Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (344 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(rah-mel′tee-on)
Rozerem
Func. class.:
Sedative/hypnotic, antianxiety
Chem. class.:
Melatonin receptor agonist
Binds selectively to melatonin receptors (MT
1
, MT
2
); thought to be involved in circadian rhythms and in the normal sleep/wake cycle
Insomnia (difficulty with sleep onset)
Breastfeeding, children, infants, hypersensitivity, alcohol intoxication, hepatic encephalopathy
Precautions:
Pregnancy (C), hepatic disease, alcoholism, COPD, seizure disorder, sleep apnea, suicidal ideation, angioedema, depression, sleep-related behaviors (sleepwalking), schizophrenia, bipolar disorder
Calculator
• Adult:
PO
8 mg at bedtime
•
Do not use with severe hepatic disease; use with caution for mild to moderate hepatic disease
Available forms:
Tabs 8 mg
•
Within 30 min of bedtime for sleeplessness; on empty stomach for fast onset
•
Do not break tabs, swallow whole
CNS:
Dizziness, somnolence, fatigue, headache, insomnia, depression, complex sleep-related reactions (sleep driving, sleep eating),
suicidal thoughts/behaviors
GI:
Nausea, diarrhea, dysgeusia, vomiting
MISC:
Myalgia, arthralgia, decreased blood cortisol, influenza, upper RI
SYST:
Severe allergic reactions, angioedema
Absorbed rapidly; peak 0.75 hr; protein binding 82%; rapid first pass metabolism via liver; 84% excreted in urine, 4% in feces; half-life 2-5 hr
Possible toxicity: antiretroviral protease inhibitors
Increase:
ramelteon effect, toxicity—alcohol; CYP1A2 inhibitors, azole antifungals (ketoconazole, fluconazole), fluvoxaMINE, anxiolytics, sedatives, hypnotics, barbiturates, ciprofloxacin
Decrease:
effect of ramelteon—rifampin
•
Prolonged absorption, sleep onset reduced: high-fat/heavy meal
Severe hypersensitive reactions:
Assess for angioedema (facial swelling), product should be discontinued
•
Sleep characteristics:
type of sleep problem: falling asleep, staying asleep; complex sleep disorders (sleep walking/driving/eating) after taking product
•
Mental status: mood, sensorium, affect, memory (long, short term), suicidal ideation
•
LFTs: before treatment, periodically
•
Storage in tight container in cool environment
•
Therapeutic response: ability to sleep at night, decreased amount of early morning awakening
•
To avoid driving, other activities requiring alertness until product stabilized, drowsiness may continue the next day
•
To avoid alcohol ingestion, CNS depressants
•
About alternative measures to improve sleep: reading, exercise several hr before bedtime, warm bath, warm milk, TV, self-hypnosis, deep breathing
•
To report if pregnancy is planned or suspected (C), avoid breastfeeding
•
To take product immediately before going to bed
•
Not to ingest a high-fat/heavy meal before taking product
To report cessation of menses, galactorrhea (women), decreased libido, infertility, worsening of insomnia, behavioral changes, severe allergic reactions, suicidal thoughts/behaviors, if insomnia gets worse
•
Med guide should be given to patient and reviewed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ra-mi′pril)
Altace
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin-converting enzyme inhibitor (ACE)
Do not confuse:
ramipril
/enalapril
Altace
/alteplase
Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE, prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial, venous vessels
Hypertension, alone or in combination with thiazide diuretics; CHF (post-MI), reduction in risk for MI, stroke, death from CV disorders
Unlabeled uses:
Proteinuria due to diabetic nephropathy
Breastfeeding, children, hypersensitivity to ACE inhibitors, history of ACE-inhibitor–induced angioedema
Black Box Warning:
Pregnancy (D) 2nd/3rd trimesters
Precautions:
Geriatric patients, impaired renal/hepatic function, dialysis
patients, hypovolemia, blood dyscrasias, CHF, COPD, asthma, renal artery stenosis, cough, African American patients
Calculator
• Adult:
PO
2.5 mg/day initially then 2.5-20 mg/day divided bid or daily
• Adult:
PO
1.25-2.5 mg bid; may increase to 5 mg bid
• Adult:
PO
2.5 mg/day × 7 days then 5 mg/day × 21 days, then may increase to 10 mg/day
• Adult: PO
CCr <40 ml/min, reduce by 50%, titrate upward to max 5 mg/day
• Adult:
PO
2.5 mg/day up to 20 mg/day
Available forms:
Caps 1.25, 2.5, 5, 10 mg
•
Without regard to meals
•
Caps can be opened, added to food, mixture is stable for 24 hr at room temperature, 48 hr refrigerated
CNS:
Headache, dizziness
, anxiety, insomnia, paresthesia,
fatigue
, depression, malaise, vertigo
CV:
Hypotension
, chest pain, palpitations, angina, syncope, dysrhythmia,
heart failure, MI
EENT:
Hearing loss
GI:
Nausea
, constipation, vomiting, dyspepsia, dysphagia, anorexia, diarrhea, abdominal pain,
hepatitis, hepatic failure, pancreatitis, hepatic necrosis
GU:
Proteinuria,
increased BUN, creatinine, impotence
HEMA:
Decreased Hct, Hgb,
eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis (rare)
INTEG:
Rash, sweating, photosensitivity, pruritus
META:
Hyperkalemia
, hyperglycemia
MISC:
Angioedema, toxic epidermal necrolysis, anaphylaxis, Stevens-Johnson syndrome
MS:
Arthralgia, arthritis, myalgia
RESP:
Cough
, dyspnea
Bioavailability >50%-60%, onset 1-2 hr, peak 3-6 hr, duration 24 hr, protein binding 73%, half-life 1-2 hr, 9-18 hr for active metabolite, metabolized by liver (metabolites excreted in urine, feces)
Increase:
hypotension—diuretics, other antihypertensives, ganglionic blockers, adrenergic blockers, nitrates, acute alcohol ingestion
Increase:
toxicity—vasodilators, hydrALAZINE, prazosin, potassium-sparing diuretics, sympathomimetics, potassium supplements
Increase:
serum levels of lithium
Decrease:
absorption—antacids
Decrease:
antihypertensive effect—indomethacin, NSAIDs, salicylates
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra
Increase:
hyperkalemia—potassium salt substitutes, avoid use
Increase:
LFTs, BUN, creatinine, glucose, potassium
Decrease:
RBC, Hgb, platelets
Collagen-vascular disease (SLE, scleroderma):
neutrophils, decreased platelets; WBC with differential at baseline, periodically; if neutrophils <1000/mm
3
, discontinue treatment
•
Hypertension:
Monitor B/P baseline and regularly, orthostatic hypotension, syncope
•
Potassium levels; hyperkalemia occurs
•
Renal disease:
protein, BUN, creatinine, potassium, sodium at baseline, periodically; increased levels may indicate nephrotic syndrome; renal symptoms: polyuria, oliguria, urinary frequency, dysuria
•
CHF:
edema in feet, legs daily; weight daily
Serious allergic reactions:
angioedema, Stevens-Johnson syndrome, rash, fever, pruritus, urticaria; product should be discontinued if antihistamines fail to help
•
Monitor electrolytes baseline and periodically, potassium may be increased
•
Storage in tight container at ≤86° F (30° C)
•
Therapeutic response: decrease in B/P; CHF
•
Not to discontinue product abruptly; to comply with dosage schedule, even if feeling better
•
Not to use OTC products (cough, cold, allergy) unless directed by prescriber; not to use salt substitutes containing potassium without consulting prescriber
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain
•
To report excessive perspiration, dehydration, vomiting, diarrhea; may lead to fall in B/P
•
That product may cause dizziness, fainting, lightheadedness; that these may occur during first few days of therapy
•
That product may cause skin rash, impaired perspiration
•
How to take B/P, normal readings for age group
Black Box Warning:
To inform prescriber if pregnancy planned, suspected, pregnancy category (D); not to breastfeed
0.9% NaCl IV inf, hemodialysis