Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (405 page)
(tran-doe′la-prill)
Mavik
Func. class.:
Antihypertensive
Chem. class.:
Angiotension-converting enzyme inhibitor
Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II, dilates arterial and venous vessels, lowers B/P
Hypertension, heart failure, left ventricular dysfunction post MI
Breastfeeding, hypersensitivity, history of angioedema
Black Box Warning:
Pregnancy (D) 2nd/3rd trimester
Precautions:
Geriatric patients, hyperkalemia, hepatic disease, bilateral renal stenosis, after kidney transplant, aorta/mitral valve stenosis, cirrhosis, severe renal disease, untreated CHF, autoimmune disease, cough, pregnancy (C) 1st trimester
Calculator
• Adult:
PO
1 mg/day; 2 mg/day in African-Americans; make dosage adjustment ≥1 wk; max 8 mg/day
• Adult:
PO
1 mg/day, titrate upward to 4 mg/day if tolerated
• Adult:
PO
CCr <30 ml/min or hepatic disease, 0.5 mg/day
Available forms:
Tabs 1, 2, 4 mg
•
Discontinue diuretic 2-3 days before starting this product; if not possible, decrease initial dose to 0.5 ml
•
Make dosage changes ≥1 wk
•
Give without regard to food
•
Space antacids by 2 hr after dose
CNS:
Dizziness, syncope
, paresthesias, headache, fatigue, drowsiness, depression, sleep disturbances, anxiety
CV:
Hypotension
,
MI,
palpitations, angina, TIAs,
stroke,
bradycardia
, dysrhythmias
GI:
Nausea, vomiting, cramps, diarrhea, constipation,
pancreatitis,
dyspepsia
GU:
Proteinuria, renal failure
HEMA:
Agranulocytosis, neutropenia, leukopenia, anemia
INTEG:
Rash, purpura, pruritus
MISC:
Hyperkalemia, hyponatremia, impotence,
myalgia
,
angioedema,
muscle cramps,
asthenia
, hypocalcemia, gout
RESP:
Dyspnea,
cough
Peak 4-10 hr, duration 24 hr, half-life 6-10 hr, metabolized by liver (active metabolite trandolaprilat), excreted in urine, protein binding 65%-94%
Increase:
effects—phenothiazines, diuretics
Increase:
severe hypotension—diuretics, other antihypertensives, NSAIDs
Increase:
potassium levels—salt substitutes, potassium-sparing diuretics, potassium supplements
Increase:
effects of ergots, neuromuscular blocking agents, antihypertensives, hypoglycemics, barbiturates, reserpine, levodopa, lithium
Decrease:
effects of trandolapril—antacids, NSAIDs, salicylates
Increase:
potassium, LFTs, BUN, creatinine
Decrease:
sodium, WBC
•
Hepatotoxicity (rare):
increased LFTs, jaundice, fulfillment hepatic necrosis; if jaundice occurs, discontinue product
•
Angioedema
of the face, edema of the extremities, mucus membranes, may need to discontinue
•
Hyperkalemia:
monitor electrolytes, check potassium
•
B/P, pulse q4hr; note rate, rhythm, quality
•
Baselines of renal, hepatic studies before therapy begins
•
Edema in feet, legs daily
•
Symptoms of CHF:
edema, dyspnea, wet crackles
•
Therapeutic response: decreased B/P
•
Not to use OTC (cough, cold, or allergy) products unless directed by prescriber, to separate antacids by 2 hr; to avoid salt substitutes
•
To comply with dosage schedule even if feeling better
•
To notify prescriber of mouth sores, sore throat, fever, swelling of hands/feet, irregular heartbeat, chest pain, signs of angioedema
•
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur
•
That product may cause dizziness, fainting; lightheadedness may occur during 1st few days of therapy
•
That product may cause skin rash or impaired perspiration
•
Not to discontinue product abruptly, taper
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
Black Box Warning:
To notify prescriber if pregnancy is planned or suspected; pregnancy (D)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTtrastuzumab (Rx)
(tras-tuz′uh-mab)
Herceptin
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Humanized monoclonal antibody
DNA-derived monoclonal antibody selectively binds to extracellular portion of human epidermal growth factor receptor 2; it inhibits the proliferation of cancer cells
Breast cancer; metastatic with overexpression of HER2, early breast cancer (adjuvant, neoadjuvant), gastric cancer; previously untreated HER2 overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma with CISplatin, 5-fluorouracil or capecitabine
Pregnancy (D); hypersensitivity to this product, Chinese hamster ovary cell protein
Precautions:
Breastfeeding, children, geriatric patients, pulmonary disease, anemia, leukopenia
Black Box Warning:
Cardiac disease, respiratory distress syndrome, respiratory insufficiency, infusion-related reactions, cardiomyopathy
Calculator
•
Several regimens may be used
• Adult:
IV
4 mg/kg given over 90 min then maintenance 2 mg/kg given over 30 min; do not give as IV push or bol; may be given in combination with other antineoplastics
• Adult:
IV
8 mg/kg over 90 min on day 1 then 6 mg/kg over 30-90 min q21days from day 22, give with CISplatin 80 mg/m
2
on day 1 plus 5-fluorouracil 800 mg/m
2
CONT INF
on days 1-5 or capecitabine 1000 mg/m
2
bid on days 1-14, repeat cycle q3wk
Available forms:
Lyophilized powder 440 mg
•
Acetaminophen as ordered to alleviate fever and headache
•
After reconstituting vial with 20 ml bacteriostatic water for inj, 1.1% benzyl alcohol preserved (supplied) to yield 21 mg/ml, mark date on vial 28 days from reconstitution date; if patient is allergic to benzyl alcohol, reconstitute with sterile water for inj; use immediately, infuse over 90 min; q3wk give 8 mg/kg loading dose over 90 min, subsequent 6 mg/kg dose may be given over 30-60 min
•
Do not mix or dilute with other products or dextrose sol
CNS:
Dizziness, numbness, paresthesias
, depression,
insomnia
, neuropathy, peripheral neuritis
CV:
Tachycardia, CHF
GI:
Nausea, vomiting,
anorexia, diarrhea
, abdominal pain,
hepatotoxicity,
dysgeusia
HEMA:
Anemia
,
leukopenia
INTEG:
Rash, acne, herpes simplex
META:
Edema, peripheral edema
MISC:
Flulike symptoms; fever, headache, chills
MS:
Arthralgia,
bone pain
RESP:
Cough, dyspnea, pharyngitis, rhinitis
, sinusitis,
pneumonia, pulmonary edema/fibrosis,
acute respiratory distress syndrome (ARDS)
SYST:
Anaphylaxis, angioedema
Half-life 1-32 days
Increase:
bleeding risk—warfarin
Increase:
cardiomyopathy—anthracyclines, cyclophosphamide; avoid use
Decrease:
immune response—vaccines, toxoids
•
CBC, HER2 overexpression
Black Box Warning:
CHF, other cardiac symptoms: dyspnea, coughing; gallop; obtain full cardiac workup including ECG, echo, multigated acquisition scan
•
Symptoms of infection; may be masked by product
•
CNS reaction: LOC, mental status, dizziness, confusion
Hypersensitive reactions, anaphylaxis
Black Box Warning:
Inf reactions
that may be fatal: fever, chills, nausea, vomiting, pain, headache, dizziness, hypotension; discontinue product
•
Pulmonary toxicity:
dyspnea, interstitial pneumonitis, pulmonary hypertension, ARDs; can occur after infusion reaction, those with lung disease may have more severe toxicity
•
Increased fluid intake to 2-3 L/day
•
Therapeutic response: decrease in size of tumors
•
To take acetaminophen for fever
•
To avoid hazardous tasks because confusion, dizziness may occur
•
To report signs of infection: sore throat, fever, diarrhea, vomiting
•
That emotional lability is common; to notify prescriber if severe or incapacitating
•
To use contraception while taking this product; pregnancy (D); to avoid breastfeeding
Black Box Warning:
To report pain at infusion site