Mosby's 2014 Nursing Drug Reference (70 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(brom′fen-ak)
Bromday
Func. class.:
Antiinflammatory (ophthalmic)
Chem. class.:
Nonsteroidal antiflammatory drug
The mechanism of action is thought to be ability to block prostaglandin synthesis by inhibiting cyclooxygenase 1 and 2. In studies performed in animal eyes, prostaglandins have been shown to produce disruption of the blood–aqueous humor barrier, vasodilation, increased vascular permeability, leukocytosis, and increased intraocular pressure
To reduce pain and inflammation after cataract surgery
Hypersensitivity to this product, sulfites, NSAIDs, salicylates
Precautions:
Bleeding disorders, complicated ocular surgery, corneal denervation, diabetes mellitus, rheumatoid ar
thritis, dry eye syndrome, pregnancy (C), breastfeeding
Do not administer while wearing contact lenses
Calculator
• Adult:
Instill 1 drop (0.09 mg) into affected eye twice daily beginning 24 hr before cataract surgery, continued on the day of surgery and through the first 14 days of the postoperative period
Available forms:
Ophthalmic solution 0.09%
•
Apply topically to the eye
•
Remove contact lenses before instilling solution. Contact lenses should not be worn during use of this product.
•
Instruct patient on proper instillation of eye solution
•
Do not touch the tip of the dropper to the eye, fingertips, or other surface
•
Do not share bottle with other patients
•
If more than one ophthalmic medication is being used, the medications should be administered at least 5 min apart
CNS:
Headache
EENT:
Abnormal sensation in eye, conjunctival hyperemia, ocular irritation, ocular pain, ocular pruritus, conjunctival hyperemia, iritis, keratitis
Unknown
Increase:
corneal erosion, poor healing—topical corticosteroids
Increase:
bleeding—anticoagulants
•
For pain, inflammation, burning, redness after cataract surgery
•
Identify if patient is using topical corticosteroids, anticoagulants, use cautiously in those using these products
•
Decreased pain and inflammation after cataract surgery
•
To apply topically to the eye
•
To remove contact lenses before instilling solution; contact lenses should not be worn during use of this product
•
Proper instillation of eye solution
•
Not to touch the tip of the dropper to the eye, fingertips, or other surface
•
Not to share bottle with other patients
•
That if more than one ophthalmic medication is being used, the medications should be administered at least 5 minutes apart
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(broe-moe-krip′teen)
Cycloset, Parlodel
Func. class.:
Dopamine receptor agonist, antiparkinson agent
Chem. class.:
Ergot alkaloid derivative
Do not confuse:
Parlodel
/pindolol/Provera bromocriptine/benztropine/brimonidine
Inhibits prolactin release by activating postsynaptic dopamine receptors; activation of striatal dopamine receptors may be reason for improvement in Parkinson’s disease
Parkinson’s disease, amenorrhea/galactorrhea caused by hyperprolactinemia, infertility, acromegaly, pituitary adenomas, adjunct for type 2 diabetes
Unlabeled uses:
Neuroleptic malignant syndrome, alcoholism, premenstrual syndrome, mastalgia, cocaine withdrawal, premenstrual breast symptoms
Severe ischemic disease, uncontrolled hypertension, severe peripheral vascular disease; hypersensitivity to ergot, bromocriptine; migraine, preeclampsia
Precautions:
Pregnancy (B), breastfeeding, children, renal/hepatic disease, pituitary tumors, peptic ulcer disease, sulfite hypersensitivity, pulmonary fibrosis, dementia, GI bleeding, bipolar disorder
Calculator
• Adult: PO
1.25-2.5 mg with meals; may increase by 2.5 mg q3-7days, usual range 2.5-15 mg/day
• Adult: PO
1.25-2.5 mg × 3 days at bedtime; may increase by 1.25-2.5 mg q3-7days; usual range 20-30 mg/day, max 100 mg/day
• Adult: PO
1.25 mg bid with meals; may increase q2-4wk by 2.5 mg/day, max 100 mg/day; levodopa should be continued while bromocriptine is being instituted
• Adult: PO
1.25 mg bid-tid; may increase over several wk to 10-20 mg/day
• Adult: PO
(initially) 0.8 mg daily in
AM
within 2 hr of waking; titrate by 0.8 mg/day no more than weekly to max 1.6-4.8 mg/day
• Adult: PO
2.5-10 mg tid
• Adult: PO
0.625 mg qid × 42 days
• Adult: PO
7.5 mg/day
• Adult: PO
2.5-7.5 bid starting 10-14 days before menses; discontinue when menses begins
Available forms:
Caps 5 mg; tabs 2.5 mg; Cycloset tabs 0.8 mg
•
With meal to prevent GI symptoms
•
At bedtime so that dizziness, orthostatic hypotension do not occur
CNS:
Headache
, depression, restlessness, anxiety, nervousness, confusion,
seizures,
hallucinations
, dizziness, fatigue, drowsiness, abnormal involuntary movements, psychosis
CV:
Orthostatic hypotension, decreased B/P, palpitations, extrasystole,
shock,
dysrhythmias, bradycardia,
MI
EENT:
Blurred vision, diplopia, burning eyes, nasal congestion
GI:
Nausea, vomiting, anorexia
, cramps, constipation, diarrhea, dry mouth, GI hemorrhage
GU:
Frequency, retention, incontinence, diuresis
INTEG:
Rash on face, arms;
alopecia; coolness, pallor of fingers, toes; peripheral edema
Peak 1-3 hr, duration 4-8 hr, 90%-96% protein bound, half-life 3 hr, metabolized by liver (inactive metabolites), 85%-98% of dose excreted in feces, >90% of absorbed dose undergoes 1st-pass metabolism
•
Disulfiram-like reaction: alcohol
Increase:
action of antihypertensives, levodopa, chloramphenicol, probenecid, salicylates, sulfonamides
Decrease:
action of bromocriptine—phenothiazines, oral contraceptives, progestins, estrogens, haloperidol, loxapine, methyldopa, metoclopramide, MAOIs, reserpine
Decrease/increase:
effect of Cyclosert-CYP3A4 inhibitors/inducers
Decrease:
effect of Cyclosert-butyrophenones, metoclopramide, phenothiazine, thioxanthenes
Increase:
growth hormone, AST, ALT, CK, BUN, uric acid, alk phos
•
B/P; establish baseline, compare with other readings; this product decreases B/P and causes orthostatic hypotension
•
Parkinson’s symptoms:
pill rolling, shuffling gait, restlessness, tremors, postural instability before and during treatment
•
Neuroleptic malignant syndrome:
decreased temp, seizures, sweating, pulse indicates resolution of symptoms
•
Change in size of soft-tissue volume with acromegaly
•
Pregnancy:
may cause postpartum conception, use pregnancy testing q4wk or if menstruation does not occur
•
Storage at room temp in tight, light-resistant container
•
Therapeutic response (Parkinson’s disease): decreased dyskinesia, slow movements, drooling
•
That tabs may be crushed, mixed with food; Cyclosert to be taken within 2 hr of rising
•
To change position slowly to prevent orthostatic hypotension
•
To use contraceptives during treatment with this product; that pregnancy may occur; to use methods other than oral contraceptives/subdermal implants
•
That therapeutic effect for Parkinson’s disease may take 2 mo
•
To avoid hazardous activity if dizziness occurs
•
To report symptoms of MI immediately
•
To take with food, avoid alcohol