Mosby's 2014 Nursing Drug Reference (396 page)

Black Box Warning:

Secondary malignancy

• Adult:
PO
2 g daily × 3 days

• Child ≥3 yr/adolescent:
PO
50 mg/kg/day × 3 days, max 2 g/day

• Adult:
PO
2 g as a single dose

• Child ≥3 yr:
PO
50 mg/kg as a single dose, max 2 g

• Adult:
PO
2 g as a single dose

• Adult (nonpregnant woman):
PO
2 g/day × 2 days with food or 1 g/day × 5 days with food

• 
Tabs can be crushed and mixed with artificial cherry syrup for children

• 
With food to increase plasma concentrations, minimize epigastric distress and other GI effects

Increase:
tinidazole action—CYP3A4 inhibitors (cimetidine, ketoconazole): increased action of tinidazole

Increase:
action of anticoagulants, cycloSPORINE, tacrolimus, fluorouracil, hydantoins, lithium

Decrease:
tinidazole action—CYP3A4 inducers (PHENobarbital, rifampin, phenytoin); cholestyramine, oxytetracycline: decreased action of tinidazole

Increase or decrease:
tinidazole level—St. John’s wort

Increase:
triglycerides, LDH, AST/ALT, glucose

Decrease:
WBCs

• 
Giardiasis:
obtain 3 stool samples several days apart beginning q3-4wk after treatment

• 
Amebic liver abscess:
Monitor CBC, ESR, amebic gel diffusion test, ultrasound; also total and differential leukocyte count

Black Box Warning:

Secondary malignancy: avoid unnecessary use

• 
Signs of infection, anemia

• 
Bowel pattern before, during treatment

• 
Therapeutic response: decrease in infection as evidenced by negative culture

• 
To take with food to increase plasma concentrations, minimize epigastric distress and other GI effects; not to use alcoholic beverages during or for 3 days after treatment

• 
Trichomoniasis:
both partners should be treated at the same time

• 
To avoid alcohol, may cause disulfiram reaction

• 
To avoid doing hazardous activities until reaction is known

• 
That product causes taste

• 
Not to use OTC, Rx, or herbal products unless approved by prescriber

Black Box Warning:

Spinal/epidural anesthesia, lumbar puncture

• Adult:
SUBCUT
175 anti-Xa international units/kg/day ≥6 days and until adequate anticoagulation with warfarin (therapeutic INR ≥2 for 2 consecutive days)

• Adult:
75 anti-Xa units/kg/day started 12-24 hr after surgery

• Adult:
3500 anti-Xa units (50 anti-Xa units/kg) daily beginning 1-2 hr prior to surgery and continued for 5-10 days

• 
Only after screening patient for bleeding disorders

• 
For 6 days, until warfarin has been given to result in adequate coagulation

• 
SUBCUT only; do not give IM

• 
To recumbent patient; give SUBCUT; rotate inj sites (left/right anterolateral, left/right posterolateral abdominal wall)

• 
Insert whole length of needle into skin fold held with thumb and forefinger

 
Only this product when ordered; not interchangeable with heparin (unfractionated) or LMWHs

• 
At same time each day to maintain steady blood levels

• 
Do not massage area or aspirate when giving SUBCUT inj

• 
Do not mix with other products or inf fluids

• 
Alternate inj sites

• 
For excessive bruising at inj site, may use ice before SUBCUT inj

Increase:
action of tinzaparin—oral anticoagulants, salicylates, thrombolytics, NSAIDs, platelet inhibitors, ticlopidine, clopidogrel

Black Box Warning:

Spinal/epidermal anesthesia, lumbar puncture: monitor neurological impairment; if impairment occurs, urgent treatment needed

• 
Blood studies (Hct, platelets, occult blood in stools), anti-Xa; thrombocytopenia may occur

• 
Bleeding:
gums, petechiae, ecchymosis, black tarry stools, hematuria, decreased Hct, Hgb

• 
Hypersensitivity (fever, urticaria, chills); report to prescriber

• 
Inj site reactions; do not use IM inj

• 
Storage at 77° F (25° C); do not freeze

• 
Therapeutic response: resolution of DVT

• 
To report any signs of bleeding: gums, under skin, urine, stools