Mosby's 2014 Nursing Drug Reference (363 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

salicylic acid topical

 

salmeterol (Rx)

(sal-met′er-ole)

Serevent
, Serevent Diskus

Func. class.:
β
2
-Adrenergic agonist, bronchodilator

ACTION:

Causes bronchodilation by action on β
2
(pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscle with little effect on heart rate; maintains improvement in FEV from 3 to 12 hr; prevents nocturnal asthma symptoms

USES:

Prevention of exercise-induced bronchospasm, COPD, asthma

CONTRAINDICATIONS:

Hypersensitivity to sympathomimetics, tachydysrhythmias, severe cardiac disease, monotherapy treatment of asthma

Precautions:
Pregnancy (C), breastfeeding, cardiac disorders, hyperthyroidism, diabetes mellitus, hypertension, closed-angle glaucoma, seizures, acute asthma, as a substitute to corticosteroids, QT prolongation

 

Black Box Warning:

Asthma-related death, children <4 yr

DOSAGE AND ROUTES
Calculator

• Adult/child ≥4 yr:
INH
50 mcg (1 inhalation as dry powder) q12hr; exercise-induced bronchospasm 50 mcg (1 inhalation) 1/2-1 hr before exercise

Available forms:
Inhalation powder 50 mcg/blister

Administer:

• 
Gum, sips of water for dry mouth

• 
Use 1 hr before exercise for exercise-induced bronchospasm prevention

SIDE EFFECTS

CNS:
Tremors, anxiety
, insomnia, headache, dizziness, fever

CV:
Palpitations, tachycardia, hypo/hypertension, angina,
dysrhythmias

EENT:
Dry nose, irritation of nose and throat

GI:
Heartburn, nausea, vomiting, abdominal pain

MS:
Muscle cramps

RESP:
Bronchospasm,
cough

PHARMACOKINETICS

INH:
Onset 30-50 min; peak 4 hr; duration 12 hr; metabolized in liver; excreted in urine, breast milk; crosses placenta, blood-brain barrier; protein binding 94%-98%; terminal half-life 3-5 hr

INTERACTIONS

Increase:
CV effect—CYP3A4 inhibitors (itraconazole, ketoconazole, nelfinavir, nefazodone, saquinavir)

Increase:
action of aerosol bronchodilators

Increase:
action of salmeterol—tricyclics, MAOIs

Decrease:
salmeterol action—other β-blockers

NURSING CONSIDERATIONS
Assess:

• 
Respiratory function:
vital capacity, forced expiratory volume, ABGs, lung sounds, heart rate and rhythm

 
Paradoxical bronchospasm:
dyspnea, wheezing, chest tightness

 

Black Box Warning:

Children should not use this product as monotherapy for asthma, use only with persistent asthma in those whose symptoms are not wellcontrolled with a long-term asthma product

Perform/provide:

• 
Storage in foil pouch; do not expose to temp >86° F (30° C); discard 6 wk after removal from foil pouch

Evaluate:

• 
Therapeutic response: absence of dyspnea, wheezing

Teach patient/family:

• 
Not to use for exercise-induced bronchospasm, never to exhale into diskus, to hold level, keep mouthpiece dry

• 
Not to use OTC medications because extra stimulation may occur

• 
Review package insert with patient

• 
To avoid getting powder in eyes

• 
To avoid smoking, smoke-filled rooms, persons with respiratory infections

• 
Not for treatment of acute exacerbation, a fast-acting β-blocker should be used instead

 
To immediately report dyspnea after use if ≥1 canister is used in 2 mo time

TREATMENT OF OVERDOSE:

β
2
-Adrenergic blocker

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

sargramostim (GM-CSF) (Rx)

(sar-gram′oh-stim)

Leukine, GM-CSF

Func. class.:
Biologic modifier

Chem. class.:
Granulocyte macrophage colony-stimulating factor (GM-CSF)

Do not confuse:
Leukine
/leucovorin/Leukeran

ACTION:

Stimulates proliferation and differentiation of hematopoietic progenitor cells (granulocytes, macrophages)

USES:

Acceleration of myeloid recovery in patients with non–Hodgkin’s lymphoma, acute lymphoblastic leukemia, acute myelogenous leukemia, autologous bone marrow transplantation in Hodgkin’s disease; bone marrow transplantation failure or engraftment delay, mobilization and transplant of peripheral blood progenitor cells (PBPCs)

Unlabeled uses:
Aplastic anemia, Crohn’s disease, HIV, ganciclovir- or zidovudine-induced neutropenia, malignant melanoma

CONTRAINDICATIONS:

Neonates; hypersensitivity to GM-CSF, benzyl alcohol, yeast products; excessive leukemic myeloid blast in bone marrow, peripheral blood

Precautions:
Pregnancy (C), breastfeeding, children; lung/cardiac/renal/hepatic disease; pleural, pericardial effusions, peripheral edema, leukocytosis, mannitol hypersensitivity, hepatic/renal disease

DOSAGE AND ROUTES
Calculator
Myeloid reconstitution after autologous bone marrow transplantation

• Adult:
IV
250 mcg/m
2
/day × 3 wk; give over 2 hr, begin 2-4 hr after bone marrow inf, not <24 hr after last dose of antineoplastics and 12 hr after last dose of radiotherapy, bone marrow transplantation failure, or engraftment delay

Acceleration of myeloid recovery

• Adult:
IV
250 mcg/m
2
/day × 14 days; give over 2 hr; may repeat in 7 days, may repeat 500 mcg/m
2
/day × 14 days after another 7 days if no improvement

Mobilization of PBPCs

• Adult:
IV/SUBCUT
250 mcg/m
2
/day during collection of PBPCs

After PBPC transplantation

• Adult:
IV/SUBCUT
250 mcg/m
2
/day until ANC >1500 cells/mm
3
× 3 days

Aplastic anemia (unlabeled)

• Adult:
SUBCUT
250-500 mcg/day or 5 mcg/kg/day × 14-90 days, used with erythropoietin or immunosuppressive therapy

Malignant melanoma (unlabeled)

• Adult:
SUBCUT
125 mcg/m
2
/day × 14 days, alternate with 14 days off

HIV (unlabeled)

• Adult:
SUBCUT
250 mcg/day 3×/wk for ≤20 mo

Available forms:
Powder for inj lyophilized 250 mcg; sol for inj 500 mcg/ml

Administer:
SUBCUT route

• 
No further dilution of reconstituted sol is needed; take care not to inject intradermally

Intermittent IV INF route

• 
After reconstituting with 1 ml sterile water for inj without preservative; do not reenter vial; discard unused portion; direct reconstitution sol at side of vial; rotate contents; do not shake

• 
Dilute in 0.9% NaCl inj to prepare IV inf; if final concentration is <10 mcg/ml, add human albumin to make final conc of 0.1% to NaCl before adding sargramostim to prevent adsorption; for a final conc of 0.1% albumin, add 1 mg human albumin/1 ml 0.9% NaCl inj run over 2 hr
(bone marrow transplant or failure of graft);
over 4 hr
(chemotherapy for AML);
over 24 hr as cont inf
(PBPCs);
give within 6 hr after reconstitution

Y-site compatibilities:
Amikacin, aminophylline, aztreonam, bleomycin, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefepime, cefotaxime, cefoTEtan, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, dexamethasone, diphenhydrAMINE, DOPamine, DOXOrubicin, doxycycline, droperidol, etoposide, famotidine, fentaNYL, floxuridine, fluconazole, fluorouracil, furosemide, gentamicin, granisetron, heparin, IDArubicin, ifosfamide, immune globulin, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methotrexate, metoclopramide, metroNIDAZOLE, minocycline, mitoXANtrone, netilmicin, pentostatin, piperacillin/tazobactam, potassium chloride, prochlorperazine, promethazine, ranitidine, teniposide, ticarcillin, ticarcillin-clavulanate, trimethoprim-sulfamethoxazole, vinBLAStine, vinCRIStine, zidovudine

SIDE EFFECTS

CNS:
Fever, malaise, CNS disorder, weakness, chills, dizziness, syncope, headache

CV:
Transient supraventricular tachycardia,
peripheral edema,
pericardial effusion,
hypotension, tachycardia

GI:
Nausea, vomiting, diarrhea, anorexia,
GI hemorrhage,
stomatitis,
liver damage,
hyperbilirubinemia

GU:
Urinary tract disorder, abnormal kidney function

HEMA:
Blood dyscrasias, hemorrhage

INTEG:
Alopecia, rash, peripheral edema

MS:
Bone pain, myalgia

RESP:
Dyspnea

PHARMACOKINETICS

Half-life elimination: IV 60 min, SUBCUT 2-3 hr; detected within 5 min after administration, peak 2 hr

INTERACTIONS

• 
Do not use product concomitantly with antineoplastics or radiation, separate by ≥24 hr

Increase:
myeloproliferation—lithium, corticosteroids

Drug/Lab Test

Increase:
bilirubin, BUN, creatinine, eosinophils, LFTs, leukocytes

NURSING CONSIDERATIONS
Assess:

 
Blood studies: CBC, differential count before treatment, 2 × weekly; leukocytosis may occur (WBC
>
50,000 cells/mm
3
, ANC
>
20,000 cells/mm
3
), platelets; if ANC
>
20,000/mm
3
or 10,000/mm
3
after nadir has occurred or platelets
>
500,000/mm
3
, reduce dose by 1/2 or discontinue; if blast cells occur, discontinue

• 
Renal, hepatic studies before treatment: BUN, creatinine, urinalysis; AST, ALT, alk phos; 2 × weekly monitoring is needed in renal/hepatic disease

• 
Hypersensitivity,
rashes, local inj site reactions; usually transient

• 
Body weight, hydration status; increased fluid retention in cardiac disease; pulmonary function

• 
Constitutional symptoms: asthenia, chills, fever, headache, malaise

• 
Myalgia, arthralgia in legs, feet; use analgesics, antipyretics

Perform/provide:

• 
Gasping syndrome in neonates:
due to benzyl alcohol hypersensitivity

• 
Storage in refrigerator; do not freeze

Evaluate:

• 
Therapeutic response: WBC and differential recovery

Teach patient/family:

• 
To report dyspnea to health care provider

• 
Review all aspects of product use

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