Mosby's 2014 Nursing Drug Reference (332 page)

• Adult:
PO
2-4 mg/kg/day for 1st wk; maintain dosage of 4-6 mg/kg/day until platelets, WBC fall; after recovery, 1-2 mg/kg/day

• Child:
PO
50 mg/m
²
/day for 7 days then 100 mg/m
²
until desired response, leukopenia, or thrombocytopenia occurs; 50 mg/m
²
/day maintenance after bone marrow recovery

• 
In divided doses and at bedtime to minimize nausea and vomiting

• 
Nonphenothiazine antiemetic 30-60 min before product and 4-10 hr after treatment to prevent vomiting

Increase:
neuroleptic malignant syndrome, seizures, hyperpyrexia—alcohol, MAOIs, tricyclics, sympathomimetic products, SSRIs, SNRIs

Increase:
hypertension—guanethidine, levodopa, methyldopa, reserpine, caffeine

Increase:
bleeding risk—NSAIDs, anticoagulants, platelet inhibitors, thrombolytics

Increase:
CNS depression—barbiturates, antihistamines, opioids, hypotensive agents, phenothiazines

• 
Hypertensive crisis: tyramine foods

• 
Bone marrow suppression:
CBC, differential, platelet count weekly; withhold product if WBC is <4000/mm
³
or platelet count is <100,000/mm
³
; notify prescriber

• 
Hepatic/renal disease:
can cause accumulation of drug, increased toxicity; renal studies: BUN; serum uric acid; urine CCr; electrolytes before, during therapy; I&O ratio, report fall in urine output to <30 ml/hr; hepatic studies before, during therapy: bilirubin, AST, ALT, alk phos, LDH prn or monthly

• 
Monitor temp; fever may indicate beginning infection

Black Box Warning:

To be used only in a specialized care setting with emergency equipment

Black Box Warning:

To be given only by an experienced clinician knowledgeable in cytotoxic products

• 
CNS changes: confusion, paresthesias, neuropathies; product should be discontinued

 
Tyramine foods in diet; hypertensive crisis can occur

 
Toxicity:
facial flushing, epistaxis, increased PT, thrombocytopenia; product should be discontinued

• 
Bleeding:
hematuria, guaiac stools, bruising or petechiae, mucosa or orifices q8hr

• 
Effects of alopecia on body image; discuss feelings about body changes

• 
Jaundiced skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea

• 
Buccal cavity for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia

• 
GI symptoms: frequency of stools, cramping

• 
Acidosis, signs of dehydration:
rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness

• 
Therapeutic response: decreasing malignancy

• 
To report any complaints, side effects to nurse or prescriber: CNS changes, diarrhea, cough, SOB, fever, chills, sore throat, bleeding, bruising, vomiting blood; black, tarry stools

• 
That hair may be lost during treatment and wig or hairpiece may make patient feel better; that new hair may be different in color, texture

• 
To avoid sunlight or UV exposure; to wear sunscreen or protective clothing

• 
To avoid foods with citric acid, hot or rough texture

• 
To report any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily

• 
To avoid driving, activities requiring alertness because dizziness may occur

• 
To use effective contraception; to avoid breastfeeding; that product may cause infertility

• 
To avoid the ingestion of alcohol, caffeine, tyramine-containing foods; that cold, hay fever, and weight-reducing products may cause serious product interactions; to avoid smoking

• 
To avoid crowds, persons with infections if granulocytes are low

• 
To avoid vaccines

Black Box Warning:

Increased mortality in elderly patients with dementia-related psychosis

• Adult:
IM
5-10 mg 1-2 hr before anesthesia; may repeat after 30 min;
IV
5-10 mg 15-30 min before anesthesia;
IV INF
20 mg/L D
₅
W or
NS
15-30 min before anesthesia, max 40 mg/day

• Adult:
PO
5-10 mg tid-qid;
SUS REL
15 mg/day in
AM
or 10 mg q12hr;
RECT
25 mg/bid;
IM
5-10 mg q3-4hr prn, max 40 mg/day

• Child 18-39 kg:
PO
2.5 mg tid or 5 mg bid;
IM
0.132 mg/kg q3-4hr prn, max 15 mg/day

• Child 14-17 kg:
PO/RECT
2.5 mg bid-tid;
IM
0.132 mg/kg q3-4hr prn, max 10 mg/day

• Child 9-13 kg:
PO/RECT
2.5 mg/day-bid;
IM
0.132 mg/kg q3-4hr prn, max 7.5 mg/day

• Adult and child
≥
12 yr:
PO
5-10 mg tid-qid; may increase q2-3days, max 150 mg/day;
IM
10-20 mg q2-4hr up to 4 doses then 10-20 mg q4-6hr

• Child 2-12 yr:
PO
2.5 mg bid-tid;
IM
0.132 mg/kg change to oral ASAP

• Adult and child
≥
12 yr:
PO
5 mg tid-qid, max 20 mg/day

• Child 2-12 yr:
IM
0.132 mg/kg change to oral ASAP

• 
Avoid other CNS depressants

Syringe compatibilities:
Atropine, butorphanol, chlorproMAZINE, cimetidine, diamorphine, diphenhydrAMINE, droperidol, fentaNYL, glycopyrrolate, hydrOXYzine, meperidine, metoclopramide, nalbuphine, pentazocine, perphenazine, promazine, promethazine, ranitidine, scopolamine, SUFentanil

Y-site compatibilities:
Amsacrine, calcium gluconate, cisatracurium, CISplatin, cladribine, cyclophosphamide, cytarabine, DOXOrubicin, DOXOrubicin liposome, fluconazole, granisetron, heparin, hydrocortisone, melphalan, methotrexate, ondansetron, PACLitaxel, potassium chloride, propofol, remifentanil, sargramostim, SUFentanil, teniposide, thiotepa, vinorelbine, vit B/C

CNS:
Neuroleptic malignant syndrome,
extrapyramidal reactions, tardive dyskinesia, euphoria
,
depression,
drowsiness
, restlessness, tremor, dizziness, headache

CV:
Circulatory failure, tachycardia,
hypotension, ECG changes

EENT:
Blurred vision

GI:
Nausea, vomiting, anorexia, dry mouth, diarrhea, constipation, weight loss, metallic taste, cramps

HEMA:
Agranulocytosis

MISC:
Impotence

RESP:
Respiratory depression

Increase:
anticholinergic action—anticholinergics, antiparkinson products, antidepressants

Increase:
CNS depression—CNS depressants

Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs

Decrease:
prochlorperazine effect—barbiturates, antacids, lithium

Increase:
CNS depression—chamomile, hops, kava, St. John’s wort, valerian

Increase:
EPS—kava

Increase:
LFTs, cardiac enzymes, cholesterol, blood glucose, prolactin, bilirubin, PBI,
¹³¹
I, alk phos, leukocytes, granulocytes, platelets

Decrease:
hormones (blood and urine)

False positive:
pregnancy tests, urine bilirubin

False negative:
urinary steroids, 17-OHCS, pregnancy tests

• 
EPS:
abnormal movement, tardive dyskinesia, akathisia

• 
VS, B/P; check patients with cardiac disease more often

 
Neuroleptic malignant syndrome:
seizures, hypo/hypertension, fever, tachycardia, dyspnea, fatigue, muscle stiffness, loss of bladder control; notify prescriber immediately

 
CBC, LFTs during course of treatment; blood dyscrasias, hepatotoxicity may occur

• 
Respiratory status before, during, after administration of emetic; check rate, rhythm, character; respiratory depression can occur rapidly among geriatric or debilitated patients

• 
Therapeutic response: absence of nausea, vomiting; reduced anxiety, agitation, excitability

• 
To avoid hazardous activities, activities requiring alertness because dizziness may occur

• 
To avoid alcohol

• 
Not to double or skip doses

• 
That urine may be pink to reddish brown

• 
That suppositories may contain coconut/palm oil

• 
To report dark urine, clay-colored stools, bleeding, bruising, rash, blurred vision

• 
To avoid sun; wear sunscreen, protective clothing