Mosby's 2014 Nursing Drug Reference (47 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
• Adult: PO
400 mg/day (unable to take ritonavir); 300 mg with ritonavir 100 mg/day
• Child ≥6 yr/adolescent ≥40 kg: PO
300 mg with ritonavir 100 mg daily
• Child ≥6 yr/adolescent 20 to <40 kg: PO
200 mg with ritonavir 100 mg daily
• Child ≥6 yr/adolescent 15 to <20 kg: PO
150 mg with ritonavir 80 mg daily
• Adult: PO
300 mg with ritonavir 100 mg daily
• Pregnant adults/adolescents (2nd/3rd trimester) with H2 blocker or tenofovir: PO
400 mg with ritonavir 100 mg daily
• Child ≥6 yr/adolescent ≥40 kg: PO
300 mg with ritonavir 100 mg daily
• Child ≥6 yr/adolescent 20 to <40 kg: PO
200 mg with ritonavir 100 mg daily
•
Adult: PO
Child-Pugh B: 300 mg/day; Child-Pugh C: do not use
Caps 100, 150, 200, 300 mg
•
With food; 2 hr before or 1 hr after antacid or didanosine, swallow cap whole
CNS:
Headache, depression, dizziness, insomnia, peripheral neurologic symptoms
GI:
Vomiting,
diarrhea, abdominal pain, nausea
,
hepatotoxicity
INTEG:
Rash
,
Stevens-Johnson syndrome,
photosensitivity
MISC:
Fatigue, fever, arthralgia, back pain, cough, lipodystrophy, pain, gynecomastia, nephrolithiasis;
lactic acidosis, hyperbilirubinemia (pregnancy, females, obesity)
Rapidly absorbed, absorption increased with food, peak 2½ hr, 86% protein bound, extensively metabolized in liver by CYP3A4, 27% excreted unchanged in urine/feces (minimal), half-life 7 hr
Increase:
levels, toxicity of immunosuppressants (cycloSPORINE, sirolimus, tacrolimus, sildenafil), tricylic antidepressants, warfarin, calcium channel blockers, clarithromycin, chlorazepate, diazepam, irinotecan, HMG-CoA reductase inhibitors, antidysrhythmics, midazolam, triazolam, ergots, pimozide, other protease inhibitors
Increase:
effects of estrogens, oral contraceptives
Increase:
atazanavir levels—CYP3A4 substrates, CYP3A4 inhibitors
Increase:
hyperbilirubinemia—indinavir
Decrease:
teleprevir level when used with atazanavir and ritonavir
Decrease:
atazanavir levels—CYP3A4 inducers, rifampin, antacids, didanosine, efavirenz, proton-pump inhibitors, H
2
-receptor antagonists
Decrease:
atazanavir levels—St. John’s wort, avoid concurrent use
Increase:
myopathy, rhabdomyolysis—red yeast rice
Increase:
AST, ALT, total bilirubin, amylase, lipase, CK
Decrease:
Hgb, neurophils, platelets
For hepatic failure; hepatic studies: ALT, AST, bilirubin
•
Immune reconstitution syndrome: When given with combination antiretroviral therapy
•
For lactic acidosis, hyperbilirubinemia (females, pregnancy, obesity), if pregnant call Antiretroviral Pregnancy Registry 800-258-4263
•
For signs of infection, anemia, nephrolithiasis
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
•
Viral load, CD4 count throughout treatment
•
Skin eruptions, rash, urticaria, itching
•
Therapeutic response: increasing CD4 counts; decreased viral load, resolution of symptoms of HIV-1 infection
•
To take as prescribed with other antiretrovirals as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose, share with others
•
That product must be taken daily to maintain blood levels for duration of therapy
•
That product may cause photosensitivity; to use protective clothing, stay out of the sun
•
To notify prescriber if diarrhea, nausea, vomiting, rash occurs; dizziness, lightheadedness may occur; ECG may be altered
•
That product interacts with many products; St. John’s wort; to advise prescriber of all products, herbal products used
•
That redistribution of body fat may occur, the effect is not known
•
That product does not cure HIV-1 infection, prevent transmission to others; only controls symptoms
•
That, if taking phosphodiesterase type 5 inhibitor with atazanavir, there may be increased risk of phosphodiesterase type 5 inhibitor–associated adverse events (hypotension, prolonged penile erection); to notify physician promptly of these symptoms
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-ten′oh-lole)
Tenormin
Func. class.:
Antihypertensive, antianginal
Chem. class.:
β-Blocker, β
1
-, β
2
-blocker (high doses)
atenolol
/albuterol
Tenormin
/thiamine/Imuran
Competitively blocks stimulation of β-adrenergic receptor within vascular smooth muscle; produces negative chronotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, negative inotropic activity decreases O
2
consumption in myocardium; decreases action of renin-aldosterone-angiotensin system at high doses, inhibits β
2
receptors in bronchial system at higher doses
Mild to moderate hypertension, prophylaxis of angina pectoris; suspected or known MI (IV use); MI prophylaxis
Migraine prophylaxis, supraventricular tachycardia prophylaxis (PSVT), unstable angina, alcohol withdrawal, lithium-induced tremor
Pregnancy (D), hypersensitivity to β-blockers, cardiogenic shock, 2nd- or 3rd-degree heart block, sinus bradycardia, cardiac failure, Raynaud’s disease, pulmonary edema
Precautions:
Breastfeeding, major surgery, diabetes mellitus, thyroid/renal disease, CHF, COPD, asthma, well-compensated heart failure, dialysis, myasthenia gravis
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult: PO
25-50 mg/day, increasing q1-2wk to 100 mg/day; may increase to 200 mg/day for angina, up to 100 mg/day for hypertension
• Child: PO
0.8-1 mg/kg/dose initially; range, 0.8-1.5 mg/kg/day; max 2 mg/kg/day
• Geriatric: PO
25 mg/day initially
• Adult: PO
50 mg/day, then 100 mg/day as needed after 7 days, max 200 mg/day
• Adult: PO
100 mg/day in 1-2 divided doses; may need for 1-3 yr after MI
• Adult: PO
CCr 15-35 ml/min, max 50 mg/day; CCr <15 ml/min, max 25 mg/day; hemodialysis 25-50 mg after dialysis
• Child: PO
0.3-1.3 mg/kg/day
• Adult: PO
50-100 mg/day
• Adult: PO
50-150 mg/day, titrate to response
• Adult: PO
50 mg/day
Tabs 25, 50, 100 mg
•
Before meals, at bedtime; tab may be crushed, swallowed whole
•
Reduced dosage with renal dysfunction
CNS:
Insomnia, fatigue, dizziness, mental changes
, memory loss, hallucinations, depression, lethargy, drowsiness, strange dreams, catatonia
CV:
Profound hypotension, bradycardia, CHF,
cold extremities, postural hypotension, 2nd- or 3rd-degree heart block
EENT:
Sore throat; dry, burning eyes; blurred vision; stuffy nose
ENDO:
Increased hypoglycemic response to insulin
GI:
Nausea, diarrhea
, vomiting,
mesenteric arterial thrombosis, ischemic colitis
GU:
Impotence, decreased libido
HEMA:
Agranulocytosis, thrombocytopenia purpura