Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (364 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sax-a-glip′tin)
Onglyza
Func. class.:
Antidiabetic, oral
Chem. class.:
Dipeptidyl-peptidase-4 inhibitor (DPP-4 inhibitor)
Do not confuse:
saxagliptin
/sitaGLIPtin
Slows the inactivation of incretin hormones; improves glucose homeostasis, improves glucose-dependent insulin synthesis, lowers glucagon secretions, and slows gastric emptying time
In adults, type 2 diabetes mellitus as monotherapy or in combination with other antidiabetic agents
Hypersensitivity, diabetic ketoacidosis (DKA), type 1 diabetes
Precautions:
Pregnancy (B), geriatric patients, GI obstruction, surgery, thyroid/renal/hepatic disease, trauma
Calculator
• Adult:
PO
2.5-5 mg; may use with other antidiabetic agents other than insulin; if used with insulin, a lower dose is needed
• Adult:
PO
CCr ≤50 ml/min, 2.5 mg daily
Available forms:
Tabs 2.5, 5 mg
•
May be taken with/without food
CNS:
Headache
ENDO:
Hypoglycemia (renal impairment)
GI:
Nausea, vomiting
, abdominal pain
INTEG:
Urticaria,
angioedema
, anaphylaxis
MISC:
Lymphopenia, peripheral edema
Rapidly absorbed, excreted by the kidneys (unchanged 24%), terminal half-life 2.5 hr, 3.1 hr metabolite, peak 2 hr, duration 24 hr
Increase:
hypoglycemia—androgens, insulins, β-blockers, cimetidine, corticosteroids, salicylates, MAOIs, fibric acid derivatives, FLUoxetine, insulin, sulfonylureas, ACE inhibitors; CYP3A4/5 inhibitors
Increase:
antidiabetic effect—garlic, horse chestnut
Decrease:
lymphocytes, glucose
•
Hypoglycemic reactions
(sweating, weakness, dizziness, anxiety, tremors, hunger); monitor blood glucose, HbA1c
renal studies:
BUN, creatinine during treatment
•
Conversion from other antidiabetic agents; change may be made with gradual dosage change
•
Storage in tight container at room temp
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait, blood glucose at normal level
•
To perform regular self-monitoring of blood glucose using blood-glucose meter
•
About the symptoms of hypo/hyperglycemia, what to do about each
•
That product must be continued on daily basis; about consequences of discontinuing product abruptly
•
To avoid OTC medications, alcohol, digoxin, exenatide, insulins, nateglinide, repaglinide, and other products that lower blood glucose unless approved by prescriber
•
That diabetes is lifelong; that this product is not a cure, only controls symptoms
•
That all food included in diet plan must be eaten to prevent hypo/hyperglycemia
•
To carry emergency ID
•
To take product without regard to food
•
To notify prescriber when surgery, trauma, stress, occurs because dose may need to be adjusted
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(skoe-pol′a-meen)
Maldemar, Scopace, Transderm Scop
Func. class.:
Cholinergic blocker
Chem. class.:
Belladonna alkaloid
Inhibits acetylcholine at receptor sites in autonomic nervous system, which controls secretions, free acids in stomach; blocks central muscarinic receptors, which decreases involuntary movements
Preoperatively to produce amnesia, sedation and to decrease secretions; motion sickness, parkinsonian symptoms
Hypersensitivity, closed-angle glaucoma, myasthenia gravis, GI/GU obstruction, hypersensitivity to belladonna, barbiturates
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, prostatic hypertrophy, CHF, hypertension, dysrhythmia, gastric ulcer, renal/hepatic disease, hiatal hernia, GERD, ulcerative colitis, hyperthyroidism
Calculator
• Adult:
TD
1 patch 4 hr before travel and q3days
• Adult:
PO
0.4-0.8 mg q8hr
• Adult:
IM/IV/SUBCUT
0.32-0.65 mg;
TD
apply 1 patch
PM
before surgery or 1 hr before c-section
• Adult:
SUBCUT
0.6-1 mg
• Child:
SUBCUT
0.006 mg/kg; max 0.3 mg/dose
Available forms:
Inj 0.4 mg/ml; TD patch 72 hr (1.5 mg)
•
Parenteral dose with patient recumbent to prevent postural hypotension
•
Parenteral dose slowly; keep patient in bed for ≥1 hr after dose
•
With or after meals for GI upset; may give with fluids other than water
•
At bedtime to avoid daytime drowsiness in patients with parkinsonism
•
With analgesic to avoid behavioral changes when given preoperatively
•
Dilute with equal sterile water; give over 2-3 min
Syringe compatibilities:
Atropine, benzquinamide, butorphanol, chlorproMAZINE, cimetidine, diamorphine, dimenhyDRINATE, diphenhydrAMINE, droperidol, fentaNYL, glycopyrrolate, HYDROmorphone, hydrOXYzine, meperidine, metoclopramide, midazolam, morphine, nalbuphine, oxyCODONE, pentazocine, PENTobarbital, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, SUFentanil, thiopental
Y-site compatibilities:
FentaNYL, heparin, hydrocortisone, HYDROmorphone, methadone, morphine, potassium chloride, propofol, SUFentanil, vit B/C
CNS:
Confusion, anxiety, restlessness, irritability, delusions, hallucinations, headache, sedation, depression, incoherence, dizziness, excitement, delirium, flushing, weakness, fatigue, loss of memory
CV:
Palpitations, tachycardia, postural hypotension, paradoxical bradycardia
EENT:
Blurred vision, photophobia, dilated pupils, difficulty swallowing, mydriasis, cycloplegia
GI:
Dryness of mouth, constipation
, nausea, vomiting, abdominal distress,
paralytic ileus
GU:
Urinary hesitancy, retention
INTEG:
Urticaria, dry skin
MISC:
Suppression of breastfeeding, nasal congestion, decreased sweating
Excreted in urine, bile, feces (unchanged), half-life 8 hr
SUBCUT/IM:
Peak 30-60 min, duration 7 hr
IV:
Peak 10-15 min, duration 2 hr
Increase:
anticholinergic effect—alcohol, opioids, antihistamines, phenothiazines, tricyclics
•
VS periodically
•
I&O ratio; retention commonly causes decreased urinary output
•
Parkinsonism, EPS:
shuffling gait, muscle rigidity, involuntary movements; affect, mood, CNS depression, worsening of mental symptoms during early therapy
•
Urinary hesitancy, retention; palpate bladder if retention occurs
•
Constipation; increase fluids, bulk, exercise
•
Tolerance during long-term therapy; dose may have to be increased or changed
•
Storage at room temp in light-resistant container
•
Hard candy, frequent drinks, sugarless gum to relieve dry mouth
•
Therapeutic response: decreased secretions
•
Not to discontinue product abruptly; to taper off over 1 wk
•
To avoid driving, other hazardous activities because drowsiness may occur
•
To avoid OTC medication: cough, cold preparations with alcohol, antihistamines unless directed by prescriber
•
Transdermal route:
to apply with clean, dry hands; to wash, dry hands before and after applying to surface behind ear; to press patch firmly
•
To avoid hazardous activities, activities requiring alertness because dizziness may occur
•
To change patch q72hr
•
To apply at least 4 hr before traveling
•
If blurred vision, severe dizziness, drowsiness occurs, to discontinue use, use another type of antiemetic, or to rotate patch to other ear
•
To read label of all OTC medications; if any scopolamine is found in product, avoid use
•
To keep out of children’s reach