Mosby's 2014 Nursing Drug Reference (90 page)

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

chloroquine (Rx)

(klor′oh-kwin)

Aralen

Func. class.:
Antimalarial

Chem. class.:
Synthetic 4-amino-quinoline derivative

ACTION:

Inhibits parasite replication, transcription of DNA to RNA by forming complexes with DNA of parasite

USES:

Malaria of
Plasmodium vivax, P. malariae, P. ovale, P. falciparum
(some strains); amebiasis

Unlabeled uses:
Discoid lupus erythematosus, polymorphous light eruption, rheumatoid arthritis, ulcerative colitis

CONTRAINDICATIONS:

Hypersensitivity, retinal field changes

Precautions:
Pregnancy (C), breastfeeding, children, blood dyscrasias, severe GI disease, neurologic disease, alcoholism, hepatic disease, G6PD deficiency, psoriasis, eczema, seizures, preexisting auditory damage, torsades de pointes

 

Black Box Warning:

Infection

DOSAGE AND ROUTES
Calculator
Acute malaria attacks

• Adult:
PO
1000 mg (600-mg base), then 500 mg (300-mg base) in 6-8 hr, then 500 mg (300-mg base) daily × 2 days for a total of 2.5 g (1.5-g base) in 3 days

• Adult/adolescent of low body weight, child/infant:
PO
16.5 mg (10-mg base)/kg, max 600-mg base; then 8.3 mg (5-mg base)/kg, max 300-mg base 6 hr after 1st dose; then 8.3 mg (5-mg base)/kg, max 300-mg base 24 hr after 1st dose; then 8.3 mg (5-mg base)/kg, max 300-mg base 36 hr after 1st dose

Malaria prophylaxis (in areas with chloroquine–sensitive
P. falciparum)

• Adult:
PO
500 mg (300-mg base) weekly on same day of each wk starting 2 wk before travel and for 8 wk after leaving

Extraintestinal amebiasis

• Adult:
PO
1 g (600-mg base) daily × 2 days, then 500 mg (300-mg base) for ≥2-3 wk

• Child (unlabeled):
PO
16.6 mg (10-mg base)/kg (max 300-mg base) daily × 2-3 wk

Rheumatoid arthritis/discoid lupus erythematosus (unlabeled)

• Adult:
PO
250 mg (150-mg base) daily

Available forms:
Tabs 250 mg (150-mg base), 500 mg (300-mg base) phosphate

Administer:

• 
Product in mg or base; they are different

PO route

• 
Before or after meals at same time each day to maintain product level

SIDE EFFECTS

CNS:
Headache, stimulation, fatigue,
seizures,
psychosis, hallucinations, insomnia

CV:
Hypotension,
heart block, asystole with syncope,
ECG changes, cardiomyopathy

EENT:
Blurred vision, corneal changes, retinal changes, difficulty focusing
, tinnitus, vertigo, deafness, photophobia, corneal edema

GI:
Nausea, vomiting, anorexia
, diarrhea, cramps

HEMA:
Thrombocytopenia, agranulocytosis, hemolytic anemia, leukopenia

INTEG:
Pruritus, pigmentary changes, skin eruptions, lichen-planus–like eruptions, eczema,
exfoliative dermatitis

PHARMACOKINETICS

Metabolized in liver; excreted in urine, feces, breast milk; crosses placenta

PO:
Peak 1-3 hr, half-life 3-5 days

INTERACTIONS

• 
Reduced oral clearance and metabolism of chloroquine: cimetidine

Increase:
QT prolongation, torsades de pointes—class IA, III antidysrhythmics

Increase:
effects—2D6 inhibitors (amiodarone, chlorpheniramine, FLUoxetine, haloperidol, ritonavir, PARoxetine, terbinafine, ticlopidine); CYP3A4 inhibitors (diltiazem, verapamil, itraconazole, ketoconazole, erythromycin, doxycycline, clarithromycin)

Decrease:
action of chloroquine—magnesium, aluminum compounds, kaolin; do not use concurrently

Decrease:
effects of ampicillin, rabies vaccine (ID)

Drug/Lab Test

Decrease:
Hgb, platelets, WBC

NURSING CONSIDERATIONS
Assess:

 

Black Box Warning:

Infection:
resistance is common, not to be used for
P. falciparum
acquired in areas of resistance or where prophylaxis has failed

• 
Ophthalmic test if long-term treatment or dosage of >150 mg/day, baseline and periodically

• 
Blood studies: CBC, since blood dyscrasias occur

• 
ECG
during therapy; watch for depression of T waves, widening of QRS complex

• 
Allergic reactions:
pruritus, rash, urticaria

• 
Blood dyscrasias:
malaise, fever, bruising, bleeding (rare)

• 
For ototoxicity
(tinnitus, vertigo, change in hearing); audiometric testing should be done before, after treatment

 
For toxicity:
blurring vision; difficulty focusing; headache; dizziness; decreased knee, ankle reflexes; seizures, CV collapse; product should be discontinued immediately and IV fluids given

Perform/provide:

• 
Storage in tight, light-resistant container at room temp; keep inj in cool environment

Evaluate:

• 
Therapeutic response: decreased symptoms of infection

Teach patient/family:

• 
To take with meals or immediately after meals

• 
To use sunglasses in bright sunlight to decrease photophobia

• 
That urine may turn rust or brown color

• 
To report hearing, visual problems; fever, fatigue, bruising, bleeding; may indicate blood dyscrasias

TREATMENT OF OVERDOSE:

Administer barbiturate (ultrashort-acting), vasopressor; tracheostomy may be necessary

• 
Keep away from pets, children, overdose is fatal

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

chlorpheniramine
(
OTC
, Rx)

(klor-fen-ir′a-meen)

AHIST, Aller-Chlor, Allergy, Chlor-Pheniton, Chlor-Trimeton, Diabetic Tussin Allergy Relief, ED-Chlor-Tann, Equaline Allergy, Equate Chlortabs Allergy, Good Sense Allergy, Leader Allergy, P-Tann, Tana Hist-PD, Teldrin, Top Care Allergy, Wal-finate Allergy

Func. class.:
Antihistamine (1st generation, nonselective)

Chem. class.:
Alkylamine, H
1
-receptor antagonist

Do not confuse:
Teldrin
/Tedral

ACTION:

Acts on blood vessels, GI system, respiratory system by competing with histamine for H
1
-receptor site; decreases allergic response by blocking histamine

USES:

Allergy symptoms, rhinitis, conjunctivitis (allergic)

Unlabeled uses:
Nausea, vomiting due to motion sickness, pruritus, urticaria

CONTRAINDICATIONS:

Newborns/neonates

Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, increased intraocular pressure, cardiac/renal disease, hypertension, asthma, seizure disorder, hyperthyroidism, prostatic hypertrophy, GI obstruction, peptic ulcer disease, emphysema, hypersensitivity to H
1
-receptor antagonists, lower respiratory tract disease, stenosed peptic ulcers, bladder neck obstruction, closed-angle glaucoma

DOSAGE AND ROUTES
Calculator

• Adult and child ≥12 yr:
PO
4 mg tid-qid, max 24 mg/day;
EXT REL
8-12 mg bid-tid, max 24 mg/day

• Child 6-12 yr:
PO
2 mg q4-6hr, max 12 mg/day;
EXT REL
8 mg bedtime or daily,
EXT REL
not recommended for child <6 yr

Available forms:
Chewable tabs 2 mg; tabs 4, 8, 12 mg; ext rel tabs 8, 12 mg; ext rel caps 8, 12 mg; syr 1 mg/5 ml, 2 mg/5 ml, 2.5 mg/5 ml

Administer:

• 
Avoid concurrent use with other CNS depressants

• 
Do not break, crush, or chew ext rel forms

• 
Without regard to meal

• 
Avoid use in children <6 yr

• 
Syrup:
Use dosing utensil to measure correct dose

SIDE EFFECTS

CNS:
Dizziness, drowsiness
, poor coordination, fatigue, anxiety, euphoria, confusion, paresthesia, neuritis

EENT:
Blurred vision; dilated pupils; tinnitus; nasal stuffiness; dry nose, throat, mouth

GI:
Nausea, anorexia, diarrhea

GU:
Retention
, dysuria, urinary frequency

HEMA:
Thrombocytopenia, agranulocytosis, hemolytic anemia

INTEG:
Photosensitivity

RESP:
Increased thick secretions, wheezing, chest tightness

PHARMACOKINETICS

Detoxified in liver, excreted by kidneys (metabolites/free drug), half-life 12-15 hr

PO:
Onset 1/2 hr, duration 4-12 hr

PO-ER:
Duration 8-24 hr

INTERACTIONS

Increase:
CNS depression—barbiturates, opiates, hypnotics, tricyclics, alcohol

Increase:
effect of chlorpheniramine—MAOIs

Increase:
anticholinergic action—atropine, phenothiazines, quiNIDine, haloperidol

Drug/Lab Test

False negative:
skin allergy tests

NURSING CONSIDERATIONS
Assess:

• 
Be alert for urinary retention, frequency, dysuria; product should be discontinued

• 
Respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness

Perform/provide:

• 
Hard candy, gum, frequent rinsing of mouth for dryness

• 
Storage in tight container at room temp

Evaluate:

• 
Therapeutic response: absence of running, congested nose, rashes, conjunctivitis

Teach patient/family:

• 
About all aspects of product use; to notify prescriber of confusion, sedation, hypotension, difficulty voiding

• 
To avoid driving, other hazardous activity if drowsiness occurs, especially geriatric patients

• 
To avoid concurrent use of alcohol

TREATMENT OF OVERDOSE:

Administer diazepam, vasopressors, phenytoin IV

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