Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (356 page)
Suicidal thoughts/behaviors:
often when depression is lessened; mental status before initial administration
•
Bilirubin, CBC, hepatic studies monthly
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
QT prolongation:
B/P standing, lying; pulse, respirations; take these q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes
•
Dizziness, faintness, palpitations, tachycardia on rising
•
EPS:
akathisia, tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
Serious reactions in geriatric patient:
fatal pneumonia, heart failure, sudden death, dementia
Neuroleptic malignant syndrome:
hyperthermia, increased CPK, altered mental status, muscle rigidity, seizures, change in B/P, fatigue, tachycardia
•
Constipation, urinary retention daily; if these occur, increase bulk, water in diet
•
Weight gain, hyperglycemia, metabolic changes in diabetes, increased lipids
•
Decreased stimuli by dimming lights, avoiding loud noises
•
Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for a long time
•
Increased fluids to prevent constipation
•
Storage in tight, light-resistant container (PO); unopened vials in refrigerator, protect from light; do not freeze
•
Therapeutic response: decrease in emotional excitement, hallucinations, de
lusions, paranoia; reorganization of patterns of thought, speech
•
That orthostatic hypotension may occur; to rise from sitting or lying position gradually
•
To avoid abrupt withdrawal of product because EPS may result; product should be withdrawn slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber; that serious product interactions may occur; to avoid use of alcohol because increased drowsiness may occur
•
To avoid hazardous activities if drowsy or dizzy
•
To comply with product regimen
•
To report impaired vision, tremors, muscle twitching
•
That heat stroke may occur in hot weather; to take extra precautions to stay cool; to avoid hot tubs, hot showers, tub baths
•
To use contraception; to inform prescriber if pregnancy is planned or suspected, do not breastfeed
•
To notify provider of suicidal thoughts/behaviors
Lavage if orally ingested; provide airway;
do not induce vomiting
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ri-toe′na-veer)
Norvir
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
Do not confuse:
ritonavir
/Retrovir
Inhibits human immunodeficiency virus (HIV-1) protease and prevents maturation of the infectious virus
HIV-1 in combination with at least 2 other antiretrovirals
Hypersensitivity
Black Box Warning:
Coadministration with other drugs
Precautions:
Pregnancy (B), breastfeeding, hepatic disease, pancreatitis, diabetes, hemophilia, AV block, hypercholesterolemia, immune reconstitution syndrome, neonates, cardiomyopathy, immune reconstitution syndrome, infants 1-6 mo (overdose)
Calculator
• Adult and adolescent >16 yr:
PO
600 mg bid; if nausea occurs, begin at 1/2 dose and gradually increase, max 1200 mg/day
• Adolescent ≤16 yr and child, infant:
PO
400 mg/m
2
bid up to 1200 mg/day, may start lower and escalate
Available forms:
Caps 100 mg; oral sol 80 mg/ml; tab 100 mg
•
Take with food, swallow whole; do not crush, break, chew
•
When switching from cap to tab, more GI symptoms may occur, will lessen over time
•
Use dosage titration to minimize side effects
•
Oral sol:
shake well, use calibrated measuring device
•
Mix liquid formulation with chocolate milk or liquid nutritional supplement to improve taste
•
Overdose:
infants, children, alcohol 43.2% alcohol, 26.57% propylene glycol oral sol, calculate total amount of alcohol, propylene glycol from all products given
CNS:
Paresthesia, headache
,
seizures,
fever, dizziness, insomnia, asthenia,
intracranial bleeding
CV:
QT, PR interval prolongation
GI:
Diarrhea
, buccal mucosa ulceration,
abdominal pain, nausea, taste perversion
, dry mouth,
vomiting, anorexia
INTEG:
Rash
MISC:
Asthenia,
angioedema, anaphylaxis, Stevens-Johnson syndrome,
increase lipids, lipodystrophy,
toxic epidermal necrolysis
MS:
Pain,
rhabdomyolysis,
myalgia
Well absorbed, 98% protein binding, hepatic metabolism, peak 2-4 hr, terminal half-life 3-5 hr
Black Box Warning:
Increase:
toxicity—amiodarone, astemizole, azole antifungals, benzodiazepines, buPROPion, CISapride, cloZAPine, desipramine, dihydroergotamine, encainide, ergotamine, flecainide, HMG-CoA reductase inhibitors, interleukins, meperidine, midazolam, pimozide, piroxicam, propafenone, propoxyphene, quiNIDine, ranolazine, saquinavir, terfenadine, triazolam, zolpidem; CYP2D6 inhibitors
Black Box Warning:
Increase:
QT prolongation—class 1A/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine, CYP3A4 inhibitors (amiodarone, clarithromycin, dasatinib, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl, CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
Increase:
ritonavir levels—fluconazole
Increase:
level of both products—clarithromycin, ddI
Increase:
levels of—bosentan
Decrease:
ritonavir levels—rifamycins, nevirapine, barbiturates, phenytoin
Decrease:
levels of anticoagulants, atovaquone, divalproex, ethinyl estradiol, lamotrigine, phenytoin, sulfamethoxazole, theophylline, voriconazole, zidovudine
Decrease:
ritonavir levels—St. John’s wort; avoid concurrent use
•
Avoid use with red yeast rice
Increase:
AST, ALT, K, CK, cholesterol, GGT, triglycerides, uric acid
Decrease:
Hct, Hgb, RBC, neutrophils, WBC
•
HIV:
viral load, CD4 at baseline, throughout therapy; blood glucose, plasma HIV RNA, serum cholesterol/lipid profile; resistance testing before starting therapy and after treatment failure
•
Immune reconstitution syndrome:
may occur with combination therapy, may develop inflammatory response with opportunistic infection (MAC, Graves’ disease, Guillain-Barré Syndrome, TB, PCP), may occur during initial treatment or months after
•
Signs of infection, anemia
•
Hepatic studies: ALT, AST, in those with hepatic disease, monitor q3mo
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, discontinue product; monitor hydration
•
Skin eruptions; rash
Rhabdomyolysis:
muscle pain, increased CPK, weakness, swelling of affected muscles; if these occur and if confirmed by CPK, product should be discontinued
QT prolongation:
ECG for QT prolongation, ejection fraction; assess for chest pain, palpitations, dyspnea
Serious skin disorders:
Stevens-Johnson syndrome, angioedema, anaphylaxis, toxic epidermal necrolysis
•
Store caps in refrigerator
•
Therapeutic response: improvement in HIV symptoms; improving viral load, CD4+ T cells
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
That product not a cure for HIV; that opportunistic infections may continue to be acquired
•
That redistribution of body fat or accumulation of body fat may occur
•
That others may continue to contract HIV from patient
•
To avoid OTC, prescription medications, herbs, supplements unless approved by prescriber; not to use St. John’s wort because it decreases product’s effect
•
That regular follow-up exams and blood work will be required
