Mosby's 2014 Nursing Drug Reference (427 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(zoh′leh-drah′nick ass′id)
Reclast, Zometa
Func. class.:
Bone-resorption inhibitor
Chem. class.:
Bisphosphonate
Potent inhibitor of osteoclastic bone resorption; inhibits osteoclastic activity, skeletal calcium release caused by stimulating factors released by tumors; reduction of abnormal bone resorption is responsible for therapeutic effect with hypercalcemia; may directly block dissolution of hydroxyapatite bone crystals
Moderate to severe hypercalcemia associated with malignancy; multiple myeloma; bone metastases from solid tumors (used with antineoplastics); active Paget’s disease; osteoporosis, glucocorticoid-induced osteoporosis, osteoporosis prophylaxis in postmenopausal women
Pregnancy (D), breastfeeding; hypersensitivity to this product or bisphosphonates; hypocalcemia
Precautions:
Children, geriatric patients, renal dysfunction, asthmatic patients, acute bronchospasm, anemia, chemotherapy, coagulopathy, dehydration, dental disease, diabetes mellitus, renal disease, electrolyte imbalance, hypertension, hypovolemia, infection, multiple myeloma, phosphate hypersensitivity
Calculator
• Adult:
IV INF
4 mg, given as single inf over ≥15 min; may re-treat with 4 mg if serum calcium does not return to normal within 1 wk
• Adult:
IV INF
4 mg, give over 15 min q3-4wk
• Adult:
IV INF
5 mg over ≥15 min q12mo
• Adult:
IV INF
5 mg over ≥15 min
• Adult:
IV INF
5 mg every other year
• Adult:
IV
5 mg every yr
• Adult:
IV
4 mg q6mo with goserelin 3.6 mg SUBCUT monthly and tamoxifen 20 mg daily or anastrozole 1 mg daily for 3 yr
Available forms:
(Zometa) sol for inj 4 mg/5 ml; (Reclast) inj 5 mg/100 ml
•
Saline hydration must be performed before administration; urine output should be 2 L/day during treatment; do not overhydrate patient
•
Administer after reconstituting by adding 5 ml of sterile water for inj to each vial then add to ≥100 ml of sterile 0.9% NaCl, D
5
W; run over ≥15 min
•
Administer in separate IV line from all other products
•
No further dilution required
•
Infuse over ≥15 min at constant rate; max 5 mg
CNS:
Dizziness, headache, anxiety, confusion, insomnia, agitation
CV:
Hypotension, leg edema,
atrial fibrillation,
chest pain
GI:
Abdominal pain, anorexia, constipation, nausea, diarrhea, vomiting, taste change
GU:
UTI, possible reduced renal function,
renal damage
META:
Anemia, hypokalemia, hypomagnesemia, hypophosphatemia, hypocalcemia, increased serum creatinine
MISC:
Fever, chills, flulike symptoms
MS:
Severe bone pain,
arthralgias, myalgias
,
osteonecrosis of jaw
Rapidly cleared from circulation, taken up mainly by bones, not metabolized, eliminated primarily by kidneys, approximately 50% eliminated in urine within 24 hr, max effect 7 days; terminal half-life 167 hr, protein binding 22%
•
Hypomagnesemia, hypokalemia: digoxin
Decrease:
effect of zoledronic acid—calcium, vit D
Decrease:
serum calcium, aminoglycosides, loop diuretics
•
Do not mix with calcium-containing infusion sol such as lactated Ringer’s sol
Increase:
nephrotoxicity—aminoglycosides, NSAIDs, radiopaque contrast agents
Increase:
creatinine
Decrease:
calcium, phosphorous, magnesium, potassium, Hct/Hgb, RBC, platelets, WBC
•
Renal tests, calcium, phosphate, magnesium, potassium; creatinine, BUN; if creatinine elevated, hold treatment
•
Hypocalcemia:
paresthesia, twitching, laryngospasm; Chvostek’s/Trousseau’s signs
•
Dental status; cover with antiinfectives for dental extraction
•
Atrial fibrillation
•
Sol reconstituted with sterile water may be stored under refrigeration for up to 24 hr
•
Acetaminophen before and for 72 hr after to decrease pain
•
Therapeutic response: decreased calcium levels, increased bone density
•
To report hypercalcemic relapse: nausea, vomiting, bone pain, thirst
•
To continue with dietary recommendations, including calcium and vit D; to take a multiple vitamin daily as well as 500 mg of calcium, 400 international units vit D with multiple myeloma
•
If nausea or vomiting occurs, to eat small, frequent meals, to use lozenges or chewing gum
•
If bone pain occurs, to notify prescriber to obtain analgesics
•
To avoid use during pregnancy (D)
•
To continue good oral hygiene
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(zole-mih-trip′tan)
Zomig, Zomig-ZMT
Func. class.:
Migraine agent, abortive
Chem. class.:
5-HT
1B
/5HT
1D
receptor agonist (triptan)
Binds selectively to the vascular 5-HT
1B
/5HT
1D
receptor subtype, exerts antimigraine effect; causes vasoconstriction in cranial arteries
Acute treatment of migraine with/without aura
Angina pectoris, history of MI, documented silent ischemia, ischemic heart disease, uncontrolled hypertension, hypersensitivity, basilar or hemiplegic migraine, risk of CV events
Precautions:
Pregnancy (C), breastfeeding, children, postmenopausal women, men >40 yr, geriatric patients, risk factors for CAD, hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function
Calculator
• Adult:
PO
start at ≤2.5 mg (tab may be broken), may repeat after 2 hr, max 10 mg/24 hr;
NASAL
1 spray in 1 nostril at onset of migraine, repeat in 2 hr if no relief
Available forms:
Tabs 2.5, 5 mg; orally disintegrating tabs 2.5, 5 mg; nasal spray 5 mg
•
Take with fluids as soon as symptoms of migraine occur
•
Orally disintegrating tab:
do not crush or chew, allow to dissolve on tongue
CNS:
Tingling, hot sensation, burning, feeling of pressure, tightness, numbness, dizziness, sedation
CV:
Palpitations, chest pain
GI:
Abdominal discomfort, nausea, dry mouth, dyspepsia, dysphagia
MISC:
Odd taste (spray)
MS:
Weakness, neck stiffness
, myalgia
RESP:
Chest tightness, pressure
Duration 2-3½ hr; 25% plasma protein binding; half-life 3-3½ hr; metabolized in liver (metabolite); excreted in urine (60-80%), feces (20-40%)
Extended vasospastic effects: ergot, ergot derivatives
Do not use within 2 wk of MAOIs
Weakness, hyperreflexia, incoordination: SSRIs (FLUoxetine, fluvoxaMINE, PARoxetine, sertraline)
Increase:
half-life of ZOLMitriptan—cimetidine, oral contraceptives
Increase:
ZOLMitriptan levels—sibutramine
•
Serotonin syndrome: SAM-e, St. John’s wort
Increase:
alk phos
•
Tingling, hot sensation, burning, feeling of pressure, numbness, flushing
•
Neurologic status: LOC, blurring vision, nausea, vomiting, tingling in extremities preceding headache
•
Ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artifical sweeteners, chocolate, caffeine, which may precipitate these types of headaches
•
Serotonin syndrome if also taking SSRI
•
Therapeutic response: decrease in frequency, severity of headache
•
To report any side effects to prescriber
•
To use contraception while taking product
•
That product does not prevent or reduce number of migraines
•
To report chest pain, rash, swelling of face
•
Not to double doses, if second dose is needed, wait at least 2 hr