Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (354 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ri-man′tah-deen)
Flumadine
Func. class.:
Synthetic antiviral
Chem. class.:
Tricyclic amine
Do not confuse:
rimantadine
/amantadine/ranitidine
Prevents uncoating of nucleic acid in viral cell, thereby preventing the penetration of the virus to the host; causes the release of dopamine from neurons
Prophylaxis or treatment of influenza type A
Hypersensitivity to this product, amantadine
Precautions:
Pregnancy (C), breastfeeding, children <1 yr, seizure disorders, renal/hepatic disease
Calculator
• Adult and child >10 yr:
PO
100 mg bid
• Child 1-10 yr:
PO
5 mg/kg/day, max 150 mg
• Adult:
PO
100 mg bid; start treatment at onset of symptoms, continue for ≥1 wk
• Child ≥10 yr (unlabeled):
PO
200 mg/day either as single dose or in 2 divided doses
• Child 1-9 yr (unlabeled):
PO
6.6 mg/kg/day in 2 divided doses, max 150 mg/day in 2 divided doses
• Geriatric:
PO
100 mg/day
• Adult:
PO
≤10 ml/min, 100 mg daily
Available forms:
Tabs 100 mg; syr 50 mg/5 ml
•
Give with full glass of water
•
Within 48 hr of exposure to influenza; continue for 10 days after contact
•
At least 4 hr before bedtime to prevent insomnia
•
After meals for better absorption, to decrease GI symptoms
•
In divided doses to prevent CNS disturbances: headache, dizziness, fatigue, drowsiness
CNS:
Headache, dizziness
, fatigue, depression, hallucinations, tremors,
seizures,
insomnia, poor concentration, asthenia, gait abnormalities,
anxiety
, confusion
CV:
Pallor, palpitations, edema
EENT:
Tinnitus, taste abnormality, eye pain
GI:
Nausea, vomiting
, constipation,
dry mouth, anorexia, abdominal pain
, diarrhea, dyspepsia
INTEG:
Rash
PO:
Peak 6 hr, elimination half-life 13-65 hr, plasma protein binding (40%)
Increase:
rimantadine concentration—cimetidine
Decrease:
peak concentration of rimantadine—acetaminophen, aspirin; intranasal influenza vaccine (separate by ≥48 hr)
Seizures;
if seizures occur, product should be discontinued
•
Bowel pattern before, during treatment
•
CNS effects in geriatric patients, patients with severe renal/hepatic disease
•
Skin eruptions, photosensitivity after administration of product
•
Respiratory status: rate, character, wheezing, tightness in chest
•
Signs of infection
•
Storage in tight, dry container
•
Therapeutic response: absence of fever, malaise, cough, dyspnea with infection
•
About aspects of product therapy: the need to report dyspnea, dizziness, poor concentration, behavioral changes
•
To avoid hazardous activities if dizziness occurs
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(rih-sed′roh-nate)
Actonel, Atelvia
Func. class.:
Bone resorption inhibitor
Chem. class.:
Bisphosphonate
Do not confuse:
Actonel
/Actos
Inhibits bone resorption, absorbs calcium phosphate crystal in bone, and may directly block dissolution of hydroxyapatite crystals of bone
Paget’s disease; prevention, treatment of osteoporosis in postmenopausal women; glucocorticoid-induced osteoporosis; osteoporosis in men
Unlabeled uses:
Osteolytic metastases
Hypersensitivity to bisphosphonates, inability to stand or sit upright for ≥30 min, esophageal stricture, achalasia, hypocalcemia
Precautions:
Pregnancy (C), breastfeeding, children, renal disease, active upper GI disorders, dental disease, hyperparathyroidism, infection, vit D deficiency, coagulopathy, chemotherapy, asthma
Calculator
• Adult:
PO
30 mg/day × 2 mo; patients with Paget’s disease should receive calcium and vit D if dietary intake lacking; if relapse occurs, retreatment advised
• Adult:
PO
5 mg/day or 35 mg/wk or 75 mg/day × 2 consecutive days 2× monthly or 150 mg/mo
• Adult:
PO
5 mg/day
• Adult:
PO
35 mg/wk
• Adult:
PO
30 mg/day × 6 mo
• Adult:
PO
CCr <30 ml/min, avoid use
Available forms:
Tabs 5, 30, 35, 150 mg; tab, gastro-resistant, weekly 35 mg; tab, weekly 35 mg
•
For 2 months to be effective for Paget’s disease
•
With a full glass of water; patient should be in upright position for 1/2 hr; swallow whole; do not crush, break, chew
•
Supplemental calcium and vit D for Paget’s disease if instructed by prescriber
•
Give daily ≥30 min before meals or give weekly
CNS:
Dizziness, headache, depression
CV:
Chest pain
, hypertension,
atrial fibrillation
GI:
Abdominal pain, diarrhea, nausea
, constipation, esophagitis
MISC:
Rash, UTI, pharyngitis, hypocalcemia, hypophosphatemia, increase PTH
MS:
Osteonecrosis of the jaw,
severe muscle/joint/bone pain, fractures
SYST:
Angioedema
Rapidly cleared from circulation, taken up mainly by bones (50%), eliminated primarily through kidneys, absorption decreased by food, terminal half-life 220 hr
Increase:
GI irritation—NSAIDs, salicylates
Decrease:
absorption of risedronate—aluminum, calcium, iron, magnesium salts, antacids
Decrease:
bioavailability—take 1/2 hr before food or drinks other than water
Decrease:
calcium
•
Paget’s disease:
headache, bone pain, increased head circumference
•
Osteoporosis:
in men or postmenopausal women; bone density study before and periodically during treatment
•
Phosphate, alk phos, calcium; creatinine, BUN (renal disease)
•
Hypocalcemia:
paresthesia, twitching, laryngospasm, Chvostek’s/Trousseau’s signs
Serious skin reactions:
angioedema
•
Dental health:
assess dental health, provide antiinfectives for dental extraction; cover with antiinfectives before dental extraction
For atrial fibrillation
•
Storage in cool environment, out of direct sunlight
•
Therapeutic response: increased bone mass, absence of fractures
•
To sit upright for 1/2 hr after dose to prevent irritation
•
To comply with diet, vitamin/mineral supplements
•
To notify prescriber if pregnancy is suspected or if breastfeeding
•
To maintain good oral hygiene
•
To notify all health care providers of use
•
That musculoskeletal pain may occur within a few days/mo after starting but usually resolves; use acetaminophen
•
To exercise regularly; to avoid alcohol, tobacco
