Mosby's 2014 Nursing Drug Reference (425 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(zal′eh-plon)
Sonata
Func. class.:
Hypnotic, nonbarbiturate
Chem. class.:
Pyrazolopyrimidine
Binds selectively to omega-1 receptor of the GABA
A
receptor complex; results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
Insomnia (short-term treatment)
Hypersensitivity, severe hepatic disease
Precautions:
Pregnancy (C), breastfeeding, children <15 yr, geriatric patients, respiratory/renal/hepatic disease, psychosis, angioedema, depression, sleep-related behaviors (sleep walking)
Calculator
• Adult:
PO
10 mg at bedtime; may increase dose to 20 mg at bedtime if needed; 5 mg may be used in low-weight persons
• Geriatric:
PO
5 mg at bedtime; may increase if needed
Available forms:
Caps 5, 10 mg
•
Immediately before bedtime for sleeplessness
•
On empty stomach for fast onset
CNS:
Lethargy, drowsiness, daytime sedation
, dizziness, confusion, anxiety, amnesia, depersonalization, hallucinations, hyperesthesia, paresthesia, somnolence, tremor, vertigo,
complex sleep related reactions: sleep driving, sleep eating
CV:
Chest pain, peripheral edema
EENT:
Vision change, ear/eye pain, hyperacusis, parosmia
GI:
Nausea, abdominal pain, constipation, anorexia, colitis, dyspepsia, dry mouth
MISC:
Asthenia, fever, headache, myalgia, dysmenorrhea
MS:
Myalgia, back pain, arthritis
RESP:
Bronchitis
SYST:
Severe allergic reactions
Rapid onset, metabolized by liver extensively, excreted by kidneys (inactive metabolites), half-life 1 hr, onset, peak 1 hr, duration 3-4 hr
Increase:
effect of zaleplon—cimetidine
Decrease:
zaleplon bioavailability—CYP3A4 inducers
•
Prolonged absorption, sleep onset reduced: high-fat/heavy meal
•
Mental status: mood, sensorium, affect, memory (long, short term), excessive sedation, impaired coordination
•
Sleep disorder:
type of sleep problem: falling asleep, staying asleep; monitor for complex sleep disorders
•
Storage in tight container in cool environment
•
Therapeutic response: ability to sleep at night, decreased amount of early morning awakening
•
To avoid driving or other activities requiring alertness until product is stabilized
•
To avoid alcohol ingestion
•
That product may cause memory problems, dependence (if used for longer periods of time), changes in behavior/thinking, complex sleep-related behaviors (sleep eating/driving)
•
That product is for short-term use only
•
To take immediately before going to bed
•
Not to ingest a high-fat/heavy meal before taking
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(zan′ah-mih-veer)
Relenza
Func. class.:
Antiviral
Chem. class.:
Neuramidase inhibitor
Inhibits neuramidase enzyme needed for influenza virus replication
Treatment of influenza types A and B for patients who have been symptomatic for ≤2 days
Unlabeled uses:
Prophylaxis against influenza; swine flu (H1N1)
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children <7 yr, geriatric patients, respiratory disease, angioedema, milk protein hypersensitivity, Reye’s syndrome
Calculator
• Adult/child >7 yr:
INH
2 inhalations (two 5-mg blisters) q12hr × 5 days; on the 1st day, 2 doses should be taken with at least 2 hr between doses
• Adult/adolescent/child ≥7 yr:
INH
2 bid × 5 days
Available forms:
Blisters of powder for inhalation: 5 mg
•
Within 2 days of symptoms of influenza; continue for 5 days
•
Give patient “Patient’s Instructions for Use,” review all points before using delivery system
•
Do not use as nebulized sol or in mechanical ventilation
CNS:
Headache, dizziness
,
seizures,
fatigue; self-injury, delirium (child)
EENT:
Ear, nose, throat infections
GI:
Nausea, vomiting
, diarrhea
RESP:
Nasal symptoms, cough, sinusitis, bronchitis,
bronchospasm
SYST:
Angioedema
Half-life 2½-5 hr, not metabolized, excreted in urine unchanged
•
May decrease intranasal influenzae vaccine; separate by ≥48 hr, do not restart antiviral products for ≥2 wk
•
Skin eruptions, photosensitivity after administration of product
•
Respiratory status: rate, character, wheezing, tightness in chest
•
Allergies before initiation of treatment, reaction of each medication
•
Signs of infection
•
Storage in tight, dry container
•
Therapeutic response: absence of fever, malaise, cough, dyspnea with infection
•
That product does not reduce transmission risk of influenza to others
•
That patients with asthma or COPD should carry a fast-acting inhaled bronchodilator because bronchospasm may occur; to use scheduled inhaled bronchodilators before using product
•
To avoid hazardous activities if dizziness occurs
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(zye-doe′-vue-deen)
Novo-AZT
, Retrovir
Func. class.:
Antiretroviral
Chem. class.:
Nucleoside reverse transcriptase inhibitor (NRTI)
Do not confuse:
Retrovir
/ritonavir
Inhibits replication of HIV-1 virus by incorporating into cellular DNA by viral reverse transcriptase, thereby terminating the cellular DNA chain
Used in combination with at least 2 other antiretrovirals for HIV-1 infection
Unlabeled uses:
Epstein-Barr virus, hepatitis B, human T-lymphotropic virus type I (HTLV-I), thrombocytopenia
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, granulocyte count <1000/mm
3
or Hgb <9.5 g/dl, severe renal disease, obesity
Black Box Warning:
Impaired hepatic function, anemia, lactic acidosis, myopathy, neutropenia
Calculator
• Adult:
PO (tabs, caps, syrup)
600 mg/day in divided doses, either 200 mg tid or 300 mg bid in combination with other antiretrovirals;
IV
1 mg/kg q4hr, initiate
PO
as soon as possible up to 1000 mg
• Child 25 kg to <30 kg:
PO (tabs/caps)
500 mg/day divided bid
• Child 19 kg to <25 kg:
PO (tabs/caps)
400 mg/day divided bid
• Infant/child ≥4 wk and 13 to <19 kg:
PO (tabs/caps)
300 mg/day divided bid
• Infant/child ≥4 wk and 7 to <13 kg:
PO (tabs/caps)
200 mg/day divided bid
• Infant/child ≥4 wk and 5 to <7 kg:
PO (tabs/caps)
150 mg/day divided bid
• Adolescent/child ≥30 kg:
PO (tabs/caps/syrup)
300 mg bid or 200 mg tid
• Infant ≥4 wk, child/adolescent ≥9 to <30 kg:
PO (syrup)
18 mg/kg/day divided bid or tid
• Infant ≥4 wk and 4 to <9 kg:
PO (syrup)
24 mg/kg/day divided bid or tid
• Neonate (unlabeled):
PO (syrup)
2 mg/kg q6hr
• Premature neonate (unlabeled):
PO (syrup)
2 mg/kg q12hr, increase to 2 mg/kg q8hr at 2 wk for neonates ≥30 wk gestation or at 4 wk for neonates <30 wk gestation
• Neonates ≥34 wk:
PO
2 mg/kg/dose q6hr × 6 wk beginning 8-12 hr after birth;
IV
1.5 mg/kg/dose over 30 min q6hr until able to take
PO
• Maternal (>14 wk gestation):
PO
100 mg 5×/day until start of labor then during labor/delivery
IV
2 mg/kg over 1 hr followed by
IV INF
1 mg/kg/hr until umbilical cord clamped
• Adult:
PO
200 mg tid plus lamiVUDine 150 mg bid plus a protease inhibitor for high-risk exposure; begin within 2 hr of exposure
Available forms:
Caps 100; tabs 300 mg; inj 10 mg/ml; oral syr 50 mg/5 ml
•
By mouth; capsules should be swallowed whole
•
Trimethoprim-sulfamethoxazole, pyrimethamine, or acyclovir as ordered to prevent opportunistic infections; if these products are given, watch for neurotoxicity
•
After diluting each 1 mg/0.25 ml or more D
5
W to ≤4 mg/ml; give over 1 hr
•
Protect unopened product from light, use diluted sol within 24 hr room temperature, 48 hr refrigerated
Y-site compatibilities:
Acyclovir, allopurinol, amifostine, amikacin, amphotericin B, amphotericin B cholesteryl, aztreonam, cefepime, cefTAZidime, cefTRIAXone, cimetidine, cisatracurium, clindamycin, dexamethasone, DOBUTamine, DOPamine, DOXOrubicin liposome, erythromycin, filgrastim, fluconazole, fludarabine, gentamicin, granisetron, heparin, imipenem-cilastatin, LORazepam, melphalan, metoclopramide, morphine, nafcillin, ondansetron, oxacillin, PACLitaxel, pentamidine, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride, ranitidine, remifentanil, sargramostim, teniposide, thiotepa, tobramycin, trimethoprim-sulfamethoxazole, trimetrexate, vancomycin, vinorelbine
CNS:
Fever, headache, malaise
, diaphoresis,
dizziness, insomnia
, paresthesia, somnolence, chills, tremor, twitching, anxiety, confusion, depression, lability, vertigo, loss of mental acuity,
seizures,
malaise
EENT:
Taste change, hearing loss, photophobia
GI:
Nausea, vomiting, diarrhea, anorexia
, cramps,
dyspepsia, constipation
, dysphagia,
flatulence
, rectal bleeding, mouth ulcer, abdominal pain,
hepatomegaly
GU:
Dysuria, polyuria, urinary frequency, hesitancy
HEMA:
Granulocytopenia, anemia
INTEG:
Rash
, acne, pruritus, urticaria
MS:
Myalgia, arthralgia, muscle spasm
RESP:
Dyspnea
SYST:
Lactic acidosis
PO:
Rapidly absorbed from GI tract, peak ½-1½ hr, metabolized in liver (inactive metabolites), excreted by kidneys, protein binding 38%, terminal half-life ½-3 hr
Increase:
bone marrow depression—antineoplastics, radiation, ganciclovir, valganciclovir, trimethoprim-sulfamethoxazole
Increase:
zidovudine level—methadone, atovaquone, fluconazole, probenecid, trimethoprim, valproic acid; may need to reduce zidovudine dose
Decrease:
zidovudine levels—interferons, NRTIs, DOXOrubicin, ribavirin, stavudine; avoid concurrent use
Decrease:
platelets
Increase:
LFTs
•
Blood dyscrasias (anemia, granulocytopenia): bruising, fatigue, bleeding, poor healing
Black Box Warning:
Blood counts q2wk; watch for decreasing granulocytes, Hgb; if low, therapy may have to be discontinued and restarted after hematologic recovery; blood transfusions may be required; viral load, CD4 counts, LFTs, plasma HIV RNA, serum creatinine/BUN at baseline and throughout treatment
Black Box Warning:
Lactic acidosis, severe hepatomegaly with steatosis:
Obtain baseline liver function tests, if elevated, discontinue treatment; discontinue even if liver function tests are normal but lactic acidosis, hepatomegaly are present; may be fatal
•
Storage in cool environment; protect from light
•
Therapeutic response: decreased viral load, increased CD4 counts, decreased symptoms of HIV
•
That GI complaints and insomnia resolve after 3-4 wk of treatment
•
That product not cure for AIDS but will control symptoms
•
To notify prescriber of sore throat, swollen lymph nodes, malaise, fever because other infections may occur
•
That patient is still infective, may pass AIDS virus on to others
•
That follow-up visits must be continued because serious toxicity may occur; that blood counts must be done q2wk; that blood transfusions may be needed for severe anemia
•
That product must be taken bid or tid
•
That serious product interactions may occur if OTC products are ingested; to check with prescriber before taking aspirin, acetaminophen, indomethacin
•
That other products may be necessary to prevent other infections
•
That product may cause fainting or dizziness