Mosby's 2014 Nursing Drug Reference (426 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
Galzin
Func. class.:
Trace element; nutritional supplement
Needed for adequate healing, bone and joint development (23% zinc)
Prevention of zinc deficiency, adjunct to vit A therapy
Unlabeled uses:
Wound healing
Precautions:
Pregnancy (C) parenteral; breastfeeding, neonates, hypocupremia, neonatal prematurity, renal disease
Calculator
• Adult/adolescent/pregnant female:
PO
11-13 mg/day
• Adult/lactating female:
PO
12-14 mg/day × 12 mo
• Adult/adolescent male ≥14 yr:
PO
11 mg/day
• Adult female ≥19 yr:
PO
8 mg/day
• Adolescent female ≥14 yr:
PO
9 mg/day
• Child 9-13 yr:
PO
8 mg/day
• Child 4-8 yr:
PO
5 mg/day
• Child 1-3 yr:
PO
3 mg/day
• Infant 7-12 mo:
PO
3 mg/day
• Infant birth to 6 mo:
PO
2 mg/day (adequate intake)
• Adult:
IV
2.5-4 mg/day; may increase by 2 mg/day if needed
• Child 1-5 yr:
IV
50 mcg/kg/day
• Adult:
PO
50 mg tid until healed (elemental zinc)
Available forms:
Tabs 66, 110 mg; caps 220 mg; inj 1 mg, 5 mg/ml
•
With meals to decrease gastric upset; avoid dairy products
GI:
Nausea, vomiting, cramps, heartburn, ulcer formation
OVERDOSE:
Diarrhea, rash, dehydration, restlessness
Decrease:
absorption of fluoroquinolones—tetracyclines
Decrease:
absorption of PO zinc—dairy products, caffeine
•
Zinc deficiency:
poor wound healing, absence of taste, smell, slowing growth
•
Alkaline phosphatase, HDL monthly in long term therapy
•
Zinc levels during treatment
•
Therapeutic response: absence of zinc deficiency
•
That element must be taken for 2-3 mo to be effective
•
To immediately report nausea, diarrhea, rash, severe vomiting, restlessness, abdominal pain, tarry stools
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(zi-praz′ih-dohn)
Geodon, Zeldox
Func. class.:
Antipsychotic/neuroleptic
Chem. class.:
Benzisoxazole derivative
Unknown; may be mediated through both dopamine type 2 (D
2
) and serotonin type 2 (5-HT
2
) antagonism
Schizophrenia, acute agitation, acute psychosis, bipolar disorder, mania, psychotic depression
Unlabeled uses:
Tourette’s syndrome
Breastfeeding, hypersensitivity, acute MI, heart failure, QT prolongation
Precautions:
Pregnancy (C), children, geriatric patients, cardiac/renal/hepatic disease, breast cancer, diabetes, seizure disorders, AV block, CNS depression
Black Box Warning:
Increased mortality in geriatric patients with dementia-related psychosis
Calculator
• Adult:
PO
20 mg bid with food, adjust dosage every 2 days upward to max of 80 mg bid;
IM
10-20 mg; may give 10 mg q2hr; doses of 20 mg may be given q4hr; max 40 mg/day (acute episodes); switch to PO as soon as possible
• Adult:
PO
40 mg bid with food; on day 2 increase to 60 or 80 mg bid, then adjust to response; maintenance as adjunct to lithium/valproate 40-80 mg bid
• Adolescent and child ≥7 yr:
PO
5 mg/day, may increase in divided doses to 20 mg bid
Available forms:
Caps 20, 40, 60, 80 mg; inj 20 mg/ml single-dose vials
•
Reduced dose in geriatric patients
•
Anticholinergic agent on order from prescriber to be used for EPS
•
Add 1.2 ml sterile water for inj to vial; shake vigorously until dissolved; do not admix; give only IM
CNS:
EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia; drowsiness, insomnia, agitation, anxiety, headache
,
seizures, neuroleptic malignant syndrome,
dizziness, tremor, facial droop
CV:
Orthostatic hypotension,
tachycardia, prolonged QT/QTc,
hypertension;
sudden death, heart failure (geriatric patients), torsades de pointes
EENT:
Blurred vision, diplopia
ENDO:
Metabolic changes
GI:
Nausea
, vomiting,
anorexia, constipation
, jaundice, weight gain, diarrhea, dry mouth, abdominal pain
GU:
Enuresis, urinary incontinence, gynecomastia, impotence, priapism
RESP:
Rhinitis, dyspnea, infection, cough
PO:
Extensively metabolized by liver to major active metabolite, plasma protein binding 90%, peak 6-8 hr, terminal half-life 7 hr
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, methadone, chloroquine, clarithromycin, droperidol, erythromycin, pentamidine, moxifloxacin
Increase:
sedation—other CNS depressants, alcohol
Increase:
EPS, possible neurotoxicity—other antipsychotics, lithium
Increase:
ziprasidone excretion—carBAMazepine
Increase:
ziprasidone level—ketoconazole
Increase:
hypotension—antihypertensives
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs
•
Mental status before initial administration
Black Box Warning:
Geriatric patient with dementia closely; heart failure, sudden death have occurred
•
Bilirubin, CBC, LFTs, fasting blood glucose monthly
•
Urinalysis before, during prolonged therapy
•
B/P standing and lying; also pulse, respirations; take these q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes; QT prolongation may occur
•
Dizziness, faintness, palpitations, tachycardia on rising; metabolic changes, weight gain
•
EPS,
including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of
the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
Neuroleptic malignant syndrome, serotonin syndrome:
hyperthermia, increased CPK, altered mental status, muscle rigidity
•
Constipation, urinary retention daily; if these occur, increase bulk and water in diet
•
Supervised ambulation until patient is stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for a long time
•
Increased fluids to prevent constipation
•
Storage in tight, light-resistant container
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech
•
That orthostatic hypotension may occur; to rise from sitting or lying position gradually
•
To avoid hot tubs, hot showers, tub baths because hypotension may occur
•
To avoid abrupt withdrawal of product because EPS may result; that product should be withdrawn slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber because serious product interactions may occur; to avoid use with alcohol because increased drowsiness may occur
•
To avoid hazardous activities if drowsy or dizzy
•
To report impaired vision, tremors, muscle twitching
•
In hot weather, that heat stroke may occur; to take extra precautions to stay cool
Lavage if orally ingested; provide airway;
do not induce vomiting