Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (173 page)
Do not confuse:
fentaNYL
/Sufenta
Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception by binding to opiate receptors
Controls moderate to severe pain; preoperatively, postoperatively; adjunct to general anesthetic, adjunct to regional anesthesia;
FentaNYL:
anesthesia as premedication, conscious sedation;
Actiq:
breakthrough cancer pain
Hypersensitivity to opiates, myasthenia gravis
Black Box Warning:
Headache, migraine (Actiq, ABSTRAL, Fentora, Lazanda, Onsolis); emergency room use (ABSTRAL, Lazanda); outpatient surgeries (Duragesic TD); opioid-naive patients, respiratory depression
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, increased intracranial pressure, seizure disorders, severe respiratory disorders, cardiac dysrhythmias
Black Box Warning:
Accidental exposure, ambient temperature increase, fever, skin abrasion (TD patch), substance abuse, surgery, requires an experienced clinician
Calculator
• Adult:
IV
50-100 mcg/kg over 1-2 min
• Adult and child >12 yr:
IM/IV
2-20 mcg/kg
IV INF
0.025-0.25 mcg/kg/min
• Child 2-12 yr:
IV
2-3 mcg/kg
• Adult and child >12 yr:
IM/IV
50-100 mcg q30-60min before surgery
• Adult and child >12 yr:
IM/IV
0.05-0.1 mg q1-2hr prn
• Adult:
IV/IM
50-100 mcg q1-2hr
• Adult:
TRANSMUCOSAL
200 mcg; redose if needed 15 min after completion of 1st dose; do not give more than 2 doses during titration period, max 4 doses/day
• Adult:
BUCCAL
100 mcg placed above rear molar between upper cheek and gum, a second 100 mcg dose, if needed, may be started 30 min after 1st dose
• Adult:
TRANSMUCOSAL
200 mcg, titrate, max 1200 mcg/dose or 4 doses/day
• Adult:
SL
100 mcg; another dose may be taken 30 min after 1st, max 2 doses per episode of breakthrough pain; ≥2 hr must elapse before treating again; titrate stepwise over consecutive episodes
• Adult:
25 mcg/hr; may increase until pain relief occurs; apply patch to flat surface on upper torso and wear for 72 hr; apply new patch on different site for continued relief
• Adult:
100 mcg (1 spray in 1 nostril), may retreat after ≥2 hr, titrate upward until adequate analgesia; treat a max of 4 episodes daily
• Adult:
100 mcg sprayed under tongue, titrate stepwise carefully
Available forms:
Inj 0.05 mg/ml; lozenges 100, 200, 300, 400, 600, 800, 1200, 1600 mcg; lozenges on a stick 200, 400, 600, 800, 1200, 1600 mcg; buccal tab 100, 200, 400, 600, 800 mcg; oral dissolving film (Onsolis) 200, 400, 600, 800, 1200 mcg; SL tab (ABSTRAL) 100, 200, 300, 400, 600, 800 mcg;
transdermal:
patch 12, 25, 50, 75, 100 mcg/hr;
SL spray:
100, 200, 400, 600, 800, 1200, 1600 mcg/spray
•
By inj (IM, IV); give slowly to prevent rigidity
•
Must have emergency equipment available, opioid antagonists, O
2
; to be used only by those appropriately trained; IV products to be used in OR, ER, ICU
•
Remove foil just before administration; instruct patient to place product between cheek and lower gum, moving it back and forth and sucking, not chewing (Actiq); place above rear molar (Fentora); place film on the inside of the cheek (Onsolis); all products not used or only partially used should be flushed down the toilet
•
q72hr for continuous pain relief; dosage adjusted after at least 2 applications; apply to clean, dry skin and press firmly
•
Give short-acting analgesics until patch takes effect (8-24 hr); when reducing dosage or switching to alternative IV treatment, withdraw gradually; serum levels drop gradually, give 1/2 the equian
algesic dose of new analgesic 12-18 hr after removal as ordered
•
Open blister package with scissors immediately before use; spray contents of unit under tongue; dispose of each used unit after use by placing it into one of the disposable bags provided; seal bag, discard into a trash container out of reach of children
•
IV undiluted by anesthesiologist or diluted with 5 ml or more sterile water or 0.9% NaCl given through
Y
-tube or 3-way stopcock at 0.1 mg or less/1-2 min. Muscular rigidity may occur with rapid IV administration
Additive compatibilities:
Bupivacaine, caffeine citrate, cloNIDine, droperidol, EPINEPHrine, ketamine, lidocaine, ziconotide
Solution compatibilities:
D
5
W, 0.9% NaCl
Syringe compatibilities:
Alprostadil, atracurium, atropine, bupivacaine/ketamine, butorphanol, chlorproMAZINE, cimetidine, cloNIDine/lidocaine, diphenhyDRINATE, diphenhydrAMINE, droperidol, heparin, HYDROmorphone, hydrOXYzine, lidocaine, meperidine, metoclopramide, midazolam, morphine, pentazocine, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, scopolamine
Y-site compatibilities:
Abciximab, acyclovir, alfentanil, alprostadil, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid injection, atenolol, atracurium, atropine, azathioprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, cephalothin, chloramphenicol, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cloNIDine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, erythromycin, esmolol, etomidate, etoposide, famotidine, fenoldopam, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, lansoprazole, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methotrexate, methotrimeprazine, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, mivacurium, morphine, moxalactam, multiple vitamins injection, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sargramostim, scopolamine, sodium acetate/bicarbonate, succinylcholine, SUFentanil,
tacrolimus, teniposide, theophylline, thiamine, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex/C, voriconazole, zoledronic acid
CNS:
Dizziness, delirium, euphoria, sedation
CV:
Bradycardia, arrest,
hypo/hypertension
EENT:
Blurred vision, miosis
GI:
Nausea, vomiting, constipation
GU:
Urinary retention
INTEG:
Rash, diaphoresis
MS:
Muscle rigidity
RESP:
Respiratory depression, arrest, laryngospasm
Metabolized by liver, excreted by kidneys, crosses placenta, excreted in breast milk, Half-life: IV: 2-4 hr, Transdermal: 13-22 hr, Transmucosal: 7 hr, Buccal: 4-12 hr, 80% bound to plasma proteins
IM:
Onset 7-8 min, peak 30 min, duration 1-2 hr
IV:
Onset 1 min, peak 3-5 min, duration 1/2-1 hr
Black Box Warning:
Increase:
fentaNYL effect, fetal respiratory depression: (cycloSPORINE, ketoconazole, itraconazole, cimetidine, conivaptan, fluconazole, nefazodine, ranolazine, zafirlukast, zileuton
Increase:
hypotension—droperidol
Increase:
CV depression—diazepam
Increase:
fentaNYL effect with other CNS depressants—alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants, protease inhibitors
Decrease:
fentaNYL effect—CYP3A4 inducers (carBAMazepine, phenytoin, PHENobarbital, rifampin)
Increase:
action of fentaNYL—St. John’s wort
Decrease:
effect of fentaNYL—echinacea
Increase:
amylase, lipase
•
VS after parenteral route; note muscle rigidity, drug history, hepatic/renal function tests
•
CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
Allergic reactions: rash, urticaria
Black Box Warning:
Respiratory dysfunction: respiratory depression,
character, rate, rhythm; notify prescriber if respirations are <10/min
Black Box Warning:
Headache/migraine:
ABSTRAL, Actiq, Fentora, Lazanda, Onsolis not to be used for this condition; ABSTRAL, Lazanda not to be used in ER; Duragesic TD not to be used for outpatient surgery patients
Black Box Warning:
Apnea, respiratory arrest in opioid-naive patients:
do not use ABSTRAL, Actiq, Duragesic, Fentora, Lazanda, Onsolis; opioid-tolerant patients are those using ≥60 mg/day oral morphine, ≥30 mg/day oxyCODONE PO, 8 mg/day HYDROmorphone, 25 mcg TD fentaNYL/hr
•
Therapeutic response: induction of anesthesia, relief of breakthrough cancer pain, general pain relief
•
Cancer pain, general pain relief
•
About CNS changes: physical dependence; not to use with alcohol, other CNS depressants
Black Box Warning:
Accidental exposure:
Discuss the dangers of children or pets ingesting or coming in contact with product
Black Box Warning:
Ambient temperature:
that excessive heat may increase absorption; do not use with heating pads, electric blankets, heat/tanning lamps, saunas, hot tubs, heated waterbeds, when sunbathing
•
That excessive perspiration may alter adhesiveness
•
To dispose of patch by placing sticky sides together and flushing down toilet
•
That patient may need to clip hair before applying to ensure adhesion
•
May add first aid tape around the edges if there is a problem with adhesion
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
