Mosby's 2014 Nursing Drug Reference (334 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pro-paff′e-nown)
Rythmol, Rythmol SR
Func. class.:
Antidysrhythmic (class IC)
Slows conduction velocity; reduces membrane responsiveness; inhibits automaticity; increases ratio of effective refractory period to action potential duration; β-blocking activity
Sustained ventricular tachycardia, atrial fibrillation (single dose), paroxysmal supraventricular tachycardia (PSVT) prophylaxis, supraventricular dysrhythmias
Unlabeled uses:
Wolff-Parkinson-White (WPW) syndrome
2nd/3rd-degree AV block, right bundle branch block, cardiogenic shock, hypersensitivity, bradycardia, uncontrolled CHF, sick-sinus syndrome, marked hypotension, bronchospastic disorders, electrolyte imbalance
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, CHF, hypo/hyperkalemia, nonallergic bronchospasm, renal/hepatic disease, hematologic disorders, myasthenia gravis
Black Box Warning:
Recent MI, cardiac arrhythmias, QT prolongation, torsades de pointes
Calculator
• Adult:
PO
150 mg q8hr; allow 3-4 day interval before increasing dose, max 900 mg/day
• Adult:
PO
450 or 600 mg as single dose; SR 225 mg q12hr, may increase to 325 q12hr, max 425 mg q12hr
Available forms:
Tabs 150, 225, 300 mg; SR cap 225, 325, 425 mg
•
Do not break, crush, or chew tabs; swallow whole
•
To hospitalized patients because heart monitoring is required
•
After hypo/hyperkalemia is corrected
•
With dosage adjustment q3-4days
•
Without regard to meals
CNS:
Headache, dizziness, abnormal dreams, syncope, confusion,
seizures,
insomnia, tremor, anxiety, fatigue
CV:
Supraventricular dysrhythmia, ventricular dysrhythmia, bradycardia,
prodysrhythmia, palpitations, AV block, intraventricular conduction delay, AV dissociation, hypotension, chest pain,
asystole
EENT:
Blurred vision, altered taste, tinnitus
GI:
Nausea, vomiting
, constipation, dyspepsia, cholestasis, abnormal hepatic studies, dry mouth, diarrhea, anorexia
HEMA:
Leukopenia, agranulocytosis, granulocytopenia, thrombocytopenia,
anemia, bruising
INTEG:
Rash
RESP:
Dyspnea
Peak 3-8 hr, half-life 2-10 hr; metabolized in liver; excreted in urine (metabolite)
Increase:
propafenone effects—CYP1A2, CYP2D6, CYP3A4 inhibitors (protease inhibitors, quiNINE, PARoxetine, saquinavir, erythromycin, azole antifungals, sertraline, tricyclics)
Increase:
QT prolongation—other class IA/IC antidysrhythmics, arsenic trioxide, chloroquine, clarithromycin, droperidol, erythromycin, haloperidol, levomethadyl, methadone, pentamidine, chlorproMAZINE, mesoridazine, thioridazine
Increase:
anticoagulation—warfarin
Increase:
CNS effects—local anesthetics
Increase:
digoxin level—digoxin
Increase:
β-blocker effect—propranolol, metoprolol
Increase:
cycloSPORINE levels—cycloSPORINE
Decrease:
propafenone effect—rifampin, cimetidine, quiNIDine
Increase:
CPK
•
GI status: bowel pattern, number of stools
Black Box Warning:
QT/PR prolongation:
ECG or Holter monitor prior to and during therapy
Black Box Warning:
CHF:
dyspnea, jugular venous distention, crackles, edema in extremities, I&O ratio; check for decreasing output; daily weight
•
CBC, ANA titer, LFTs
•
Chest x-ray, pulmonary function test during treatment
•
Lung fields; bilateral crackles, dyspnea, peripheral edema, weight gain; jugular venous distention may occur in patient with CHF
Toxicity:
fine tremors, dizziness, hypotension, drowsiness, abnormal heart rate
•
Therapeutic response: absence of ventricular dysrhythmias; decreasing recurrence of PAF, PSVT
•
To avoid hazardous activities until response is known
•
To report fever, chills, sore throat, bleeding, SOB, chest pain, palpitations, blurred vision
•
To take tab with food
•
To carry emergency ID identifying medication and prescriber
•
To avoid abrupt discontinuation of product; to take as prescribed; not to miss, double doses
O
2
, artificial ventilation, defibrillation ECG; administer DOPamine for circulatory depression, diazepam or thiopental for seizures, isoproterenol
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERT(pro′poh-fole)
Diprivan, Fresenius Propoven
Func. class.:
General anesthetic
Produces dose-dependent CNS depression by activation of GABA receptor
Induction or maintenance of anesthesia as part of balanced anesthetic technique; sedation in mechanically ventilated patients
Hypersensitivity to this product or soybean oil, egg, benzyl alcohol (some products)
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, respiratory depression, severe respiratory disorders, cardiac dysrhythmias, labor and delivery, renal disease, hyperlipidemia
Calculator
• Adult
<
55 yr and asa I/II IV (diprivan or generic):
IV
40 mg q10sec until induction onset, maintenance 100-200 mcg/kg/min or
IV BOL
20-50 mg prn, allow 3-5 min between adjustments; Fresenius Propoven 1%
IV
20-40 q10sec until induction then 3-6 mg/kg/hr
• Child
≥
3 yr or asa I or II:
IV induction:
2.5-3.5 mg/kg over 20-30 sec when not premedicated or lightly premedicated
• Child 2 mo-16 yr maintenance:
IV
125-300 mcg/kg/min, lower dose for ASA III or
IV
• Adult:
IV
5 mcg/kg/min over 5 min; may increase by 5-10 mcg/kg/min over 5-10 min until desired response (Diprivan or generic): 0.3-4 mg/kg/hr, max 4 mg/kg/hr (Fresenius Propoven)
Available forms:
Inj 10 mg/ml in 20-ml ampule, 50-ml and 100-ml vials
•
Shake well before use; dilution is not necessary but, if diluted, use only D
5
W to ≥2 mg/ml; give over 3-5 min, titrate to needed level of sedation; use only glass containers when mixing, not stable in plastic; use aseptic technique when transferring from original container
•
Fresenius Propoven 1%:
dilution is not necessary but, if diluted, use D
5
W or NS to ≥2 mg/ml (max dilution max 1 part Fresenius Propoven/4 parts D
5
W or NS); do not admix; lidocaine can be used to reduce pain at site
•
May be given by cont inf; give by inf pump
•
Only with resuscitative equipment available; only by qualified persons trained in anesthesia
Y-site compatibilities:
Acyclovir, alfentanil, aminophylline, ampicillin, aztreonam, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, ceFAZolin, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dexamethasone, diphenhydrAMINE, DOBUTamine, DOPamine, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, esmolol, famotidine, fentaNYL, fluconazole, fluorouracil, furosemide, ganciclovir, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem/cilastatin, inamrinone, regular insulin, isoproterenol, ketamine, labetalol, levorphanol, lidocaine, LORazepam, magnesium sulfate, mannitol, meperidine, mezlocillin, miconazole, morphine, nafcillin, nalbuphine, naloxone, nitroglycerin, norepinephrine, ofloxacin, PACLitaxel, PENTobarbital, PHENobarbital, piperacillin, potassium chloride, prochlorperazine, propranolol, ranitidine, scopolamine, sodium bicarbonate, sodium nitroprusside, succinylcholine, SUFentanil, thiopental ticarcillin, ticarcillin/clavulanate, vecuronium, verapamil
Solution compatibilities:
if given together via
Y
-site: D
5
W, D
5
LR, LR, D
5
/0.45% NaCl, D
5
/0.2% NaCl
CNS:
Involuntary movement, headache, jerking, fever, dizziness, shivering, tremor, confusion, somnolence, paresthesia, agitation, abnormal dreams, euphoria fatigue,
increased intracranial pressure, impaired cerebral flow, seizures
CV:
Bradycardia, hypotension
, hypertension, PVC, PAC, tachycardia, abnormal ECG, ST segment depression,
asystole, bradydysrhythmias
EENT:
Blurred vision, tinnitus, eye pain, strange taste, diplopia
GI:
Nausea, vomiting, abdominal cramping
, dry mouth, swallowing, hypersalivation,
pancreatitis
GU:
Urine retention, green urine, cloudy urine, oliguria
INTEG:
Flushing, phlebitis, hives, burning/stinging at inj site
, rash, pain of extremities
MS:
Myalgia
RESP:
Apnea,
cough, hiccups
, dyspnea, hypoventilation, sneezing, wheezing, tachypnea, hypoxia, respiratory acidosis
SYST:
Propofol infusion syndrome
Onset 15-30 sec, rapid distribution, half-life 1-8 min, terminal half-life 3-12 hr; 70% excreted in urine; metabolized in liver by conjugation to inactive metabolites, 95%-99% protein binding
•
Do not use within 10 days of MAOIs
Increase:
CNS depression—alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants, inhalational anesthetics
Increase:
propofol effect—St. John’s wort
•
Inj site: phlebitis, burning, stinging
•
ECG
for changes: PVC, PAC, ST segment changes; monitor VS
•
Neurologic excitatory symptoms:
movement, tremors, dizziness, LOC, pupil reaction
•
Allergic reactions: hives
Respiratory dysfunction:
respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min
•
Propofol infusion syndrome:
rhabdomyolysis, renal failure, hyperkalemia, metabolic acidosis, cardiac dysrhythmias, heart failure usually between 35 and 93 hr after inf begun at >5 mg/kg/hr for >58 hr
•
Storage in light-resistant area at room temp, use within 6 hr of opening
•
If transferred from original container to another container, complete inf within 12 hr (Dipravan), 6 hr (generic propofol)
•
Therapeutic response: induction of anesthesia
•
That product will cause dizziness, drowsiness, sedation; to avoid hazardous activities until drug effect wears off
Discontinue product; administer vasopressor agents or anticholinergics, artificial ventilation