Mosby's 2014 Nursing Drug Reference (55 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
See
Appendix B
Edarbi
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin II receptor antagonist
Antagonizes angiotensin II at the AT
1
receptor in tissues like vascular smooth muscle and the adrenal gland. Two angiotensin II receptors, AT
1
and AT
2
, have been identified; azilsartan exhibits more than 10,000-fold greater affinity for the AT
1
receptor than the AT
2
receptor.
Hypertension, alone or in combination with other antihypertensives
Black Box Warning:
Pregnancy (D) 2nd/3rd trimesters
Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children, geriatric patients, angioedema, African descent, renal disease, renal artery stenosis, heart failure, hypovolemia
Calculator
• Adult: PO
80 mg/day, may give an initial dose of 40 mg/day in patients receiving high-dose diuretic therapy
Available forms:
Tabs 40, 80 mg
•
May administer without regard to food
CNS:
Dizziness, fatigue, asthenia
CV:
Hypotension, orthostatic hypotension
GI:
Nausea, diarrhea
HEMA:
Anemia
INTEG:
Angioedema
MS:
Muscle cramps
RESP:
Cough
SYST:
Secondary malignancy
Protein binding >99% to serum albumin; metabolized by CYP2C9; elimination half-life 11 hr, steady state within 5 days and no accumulation in plasma occurs with once-daily dosing; elimination 55% in feces, 42% in urine; hydrolyzed to the active metabolite, azilsartan, in GI tract during absorption, rapidly absorbed, peak 1.5-3 hr; absolute bioavailability (60%) not affected by food
Increase:
hypotensive effect—other antihypertensives, other angiotensin receptor antagonists, MAOIs
Increase:
hypoglycemia—antidiabetics
Increase:
renal failure risk—cyclosporine, diuretics, NSAIDs in those with poor renal function; monitor closely
Increase:
lithium toxicity—lithium
Increase:
phosphate nephropathy—sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous
Increase:
antihypertensive effect—Hawthorn
Decrease:
antihypertensive effect—ephedra
Angioedema:
Assess for facial swelling, difficulty breathing
Black Box Warning:
For pregnancy (D) 2nd/3rd trimester, can cause fetal death
•
Response and adverse reactions especially in renal disease
•
B/P, pulse when beginning therapy and periodically thereafter; note rhythm, rate, quality; obtain electrolytes before beginning therapy
•
Use original package to protect from light and moisture beat
•
Therapeutic response: decreased B/P
•
To comply with dosage schedule even if feeling better
To notify prescriber of facial swelling; if pregnancy is planned or suspected (category D 2nd/3rd trimester)
•
That diarrhea, dehydration, excessive perspiration, vomiting, may lead to fall in B/P; to consult prescriber if these occur
•
To rise slowing from lying or sitting to minimize orthostatic hypotension; that product may cause dizziness
•
To avoid OTC medications unless approved by prescriber; to inform all health care providers of product use
•
To use proper technique for obtaining B/P
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ay-zi-thro-my′sin)
Zithromax, Zmax, Zithromax Tri Pak, Zithromax Z Pak
Func. class.:
Antiinfective
Chem. class.:
Macrolide (azalide)
Do not confuse:
azithromycin
/erythromycin
Zithromax
/Zinacef
Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis; much greater spectrum of activity than erythromycin; more effective against gram-negative organisms
Mild to moderate infections of the upper respiratory tract, lower respiratory tract; uncomplicated skin and skin structure infections caused by
Moraxella catarrhalis, Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Streptococcus agalactiae, Mycoplasma pneumoniae, Haemophilus influenzae, Clostridium, Legionella pneumophila;
NGU or cervicitis due to
Chlamydia trachomatis;
in children: acute otitis media
(H. influenzae, M. catarrhalis, S. pneumoniae)
PO;
acute pharyngitis/tonsillitis (group A streptococcal)
PO;
acute skin/soft tissue infections
PO;
community-acquired pneumonia
(Chlamydia pneumoniae, H. influenzae, M. pneumoniae, S. pneumoniae)
PO;
pharyngitis/tonsillitis
(S. pyogenes);
prophylaxis of disseminated
Mycobacterium avium
complex (MAC)
Unlabeled uses:
Babesiosis, cholera, cystic fibrosis, dental abscess/infection, endocarditis prophylaxis, granuloma inguinale,
Helicobacter pylori, Klebsiella granulomatis
, Legionnaire’s disease, Lyme disease, lymphogranuloma venereum, MAC,
Mycoplasma hominis
, periodontitis, pertussis, prostatitis,
Rickettsia tsutsugamushi, Salmonella typhi
,
shigellosis, syphilis, toxoplasmosis, typhoid fever
Hypersensitivity to azithromycin, erythromycin, any macrolide
Precautions:
Pregnancy (B), breastfeeding; geriatric patients; renal/hepatic/cardiac disease; <6 mo for otitis media; <2 yr for pharyngitis, tonsillitis
Calculator
• Adult: PO
500 mg on day 1 then 250 mg/day on days 2-5 for a total dose of 1.5 g or 500 mg a day × 3 days