Mosby's 2014 Nursing Drug Reference (239 page)

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levodopa-carbidopa (Rx)

(lee-voe-doe′pa)-(kar-bi-doe′pa)

Apo-Levocarb
, Atamet, Parcopa, Sinemet, Sinemet CR

Func. class.:
Antiparkinson agent

Chem. class.:
Catecholamine

ACTION:

Decarboxylation of levodopa in periphery is inhibited by carbidopa; more levodopa is made available for transport to the brain and for conversion to dopamine in the brain

USES:

Parkinson’s disease, parkinsonism resulting from carbon monoxide, chronic manganese intoxication, cerebral arteriosclerosis

Unlabeled uses:
Restless leg syndrome

CONTRAINDICATIONS:

Hypersensitivity, malignant melanoma, history of malignant melanoma or undiagnosed skin lesions resembling melanoma

Precautions:
Pregnancy (C), breastfeeding, diabetes, closed-angle glaucoma, respiratory/cardiac/renal/hepatic disease, MI with dysrhythmias, seizures, peptic ulcer, depression

DOSAGE AND ROUTES
Calculator
Beginning therapy for those not taking levodopa

• Adult:
PO
25 mg carbidopa/100 mg levodopa tid, may increase daily or every other day by 1 tab to desired response (8 tabs/day);
EXT REL
tabs 50 mg carbidopa/200 mg levodopa bid

For those not taking levodopa ER

• 
50 mg carbidopa/200 mg levodopa bid

For those taking levodopa ER

• 
Begin treatment with 10% more levodopa/day given q4-8hr, may increase or decrease dose q3days

For those taking levodopa <1.5 g/day

• Adult:
PO
25 mg carbidopa/100 mg levodopa tid-qid, may increase daily to desired response

For those taking levodopa >1.5 g/day

• Adult:
PO
25 mg carbidopa/250 mg levodopa tid-qid, may increase daily to desired response

Restless leg syndrome (RLS) (unlabeled)

• Adult:
PO
25 mg carbidopa/100 mg levodopa, 1 tab at bedtime, may repeat if awakening within 2 hr or 50 mg carbidopa/200 mg levodopa sus rel tab 1-2 tabs 1 hr before bedtime

Available forms:
Tabs 10 mg carbidopa/100 mg levodopa, 25 mg carbidopa/100 mg levodopa, 25 mg carbidopa/250 mg levodopa; ext rel tab 25 mg/100 mg, 50 mg carbidopa/200 mg levodopa (Sinemet CR); oral disintegrating tab (Parcopa) 10 mg carbidopa/100 mg levodopa, 25 mg carbidopa/100 mg levodopa; 25 mg carbidopa/250 mg levodopa

Administer:

• 
Pyridoxine (B
6
) not effective for reversing Sinemet or Sinemet CR

PO route

• 
Do not crush or chew
ext rel tabs;
they may be broken in half; adjust dosage to response

• 
Oral disintegrating tab
by gently removing from bottle, placing on tongue and swallowing with saliva; after tab dissolves, liquid is not necessary

• 
With meals if GI symptoms occur; limit protein taken with product

• 
Only after nonselective MAOIs have been discontinued for 2 wk; if patient has been previously treated with levodopa, discontinue for at least 12 hr before change to carbidopa-levodopa

SIDE EFFECTS

CNS:
Involuntary choreiform movements, hand tremors, fatigue, headache, anxiety, twitching, numbness, weakness, confusion, agitation, insomnia, nightmares
, psychosis, hallucination, hypomania, severe depression, dizziness, impulsive behaviors,
neuroleptic malignant syndrome

CV:
Orthostatic hypotension
, tachycardia, hypertension, palpitation

EENT:
Blurred vision, diplopia, dilated pupils

GI:
Nausea, vomiting, anorexia, abdominal distress, dry mouth, flatulence, dysphagia
, bitter taste, diarrhea, constipation

HEMA:
Hemolytic anemia, leukopenia, agranulocytosis

INTEG:
Rash, sweating, alopecia

MISC:
Urinary retention, incontinence, weight change, dark urine

PHARMACOKINETICS

PO:
Onset 30 min, peak 1-3 hr, excreted in urine (metabolites)

EXT REL:
Onset 4-6 hr

INTERACTIONS

• 
Hypertensive crisis: nonselective MAOIs

Increase:
effects of levodopa—antacids, metoclopramide

Decrease:
effects of levodopa—anticholinergics, hydantoins, papaverine, pyridoxine, benzodiazepines, antipsychotics

Drug/Lab Test

Increase:
BUN, AST, ALT, bilirubin, alk phos, LDH, serum glucose

Decrease:
BUN, creatinine, uric acid

False positive:
urine ketones (dipstick), Coombs’ test

False negative:
urine glucose

False increase:
urine protein

Drug/Food

Decrease:
absorption of levodopa—protein

NURSING CONSIDERATIONS
Assess:

• 
Parkinson’s symptoms:
tremors, pill rolling, drooling, akinesia, rigidity, shuffling gait before, during treatment

• 
B/P, respiration; orthostatic B/P

• 
Mental status: affect, mood, behavioral changes, depression, complete suicide assessment

• 
Toxicity:
muscle twitching, blepharospasm

• 
Renal, hepatic, hematopoietic tests; also for diabetes, acromegaly if on long-term therapy

Evaluate:

• 
Therapeutic response: decrease in akathisia/bradykinesis, tremor, rigidity, improved mood

Teach patient/family:

• 
To change positions slowly to prevent orthostatic hypotension

• 
To report side effects: twitching, eye spasms because these indicate overdose

• 
To use product as prescribed; if discontinued abruptly, parkinsonian crisis, neuroleptic malignant syndrome (NMS) may occur; to gradually taper

• 
That urine, sweat may darken

• 
To use physical activities to maintain mobility, lessen spasms

• 
That improvement may not occur for 2-4 mo; about “on-off phenomenon”

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

levofloxacin (Rx)

(lee-voh-floks′a-sin)

Levaquin

Func. class.:
Antiinfective

Chem. class.:
Fluoroquinolone

ACTION:

Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; DNA gyrase inhibitor; inhibits topoisomerase IV

USES:

Acute sinusitis, acute chronic bronchitis, community-acquired pneumonia, uncomplicated skin infections, UTI, cellulitis, prostatitis, inhalational anthrax (postexposure); acute pyelonephritis caused by
Streptococcus pneumoniae, Haemophilus influenzae, Haemophilis parainfluenzae, Moraxella catarrhalis, Escherichia coli, Serratia marcescens, Klebsiella pneumoniae, Chlamydia pneumoniae, Legionella pneumophilia, Mycoplasma pneumoniae, Enterococcus faecalis, Staphylococcus epidermidis, Staphylococcus pyogenes;
inhalation anthrax in children

Unlabeled uses:
Adnexitis, Bartholin abscess, bartholinitis, cervicitis, epididymis, gastroenteritis,
H. pylori
eradication, mastitis, MAC, nongonococcal urethritis, obstetric infections, PID, plague, SARS, shigellosis, TB, typhoid fever, gonococcal infections, disseminated; otitis media, otitis externa, tonsillitis, pharyngitis, sialadenitis

CONTRAINDICATIONS:

Hypersensitivity to quinolones

Precautions:
Pregnancy (C), breastfeeding, children, photosensitivity, acute MI, atrial fibrillation, colitis, dehydration, diabetes, QT prolongation, myasthenia gravis, renal disease, seizure disorder, syphilis

 

Black Box Warning:

Tendon pain/rupture, tendinitis

DOSAGE AND ROUTES
Calculator
Acute bacterial exacerbation of chronic bronchitis

• Adult:
PO/IV
500 mg q24hr × 7 days

Acute bacterial sinusitis

• Adult:
PO
500 mg q24hr × 10-14 days or 750 mg q24hr × 5 days

Acute pyelonephritis

• Adult:
PO
250 mg q24hr × 10 days or 750 mg q24hr × 5 days

Chronic bacterial prostitis

• Adult:
PO
500 mg q24hr × 28 days

Postexposure inhalational anthrax

• Adult/adolescent/child >50 kg:
PO/IV
500 mg q24hr × 60 days

• Infant >6 mo/child <50 kg:
IV
8 mg/kg q12hr × 60 days, max 250 mg/dose

Pneumonia, community acquired

• Adult:
PO/IV
500 mg q24hr × 7-14 days or 750 mg q24hr × 5 days

Pneumonia, nosocomial

• Adult:
PO/IV
750 mg q24hr × 7-14 days

Skin/skin-structure infections, complicated

• Adult:
PO/IV
750 mg q24hr × 7-14 days

Skin/skin-structure infections, uncomplicated

• Adult:
PO
500 mg q24hr × 7-10 days

UTI, complicated

• Adult:
PO/IV
250 mg q24hr × 10 days

UTI, uncomplicated

• Adult:
PO
250 mg q24hr × 3 days

Plague
(y. pestis)

• Adult:
PO/IV
500 mg q24hr × 10-14 days, with pneumonia 750 mg q24hr

• Child/adolescent <50 kg:
PO/IV
8 mg/kg (max 250 mg/dose) q12hr × 10-14 days

Gonococcal infection, disseminated (unlabeled)

• Adult:
IV
250 mg q24hr × 24-48 hr then
PO
500 mg/day × 7 days

PID

• Adult:
IV
500 mg q24hr × 14 days

Otitis media (unlabeled)

• Adult:
PO
100-200 mg bid-tid × 3-14 days

• Child 6 mo-14 yr:
PO
10 mg/kg bid × ≥10 days

Renal disease

• Adult:
PO/IV
CCr 20-49 ml/min, initial 500 mg then 250 mg q24hr; CCr 10-19 ml/min, 500-700 mg, depending on condition, then 250-500 mg q48hr

Available forms:
Single-use vials 500, 750 mg; premixed flexible containers 250 mg/50 ml D
5
W, 500 mg/100 ml D
5
W, 750 mg/150 ml D
5
W; tabs 250, 500, 750 mg; oral sol 25 mg/ml

Administer:

• 
Obtain C&S before treatment and periodically

• 
PO 4 hr before or 2 hr after antacids, iron, calcium, zinc, give fluids

• 
Do not use theophylline with this product; toxicity may result

• 
Oral solution:
Give 1 hr before or 2 hr after food

Intermittent IV INF route

• 
Discard any unused sol in single-dose vial

• 
Dilute with 0.9% NaCl, D5W to 5 mg/ml; give over 60 min/250 mg or 90 min/750 mg or using premix; tear outer wrap at notch and remove sol container; check for leaks; close control clamps; remove cover from port at bottom of container; insert pin into port with a twist; suspend container from hanger; squeeze, release drip chamber to proper fluid level; open flow control to expel air, close clamp; regulate rate with flow control clamps

Y-site compatibilities:
Alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, ampicillin, anidulafungin, atenolol, atracurium, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, caffeine citrate, calcium gluconate, CARBOplatin, carmustine, caspofungin, cefepime, cefoTEtan, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, floxuridine, fluconazole, fludarabine, fosphenytoin, gemcitabine, gentamicin, granisetron, haloperidol, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem-cilastatin, isoproterenol, labetalol, leucovorin, levorphanol, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methylPREDNISolone, metoclopramide, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mitoXANtrone, morphine, nalbuphine, naloxone, nesiritide, octreotide, ondansetron, oxacillin, oxaliplatin,
oxytocin, PACLitaxel, palonosetron, pancuronium, PEMEtrexed, penicillin G sodium, pentamidine, phenylephrine, plicamycin, potassium chloride, promethazine, propranolol, ranitidine, remifentanil, rocuronium, sargramostim, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiotepa, tirofiban, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine

Solution compatibilities:
0.9% NaCl, D
5
W, D
5
/0.9% NaCl, D
5
LR, D
5
/0.45% NaCl, sodium lactate, plasma-lyte 56/D
5
W

SIDE EFFECTS

CNS:
Headache
, dizziness,
insomnia
, anxiety,
seizures,
encephalopathy
, paresthesia,
pseudotumor cerebri

CV:
Chest pain, palpitations, vasodilation,
QT prolongation

EENT:
Dry mouth, visual impairment

GI:
Nausea
, flatulence,
vomiting
, diarrhea, abdominal pain,
pseudomembranous colitis, hepatotoxicity

GU:
Vaginitis, crystalluria

HEMA:
Eosinophilia,
hemolytic anemia,
lymphopenia

INTEG:
Rash, pruritus,
photosensitivity
,
epidermal necrolysis

MISC:
Hypoglycemia, hypersensitivity, tendinitis,
tendon rupture

RESP:
Pneumonitis

SYST:
Anaphylaxis, multisystem organ failure, Stevens-Johnson syndrome

PHARMACOKINETICS

Metabolized in liver, excreted in urine unchanged, half-life 6-8 hr, peak 1-2 hr

INTERACTIONS

 

Black Box Warning:

Increase:
tendon rupture—corticosteroids

• 
Do not use with magnesium in same IV line

Increase:
levofloxacin levels—probenecid

Increase:
CNS stimulation, seizures—NSAIDs, foscarnet

Increase:
bleeding risk—warfarin

Decrease:
levofloxacin absorption—antacids containing aluminum, magnesium; sucralfate, zinc, iron, calcium

Decrease:
clearance of theophylline; toxicity may result

Drug/Lab Test

Decrease:
glucose, lymphocytes

NURSING CONSIDERATIONS
Assess:

• 
Previous sensitivity reaction

• 
Signs, symptoms of infection:
characteristics of sputum, WBC >10,000/mm
3
, fever; obtain baseline information before, during treatment

• 
C&S before beginning product therapy to identify if correct treatment initiated

 
Allergic reactions, anaphylaxis:
rash, urticaria, pruritus, chills, fever, joint pain; may occur a few days after therapy begins; EPINEPHrine and resuscitation equipment should be available for anaphylactic reaction

• 
Pseudomembranous colitis:
bowel pattern daily; if severe diarrhea, fever occurs, product should be discontinued

 
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

• 
Renal function (BUN/creatinine)

 

Black Box Warning:

Tendon rupture:
discontinue product at first sign of tendon pain or inflammation, usually the Achilles tendon is affected; can occur up to few months after treatment and may require surgical repair; steroids may increase risk

Perform/provide:

• 
Increased fluid intake to 2 L/day to prevent crystalluria

Evaluate:

• 
Therapeutic response: absence of signs, symptoms of infection (WBC <10,000/mm
3
, temp WNL)

Teach patient/family:

• 
To contact prescriber if vaginal itching; loose, foul-smelling stools; furry tongue occur (may indicate superinfection); to report itching, rash, pruritus, urticaria

• 
To notify prescriber of diarrhea with blood or pus

• 
To take product 4 hr before or 2 hr after antacids, iron, calcium, zinc products

• 
To complete full course of therapy

• 
To avoid hazardous activities until response is known

• 
To use frequent rinsing of mouth, sugarless candy or gum for dry mouth

• 
To avoid other medication unless approved by prescriber

• 
To prevent sun exposure or to use sunscreen to prevent phototoxicity

 

Black Box Warning:

To notify prescriber of tendon pain, inflammation; avoid corticosteroids with this product

BOOK: Mosby's 2014 Nursing Drug Reference
10.62Mb size Format: txt, pdf, ePub
ads

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