Mosby's 2014 Nursing Drug Reference (57 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(bak′loe-fen)
Gablofen, Lioresal
Func. class.:
Skeletal muscle relaxant, central acting
Chem. class.:
GABA chlorophenyl derivative
Do not confuse:
Lioresal
/Lotensin
Inhibits synaptic responses in CNS by stimulating GABAb receptor subtype, which decreases neurotransmitter function; decreases frequency, severity of muscle spasms
Spasticity with spinal cord injury, multiple sclerosis
Unlabeled uses:
Neuropathic pain, hiccups, trigeminal neuralgia/nystagmus, recurrent priapism
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, peptic ulcer disease, renal/hepatic disease, stroke, seizure disorder, diabetes mellitus
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult: PO
5 mg tid × 3 days, then 10 mg tid × 3 days, then 15 mg tid × 3 days, then 20 mg tid × 3 days, then titrated to response, max 80 mg/day;
INTRATHECAL
use implantable intrathecal inf pump, use screening trial of 3 separate bol doses if needed 24 hr apart (50 mcg, 75 mcg, 100 mcg); patients who do not respond to 100 mcg should not be considered for chronic IT therapy; initial: double screening dose that produced result, give over 24 hr, increase by 10%-30% q24hr only; maintenance: 1200-1500 mcg/day
• Child >2-7 yr: PO
10-15 mg/day divided q8hr; titrate q3days by 5-15 mg/day to max 40 mg/day
• Child ≥8 yr:
As above; max 60 mg/day
• Child: INTRATHECAL
initial test dose same as adult; for small children, initial dose of 25 mcg/dose may be used; 25-1200 mcg/day inf titrated to response in screening phase
• Geriatric: PO
5 mg bid-tid
• Adult: PO
10 mg tid, may increase by 10 mg every other day; max 80 mg/day
• Adult: PO
10 mg qid
• Adult: PO
40 mg at bedtime
Available forms:
Tabs 10, 20 mg; IT inj 10 mg/20 ml (500 mcg/ml), 10 mg/5 ml (2000 mcg/ml); pharmacy can prepare extemperaneous liquid preparations
•
With meals for GI symptoms
•
For screening,
dilute to a concentration of 50 mcg/ml with NaCl for inj (preservative free), give test dose over 1 min; watch for decreasing muscle tone, frequency of spasm; if inadequate, use 2 more test doses q24hr;
maintenance inf
via implantable pump of 500-2000 mcg/ml because individual titration is required
•
Do not give IT dose by inj, IV, IM, SUBCUT, epidural
Additive compatibilities:
CloNIDine, morphine, ziconotide
CNS:
Dizziness, weakness, fatigue, drowsiness
, headache,
disorientation
, insomnia, paresthesias, tremors;
seizures, life-threatening CNS depression, coma; CNS infection
(IT)
CV:
Hypotension, chest pain, palpitations, edema;
cardiovascular collapse (IT)
EENT:
Nasal congestion, blurred vision, mydriasis, tinnitus
GI:
Nausea
, constipation,
vomiting
, increased AST, alk phos, abdominal pain, dry mouth, anorexia
GU:
Urinary frequency, hematuria
INTEG:
Rash, pruritus
RESP:
Dyspnea; respiratory failure (IT)
PO:
Onset 3-4 days, peak 2-3 hr, duration >8 hr, half-life 2½-4 hr, partially metabolized in liver, excreted in urine (unchanged)
INTRATHECAL:
CSF levels with plasma levels 100 times that of the oral route, peak 4 hr, duration 4-8 hr
BOLUS:
Onset 1/2-1 hr
CONT INF:
Onset 6-8 hr, peak 24-48 hr
Increase:
CNS depression—alcohol, tricyclics, opiates, barbiturates, sedatives, hypnotics, MAOIs
Increase:
hypotension—antihypertensives
Increase:
CNS depression—kava, valerian
Increase:
AST, alk phos, blood glucose
•
Multiple sclerosis:
spasms, spasticity, ataxia; improvement should occur with product
•
B/P, weight, blood glucose, hepatic function periodically
Seizures:
for increased seizure activity with seizure disorders; product decreases seizure threshold; EEG in epileptic patients
•
I&O ratio; check for urinary frequency
•
Allergic reactions: rash, fever, respiratory distress
•
Severe weakness, numbness in extremities
•
Tolerance: increased need for medication, more frequent requests for medication, increased pain
•
Withdrawal symptoms:
CNS depression, dizziness, drowsiness, psychiatric symptoms
•
Intrathecal:
have emergency equipment nearby; assess test dose and titration; if no response, check pump, catheter for proper functioning
•
Storage in tight container at room temperature
•
Assistance with ambulation if dizziness, drowsiness occurs
•
Therapeutic response: decreased pain, spasticity
•
Not to discontinue medication quickly; hallucinations, spasticity, tachycardia will occur; product should be tapered off over 1-2 wk
•
Not to take with alcohol, other CNS depressants
•
To avoid hazardous activities if drowsiness, dizziness occurs; to rise slowly to prevent orthostatic hypotension
•
To avoid using OTC medications; not to take cough preparations, antihistamines unless directed by prescriber
•
To notify prescriber if nausea; headache; tinnitus; insomnia; confusion; constipation; inadequate, painful urination continues
•
MS:
may require 1-2 mo for full response
Induce emesis in conscious patient, activated charcoal, dialysis, physostigmine to reduce life-threatening CNS side effects
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTbasiliximab (Rx)
(bas-ih-liks′ih-mab)
Simulect
Func. class.:
Immunosuppressant
Chem. class.:
Murine/human monoclonal antibody (interleukin-2) receptor antagonist
Binds to and blocks the IL-2 receptor, which is selectively expressed on the surface of activated T lymphocytes; impairs the immune system to antigenic challenges
Acute allograft rejection in renal transplant patients when used with cycloSPORINE and corticosteroids
Unlabeled uses:
Liver transplant rejection prophylaxis, graft-versus-host disease
Breastfeeding, hypersensitivity to mannitol/murine, exposure to viral infections
Precautions:
Pregnancy (B), children, geriatric patients, human anti-murine antibody
Black Box Warning:
Infections
Calculator
• Adult/child ≥35 kg: IV
20 mg × 2 doses; 1st dose within 2 hr before transplant surgery; 2nd dose 4 days after transplantation
• Child/adolescent <35 kg: IV
10 mg × 2 doses; 1st dose within 2 hr before transplant surgery; 2nd dose 4 days after transplantation
Available forms:
Powder for inj 10, 20 mg
•
Reconstitute
10 mg vial/2.5 ml or 20-mg vial in 5 ml sterile water for inj; shake gently to dissolve,
dilute
reconstituted sol in 25 ml (10 mg vial) or 50 ml (20-mg vial) with 0.9% NaCl or D
5
, gently invert bag, do not shake;
give
over 1/2 hr, do not admix
CNS:
Pyrexia, chills, tremors, headache, insomnia, weakness, dizziness
CV:
Chest pain
, angina,
cardiac failure,
hypotension,
hypertension, edema
GI:
Vomiting, nausea, diarrhea, constipation, abdominal pain
,
GI bleeding,
gingival hyperplasia, stomatitis
INTEG:
Acne
, pruritus, impaired wound healing
META:
Acidosis, hypercholesterolemia, hyperuricemia, hypo/hyperkalemia, hypocalcemia, hypophosphatemia
MISC:
Infection, moniliasis
,
anaphylaxis,
anemia, allergic reaction, dysuria, CMV infection, candidiasis
MS:
Arthralgia, myalgia
RESP:
Dyspnea, wheezing
,
pulmonary edema,
cough
Peak 1/2 hr (adults); terminal half-life 7 days (adult), 9½ days (children)
Increase:
immunosuppression—other immunosuppressants
Decrease:
St. John’s wort, turmeric
Increase:
cholesterol, BUN, uric acid, creatinine, K, Ca, blood glucose, Hgb, Hct
Decrease:
Hgb, Hct, platelets, magnesium, phosphate
Black Box Warning:
For infection: increased temp, WBC, sputum, urine; may be fatal (bacterial, protozoal, fungal)
•
Blood studies: Hgb, WBC, platelets during treatment monthly; if leukocytes are <3000/mm
3
, product should be discontinued; electrolytes, B/P, edema assessment
•
Hepatic studies: alk phos, AST, ALT, bilirubin
Anaphylaxis, hypersensitivity:
dyspnea, wheezing, rash, pruritus, hypotension, tachycardia; if severe hypersensitivity reactions occur, product should not be used again
•
Storage of reconstituted sol refrigerated for up to 24 hr or at room temp for 4 hr
•
Therapeutic response: absence of graft rejection
Black Box Warning:
To report fever, chills, sore throat, fatigue, serious infection may occur
•
To avoid crowds, persons with known upper respiratory tract infections
•
To use contraception during treatment
•
To report GI symptoms, bleeding, allergic reactions