Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (226 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(eye-soe-tret′i-noyn)
Amnesteem, Claravis, Sotret
Func. class.:
Antiacne agent, retinoid
Severe recalcitrant nodulocystic acne
Hypersensitivity, inflamed skin
Black Box Warning:
Pregnancy (X)
Calculator
• Adult: PO
0.5-2 mg/kg/day in 2 divided doses × 15-20 wk; if relapse occurs, repeat after 2 mo off product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(it-ra-con′a-zol)
Sporanox
Func. class.:
Antifungal, systemic
Chem. class.:
Triazole derivative
Alters cell membranes; inhibits several fungal enzymes
Histoplasmosis, blastomycosis (pulmonary and extrapulmonary), aspergillosis, onychomycosis of toenail/fingernail
Unlabeled uses:
Dermatomycosis, histoplasmosis, chromoblastomycosis, coccidioidomycosis, pityriasis versicolor, sebopsoriasis, vaginal candidiasis, cryptococcus, subcutaneous mycoses, dimorphic infections, fungal keratitis, zygomycosis, superficial mycoses (dermatophytoses), chronic mucocutaneous candidiasis
Hypersensitivity, fungal meningitis; onychomycosis or dermatomycosis with cardiac dysfunction, in pregnant women
Black Box Warning:
Heart failure, ventricular dysfunction, coadministration with other products
Precautions:
Pregnancy (C), breastfeeding, children, cardiac/renal/hepatic disease, achlorhydria or hypochlorhydria (product-induced), dialysis
Calculator
Dose varies with type of infection
• Adult: PO
200 mg/day with food; may increase to 400 mg/day if needed; life-threatening infections may require a loading dose of 200 mg tid × 3 days
• Child: PO
3-5 mg/kg/day
Available forms:
Caps 100 mg; oral sol 10 mg/ml
•
In the presence of acid products only; do not use alkaline products, antacids within 2 hr of product; may give coffee, tea, acidic fruit juices
•
Swallow caps whole; do not break, crush, or chew caps
•
Give caps after full meal to ensure absorption
•
Oral sol: patient should swish in mouth vigorously, use on empty stomach
•
Oral sol and caps are not interchangeable on mg/mg basis
CNS:
Headache, dizziness
, insomnia, somnolence, depression
CV:
Hypertension
GI:
Nausea, vomiting, anorexia, diarrhea
, cramps, abdominal pain, flatulence,
GI bleeding, hepatotoxicity
GU:
Gynecomastia, impotence, decreased libido
INTEG:
Pruritus
, fever,
rash
,
toxic epidermal necrolysis
MISC:
Edema, fatigue
, malaise, hypokalemia, tinnitus,
rhabdomyolysis
PO:
Peak 3-5 hr; half-life 21 hr, IV 35.4 hr; metabolized in liver; excreted in bile, feces, urine 40%; requires acid pH for absorption; distributed poorly to CSF; 99.8% protein bound; inhibits CYP4503A4
Life-threatening CV reactions: pimozide, quiNIDine, dofetilide, levomethadyl
Increase:
tinnitus, hearing loss—quiNIDine
Increase:
hepatotoxicity—other hepatotoxic products
Increase:
edema—calcium channel blockers
Increase:
severe hypoglycemia—oral hypoglycemics
Increase:
sedation—ALPRAZolam, clorazepate, diazepam, estazolam, flurazepam, triazolam, oral midazolam
Increase:
levels, toxicity—busPIRone, busulfan, clarithromycin, cycloSPORINE, diazepam, digoxin, felodipine, fentaNYL, atorvastatin, carBAMazepine, disopyramide, indinavir, isradipine, niCARdipine, niFEDipine, niMODipine, phenytoin, quiNIDine, QUEtiapine, ritonavir, saquinavir, tacrolimus, warfarin
Decrease:
itraconazole action—antacids, H
2
-receptor antagonists, rifamycins, didanosine, carBAMazepine, isoniazid, proton pump inhibitors
•
Food increases absorption
•
Grapefruit juice decreases itraconazole level
•
CHF:
if present, discontinue product
•
Type of infection; may begin treatment prior to obtaining results
•
Infection:
temp, WBC, sputum at baseline and periodically
•
I&O ratio, potassium levels
•
Hepatic studies (ALT, AST, bilirubin) if patient receiving long-term therapy
•
Allergic reaction: rash, photosensitivity, urticaria, dermatitis
Hepatotoxicity:
nausea, vomiting, jaundice, clay-colored stools, fatigue
•
Storage in tight container at room temp, do not freeze
•
Therapeutic response: decreased fever, malaise, rash, negative C&S for infecting organism
•
That long-term therapy may be needed to clear infection (1 wk-6 mo, depending on infection)
•
To avoid hazardous activities if dizziness occurs
•
To take 2 hr before administration of other products that increase gastric pH (antacids, H
2
-blockers, omeprazole, sucralfate, anticholinergics); to avoid grapefruit juice; to notify health care provider of all medications taken; to take after a full meal (caps) or on empty stomach (oral sol)
•
About the importance of compliance with product regimen; to use alternative methods of contraception
•
To notify prescriber of GI symptoms; signs of hepatic dysfunction (fatigue, jaundice, nausea, anorexia, vomiting, dark urine, pale stools); heart failure (trouble breathing, unusual weight gain, fatigue, swelling); hearing changes
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
