Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (409 page)
OTC
)
(trye-am-sin′oh-lone)
Kenalog in Orabase, Oralone Dental
Func. class.:
Topical anesthetic
Chem. class.:
Synthetic fluorinated adrenal corticosteroid
Binds with steroid receptors, decreases inflammation
Oral pain
Infants <1 yr, hypersensitivity, application to large areas; presence of fungal, viral, or bacterial infections of mouth or throat
Precautions:
Pregnancy (C), children <6 yr, sepsis, denuded skin
Calculator
• Adult and child:
TOP
Press 1/4 inch into affected area until film appears, repeat bid-tid
Available forms:
Paste 0.1%
•
After cleansing oral cavity after meals
INTEG:
Rash, irritation, sensitization
•
Allergy: rash, irritation, reddening, swelling
•
Infection: if affected area is infected, do not apply
•
Therapeutic response: absence of pain in affected area
•
To report rash, irritation, redness, swelling
•
How to apply paste
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(trye-ay′zoe-lam)
Apo-Triazo
, Halcion
Func. class.:
Sedative-hypnotic, antianxiety
Chem. class.:
Benzodiazepine, short acting
Do not confuse:
Halcion
/Haldol/halcinonide
Produces CNS depression at limbic, thalamic, hypothalamic levels of CNS; may be mediated by neurotransmitter γ-aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
Insomnia, sedative/hypnotic
Pregnancy (X), breastfeeding, hypersensitivity to benzodiazepines, intermittent porphyria
Precautions:
Children <15 yr, geriatric patients, anemia, renal/hepatic disease, suicidal individuals, drug abuse, psychosis, acute closed-angle glaucoma, seizure disorders, angioedema, respiratory disease, depression, sleep-related behaviors (sleep walking)
Calculator
• Adult:
PO
0.125-0.5 mg at bedtime, max 0.5 mg/day
• Geriatric:
PO
0.0625-0.125 mg at bedtime, max 0.25 mg/day
Available forms:
Tabs 0.125, 0.25 mg
•
After trying conservative measures for insomnia
•
1/2 hr before bedtime for sleeplessness
•
On empty stomach for fast onset; may be taken with food if GI symptoms occur
•
Avoid use with CNS depressants; serious CNS depression may result
CNS:
Headache, lethargy, drowsiness, daytime sedation
, dizziness, confusion, lightheadedness, anxiety, irritability, amnesia, poor coordination,
complex sleep-related reactions: sleep driving, sleep eating
CV:
Chest pain, pulse changes
GI:
Nausea, vomiting, diarrhea, heartburn, abdominal pain, constipation,
hepatic injury
SYST:
Severe allergic reactions
Onset 30-45 min, duration 6-8 hr, metabolized by liver, excreted by kidneys (inactive metabolites), crosses placenta, excreted in breast milk, half-life 2-3 hr
•
Smoking may decrease hypnotic effect
Increase:
triazolam levels—CYP3A4 inhibitors, protease inhibitors
Increase:
effects of cimetidine, disulfiram, erythromycin, clarithromycin, probenecid, isoniazid, oral contraceptives; do not use concurrently
Increase:
action of both products—alcohol, CNS depressants
Decrease:
effect of antacids, theophylline, rifampin, smoking
Increase:
CNS depression—chamomile, hops, kava, lavender, valerian
•
Grapefruit may increase action, avoid concurrent use
Increase:
ALT, AST, serum bilirubin
Decrease:
RAI uptake
False increase:
urinary 17-OHCS
•
Blood studies: Hct, Hgb, RBC if blood dyscrasias suspected (rare)
•
Hepatic studies: AST, ALT, bilirubin if hepatic damage has occurred
•
Mental status: mood, sensorium, affect, memory (long, short term), insomnia, withdrawal symptoms, excessive sedation, impaired coordination
•
Blood dyscrasias: fever, sore throat, bruising, rash, jaundice, epistaxis (rare)
•
Type of sleep problem: falling asleep, staying asleep
•
Assistance with ambulation after receiving dose
•
Cool storage in tight container
•
Therapeutic response: ability to sleep at night, decreased amount of early morning awakening if taking product for insomnia
•
To use reliable contraception; pregnancy category (X)
•
That dependence is possible after long-term use
•
To avoid driving, other activities requiring alertness until product is stabilized
•
To avoid alcohol ingestion
•
That effects may take 2 nights for benefits to be noticed; that product is for short-term use only; to use for 7-10 continuous nights
•
About alternative measures to improve sleep: reading, exercise several hours before bedtime, warm bath, warm milk, TV, self-hypnosis, deep breathing
•
That complex sleep-related behaviors (sleep eating/driving) may occur
•
That hangover common in geriatric patients but less common than with barbiturates; that rebound insomnia may occur for 1-2 nights after discontinuing product; to discontinue by decreasing dose by 50% q2 nights until 0.125 mg for 2 nights, then stop
Lavage, activated charcoal; monitor electrolytes, VS
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(trye-meth-oh-ben′za-mide)
Tigan
Func. class.:
Antiemetic, anticholinergic
Chem. class.:
Ethanolamine derivative
Acts centrally by blocking chemoreceptor trigger zone, which in turn acts on vomiting center
Nausea, vomiting
Children (parenterally), hypersensitivity to opioids, shock
Precautions:
Pregnancy (C), children, geriatric patients, cardiac dysrhythmias, acute febrile illness, encephalitis, gastroenteritis, dehydration, electrolyte imbalances, Reye’s syndrome
Calculator
• Adult:
IM
200 mg 3-4×/day;
PO
300 mg 3-4×/day
• Adult:
IM
200 mg followed by 2nd dose 1 hr later
• Adult:
IM
CCr 15-30 ml/min, give 50% of dose
Available forms:
Caps 300 mg; inj 100 mg/ml
•
Capsules may be swallowed whole, chewed, allowed to dissolve
•
Inj in large muscle mass; aspirate to avoid IV administration; inj not to be used in children or infants
Syringe compatibilities:
Butorphanol, glycopyrrolate, HYDROmorphone, midazolam, nalbuphine
CNS:
Drowsiness
, headache, dizziness, confusion, disorientation,
coma, seizures,
depression,
vertigo
, EPS
CV:
Hypo/hypertension, palpitation,
cardiac dysrhythmias
EENT:
Dry mouth, blurred vision, photosensitivity
GI:
Nausea, diarrhea, vomiting, difficulty swallowing
INTEG:
Rash, urticaria, fever, chills, flushing, hyperpyrexia
Metabolized by liver, excreted by kidneys
PO:
Onset 20-40 min, duration 3-4 hr
IM:
Onset 15-35 min, duration 2-3 hr
Increase:
effect—CNS depressants, alcohol
•
Nausea, vomiting before, after treatment
•
VS, B/P; check patients with cardiac disease more often
•
Signs of toxicity of other products or masking of symptoms of disease: brain tumor, intestinal obstruction
•
Observe for drowsiness, dizziness
•
Therapeutic response: decreased nausea, vomiting
•
To avoid hazardous activities, activities requiring alertness because dizziness may occur; to request assistance with ambulation
•
To avoid alcohol, other depressants
•
To keep out of children’s reach