Mosby's 2014 Nursing Drug Reference (79 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(kap′toe-pril)
Apo-Capto
, Capoten
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin-converting enzyme (ACE) inhibitor
Do not confuse:
captopril
/Capitrol/carvedilol
Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II
Hypertension, CHF, left ventricular dysfunction after MI, diabetic nephropathy
Unlabeled uses:
Acute MI, hypertensive emergency/urgency, scleroderma renal crisis (SRC)
Breastfeeding, children, hypersensitivity, heart block, potassium-sparing diuretics, bilateral renal artery stenosis, angioedema
Black Box Warning:
Pregnancy (D)
Precautions:
Dialysis patients, hypovolemia, leukemia, scleroderma, SLE, blood dyscrasias, CHF, diabetes mellitus, thyroid/renal/hepatic disease, COPD, asthma
Calculator
• Adult:
PO
initial dose: 12.5-25 mg bid-tid; may increase to 50 mg bid-tid at 1-2 wk intervals; usual range: 25-150 mg bid-tid; max 450 mg/day
• Child:
PO
0.3-0.5 mg/kg/dose, titrate up to 6 mg/kg/day in 2-4 divided doses
• Neonate:
PO
0.01-0.1 mg/kg/dose, may increase as needed
• Adult:
PO
25 mg bid; may increase to 50 mg tid; after 14 days, may increase to 150 mg tid if needed
• Adult:
PO
25 mg tid
• Adult:
PO
CCr >50 ml/min, no change; CCr 10-50 ml/min, decrease dose by 25%; CCr <10 ml/min, decrease dose by 50%
• Adult:
PO
6.25-12.5 mg tid, increase to 25 mg tid gradually
• Adult:
PO
25 mg, may repeat q30min
Available forms:
Tabs 12.5, 25, 50, 100 mg
•
1 hr before or 2 hr after meals
•
Oral sol:
may crush tab, dissolve in water; give within 1/2 hr; make sure tab completely dissolved
CNS:
Fever, chills
CV:
Hypotension
, postural hypotension,
tachycardia
, angina
GI:
Loss of taste, increased LFTs
GU:
Impotence, dysuria, nocturia, proteinuria,
nephrotic syndrome, acute reversible renal failure,
polyuria, oliguria, urinary frequency
HEMA:
Neutropenia, agranulocytosis, pancytopenia, thrombocytopenia,
anemia
INTEG:
Rash, pruritus
MISC:
Angioedema,
hyperkalemia
RESP:
Bronchospasm,
dyspnea, cough
Peak 1 hr; duration 2-6 hr; half-life <2 hr, increased in renal disease; metabolized by liver (metabolites); excreted in urine; crosses placenta; excreted in breast milk, small amounts; protein binding 25%-30%
•
Do not use with potassium-sparing diuretics, sympathomimetics, potassium supplements
Increase:
possible toxicity—lithium, digoxin
Increase:
hypoglycemia—insulin, oral antidiabetics
Increase:
hypotension—diuretics, other antihypertensives, phenothiazines, nitrates, acute alcohol ingestion
Decrease:
captopril effect—antacids, NSAIDs, salicylates
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra
Decrease:
absorption of captopril
Increase:
AST, ALT, alk phos, bilirubin, uric acid, potassium
Decrease:
platelets, WBC, RBC, Hgb/HcT
False positive:
urine acetone, ANA titer
•
Blood dyscrasias:
blood studies: decreased platelets; WBC with differential at baseline and periodically q3mo; if neutrophils <1000/mm
3
, discontinue treatment (recommended with collagen-vascular or renal disease)
•
Hypertension:
B/P, pulse rates at baseline, frequently
•
Renal studies: protein, BUN, creatinine; watch for raised levels, may indicate nephrotic syndrome; increased LFTs, uric acid; glucose may be increased
•
Allergic reaction:
rash, fever, pruritus, urticaria; discontinue product if antihistamines fail to help
•
CHF:
edema, dyspnea, wet crackles, increased B/P, weight gain
•
Storage in tight container at 86° F (30° C) or less
•
Therapeutic response: decrease in B/P with hypertension; edema, moist crackles (CHF)
•
To take 1 hr before or 2 hr after meals; not to discontinue product abruptly; if dose is missed, take as soon as remembered but not if almost time for next dose; not to double doses
•
Not to use OTC products (cough, cold, or allergy) unless directed by prescriber; avoid salt substitutes, high-potassium or high-sodium foods
•
To adhere to dosage schedule, even if feeling better
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
•
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, signs of angioedema
•
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur
•
That dizziness, fainting, light-headedness may occur during first few days of therapy
•
That skin rash or impaired perspiration may occur
•
How to take B/P and when to notify prescriber
Black Box Warning:
To report if pregnancy is suspected or planned, pregnancy (D)
0.9% NaCl IV/INF; hemodialysis
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(kar-ba-maz′e-peen)
Carbatrol, Epitol, Equetro, Tegretol, Tegretol-XR
Func. class.:
Anticonvulsant
Chem. class.:
Iminostilbene derivative
Do not confuse:
TEGretol
/Toradol
Exact mechanism unknown; appears to decrease polysynaptic responses and block posttetanic potentiation
Tonic-clonic, complex-partial, mixed seizures; trigeminal neuralgia; bipolar disorder
Unlabeled uses:
Neurogenic pain, psychotic behavior with dementia, diabetic neuropathy, agitation, hiccups
Pregnancy (D), hypersensitivity to carBAMazepine or tricyclics, AV or bundle branch block
Black Box Warning:
Bone marrow depression
Precautions:
Breastfeeding, children <6 yr, glaucoma, cardiac/renal/hepatic disease, psychosis, alcoholism, hepatic porphyria
Black Box Warning:
Hematologic disease, Asian patients, agranulocytosis, leukopenia, neutropenia, thrombocytopenia
Calculator
• Adult and child >12 yr:
PO
200 mg bid, may be increased by 200 mg/day in weekly intervals, give in divided doses q6-8hr; maintenance 800-1200 mg/day, max 1600 mg/day (adult); max child 12-15 yr 1000 mg/day; max child >15 yr 1200 mg/day; adjust to minimum dose to control seizures;
EXT REL
give bid; rectal administration of
ORAL SUSP
200 mg/10 ml or 6 mg/kg as a single dose
• Child 6-12 yr:
PO
tabs 100 mg bid or susp 50 mg qid; may increase by <100 mg q wk; max 1000 mg/day
EXT REL
tabs daily-bid
• Child <6 yr:
PO
10-20 mg/kg/day in 2-3 divided doses, may increase every wk
• Adult:
PO
100 mg bid with meals; may increase 100 mg q12hr until pain subsides, max 1200 mg/day; maintenance 200-400 mg bid
• Adult:
PO
100 mg bid or 50 mg qid, titrate to 600-800 mg/day
• Adult:
PO
(Equetro only) 200 mg bid, may adjust dose by 200 mg/day to desired response, max 1600 mg/day
• Adult:
PO
100 mg bid, may increase to 250-300 mg/day
• Adult:
PO
200 mg tid
Available forms:
Chewable tabs 100, 200 mg; tabs 200 mg; ext rel tabs (XR) 100, 200, 400 mg; oral susp 100 mg/5 ml; ext rel caps 100, 200, 300 mg
•
Do not crush, chew ext rel tab; ext rel cap may be opened and beads sprinkled over food; patient should chew chewable tab, not swallow it whole
•
With food, milk to decrease GI symptoms; shake oral susp before use
•
Mix an equal amount of water, D
5
W, 0.9% NaCl when giving by NG tube; flush tube with 100 ml of above sol
CNS:
Drowsiness
, dizziness, unsteadiness, confusion, fatigue,
paralysis,
headache, hallucinations,
worsening of seizures,
speech disturbance,
suicidal thoughts/behaviors
CV:
Hypertension, CHF, dysrhythmias, AV block,
hypotension, aggravation of cardiac artery disease
EENT:
Tinnitus, dry mouth, blurred vision, diplopia, nystagmus, conjunctivitis
ENDO:
SIADH (geriatric patients)
GI:
Nausea, constipation, diarrhea
, anorexia, vomiting, abdominal pain, stomatitis, glossitis, increased hepatic enzymes,
hepatitis, hepatic porphyria
GU:
Frequency, retention, albuminuria, glycosuria, impotence, increased BUN,
renal failure
HEMA:
Thrombocytopenia, leukopenia, agranulocytosis, leukocytosis, aplastic anemia, eosinophilia,
increased PT
INTEG:
Rash
,
Stevens-Johnson syndrome,
urticaria, photosensitivity,
toxic epidermal necrolysis
RESP:
Pulmonary hypersensitivity (fever, dyspnea, pneumonitis)
Onset slow; peak 4-5 hr; metabolized by liver; excreted in urine, feces; crosses placenta, blood-brain barrier; excreted in breast milk; half-life 18-65 hr then 8-29 hr after 1st month; protein binding 76%; metabolized by CYP3A4
•
CNS toxicity: lithium
Fatal reaction: MAOIs
Increase:
carBAMazepine levels—CYP3A inhibitors (cimetidine, clarithromycin, danazol, diltiazem, erythromycin, FLUoxetine, fluvoxamine, isoniazid, propoxyphene, valproic acid, verapamil, voriconazole)
Increase:
effects of desmopressin, lithium, lypressin, vasopressin
Decrease:
carBAMazepine effect—CYP1A2, CYP2C9 substrates
Decrease:
effect of CYP3A inducers
Decrease:
effects of benzodiazepines, doxycycline, felbamate, haloperidol, oral contraceptives, PHENobarbital, phenytoin, primidone, theophylline, thyroid hormones, warfarin
Decrease:
carBAMazepine levels—CYP3A4 inducers (CISplatin, darunavir, delavirdine, DOXOrubicin, felbamate, nefazodone, OXcarbazepine, PHENobarbital, phenytoin, primidone, rifampin, theophylline)
Decrease:
carBAMazepine metabolism, increased levels—echinacea
Decrease:
anticonvulsant effect—St. John’s wort
Increase:
peak concentration of carBAMazepine—grapefruit juice
Black Box Warning:
Asian patients for serious skin reaction; genetic test before administration
•
Seizures:
character, location, duration, intensity, frequency, presence of aura
•
Trigeminal neuralgia:
facial pain including location, duration, intensity, character, activity that stimulates pain
•
Renal studies: urinalysis, BUN, urine creatinine q3mo
Black Box Warning:
Bone marrow depression:
blood studies: RBC, Hct, Hgb, reticulocyte counts every wk for 4 wk then q3-6mo if on long-term therapy; if myelosuppression occurs, product should be discontinued; blood dyscrasias: fever, sore throat, bruising, rash, jaundice
•
Hepatic studies: ALT, AST, bilirubin
•
Product levels during initial treatment or when changing dose; should remain at 4-12 mcg/ml; anorexia may indicate increased blood levels
Mental status: mood, sensorium, affect, behavioral changes,
suicidal thoughts/behaviors;
if mental status changes, notify prescriber
•
Eye problems: need for ophthalmic examinations before, during, after treatment (slit lamp, funduscopy, tonometry)
•
Allergic reaction: purpura, red, raised rash; if these occur, product should be discontinued
Toxicity: bone marrow depression, nausea, vomiting, ataxia, diplopia, CV collapse, Stevens-Johnson syndrome
•
Storage at room temp
•
Hard candy, gum, frequent rinsing for dry mouth
•
Therapeutic response: decreased seizure activity; document on patient’s chart
•
To carry emergency ID stating patient’s name, products taken, condition, prescriber’s name and phone number
•
To avoid driving, other activities that require alertness usually for the first 3 days of treatment
•
Not to discontinue medication quickly after long-term use
•
To immediately report chills, rash, light-colored stools, dark urine, yellowing of skin and eyes, abdominal pain, sore throat, mouth ulcers, bruising, blurred vision, dizziness
•
That urine may turn pink to brown
•
To notify if pregnancy is planned or suspected, pregnancy (D), avoid breastfeeding
Lavage, VS