: muscle cramps, pain, weakness, dizziness, excessive thirst
•
To maintain fluid consumption
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(fye-toe-na-dye′one)
Mephyton, Vit K
Func. class.:
Vit K
1
, fat-soluble vitamin
Needed for adequate blood clotting (factors II, VII, IX, X)
Vit K malabsorption, hypoprothrombinemia, prevention of hypoprothrombinemia caused by oral anticoagulants, prevention of hemorrhagic disease of the newborn
Hypersensitivity, severe hepatic disease, last few weeks of pregnancy
Precautions:
Pregnancy (C), neonates, hepatic disease
Black Box Warning:
IV use
Calculator
• Adult:
PO/IM
2.5-25 mg, may repeat or increase to 50 mg
• Child:
PO
2.5-5 mg
• Infant:
PO/IM
2 mg
• Neonate:
IM
0.5-1 mg within 1 hr after birth, repeat after 2-3 wk if required
• Adult and child:
PO/SUBCUT/IM
1-10 mg, may repeat 12-48 hr after
PO
dose or 6-8 hr after
SUBCUT/IM
dose based on INR
Available forms:
Tabs 5 mg; inj 10 mg/ml, 1 mg/0.5 ml
•
After diluting with ≥10 ml D
5
NS; give max 1 mg/min
IV only when other routes not possible (deaths have occurred)
Y-site compatibilities:
Alfentanil, amikacin, aminophylline, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, ceFAZolin, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, clindamycin, cyanocobalamin, cycloSPORINE, dexamethasone, digoxin, diphenhydrAMINE, DOPamine, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, erythromycin, esmolol, famotidine, fentaNYL, fluconazole, folic acid, furosemide, ganciclovir, gentamicin, glycopyrrolate, heparin, hydrocortisone, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, lidocaine, mannitol, meperidine, metaraminol, methoxamine, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, ondansetron, oxacillin, oxytocin, papaverine, penicillin G potassium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, potassium chloride, procainamide, prochlorperazine, propranolol, pyridoxime, ranitidine, sodium bicarbonate, succinylcholine, SUFentanil, theophylline, thiamine, ticarcillin/clavulanate, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, verapamil, vitamin B with C
CNS:
Headache,
brain damage
(large doses)
GI:
Nausea, decreased LFTs
HEMA:
Hemolytic anemia, hemoglobinuria, hyperbilirubinemia
INTEG:
Rash, urticaria
RESP:
Bronchospasm,
dyspnea, feeling of chest constriction,
respiratory arrest
PO/INJ:
Metabolized, crosses placenta
Decrease:
action of phytonadione—bile acid sequestrants, sucralfate, antiinfectives, salicylates, mineral oil
Decrease:
action of warfarin—large dose of product
•
Bleeding:
emesis, stools, urine; pressure on all venipuncture sites; avoid all inj if possible
•
PT during treatment (2-sec deviation from control time, bleeding time, clotting time); monitor for bleeding, pulse, and B/P
•
Storage in tight, light-resistant container
•
Therapeutic response: prevention of hemorrhagic disease of the newborn, resolution of hypoprothrombinemia
•
Not to take other supplements, OTC products, prescription products unless directed by prescriber
•
About the necessary foods for associated diet
•
To avoid IM inj; to use soft toothbrush; not to floss, use electric razor until coagulation defect corrected
•
To report symptoms of bleeding
•
About the importance of frequent lab tests to monitor coagulation factors
•
To notify all health care providers of use of this product
•
To carry emergency ID describing condition and products used
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
See
Appendix B
(pie-oh-glye′ta-zone)
Actos
Func. class.:
Antidiabetic, oral
Chem. class.:
Thiazolidinedione
Specifically targets insulin resistance; an insulin sensitizer; regulates the transcription of a number of insulin-responsive genes
Type 2 diabetes mellitus
Breastfeeding, children, hypersensitivity to thiazolidinedione, diabetic ketoacidosis
Black Box Warning:
NYHA Class III/IV heart failure
Precautions:
Pregnancy (C), geriatric patients, geriatric patients with CV disease, renal/hepatic/thyroid disease, edema, polycystic ovary syndrome, bladder cancer, osteoporosis, pulmonary disease, secondary malignancy
Calculator
• Adult:
PO
15 or 30 mg/day, may increase to 45 mg/day; with strong CYP2C8, max 15 mg/day; with NYHA class I/II heart failure, max 15 mg/day
• Adult:
PO
15 or 30 mg/day with a sulfonylurea, metformin, or insulin; decrease sulfonylurea dose if hypoglycemia occurs; decrease insulin dose by 10%-25% if hypoglycemia occurs or if plasma glucose is <100 mg/dl, max 45 mg/day
•
Do not use in active hepatic disease or if ALT >2.5 times ULN
Available forms:
Tabs 15, 30, 45 mg
•
Once a day; without regard to meals
•
Tabs crushed and mixed with food or fluids for patients with difficulty swallowing
CNS:
Headache
CV:
MI, heart failure, death (geriatric patients)
ENDO:
Hypo/hyperglycemia
MISC:
Sinusitis, upper respiratory tract infection, pharyngitis
,
hepatotoxicity,
edema, weight gain, anemia, macular edema;
risk of bladder cancer (use >1 yr)
MS:
Rhabdomyolysis,
fractures (females), myalgia
Maximal reduction in FBS after 12 wk; half-life 3-7 hr, terminal 16-24 hr; protein binding >99%
Decrease:
effect of atorvastatin
Decrease:
effect of oral contraceptives; use alternative contraceptive method
Decrease:
pioglitazone effect—CYP2C8 inducers (ketoconazole, fluconazole, itraconazole, miconazole, voriconazole)
Increase:
hypoglycemia—garlic, green tea, horse chestnut
Increase:
CPK, LFTs, HDL, cholesterol
Decrease:
glucose, Hct/Hgb
Black Box Warning:
Heart failure: do not use in NYHA Class III/IV; excessive/rapid weight gain >5 lb, dyspnea, edema; may need to be reduced or discontinued
• Bladder cancer:
avoid use in a history of bladder cancer; use of pioglitazone >1 yr has shown an increase in bladder cancer
•
Hypoglycemic reactions:
sweating, weakness, dizziness, anxiety, tremors, hunger; hyperglycemic reactions soon after meals (rare); may occur more often with insulin or other antidiabetics
• Hepatic disease:
check LFTs periodically: AST, LDH; do not start treatment in active heart disease or if ALT >2.5× upper limit of normal; if treatment has already begun, follow closely with continuing ALT levels; if ALT increases to >3× upper limit of normal, recheck ALT as soon as possible; if ALT remains >3× upper limit of normal, discontinue
• FBS, glycosylated HbA1c, plasma lipids/lipoproteins, B/P, body weight during treatment
•
CBC with differential prior to and during therapy; more necessary in those with anemia, Hct/Hgb (may be decreased in first few months of treatment)
•
Conversion from other oral hypoglycemic agents; change may be made with gradual dosage change; monitor serum glucose during conversion
•
Storage in tight container in cool environment
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; blood glucose A1c improvement
•
To self-monitor using a blood glucose meter
•
About the symptoms of hypo/hyperglycemia, what to do about each
•
That product must be continued on daily basis; about the consequences of discontinuing product abruptly
•
To avoid OTC medications or herbal preparations unless approved by prescriber
•
That diabetes is a lifelong illness; that product is not a cure, it only controls symptoms
• To notify prescriber if oral contraceptives are used, effect may be decreased; not to use product if breastfeeding
• To report symptoms of hepatic dysfunction: nausea, vomiting, abdominal pain, fatigue, anorexia, dark urine, jaundice
•
To report weight gain, edema
•
That lab work, eye exams will be needed periodically