Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (363 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(sal-met′er-ole)
Serevent
, Serevent Diskus
Func. class.:
β
2
-Adrenergic agonist, bronchodilator
Causes bronchodilation by action on β
2
(pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscle with little effect on heart rate; maintains improvement in FEV from 3 to 12 hr; prevents nocturnal asthma symptoms
Prevention of exercise-induced bronchospasm, COPD, asthma
Hypersensitivity to sympathomimetics, tachydysrhythmias, severe cardiac disease, monotherapy treatment of asthma
Precautions:
Pregnancy (C), breastfeeding, cardiac disorders, hyperthyroidism, diabetes mellitus, hypertension, closed-angle glaucoma, seizures, acute asthma, as a substitute to corticosteroids, QT prolongation
Black Box Warning:
Asthma-related death, children <4 yr
Calculator
• Adult/child ≥4 yr:
INH
50 mcg (1 inhalation as dry powder) q12hr; exercise-induced bronchospasm 50 mcg (1 inhalation) 1/2-1 hr before exercise
Available forms:
Inhalation powder 50 mcg/blister
•
Gum, sips of water for dry mouth
•
Use 1 hr before exercise for exercise-induced bronchospasm prevention
CNS:
Tremors, anxiety
, insomnia, headache, dizziness, fever
CV:
Palpitations, tachycardia, hypo/hypertension, angina,
dysrhythmias
EENT:
Dry nose, irritation of nose and throat
GI:
Heartburn, nausea, vomiting, abdominal pain
MS:
Muscle cramps
RESP:
Bronchospasm,
cough
INH:
Onset 30-50 min; peak 4 hr; duration 12 hr; metabolized in liver; excreted in urine, breast milk; crosses placenta, blood-brain barrier; protein binding 94%-98%; terminal half-life 3-5 hr
Increase:
CV effect—CYP3A4 inhibitors (itraconazole, ketoconazole, nelfinavir, nefazodone, saquinavir)
Increase:
action of aerosol bronchodilators
Increase:
action of salmeterol—tricyclics, MAOIs
Decrease:
salmeterol action—other β-blockers
•
Respiratory function:
vital capacity, forced expiratory volume, ABGs, lung sounds, heart rate and rhythm
Paradoxical bronchospasm:
dyspnea, wheezing, chest tightness
Black Box Warning:
Children should not use this product as monotherapy for asthma, use only with persistent asthma in those whose symptoms are not wellcontrolled with a long-term asthma product
•
Storage in foil pouch; do not expose to temp >86° F (30° C); discard 6 wk after removal from foil pouch
•
Therapeutic response: absence of dyspnea, wheezing
•
Not to use for exercise-induced bronchospasm, never to exhale into diskus, to hold level, keep mouthpiece dry
•
Not to use OTC medications because extra stimulation may occur
•
Review package insert with patient
•
To avoid getting powder in eyes
•
To avoid smoking, smoke-filled rooms, persons with respiratory infections
•
Not for treatment of acute exacerbation, a fast-acting β-blocker should be used instead
To immediately report dyspnea after use if ≥1 canister is used in 2 mo time
β
2
-Adrenergic blocker
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(sar-gram′oh-stim)
Leukine, GM-CSF
Func. class.:
Biologic modifier
Chem. class.:
Granulocyte macrophage colony-stimulating factor (GM-CSF)
Do not confuse:
Leukine
/leucovorin/Leukeran
Stimulates proliferation and differentiation of hematopoietic progenitor cells (granulocytes, macrophages)
Acceleration of myeloid recovery in patients with non–Hodgkin’s lymphoma, acute lymphoblastic leukemia, acute myelogenous leukemia, autologous bone marrow transplantation in Hodgkin’s disease; bone marrow transplantation failure or engraftment delay, mobilization and transplant of peripheral blood progenitor cells (PBPCs)
Unlabeled uses:
Aplastic anemia, Crohn’s disease, HIV, ganciclovir- or zidovudine-induced neutropenia, malignant melanoma
Neonates; hypersensitivity to GM-CSF, benzyl alcohol, yeast products; excessive leukemic myeloid blast in bone marrow, peripheral blood
Precautions:
Pregnancy (C), breastfeeding, children; lung/cardiac/renal/hepatic disease; pleural, pericardial effusions, peripheral edema, leukocytosis, mannitol hypersensitivity, hepatic/renal disease
Calculator
• Adult:
IV
250 mcg/m
2
/day × 3 wk; give over 2 hr, begin 2-4 hr after bone marrow inf, not <24 hr after last dose of antineoplastics and 12 hr after last dose of radiotherapy, bone marrow transplantation failure, or engraftment delay
• Adult:
IV
250 mcg/m
2
/day × 14 days; give over 2 hr; may repeat in 7 days, may repeat 500 mcg/m
2
/day × 14 days after another 7 days if no improvement
• Adult:
IV/SUBCUT
250 mcg/m
2
/day during collection of PBPCs
• Adult:
IV/SUBCUT
250 mcg/m
2
/day until ANC >1500 cells/mm
3
× 3 days
• Adult:
SUBCUT
250-500 mcg/day or 5 mcg/kg/day × 14-90 days, used with erythropoietin or immunosuppressive therapy
• Adult:
SUBCUT
125 mcg/m
2
/day × 14 days, alternate with 14 days off
• Adult:
SUBCUT
250 mcg/day 3×/wk for ≤20 mo
Available forms:
Powder for inj lyophilized 250 mcg; sol for inj 500 mcg/ml
•
No further dilution of reconstituted sol is needed; take care not to inject intradermally
•
After reconstituting with 1 ml sterile water for inj without preservative; do not reenter vial; discard unused portion; direct reconstitution sol at side of vial; rotate contents; do not shake
•
Dilute in 0.9% NaCl inj to prepare IV inf; if final concentration is <10 mcg/ml, add human albumin to make final conc of 0.1% to NaCl before adding sargramostim to prevent adsorption; for a final conc of 0.1% albumin, add 1 mg human albumin/1 ml 0.9% NaCl inj run over 2 hr
(bone marrow transplant or failure of graft);
over 4 hr
(chemotherapy for AML);
over 24 hr as cont inf
(PBPCs);
give within 6 hr after reconstitution
Y-site compatibilities:
Amikacin, aminophylline, aztreonam, bleomycin, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefepime, cefotaxime, cefoTEtan, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, dexamethasone, diphenhydrAMINE, DOPamine, DOXOrubicin, doxycycline, droperidol, etoposide, famotidine, fentaNYL, floxuridine, fluconazole, fluorouracil, furosemide, gentamicin, granisetron, heparin, IDArubicin, ifosfamide, immune globulin, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methotrexate, metoclopramide, metroNIDAZOLE, minocycline, mitoXANtrone, netilmicin, pentostatin, piperacillin/tazobactam, potassium chloride, prochlorperazine, promethazine, ranitidine, teniposide, ticarcillin, ticarcillin-clavulanate, trimethoprim-sulfamethoxazole, vinBLAStine, vinCRIStine, zidovudine
CNS:
Fever, malaise, CNS disorder, weakness, chills, dizziness, syncope, headache
CV:
Transient supraventricular tachycardia,
peripheral edema,
pericardial effusion,
hypotension, tachycardia
GI:
Nausea, vomiting, diarrhea, anorexia,
GI hemorrhage,
stomatitis,
liver damage,
hyperbilirubinemia
GU:
Urinary tract disorder, abnormal kidney function
HEMA:
Blood dyscrasias, hemorrhage
INTEG:
Alopecia, rash, peripheral edema
MS:
Bone pain, myalgia
RESP:
Dyspnea
Half-life elimination: IV 60 min, SUBCUT 2-3 hr; detected within 5 min after administration, peak 2 hr
•
Do not use product concomitantly with antineoplastics or radiation, separate by ≥24 hr
Increase:
myeloproliferation—lithium, corticosteroids
Increase:
bilirubin, BUN, creatinine, eosinophils, LFTs, leukocytes
Blood studies: CBC, differential count before treatment, 2 × weekly; leukocytosis may occur (WBC
>
50,000 cells/mm
3
, ANC
>
20,000 cells/mm
3
), platelets; if ANC
>
20,000/mm
3
or 10,000/mm
3
after nadir has occurred or platelets
>
500,000/mm
3
, reduce dose by 1/2 or discontinue; if blast cells occur, discontinue
•
Renal, hepatic studies before treatment: BUN, creatinine, urinalysis; AST, ALT, alk phos; 2 × weekly monitoring is needed in renal/hepatic disease
•
Hypersensitivity,
rashes, local inj site reactions; usually transient
•
Body weight, hydration status; increased fluid retention in cardiac disease; pulmonary function
•
Constitutional symptoms: asthenia, chills, fever, headache, malaise
•
Myalgia, arthralgia in legs, feet; use analgesics, antipyretics
•
Gasping syndrome in neonates:
due to benzyl alcohol hypersensitivity
•
Storage in refrigerator; do not freeze
•
Therapeutic response: WBC and differential recovery
•
To report dyspnea to health care provider
•
Review all aspects of product use