Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (381 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ta-pen′ta-dol)
Nucynta, Nucynta ER
Func. class.:
Analgesic, misc.
Chem. class.:
μ-Opioid receptor agonist
Centrally acting synthetic analgesic; μ-opioid agonist activity is thought to result in analgesia; inhibits norepinephrine uptake
Moderate to severe pain, diabetic peripheral neuropathy
Hypersensitivity, asthma, ileus, respiratory depression
Black Box Warning:
Respiratory depression
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, increased intracranial pressure, MI (acute), severe heart disease, respiratory depression, renal/hepatic disease, GI obstruction, ulcerative colitis, sleep apnea, seizure disorder
Black Box Warning:
Accidental exposure, avoid ethanol, substance abuse
Calculator
• Adult:
PO
50-100 mg q4-6hr, may give 2nd dose ≥1 hr after 1st dose, max 700 mg on day 1, max 600 mg/day thereafter; ext rel 50 mg q12hr (opioid-naive), titrate to 100-250 mg q12hr, max 250 mg q12hr
Available forms:
Tabs 50, 75, 100 mg; tabs ext rel 50, 100, 150, 200, 250 mg
•
With antiemetic if nausea, vomiting occur
•
When pain is beginning to return; determine dosage interval by response
•
Do not crush, chew, break, or use with alcohol, ext rel product
CNS:
Drowsiness, dizziness, confusion, headache, euphoria
, hallucinations, restlessness, syncope, anxiety, flushing, psychological dependence, insomnia, lethargy, tremor,
seizures
CV:
Palpitations, bradycardia, hypo/hypertension, orthostatic hypotension, sinus tachycardia
GI:
Nausea, vomiting, anorexia, constipation, cramps
, gastritis, dyspepsia, biliary spasms
GU:
Urinary retention/frequency
INTEG:
Rash
, urticaria, diaphoresis, pruritus
RESP:
Respiratory depression,
cough
SYST:
Anaphylaxis,
infection, serotonin syndrome
Bioavailability 32%, extensively metabolized by liver, excreted in urine 99%, terminal half-life 4 hr, protein binding 20%
Increase:
effects with other CNS depressants—alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants
Increase:
toxicity—MAOIs
Increase:
serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists, tricyclics
Increase:
sedative effect—kava, St. John’s wort, valerian
•
Pain:
intensity, location, type, characteristics; need for pain medication by pain/sedation scoring; physical dependence
•
I&O ratio; check for decreasing output; may indicate urinary retention
•
CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
Serotonin syndrome:
increased heart rate, shivering, sweating, dilated pupils, tremors, high B/P, hyperthermia, headache, confusion; if these occur, stop product, administer serotonin antagonist if needed
•
Allergic reactions: rash, urticaria, anaphylaxis
Black Box Warning:
Respiratory dysfunction:
respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min; B/P, pulse
•
Storage in light-resistant area at room temp
•
Assistance with ambulation
•
Safety measures: nightlight, call bell within easy reach
•
Therapeutic response: decrease in pain
•
To report any symptoms of CNS changes, allergic reactions, seizures, serotonin syndrome
•
That physical dependency may result from extended use
•
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
•
To avoid CNS depressants, alcohol
•
To avoid driving, operating machinery if drowsiness, dizziness occur
•
To change positions slowly to decrease orthostatic hypotension
•
To notify prescriber if pregnancy planned, suspected or if breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Incivek
Func. class.:
Antivirals, antihepatitis agent
Chem. class.:
NS3/4A protease inhibitor
Prevents hepatitis C viral (HCV) replication by blocking the proteolytic activity of HCV NS3/4A serine protease; hepatitis C virus NS3/4A serine protease is an enzyme responsible for the conversion of HCV encoded polyproteins to mature/functioning viral proteins. These proteins (NS4A, NS4B, NS5A, NS5B) are needed for viral replication.
Chronic hepatitis C
Pregnancy (X) in combination, male partners of women who are pregnant
Precautions:
Breastfeeding, neonates, infants, children, adolescents <18 years of age, anemia, neutropenia, thrombocytopenia, HIV, hepatitis B, decompensated hepatic disease, liver or other organ transplants, serious rashes
Calculator
• Adults:
PO 750 mg tid (q7-9 hr) with peginterferon alfa and ribavirin; duration is determined by patient’s HCV RNA level at treatment wk 4, 12; if the HCV RNA is undetectable at wk 4, 12, give three-drug regimen for 12 wk then give an additional 12 wk of only peginterferon alfa and ribavirin (24 wk total); if the HCV RNA is detectable but #1000 international units/ml at wk 4 or 12, give three-drug regimen × 12 wk then an additional 36 wk of only peginterferon alfa and ribavirin (48 wk total)
• Adults:
PO 750 mg tid (q7-9 hr) with peginterferon alfa and ribavirin; give three-drug regimen × 12 wk then another 36 wk (48 wk total) of only peginterferon alfa and ribavirin
Available forms:
Tab 375 mg
•
Only use in combination with peginterferon alfa and ribavirin; never give as monotherapy
Discontinue in all patients with hepatitis C virus RNA concentrations ≥1000 IU/ml at wk 4 or 12 or a confirmed detectable HCV RNA concentration at wk 24
Any contraindication to peginterferon alfa or ribavirin also applies to this product; see ribavirin or peginterferon alfa monographs for additional information regarding contraindications and warning associated with these products
•
For relief of mild to moderate rashes, give oral antihistamines and/or topical corticosteroids; treatment with systemic steroids is not recommended
•
Give with food, not low-fat
CNS:
Fatigue
GI:
Hemorrhoids, anorectal discomfort, pruritus ani, rectal burning, nausea, diarrhea, vomiting, dysgeusia, hyperbilirubinemia
HEMA:
Anemia, decreased Hgb, lymphopenia, leukopenia, neutropenia, thrombocytopenia
INTEG:
Drug reaction with eosinophilia, and systemic symptoms (DRESS), Stevens-Johnson Syndrome (SJS),
rash, pruritus, severe rashes (bullous rash, vesicular rash, and skin ulcerations)
META:
Increased uric acid
59%-76% plasma protein binding, primarily to α 1-acid glycoprotein and albumin; metabolized extensively in liver by hydrolysis, oxidation, reduction by CYP3A4; excreted in feces (82%), exhaled (9%), excreted in urine (1%); elimination half life 4-4.7 hr; steady state half life 9-11 hr, peak 4-5 hr; food increases effect; steady state is reduced by 15% in mild hepatic disease, 46% in moderate hepatic disease (Child-Pugh class B)
Increase:
life-threatening reactions of each product—alfuzosin, ergots (dihydroergotamine, ergotamine, ergonovine, methylergonovine), cisapride, pimozide, lovastatin, simvastatin, ezetimibe, niacin with simvastatin and boceprevir; triazolam, oral midazolam; sildenafil, tadalafil (pulmonary arterial hypertension); do not use concurrently
Increase:
effect and adverse reactions of each product—phosphodiesterase type 5 (PDE5) inhibitors (for erectile dysfunction), atorvastin, lidocaine, atorvastatin, amiodarone, bepridil, flecainide, propafenone, quiNIDine, digoxin, ketoconazole, itraconazole, posaconazole, voriconazole, desipramine, traZODone, erythromycin, clarithromycin, telithromycin, rifabutin, dexamethasone, felodipine, niCARdipine, NIFEdipine, budesonide, bosentan, warfarin, astemizole, boceprevir, bupivacaine, busPIRone, cevimeline, chloroquine, cilostazol, cinacalcet, clomipramine, clonazePAM, clopidogrel, cloZAPine, cyclobenzaprine, dapsone, dextromethorphan, diazepam, diclofenac, disopyramide, disulfiram, dolasetron, donepezil, colchicine, cycloSPORINE, tacrolimus, sirolimus, buprenorphine, salmeterol, vardenafil, ALPRAZolam, citalopram, amLODIPine, diltiazem, nisoldipine, verapamil, systemic corticosteroids, acetaminophen, alfentanil, aliskiren, almotriptan, alosetron, ARIPiprazole, dutasteride, ebastine, eplerenone, erlotinib, omeprazole, estazolam, eszopiclone, ethosuximide, exemestane, finasteride, flunitrazepam, flurazepam, galantamine, gefitinib, granisetron, halofantrine, haloperidol, HYDROcodone, ifosfamide, imipramine, indiplon, isradipine, ivermectin, ixabepilone, losartan, meloxicam, mirtazapine, montelukast, nateglinide, oxybutynin, oxyCODONE, palonosetron, paricalcitol, prasugrel, praziquantel, quazepam, QUEtiapine, quinacrine, ramelteon, repaglinide, ropivacaine, selegiline, sibutramine, sitaxsentan, solifenacin, SUFentanil, SUNItinib, theophylline, aminophylline, tiaGABine, tinidazole, tolterodine, traMADol, venlafaxine, amitriptyline, carvedilol, DAUNOrubicin, loratadine, desloratadine, lansoprazole, dexlansoprazole, DOCEtaxel, DOXOrubicin, droperidol, eletriptan, etoposide, fentaNYL, fexofenadine, glyburide, irinotecan, loperamide, maraviroc, mefloquine, mitoMYcin, morphine, nortriptyline, ondansetron, PACLitaxel, plicamycin, risperiDONE, sertraline, silodosin, teniposide, terfenadine, testosterone, tolvaptan, vinBLAStine, vinCRIStine and others; use cautiously, may need to reduce dose
Increase:
hyperkalemia—drospirenone
Decrease:
estrogen levels—ethinyl estradiol
Decrease:
telaprevir effect—CYP3A4 inhibitors (phenytoin, carBAMazepine, PHENobarbital, rifampin)
Decrease:
effect of—methadone
Possible treatment failure: efavirenz, ritonavir, atazanavir, lopinavir with ritonavir
Do not use with St. John’s wort
Pregnancy:
pregnancy (X) combination therapy; obtain a pregnancy test before, monthly during, and for 6 months after treatment is completed; those who are not willing to practice strict contraception should not receive treatment with these products; report any cases of prenatal ribavirin exposure to the Ribavirin Pregnancy registry at (800) 593-2214
Anemia:
monitor hemoglobin before, at treatment wk 4, 8, 12, and as needed; if Hgb is <10 g/dL, decrease ribavirin dosage; if Hgb is <8.5 g/dL, discontinuation of therapy is recommended; telaprevir dosage should not be altered based on adverse reactions; anemia may be managed through ribavirin dose modifications; never alter the dose of telaprevir; if anemia persists despite a reduction in ribavirin dose, consider discontinuing telaprevir; if management of anemia requires permanent discontinuation of ribavirin, treatment with telaprevir must also be permanently discontinued; once telaprevir has been discontinued, it must not be restarted; monitor CBC with differential at treatment wk 4, 8, 12, and at other treatment points
Stevens-Johnson syndrome:
eosinophilia, fever, mucosal skin erosion, mucosal ulceration, target lesions; if serious skin reaction occurs, immediately discontinue all components of the three-drug regimen and refer the patient for urgent medical care
•
Thyroid function tests, LFTs, serum bilirubin/creatinine, BUN, bilirubin, serum electrolytes, serum uric acid, baseline and periodically during treatment
•
Storage of tablet at room temperature
•
Decreasing hepatitis C viral infection
To use two forms of effective contraception (intrauterine devices and barrier methods) during treatment and for 6 months after treatment (pregnancy category X), not to breastfeed
That if a serious skin reaction occurs, to seek urgent medical care; all components of the triple-drug regimen must be discontinued immediately