Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (275 page)
(mo-daf′i-nil)
Alertec
, Provigil
Func. class.:
CNS stimulant
Chem. class.:
Racemic compound
Similar action as that of sympathomimetics; does not alter release of dopamine, norepinephrine
Narcolepsy, shift-work sleep disturbance, obstructive sleep apnea
Unlabeled uses:
Fatigue in MS, ADHD
Hypersensitivity, ischemic heart disease, left ventricular hypertrophy, chest pain, dysrhythmias
Precautions:
Pregnancy (C), breastfeeding, child <16 yr, geriatric patients, unstable angina, history of MI, severe hepatic disease
Calculator
• Adult and adolescent ≥16 yr:
PO
200 mg daily
• Adult:
PO
100 mg daily
• Adult/geriatric/adolescents ≥6 yr:
PO
200-400 mg daily in the
AM
Available forms:
Tabs 100, 200 mg
•
Give 1 hr before start of shift work or in
AM
for those with narcolepsy or sleep apnea
CNS:
Headache
, anxiety, cataplexy, depression, dizziness, insomnia, amnesia, confusion, ataxia, tremors, paresthesia, dyskinesia,
suicidal ideation
CV:
Dysrhythmias, hypo/hypertension, chest pain, vasodilation
EENT:
Change in vision,
rhinitis
, pharyngitis, epistaxis
GI:
Nausea, vomiting, changes in LFTs, anorexia, diarrhea, thirst, mouth ulcers
GU:
Ejaculation disorder, urinary retention, albuminuria
HEMA:
Eosinophilia
INTEG:
Rash, dry skin, herpes simplex,
Stevens-Johnson syndrome
MISC:
Infection, hyperglycemia, neck pain
RESP:
Dyspnea
, lung changes
Absorbed rapidly, 60% protein binding, metabolized by the liver (90%), half-life 15 hr, peak 2-4 hr
Increase:
Altered levels of CYP3A4 inhibitors (azole antibiotics some SSRIs), reaction difficult to predict
Increase:
levels of CYP2C19 substrates (diazepam, phenytoin some tricyclics)
Decrease:
effects of—cycloSPORINE, hormonal contraceptives, theophylline, estrogens
Delayed effect modafinil by 1 hr:
methylphenidate
Altered:
Levels of CYP3A4 inducers (carBAMazepine, phenytoin, rifampin, cycloSPORINE, theophylline)
Increase:
stimulation—cola nut, guarana, yerba maté, coffee, tea
Increase:
LFTs, glucose, eosinophils
•
Narcolepsy, shift work, history of sleep apnea
•
Depression, suicidal ideation
•
Monitor B/P in those with hypertension
•
Storage at room temp
•
Ability to stay awake
•
To take only as directed; that product may be taken with/without food
•
To use other form of contraception during and for ≥30 days after discontinuing medication if using hormonal birth control; to notify prescriber if pregnancy is planned or suspected or if breastfeeding
•
To notify prescriber of allergic reaction, tremors, confusion
•
To avoid all OTC medications unless approved by prescriber
•
To avoid hazardous activities until drug effect is known
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mon-teh-loo′kast)
Singulair
Func. class.:
Bronchodilator
Chem. class.:
Leukotriene receptor antagonist, cysteinyl
Inhibits leukotriene (LTD
4
) formation; leukotrienes exert their effects by increasing neutrophil, eosinophil migration; aggregation of neutrophils, monocytes; smooth muscle contraction, capillary permeability; these actions further lead to bronchoconstriction, inflammation, edema
Chronic asthma in adults and children, seasonal allergic rhinitis, bronchospasm prophylaxis
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children <6 yr, acute attacks of asthma, alcohol consumption, severe hepatic disease, corticosteroid withdrawal, phenylketonuria
Calculator
• Adult and child ≥15 yr:
PO
10 mg/day in
PM
• Child 6-14 yr:
PO
5-mg chew tab/day in
PM
• Child 2-5 yr:
PO
(chew tab/granules) 4 mg/day
• Child 12-23 mo:
PO
1 packet (4 mg) granules taken in
PM
• Adult/child ≥6 yr:
PO
10 mg 2 hr before exercise; do not take another dose within 24 hr
Available forms:
Tabs 10 mg; chew tabs 4, 5 mg; oral granules 4 mg/packet
•
In
PM
daily for all uses except exercise-induced bronchoconstriction; then take 2 hr before exercise
•
Granules directly in mouth or mixed with spoonful of soft food (carrots, applesauce, ice cream, rice)
•
Do not open granules packet until ready to use; mix whole dose; give within 15 min
CNS:
Dizziness, fatigue, headache
, behavior changes, hallucinations,
seizures,
agitation, anxiety, depression, fever, drowsiness
GI:
Abdominal pain
, dyspepsia, nausea, vomiting, diarrhea,
pancreatitis
HEMA:
Thrombocytopenia
INTEG:
Rash, pruritus, erythema
MS:
Asthenia, myalgia, muscle cramps
RESP:
Influenza, cough
, nasal congestion
SYST:
Anaphylaxis, angioedema, Churg-Strauss syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis
Rapidly absorbed; peak 3-4 hr, chew tab (5 mg) 2-2.5 hr; half-life 2.7-5.5 hr, extended in hepatic disease; protein binding 99%; metabolized by liver; excreted via bile
Increase:
adverse reactions of CYP2C8 substrates
Decrease:
montelukast levels—barbiturates, rifabutin, rifapentine, carBAMazepine, fosphenytoin, phenytoin, rifampin
Increase:
stimulation—black, green tea, guarana
Increase:
ALT, AST
Churg-Strauss syndrome:
rare adult patients carefully for symptoms: eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, neuropathy
•
Allergic reactions: rash, urticaria; product should be discontinued
For behavior changes and suicidal ideation, other neuropsychiatric reactions
•
Severe hepatic disease:
use cautiously
•
Therapeutic response: ability to breathe more easily
•
To check OTC medications, current prescription medications for ePHEDrine, which will increase stimulation; to avoid alcohol
•
To avoid hazardous activities; dizziness may occur
•
That product is not to be used for acute asthma attacks
•
If aspirin sensitivity is known, not to take NSAIDs while taking this product
•
To continue to use inhaled β-agonists if exercise-induced asthma occurs
•
Granules:
to give directly in mouth or mixed in a spoonful of room temperature soft food (use only applesauce, carrots, rice, or ice cream) use within 15 min of opening packets, discard used portions
