Mosby's 2014 Nursing Drug Reference (338 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
, Rx)
(sill′ee-um)
Hydrocil, Leader Fiber Laxative, Metamucil, Natural Fiber, Natural Vegetable Fiber, Reguloid, Wal-Mucil
Func. class.:
Bulk laxative
Chem. class.:
Psyllium colloid
Bulk-forming laxative
Chronic constipation, ulcerative colitis
Unlabeled uses:
Diarrhea, diverticulosis, irritable bowel syndrome, hypercholesterolemia
Hypersensitivity, intestinal obstruction, abdominal pain, nausea, vomiting, fecal impaction
Precautions:
Pregnancy (C)
Calculator
• Adult:
PO
1-2 tsp in 8 oz water bid or tid then 8 oz water or 1 premeasured packet in 8 oz water bid or tid, then 8 oz water
• Child
>
6 yr:
PO
1 tsp in 4 oz water at bedtime
Available forms:
Chew pieces 1.7, 3.4 g/piece; effervescent powder 3.4, 3.7 g/
packet; powder 3.3, 3.4, 3.5, 4.94 g/tsp; wafers 3.4 g/wafer
•
Alone for better absorption, separate from other products by 1-2 hr
•
In morning or evening (oral dose)
•
Immediately after mixing with water or will congeal
•
With 8 oz water or juice followed by another 8 oz of fluid
GI:
Nausea, vomiting, anorexia, diarrhea
, cramps, intestinal esophageal blockage
Onset 12-72 hr, excreted in feces, not absorbed in GI tract
Decrease:
absorption of cardiac glycosides, oral anticoagulants, salicylates
Increase:
laxative effect—flax, senna
•
Blood, urine electrolytes if used often
•
I&O ratio to identify fluid loss
•
Constipation:
cause of constipation; fluids, bulk, exercise missing; bowel sounds, distention, usual bowel function; color, consistency, amount
•
Cramping, rectal bleeding, nausea, vomiting; product should be discontinued
•
Therapeutic response: decrease in constipation, decreased diarrhea with colitis
•
To maintain adequate fluid consumption
•
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
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(peer-id-oh-stig′meen)
Mestinon, Mestinon Timespan, Regonol
Func. class.:
Cholinergic; anticholinesterase
Chem. class.:
Tertiary amine carbamate
Inhibits destruction of acetylcholine, which increases concentration at sites where acetylcholine is released; this facilitates the transmission of impulses across the myoneural junction
Nondepolarizing muscle relaxant antagonist, myasthenia gravis, pretreatment for nerve gas exposure (military only)
Bradycardia; hypotension; obstruction of intestine, renal system; bromide, benzyl alcohol sensitivity; adrenal insufficiency; cholinesterase inhibitor toxicity
Precautions:
Pregnancy (C), seizure disorders, bronchial asthma, coronary occlusion, hyperthyroidism, dysrhythmias, peptic ulcer, megacolon, poor GI motility
Calculator
• Adult:
PO
600 mg/day in 5-6 divided doses, max 1.5 g/day;
IM/IV
2 mg or 1/30 of
PO
dose;
SUS REL
180-540 mg/day or bid at intervals of ≥6 hr
• Child:
PO
7 mg/kg/day in 5-6 divided doses;
IM/IV
0.05-0.15 mg/kg/dose
• Adult:
0.6-1.2 mg IV
atropine then 0.1-0.25 mg/kg/dose
• Child:
IV
0.1-0.25 mg/kg/dose
• Adult:
PO
30 mg q8hr if threat of exposure to Soman gas is anticipated; start several hours prior to exposure and discontinue upon exposure; after product is discontinued, give antidotes (atropine, pralidoxime)
Available forms:
Tabs 60 mg; ext rel tabs 180 mg; syr 60 mg/5 ml; inj 5 mg/ml
•
Only with atropine sulfate available for cholinergic crisis
•
Only after all other cholinergics have been discontinued
•
Increased doses for tolerance as ordered
•
Larger doses after exercise or fatigue as ordered
•
Do not break, crush, or chew sus rel tabs
•
On empty stomach for better absorption
•
Undiluted (5 mg/ml), give through
Y
-tube or 3-way stopcock, give ≤0.5 mg/min (myasthenia gravis); 5 mg/min (reversal of nondepolarizing neuromuscular blockers)
Syringe compatibilities:
Glycopyrrolate
Y-site compatibilities:
Heparin, hydrocortisone, potassium chloride, vit B/C
CNS:
Dizziness, headache, sweating, weakness,
seizures,
incoordination,
paralysis,
drowsiness, LOC
CV:
Tachycardia, dysrhythmias, bradycardia, AV block, hypotension, ECG changes,
cardiac arrest,
syncope
EENT:
Miosis, blurred vision, lacrimation, visual changes
GI:
Nausea, diarrhea, vomiting, cramps, increased salivary and gastric secretions, peristalsis
GU:
Urinary frequency, incontinence, urgency
INTEG:
Rash, urticaria, flushing
RESP:
Respiratory depression, bronchospasm, constriction, laryngospasm, respiratory arrest
SYST:
Cholinergic crisis
Metabolized in liver, excreted in urine (unchanged)
PO:
Onset 20-30 min, duration 3-6 hr
PO-EXT rel:
Onset 30-60 min, duration 6-12 hr
IM/IV/SUBCUT:
Onset 2-15 min, duration 2½-4 hr
Increase:
action—succinylcholine
Decrease:
action—gallamine, metocurine, pancuronium, tubocurarine, atropine
Decrease:
pyridostigmine action—aminoglycosides, anesthetics, procainamide, quiNIDine, mecamylamine, polymyxin, magnesium, corticosteroids, antidysrhythmics, quinolones
•
Myasthenia gravis:
fatigue, ptosis, diplopia, difficulty swallowing, SOB, hand/gait before, after product; improvement should be seen after 1 hr
•
VS, respiration q8hr
•
I&O ratio; check for urinary retention or incontinence
•
Toxicity:
bradycardia, hypotension, bronchospasm, headache, dizziness, seizures, respiratory depression; product should be discontinued if toxicity occurs
•
Therapeutic response: increased muscle strength, hand grasp, improved gait, absence of labored breathing (if severe); reversal of nondepolarizing neuromus
cular blockers; prevention of nerve gas toxicity
•
Myasthenia gravis:
that product is not a cure, only relieves symptoms
•
To wear emergency ID specifying myasthenia gravis, products taken
•
To avoid driving, other hazardous activities until effect is known
•
To report muscle weakness (cholinergic crisis or underdosage), bradycardia
•
Not to drink alcohol
•
To take with food to decrease gastric side effects
Discontinue product, atropine 1-4 mg IV
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert