Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (43 page)
INTEG:
Rash
META:
Hyperglycemia, dyslipidemia
RESP:
Cough
SYST:
Death among geriatric patients with dementia
PO:
Absorption 87%; extensively metabolized by liver to a major active metabolite; plasma protein binding >99%; terminal half-life 75-146 hr; excretion via urine 25%, feces 55%; clearance decreased in geriatric patients
Increase:
effects of ARIPiprazole—CYP3A4 inhibitors (ketoconazole, erythromycin), CYP2D6 inhibitors (quiNIDine, FLUoxetine, PARoxetine); reduce dose of ARIPiprazole
Increase:
sedation—other CNS depressants, alcohol
Increase:
EPS—other antipsychotics, lithium
Decrease:
ARIPiprazole level—famotidine, valproate
Decrease:
effects of ARIPiprazole—CYP3A4 inducers (carBAMazepine)
Decrease:
ARIPiprazole effect—St. John’s wort
Black Box Warning:
Mental status
before initial administration, children/young adults may exhibit suicidal thoughts/behaviors, therefore smallest amount of product should be given; elderly patients with dementia-related psychosis are at increased risk of death
•
Swallowing of PO medication; check for hoarding, giving of medication to other patients
•
I&O ratio; palpate bladder if urinary output is low
•
Bilirubin, CBC, LFTs, weight, lipid profile, fasting blood glucose q mo
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
•
B/P standing and lying; also pulse, respirations; take q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes
•
Dizziness, faintness, palpitations, tachycardia on rising
•
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:
hyperthermia, increased CPK, altered mental status, muscle rigidity; notify prescriber immediately
•
Constipation, urinary retention daily; if these occur, increase bulk, water in diet; stool softeners, laxatives may be needed
•
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
•
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; hypotension may occur
•
To avoid abrupt withdrawal of this product; EPS may result; 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, CNS depressants because increased drowsiness may occur
•
To avoid hazardous activities if drowsy, dizzy
•
About compliance with product regimen
•
To report impaired vision, tremors, muscle twitching, urinary retention
•
That heat stroke may occur in hot weather; to take extra precautions to stay cool
•
To notify prescriber if pregnant or intending to become pregnant; not to breastfeed
Black Box Warning:
To report suicidal thoughts/behaviors immediately
Lavage if orally ingested; provide airway;
do not induce vomiting
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
armodafinil (Rx)
(ar-moe-daf′in-il)
Nuvigil
Narcolepsy, obstructive sleep apnea/hypoapnea syndrome, circadian rhythm disruption (shift-work sleep problems)
Hypersensitivity to this product or modafinil
• Adult and adolescent
≥
17 yr: PO
150-250 mg in
AM
• Adult and adolescent
≥
17 yr: PO
150 mg at start of shift
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC,
Rx)
(a-skor′bic)
Acerola C, Apo-C
, Ascor L-500, Cenolate, Equaline Vitamin C, Walgreens Gold Seal, and many more
Func. class.:
Vit C—water-soluble vitamin
Wound healing, collagen synthesis, antioxidant, carbohydrate metabolism
Vit C deficiency, scurvy; delayed wound, bone healing; chronic disease; urine acidification; before gastrectomy; dietary supplement
Common cold prevention
Tartrazine, sulfite sensitivity; G6PD deficiency
Precautions:
Pregnancy (C), gout, diabetes, renal calculi (large doses)
• Child 14-18 yr: PO
65 mg (female), 75 mg (male)
• Child 9-13 yr: PO
45 mg/day
• Child 4-8 yr: PO
25 mg/day
• Child 1-3 yr: PO
15 mg/day
• Infant: PO
40-50 mg/day
• Adult: PO/SUBCUT/IM/IV
100-250 mg/day × 2 wk then 50 mg or more daily
• Child: PO/SUBCUT/IM/IV
100-300 mg/day × 2 wk then 35 mg or more daily
• Adult: SUBCUT/IM/IV/PO
200-500 mg/day for 1-2 mo
• Child: SUBCUT/IM/IV/PO
100-200 mg added doses for 1-2 mo
• Adult:
4-12 g/day in divided doses
• Child:
500 mg q6-8hr
Tabs 25, 50, 100, 250, 500, 1000, 1500 mg; effervescent tabs 1000 mg; chewable tabs 100, 250, 500 mg; timed-release tabs 500, 750, 1000, 1500 mg; timed-release caps 500 mg; crys 4 g/tsp; powder 4 g/tsp; liq 35 mg/0.6 ml; sol 100 mg/ml; syr 20 mg/ml, 500 mg/5 ml; inj SUBCUT, IM, IV 100, 250, 500 mg/ml