Mosby's 2014 Nursing Drug Reference (419 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(vye-ga′ba-trin)
Sabril
Func. class.:
Anticonvulsant
Chem. class.:
GABA transaminase inhibitor
May inhibit reuptake and metabolism of GABA, may increase seizure threshold; structurally similar to GABA
Adjunct treatment of partial seizures in adults and children ≥12 yr, infantile spasm
Hypersensitivity to this product
Precautions:
Pregnancy (C), breastfeeding, children <2 yr, geriatric patients, renal/hepatic disease, suicidal thoughts/behaviors, abrupt discontinuation
Black Box Warning:
Visual disturbance
Calculator
• Adult:
PO
500 mg bid, titrate in 500- mg increments at weekly intervals up to 1.5 g bid
• Infant >1 mo, child ≤2 yr:
PO
50 mg/kg/day in 2 divided doses, titrate in 25 to 50-mg/kg/day increments q3days, max 150 mg/kg/day
• Adult:
PO
CCr 50-80 ml/min, reduce dose by 25%; CCr 30-50 ml/min, reduce dose by 50%; CCr 10-30 ml/min, reduce dose by 75%
Available forms:
Tabs 500 mg; powder for oral solution 500 mg
•
Give without regard to meals
•
Reconstitute immediately before using
•
Empty contents of appropriate number of packets into clean cup
•
For each packet, dissolve 10 ml water, conc 50 mg/ml; do not use other liquids
•
Stir until dissolved, sol should be clear
•
Use calibrated oral syringe to measure correct dosage
•
Discard any unused sol
CNS:
Dizziness
, irritability, lethargy,
malignant hyperthermia,
insomnia
CV:
Edema
EENT:
Visual impairment
GI:
Nausea, vomiting, diarrhea, increased appetite, abdominal pain, GI bleeding, hemorrhoids, weight gain, constipation
HEMA:
Anemia
INTEG:
Pruritus, rash
RESP:
Coughing,
respiratory depression, pulmonary embolism
Absorption >95%, no protein binding, widely distributed, not metabolized, excretion in urine 80% parent drug, excretion slowed in renal disease, peak 2 hr, half-life 7.5 hr
Increase:
CNS depression—CNS depressants
Increase:
Serious ophthalmic effects (glaucoma, retinopathy): azaTHIOprine, chloroquine, corticosteroids, deferoxamine, ethambutol, hydroxychloroquine, interferons, loxapine, mecasermin, rh-IGF-1, pentostatin, phenothiazine, phosphodiesterase inhibitors, tamoxifen, thiothixene; avoid concurrent use
•
Renal studies: urinalysis, BUN, urine creatinine q3mo
•
Hepatic studies: ALT, AST, bilirubin
•
Description of seizures: location, duration, presence of aura
•
Mental status: mood, sensorium, affect, behavioral changes; if mental status changes, notify prescriber
•
Storage at room temp
•
Assistance with ambulation during early part of treatment; dizziness occurs
•
Seizure precautions: padded side rails; move objects that may harm patient
•
Therapeutic response: decreased seizure activity; document on patient’s chart
•
To carry emergency ID stating patient’s name, products taken, condition, prescriber’s name and phone number
•
To avoid driving, other activities that require alertness
•
Not to discontinue medication quickly after long-term use
•
To notify prescriber if pregnancy is planned or suspected
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(vil-az′oh-done)
Viibryd
Func. class.:
Antidepressant, miscellaneous
Novel antidepressant unrelated to other antidepressants, enhances serotonergic action by a dual mechanism
Major depression
Concomitant use of MOA inhibitors or within 14 days after discontinuing MOA inhibitor or within 14 days after discontinuing vilazodone
Precautions:
Pregnancy (C), labor, infants, geriatric patients, abrupt discontinuation, bipolar disorder, bleeding, operating machinery, ECT, hepatic disease, hyponatremia, hypovolemia, substance abuse, history of seizures, serotonin syndrome, neuroleptic malignant syndrome; use with serotonin precursors (e.g., tryptophan) or serotonergic drugs; suicidal ideation, worsening depression or behavior
Black Box Warning:
Children, suicidal ideation
Calculator
• Adult:
PO
10 mg × 7 days, then 20 mg × 7 days, then 40 mg/day; if taking potent CYP3A4 inhibitor, max 20 mg/day
Available forms:
Tabs 10, 20, 40 mg
•
With food to increase absorption
•
Do not use within 2 wk of MAOIs
CNS:
Restlessness, dizziness, drowsiness, fatigue, mania, insomnia, migraine,
neuroleptic-malignant–like syndrome,x
paresthesias,
seizures, suicidal ideation,
tremor, night sweats, dream disorders
EENT:
Cataracts, blurred vision
GI:
Nausea, vomiting, flatulence, diarrhea, xerostomia, altered taste, gastroenteritis
GU:
Decreased libido, ejaculation disorder, increased frequency of urination, sexual dysfunction
HEMA:
Bleeding, decreased platelets
MS:
Arthralgia
SYST:
Neonatal abstinence syndrome, withdrawal,
serotonin syndrome
Do not use within 2 wk of MAO inhibitors
Increased:
serotonin syndrome—SSRIs, SNRIs, serotonin receptor agonists, selegiline, busPIRone, dextromethorphan, ergots, fenfluramine, dexfluramine, lithium, meperidine, fentaNYL, methy
lphenidate, dexmethylphenidate, metoclopramide, mirtazapine, nefazodone, pentazocine, phenothiazines, haloperidol, loxapine, thiothixene, molindone, amphetamines
Increased:
bleeding—anticoagulants, thrombolytics, platelet inhibitors, salicylates, NSAIDs
Increased:
vilazodone levels—CYP3A4 inhibitors (ketoconazole, erythromycin, efavirenz, dronedarone, clarithromycin and others)
Decrease:
vilazodone effect—CYP3A4 inducers
•
Avoid use with grapefruit juice
Increased:
serotonin syndrome—St. John’s wort
Protein binding 96%-99%, metabolized by liver by CYP3A4 (major) and CYP2C19 and CYP2D (minor) and non-CYP pathways, peak 4-5 hr, half-life 25 hr
Black Box Warning:
Mental status: orientation, mood behavior initially and periodically; initiate suicide precautions if indicated; history of seizures, mania
•
Renal/hepatic status: hyponatremia
•
Abrupt discontinuation:
Do not discontinue abruptly, taper, monitor for symptoms of withdrawal; if intolerable, resume previous dose and decrease more slowly
•
Serotonin syndrome/neuroleptic malignant syndrome: nausea, vomiting, sedation, sweating, facial flushing, high B/P; discontinue product
•
Storage at room temp, away from moisture, heat
•
Therapeutic response: remission of depressive symptoms
•
To take as directed; not to double dose
•
To avoid abrupt discontinuation unless approved by prescriber
•
Not to drive or operate machinery until effects are known
•
Not to use other products unless approved by prescribed
To contact prescriber regarding the following: allergic reactions; personality changes (aggression, anxiety, anger, hostility); extreme sleepiness or drowsiness; feeling confused, nervous, restless or clumsy; numbness, tingling, or burning pain in hands, arms, legs, or feet; tremors; unusual behavior or thoughts about hurting oneself
•
To notify prescriber if pregnancy is planned or suspected; avoid breastfeeding