Mosby's 2014 Nursing Drug Reference (362 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(roe-soo′va-sta-tin)
Crestor
Func. class.:
Antilipemic
Chem. class.:
HMG-CoA reductase inhibitor
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
As an adjunct for primary hypercholesterolemia (types IIa, IIb) and mixed dyslipidemia, elevated serum triglycerides, homozygous/heterozygous familial hypercholesterolemia (FH), slowing of atherosclerosis, CV disease prophylaxis
Unlabeled uses:
MI, stroke prophylaxis (normal LDL)
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Precautions:
Children, geriatric patients, past hepatic disease, alcoholism, severe acute infections, trauma, hypotension, uncontrolled seizure disorders, severe metabolic disorders, electrolyte imbalances, severe renal impairment, hypothyroidism, Asian patients
Calculator
• Adult:
PO
5-40 mg/day; initial dose 10 mg/day, reanalyze lipid levels at 2-4 wk, adjust dosage accordingly
• Adult:
PO
20 mg/day, max 40 mg
• Adult:
PO
5 mg/day, max 10 mg/day
• Adult:
PO
5 mg/day
• Adult:
PO
10 mg/day (for those not taking cycloSPORINE or gemfibrozil)
• Females ≥1 yr postmenarche and ≥10 yr):
PO
5-20 mg/day individualized
• Adult:
PO
20 mg daily
• Adult:
PO
CCr <30 ml/min, 5 mg/day; max 10 mg/day; avoid use with hepatic disease
Available forms:
Tabs 5, 10, 20, 40 mg
•
May be taken at any time of day, with/without food
CNS:
Headache, dizziness
, insomnia, paresthesia
GI:
Nausea, constipation, abdominal pain, flatus, diarrhea, dyspepsia, heartburn
,
kidney failure, liver dysfunction,
vomiting
HEMA:
Thrombocytopenia, hemolytic anemia, leukopenia
INTEG:
Rash, pruritus
MS:
Asthenia, muscle cramps, arthritis, arthralgia, myalgia
,
myositis, rhabdomyolysis;
leg, shoulder, or localized pain
RESP:
Rhinitus, sinusitis,
pharyngitis
, increased cough
Peak 3-5 hr, minimal live metabolism (about 10%), 88% protein bound, excreted primarily in feces (90%), crosses placenta, half-life 19 hr, not dialyzable
Increase:
hepatotoxicity—alcohol
Increase:
rosuvastatin effect—bile acid sequestrants
Increase:
myalgia, myositis, rhabdomyolysis—cycloSPORINE, gemfibrozil, niacin, clofibrate, azole antifungals, antiretroviral protease inhibitors, fibric acid derivatives
Increase:
bleeding risk—warfarin
Increase:
LFTs
•
Diet; obtain diet history including fat, cholesterol in diet
•
Fasting cholesterol, LDL, HDL, triglycerides at baseline and q4-6wk, then periodically
•
Liver function: LFTs at baseline, 12 wk, then q6mo; AST, ALT, LFTs may increase
•
Renal function in patients with compromised renal system: BUN, creatinine, I&O ratio
Rhabdomyolysis:
muscle pain, tenderness, obtain CPK; if these occur, product may need to be discontinued; for patients with Asian ancestry: increased blood levels, rhabdomyolysis
•
Storage in cool environment in airtight, light-resistant container
•
Therapeutic response: decreased LDL, cholesterol, triglycerides, increased HDL, slowing CAD
To report suspected pregnancy; to use contraception while taking product, pregnancy category (X); not to breastfeed
To report weakness, muscle tenderness, pain, fever; liver injury (jaundice, anorexia, abdominal pain)
•
That blood work and follow-up exams will be necessary during treatment
•
To report severe GI symptoms, dizziness, headache, muscle pain, weakness
•
That previously prescribed regimen will continue: low-cholesterol diet, exercise program, smoking cessation
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(roo-fin′a-mide)
Banzel
Func. class.:
Anticonvulsant
Chem. class.:
Triazole derivative
May act through action at sodium channels; exact action is unknown
Lennox-Gastaut syndrome
Unlabeled uses:
Partial seizures
Hypersensitivity, familial short QT syndrome
Precautions:
Pregnancy (C), breastfeeding, children <16 yr, geriatric patients, renal/hepatic disease, depression, dialysis, hazardous activities, suicidal ideation
Calculator
• Adult:
PO
400-800 mg/day divided bid, increase by 400-800 mg/day q2days to 3200 mg/day
• Child ≥4 yr:
PO
10 mg/kg/day divided equally bid; increase by 10 mg/kg/day every other day to 45 mg/kg/day or 3200 mg/day, whichever is less
Available forms:
Tabs 200, 400 mg; oral susp 40 mg/ml
•
PO tabs:
give with food; may give whole, crushed, or halved
•
Oral susp:
shake well before use, use provided adapter and calibrated oral dosing syringe, insert adapter firmly in neck of bottle before use, keep in place for duration of bottle use; insert dosing syringe into adapter, withdraw dose from inverted bottle; replace cap after each use, use within 90 days of opening, give with food
CNS:
Dizziness, ataxia, drowsiness, fever, seizures, tremor, fatigue, headache, gait disturbance
EENT:
Diplopia, blurred vision, nystagmus
GI:
Nausea, hepatitis, vomiting
HEMA:
Anemia, leukopenia, neutropenia, thrombocytopenia,
lymphadenopathy
INTEG:
Rash, urticaria
MISC:
Edema, hematuria, influenzae, nephrolithiasis
Peak 4-6 hr, half-life 6-10 hr, metabolized by liver, excreted by kidneys, 34% protein binding
Increase:
rufinamide effect—valproate
Decrease:
effect of hormonal contraceptives
Decrease:
effect of rufinamide—carBAMazepine, phenytoin, primidone, PHENobarbital
Increase:
LFTs
•
Seizures:
duration, type, intensity precipitating factors
Mental status: mood, sensorium, affect, memory (long, short), increased suicidal thoughts/actions
•
Therapeutic response: decrease in severity of seizures
•
Not to discontinue product abruptly because seizures may occur
•
To avoid hazardous activities until stabilized on product
•
To carry emergency ID stating product use
•
To notify prescriber if pregnancy is planned or suspected; to use alternative form of contraception because effect of hormonal contraceptives may be decreased
•
To consume adequate fluids