Mosby's 2014 Nursing Drug Reference (351 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(rif′am-pin)
Rifadin, Rofact
Func. class.:
Antitubercular
Chem. class.:
Rifamycin B derivative
Do not confuse:
rifampin
/rifabutin
Inhibits DNA-dependent polymerase, decreases tubercle bacilli replication
Pulmonary TB, meningococcal carriers (prevention)
Unlabeled uses:
Endocarditis,
Haemophilus influenzae type B prophylaxis
, Hansen’s disease,
Mycobacterium avium
complex (MAC), orthopedic-device–related infection, pruritus
Hypersensitivity to this product, rifamycins; active
Neisseria meningitidis
infection
Precautions:
Pregnancy (C), breastfeeding, children <5 yr, hepatic disease, blood dyscrasias
Calculator
• Adult:
PO/IV
Max 600 mg/day as single dose 1 hr before meals or 2 hr after meals or 10 mg/kg/day 2-3×/wk
• Child >5 yr:
PO/IV
10-20 mg/kg/day as single dose 1 hr before meals or 2 hr after meals, max 600 mg/day with other antituberculars
• 6-mo regimen:
2 mo treatment of isoniazid, rifampin, pyrazinamide, and possibly streptomycin or ethambutol then rifampin and isoniazid 3 4 mo
• 9-mo regimen:
rifampin and isoniazid supplemented with pyrazinamide, streptomycin, or ethambutol
• Adult:
PO/IV
600 mg bid × 2 days, max 600 mg/dose
• Child >5 yr:
PO/IV
10-20 mg/kg × 2 days, max 600 mg/dose
• Infant 3 mo-1 yr:
5 mg/kg PO
bid × 2 days
H. influenzae
type B infection (unlabeled)
• Adult:
PO
600 mg/day × 4 days
• Child:
PO
20 mg/kg/day × 4 days
• Adult:
PO/IV
600 mg/day used with ≥3 other active microbials
• Child:
PO/IV
10-20 mg/kg/day used with ≥3 other active microbials
• Adult:
PO
300 mg q8hr with gentamicin and vancomycin
• Child:
PO
20 mg/kg/day in 2 divided doses with gentamicin and vancomycin, max 900 mg/day
Available forms:
Caps 150, 300 mg; powder for inj 600 mg/vial
•
After C&S completed; monthly to detect resistance
•
Do not give IM, SUBCUT
•
On empty stomach, 1 hr before or 2 hr after meals with full glass of water, give with other products for TB
•
Antiemetic if vomiting occurs
•
Capsules may be opened, mixed with applesauce or jelly
•
After diluting each 600 mg/10 ml of sterile water for inj (60 mg/ml), swirl, withdraw dose and dilute in 100 ml or 500 ml of D
5
W given as inf over 3 hr; if diluted in 100 ml, give over 1/2 hr; do not admix with other sol or products
Y-site compatibilities:
amiodarone, bumetanide, midazolam, pantoprazole, vancomycin
CNS:
Headache, fatigue, anxiety, drowsiness, confusion
EENT:
Visual disturbances
GI:
Nausea, vomiting, anorexia, diarrhea
,
pseudomembranous colitis,
heartburn
, sore mouth and tongue,
pancreatitis,
increased LFTs
GU:
Hematuria, acute renal failure, hemoglobinuria
HEMA:
Hemolytic anemia, eosinophilia, thrombocytopenia, leukopenia
INTEG:
Rash, pruritus, urticaria
MISC:
Flulike symptoms, menstrual disturbances, edema, SOB,
Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, anaphylaxis
MS:
Ataxia, weakness
PO:
Peak 1-4 hr, duration >24 hr, half-life 3 hr, metabolized in liver (active/inactive metabolites), excreted in urine as free product (30% crosses placenta) and in breast milk
Do not use with protease inhibitors
Increase:
hepatotoxicity—isoniazid
Decrease:
action of acetaminophen, alcohol, anticoagulants, antidiabetics, β-blockers, barbiturates, benzodiazepines, chloramphenicol, clofibrate, corticosteroids, cycloSPORINE, dapsone, digoxin, doxycycline, haloperidol, hormones, imidazole antifungals, NIFEdipine, oral contraceptives, phenytoin, protease inhibitors, theophylline, verapamil, zidovudine
Increase:
LFTs
Decrease:
Hgb
Interference:
folate level, vit B
12
•
Infection:
sputum culture, lung sounds, characteristics of sputum
•
Signs of anemia: Hct, Hgb, fatigue
•
Hepatic function monthly: ALT, AST, bilirubin, decreased appetite, jaundice, dark urine, fatigue
•
Renal status before, each mo: BUN, creatinine, output, specific gravity, urinalysis
Serious skin reactions:
fever, sore throat, fatigue, ulcers; lesions in mouth, lips, rash; can be fatal
Pseudomembranous colitis:
diarrhea, fever, abdominal pain/cramping, bloody stools, product should be discontinued, prescriber notified
•
Therapeutic response: decreased symptoms of TB, culture negative
•
That compliance with dosage schedule, duration necessary
•
That scheduled appointments must be kept because relapse may occur
•
To avoid alcohol because hepatotoxicity may occur
•
That urine, feces, saliva, sputum, sweat, tears may be colored red-orange;
that soft contact lenses may be permanently stained
To report flulike symptoms: excessive fatigue, anorexia, vomiting, sore throat; unusual bleeding; yellowish discoloration of skin, eyes; diarrhea with pus, mucous, blood
•
To use nonhormonal form of birth control; to notify prescriber if pregnancy planned, suspected; not to breastfeed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
