Mosby's 2014 Nursing Drug Reference (341 page)

• Adult:
PO
10-20 mg/day initially then 20-80 mg/day divided bid or daily (monotherapy); start at 5 mg/day (with diuretics)

• Geriatric:
PO
10 mg/day, titrate to desired response (monotherapy); start at 2.5 mg/day (with diuretics)

• Adult:
PO
5 mg bid, may increase weekly until 20-40 mg/day in 2 divided doses

• Adult:
PO
CCr 30-60 ml/min, 5 mg/day initially; CCr <30 ml/min, 2.5 mg/day initially

• 
Tabs may be crushed if necessary

• 
Take 1-2 hr before food or antacids; avoid high-fat foods

• 
Store in airtight container at room temp

Increase:
hypotension—diuretics, other antihypertensives, ganglionic blockers, adrenergic blockers, phenothiazines, nitrates, acute alcohol ingestion

Increase:
toxicity of lithium

Decrease:
absorption of tetracycline, quinolone antibiotics

Decrease:
hypotensive effect of quinapril—NSAIDs

Increase:
potassium, creatinine, BUN, LFTs

 
Collagen-vascular disease:
blood studies: neutrophils, decreased platelets; WBC with differential at baseline, periodically, q3mo; if neutrophils <1000/mm
³
, discontinue treatment

• 
Hypertension:
B/P, orthostatic hypotension, syncope, monitor B/P before giving and after 2 hr, African American patients are more resistant to antihypertension effect

• 
Renal studies: protein, BUN, creatinine; watch for increased levels; may indicate nephrotic syndrome

• 
Baselines of hepatic studies before therapy, periodically; increased LFTs; uric acid, glucose may be increased

• 
Potassium levels; hyperkalemia rare

• 
CHF:
edema in feet, legs daily; weight daily

 
Allergic reactions:
rash, fever, pruritus, urticaria, swelling of eyes/face/throat/neck, SOB, difficulty breathing; product should be discontinued, angioedema is more common in African American patients

Black Box Warning:

For pregnancy (D), 2nd/3rd trimester, if pregnancy is suspected, discontinue use

• 
Therapeutic response: decrease in B/P

• 
Not to discontinue product abruptly

• 
Not to use OTC products (cough, cold, allergy); not to use salt substitutes containing potassium unless directed by prescriber, avoid high-fat meal at same time as product

• 
To comply with dosage schedule, even if feeling better

• 
To rise slowly to sitting or standing position to minimize orthostatic hypotension

• 
To notify prescriber of mouth sores, sore throat, fever, swelling of hands/feet, irregular heartbeat, chest pain, persistent dry cough

• 
To report excessive perspiration, dehydration, vomiting, diarrhea; may lead to fall in B/P

• 
That product may cause dizziness, fainting, lightheadedness; may occur during first few days of therapy

• 
That product may cause skin rash, impaired taste perception

• 
How to take B/P, normal readings for age group

Black Box Warning:

Pregnancy:
to report if pregnancy planned, suspected; pregnancy category (D) 2nd/3rd trimester, do not breastfeed

Black Box Warning:

Cardiac arrhythmias, MI

• Adult:
PO
(ext rel) 324-648 mg q8-12hr;
IM
600 mg then 400 mg q2hr;
IV
give 16 mg/min

• Adult/adolescents/children/infants:
IV Regimen 1:
Loading dose 24/kg (15 mg/kg base) over 4 hr, then 12 mg/kg (7.5 mg/kg base) over 4 hr q8hr, starting 8 hr after beginning of loading dose × 7 days in SE Asia, 3 days in Africa or South America, maintenance infusions may be replaced with PO if feasible;
Regimen 2:
Loading dose IV 10 mg/kg (6.25 base) over 1-2 hr, then 0.02 mg/kg (0.0125/kg/min base) for ≥24 hr

• Adult:
PO
200 mg q2-3hr × 5-8 doses; may increase daily until sinus rhythm restored; max 4 g/day given only after digitalization; maintenance 200-300 mg tid-qid or
EXT REL
300-600 mg q8-12hr

• Adult:
PO
400-600 mg q2-3hr then 200-300 mg q6-8hr or
EXT REL
300-600 mg q8-12hr

• Adult:
PO
200-300 mg q6-8hr or
EXT REL
300-600 mg q8-12hr; max 4 g/day

• Child:
PO
30 mg/kg/day or 900 mg/m
²
/day in 5 divided doses

• 
AV node blocker (digoxin) before starting quinidine to avoid increased ventricular rate

Y-site compatibilities:
Alfentanil, amikacin, anidulafungin, ascorbic acid, atenolol, atracurium, atropine, benztropine, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, caspofungin, chlorproMAZINE, cimetidine, CISplatin, cyanocobalamin, cycloSPORINE, DACTINomycin, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, IDArubicin, imipenem-cilastatin, irinotecan, isoproterenol, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methoxamine, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, milrinone, mitoXANtrone, morphine, multiple vitamins, mycophenolate, nalbuphine, naloxone, nesiritide, netilmicin, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, pentamidine, pentazocine, phenylephrine, phytonadione, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyri
doxine, ranitidine, ritodrine, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, verapamil, vinorelbine, voriconazole, zoledronic acid

Increase:
cardiac depression: other antidysrhythmics, phenothiazines, reserpine

Increase:
effects of neuromuscular blockers, digoxin, warfarin, tricyclics, propranolol

Increase:
QT prolongation—macrolides, quinolones, tricyclics procainamide, antipsychotics

Increase:
quiNIDine effects—cimetidine, sodium bicarbonate, carbonic anhydrase inhibitors, antacids, hydroxide suspensions, amiodarone, verapamil, NIFEdipine, protease inhibitors

Decrease:
quiNIDine effects—barbiturates, phenytoin, rifampin, sucralfate, cholinergics

Increase:
quiNIDine effect—hawthorn

• 
Delayed absorption, decreased metabolism: grapefruit juice

Increase:
Hgb

Decrease:
platelets

Interference:
triamterene therapy interferes with quiNIDine test levels

 
ECG B/P, pulse continuously during IV, baseline, and periodically (PO) to determine increased PR or QRS segments, QT interval; discontinue product or reduce dose

• 
Blood levels (therapeutic level 2-7 mcg/ml), CBC, LFTs

 
For cinchonism:
tinnitus, headache, nausea, dizziness, fever, vertigo, tremor; may lead to hearing loss

• 
Cardiac toxicity:
asystole, ventricular dysrhythmias, widening QRS, torsades de pointes

• 
CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued

• 
Hepatotoxicity:
monitor LFTs for first 1-2 mo of treatment

• 
Therapeutic response: decreased dysrhythmias

• 
That if dizziness, drowsiness occurs, to avoid driving or hazardous activities

• 
To use sunglasses; product may cause sensitivity to light

• 
To carry emergency ID stating disease, medication use

• 
How to take pulse, when to notify prescriber

• 
To avoid all products unless approved by prescriber

• 
Not to crush, chew ext rel product

• 
Do not use grapefruit juice with this product

• 
QuiNIDine toxicity:
visual changes, nausea, headache, ringing in the ears, report immediately

• 
To report signs of cinchonism, diarrhea, anorexia, decreased B/P