Mosby's 2014 Nursing Drug Reference (95 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ophthalmic)
(sip-roe-flox′a-sin)
Ciloxan
Func. class.:
ophthalmic anti-infective
Chem. class.:
fluoroquinolone
Do not confuse:
ciprofloxacin/gatifloxacin/levofloxacin/moxifloxacin/ofloxacin
Inhibits DNA gyrase, thereby decreasing bacterial replication
Corneal ulcers, bacterial conjunctivitis
Hypersensitivity to this product or fluoroquinolones
Precautions:
Pregnancy (C), breastfeeding
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• Adult/adolescent/child ≥1 yr:
Ophthalmic (sol): 1-2 drops in affected eye(s) every 2 hr while awake × 2 days, then every 4 hr while awake for the next 5 days
• Adult/adolescent/child ≥2 yr:
Ophthalmic (ointment): 1/2-inch ribbon to conjunctival sac tid × 2 days, then 1/2 inch bid for next 5 days
• Adult/adolescent/child ≥1 yr:
Ophthalmic (solution): 2 drops in affected eye(s) every 15 min × 6 hr, then every 30 min for the remainder of the first day; for the second day, 2 drops every hr; for days 3-14, 2 drops every 4 hr
Available forms:
Ophthalmic ointment, solution 0.3%
•
Commercially available ophthalmic solutions are not for injection subconjunctivally or into the anterior chamber of the eye
•
Apply topically to the eye, taking care to avoid contamination
•
Do not touch the tip of the dropper to the eye, fingertips, or other surface
•
Apply pressure to lacrimal sac for 1 min after instillation
•
Avoid wearing contact lens(es) while treating eye infection
EENT:
Burning, hypersensitivity, pruritus, precipitate in those with corneal ulcers
•
Assess for hypersensitivity, discontinue product
•
Decreased ophthalmic infection
•
To apply topically to the eye, taking care to avoid contamination; for ophthalmic use only
•
Not to touch the tip of the dropper to the eye, fingertips, or other surface
•
To apply pressure to lacrimal sac for 1 min after instillation
•
To avoid wearing contact lens(es) while treating eye infection
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(sis-ah-trah-kyoo′ree-um)
Nimbex
Func. class.:
skeletal muscle relaxant
Chem. class.:
nondepolarizing neuromuscular blocker
Antagonizes acetylcholine by binding to cholinergic receptors on the motor end plate, resulting in neuromuscular blockade
To maintain neuromuscular blockade during mechanical ventilation and as an adjunct to general anesthesia
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, benzyl alcohol hypersensitivity, electrolyte imbalances, long-term use in ICU, trauma or burns
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For neuromuscular blockade, as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation in the ICU
• Adult/adolescent (healthy):
IV
0.15-0.2 mg/kg, one time
• Adult with myasthenia gravis:
IV
Use peripheral nerve stimulator monitoring and an initial dose ≤0.02 mg/kg
• Child 2-12 yr:
IV
0.1-0.15 mg/kg over 5-10 sec during either halothane or opioid anesthesia
• Infant/child ≤23 mo:
IV
0.15 mg/kg over 5-10 sec during either halothane or opioid anesthesia
• Adult/adolescent/child ≥2 yr (healthy):
IV
Maintenance dose 0.03 mg/kg; maintenance dosing is generally required 40-50 min after an initial dose of 0.15 mg/kg IV or 50-60 min after an initial dose of 0.2 mg/kg; the need for maintenance doses should be determined by clinical criteria
Available forms:
Injection solution 2, 10 mg/ml
•
Visually inspect for particulate matter and discoloration before use
•
Only experienced clinicians, familiar with the use of neuromuscular blocking drugs, should administer or supervise the use this product
•
Use by rapid IV injection or by continuous IV infusion
•
Inject IV over 5-10 sec
•
Dilute with NS, D
5
W, or D
5
NS (0.1-0.4 mg/ml); adjust the rate of infusion according to peripheral nerve stimulation
•
The amount of inf sol required per minute depends on the concentration of cisatracurium in the inf sol, the desired dose of cisatracurium, and the patient’s weight
•
Store Nimbex injection diluted to 0.1 mg/ml either under refrigeration or at room temperature for 24 hr; dilutions to 0.1 mg/ml or 0.2 mg/ml in D
5
W/LR injection may be stored under refrigeration for 24 hr
CV:
Bradycardia,
flushing, hypotension
RESP:
Apnea, bronchospasm, prolonged neuromuscular block
Onset 2 min, peak 3-5 min, duration 25-44 min, half-life 22-30 min
Increase:
neuromuscular blockade—aminoglycosides, clindamycin, lithium, local anesthetics, magnesium salts, colistin, colistimethate, procainamide, quiNIDine, tetracyclines, bacitracin, capreomycin, polymyxin B, vancomycin; amphotericin B, CISplatin, corticosteroids, loop/thiazide diuretics (if hypokalemia is present)
Decrease:
neuromuscular blockade—carBAMazepine, phenytoin
•
Use nerve stimulator to monitor neuromuscular function; if no response, stop until response;
not to be used for rapid-sequence endotracheal intubation
•
Electrolytes and acid-base balance may be altered
Assess for malignant hyperthermia; those with a family history of this condition should not receive this product or it should be used cautiously
•
Maintenance of neuromuscular blockade
•
Reason for product and expected results
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert