Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (373 page)
•
Unreconstituted vials of drug and diluent may be stored at room temperature until expiration date
•
Reconstitute each vial of 4 mg, 5 mg, or 6 mg with 0.5–1 ml sterile water for injection, USP; reconstitute each 8.8 mg with 1–2 ml bacteriostatic water for injection (0.9% benzyl alcohol preserved); in newborns or patients with a benzoyl alcohol hypersensitivity, sterile water for injection may be used; review manufacturer’s labeling for expected concentrations; direct the liquid against the glass vial wall; swirl vial with a gentle rotary motion until contents are dissolved completely; do not shake; the solution should be clear, if it is cloudy after reconstitution or refrigeration, do not use; small color
less particles may be present after refrigeration, this is not unusual for solutions containing proteins
•
After reconstitution with sterile water for injection, use the solution immediately and discard any unused portion; when using bacteriostatic water for injection, reconstituted solutions are stable for up to 14 days refrigerated; avoid freezing vials of drug or diluent or reconstituted vials
•
Inject deeply into a large muscle; aspirate before injection; rotate injection sites daily
•
Volumes >1 ml of reconstituted solution is not recommended, do not inject intradermally
•
Allow refrigerated solutions to come to room temperature before injection
•
Subcutaneous injections may be given in the thigh, buttocks, or abdomen; rotate injection sites daily
CNS:
Headache, growth of intracranial tumor, fever, aggressive behavior
ENDO:
Hyperglycemia, ketosis, hypothyroidism, thyroid hormone replacement may be needed
GI:
Nausea, vomiting,
pancreatitis
GU:
Hypercalciuria
INTEG:
Rash, urticaria, pain; inflammation at inj site, hematoma
MS:
Tissue swelling, joint and muscle pain
SYST:
Antibodies to growth hormone
Half-life 15-60 min, duration 7 days, metabolized in liver
Increase:
epiphyseal closure—androgens, thyroid hormones
Decrease:
growth—glucocorticosteroids
Decrease:
insulin, antidiabetic effect—dosage adjustment may be needed
Increase:
glucose, urine glucose
Decrease:
glucose thyroid hormones
•
Signs/symptoms of diabetes
•
Growth hormone antibodies if patient fails to respond to therapy
•
Thyroid function tests: T
3
, T
4
, T
7
, TSH to identify hypothyroidism
•
Allergic reaction:
rash, itching, fever, nausea, wheezing
•
Hypercalciuria:
urinary stones; groin, flank pain; nausea, vomiting, urinary frequency, hematuria, chills
•
Growth rate, bone age of child at intervals during treatment
•
Respiratory infection:
in those with Prader-Willi syndrome, may have sleep apnea, upper airway obstruction; discontinue if obstruction occurs
•
Rapid growth: assess for slipped capital femoral epiphysis may also occur in endocrine disorders
•
Monitor ophthalmologic status baseline and periodically; intracranial hypertension may occur
•
Storage in refrigerator for <1 mo; if reconstituted, <1 wk; do not use discolored or cloudy sol
•
Therapeutic response: growth in children
•
That treatment may continue for years; that regular assessments are required
•
To maintain a growth record; to report knee/hip pain or limping
•
That treatment is very expensive
•
Identify creosol or benzyl-alcohol hypersensitivity before use
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sot′ah-lahl)
Betapace, Betapace AF, Sorine
Func. class.:
Antidysrhythmic group III
Chem. class.:
Nonselective β-blocker
Blockade of β
1
- and β
2
-receptors leads to antidysrhythmic effect, prolongs action potential in myocardial fibers without affecting conduction, prolongs QT interval, no effect on QRS duration
Life-threatening ventricular dysrhythmias; Betapace AF: to maintain sinus rhythm with symptomatic atrial fibrillation/flutter
Unlabeled uses:
Atrial fibrillation prophylaxis, cardiac surgery, PSVT, Wolff-Parkinson-White (WPW) syndrome
Hypersensitivity to β-blockers, cardiogenic shock, heart block (2nd/3rd degree), sinus bradycardia, CHF, bronchial asthma, CCr <40 ml/min
Black Box Warning:
Congenital or acquired long QT syndrome, hypokalemia
Precautions:
Pregnancy (B), breastfeeding, major surgery, diabetes mellitus, renal/thyroid disease, COPD, well-compensated heart failure, CAD, nonallergic bronchospasm, electrolyte disturbances, bradycardia, peripheral vascular disease
Black Box Warning:
Cardiac dysrhythmias, torsades de pointes, ventricular dysrhythmias, ventricular fibrillation
Calculator
• Adult:
PO
initial 80 mg bid, may increase to 240-320 mg/day
• Child >2 yr with normal renal function (unlabeled):
PO
30 mg/m
2
tid, adjust dose gradually after ≥36 hr to max 60 mg/m
2
tid
• Adult:
PO
CCr 30-60 ml/min, give q24hr; CCr 10-29 ml/min, give q36-48hr; CCr <10 ml/min, individualize dose
• Adult (CCR 40-60 ml/min):
IV
75 mg over 5 hr daily, monitor QTc at end of each inf during initiation and titration; 80 mg PO = 75 mg IV; 120 mg PO = 112.5 mg IV; 160 mg PO = 150 mg IV
• Adult:
PO
initial 80 mg bid, titrate upward to 120 mg bid during initial hospitalization
• Adult:
PO
CCr >60 ml/min, give q12hr; CCr 40-60 ml/min, give q24hr; CCr <40 ml/min, do not use
Available forms:
Tabs 80, 120, 160, 240 mg; (Betapace AF) 80, 120, 160 mg; inj 150 mg/10 ml (15 mg/ml)
•
Before, at bedtime; tablet may be crushed or swallowed whole; give 1 hr before or 2 hr after meals
•
Reduced dosage in renal dysfunction
•
Betapace and Betapace AF are not interchangeable
•
Do not give within 2 hr of antacids
•
Dilute to vol of either 120 ml or 300 ml with D
5
W, LR
•
75 mg dose:
withdraw 6 ml sotalol inj (90 mg), add 114 ml dilute to make 120 ml (0.75 mg/ml) or withdraw 6 ml sotalol inj (90 mg), add 294 ml dilute to make 300 ml (0.3 mg/ml)
•
112.5 mg dose:
withdraw 9 ml sotalol inj (135 ml), add 111 ml dilute to make 120 ml (1.125 mg/ml); or withdraw 9 ml sotalol (135 mg), add 291 ml dilute to make 300 ml (0.45 mg/ml)
•
150 mg dose:
withdraw 12 ml of sotalol (180 mg), add 108 ml to make 120 ml (1.5 mg/ml) or withdraw 12 ml sotalol (180 mg), add 288 ml to make 300 ml (0.6 mg/ml)
•
Use inf pump and infuse 100 or 250 ml over 5 hr at a constant rate
CNS:
Dizziness, mental changes, drowsiness, fatigue, headache, catatonia, depression, anxiety, nightmares, paresthesia, lethargy, insomnia, decreased concentration
CV:
Prodysrhythmia, prolonged QT,
orthostatic hypotension, bradycardia,
CHF,
chest pain, ventricular dysrhythmias, AV block, peripheral vascular insufficiency, palpitations, torsades de pointes;
life-threatening ventricular dysrhythmias (Betapace AF)
EENT:
Tinnitus, visual changes, sore throat, double vision; dry, burning eyes
GI:
Nausea, vomiting, diarrhea, dry mouth, flatulence, constipation, anorexia, indigestion
GU:
Impotence, dysuria, ejaculatory failure, urinary retention
HEMA:
Agranulocytosis, thrombocytopenic purpura
(rare),
thrombocytopenia, leukopenia
INTEG:
Rash, alopecia, urticaria, pruritus, fever, diaphoresis
MISC:
Facial swelling, decreased exercise tolerance, weight change, Raynaud’s disease
MS:
Joint pain, arthralgia, muscle cramps, pain
RESP:
Bronchospasm,
dyspnea, wheezing, nasal stuffiness, pharyngitis
PO:
Onset 1-2 hr, peak 2-4 hr, duration 8-12 hr, half-life 12 hr, excreted unchanged in urine, crosses placenta, excreted in breast milk, protein binding 0%
Black Box Warning:
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl; CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
Increase:
hypoglycemia effect—insulin
Increase:
effects of lidocaine
Increase:
hypotension—diuretics, other antihypertensives, nitroglycerin
Decrease:
β-blocker effects—sympathomimetics
Decrease:
bronchodilating effects of theophylline, β
2
-agonists
Decrease:
hypoglycemic effects of sulfonylureas
False increase:
urinary catecholamines
Interference:
glucose, insulin tolerance tests
•
I&O, weight daily; edema in feet, legs daily
•
B/P, pulse q4hr; note rate, rhythm, quality
•
Potassium, magnesium levels
Black Box Warning:
Requires a specialized care setting: for a minimum of at least 3 days on maintenance dose with continuous ECG monitoring, creatinine clearance; calculate before dosing
Black Box Warning:
Cardiogenic shock, acute pulmonary edema: Do not use, effect can further depress cardiac output
QT syndrome:
apical/radial pulse before administration: notify prescriber of any significant changes; monitor ECG continuously (Betapace AF); use QT interval to determine patient eligibility; baseline QT must be
≤
450 msec, if ≥500 msec, frequency or dosage must be decreased or drug discontinued
•
Baselines of renal studies before therapy begins
•
Abrupt discontinuation:
do not discontinue abruptly, taper over 1-2 wk
•
Dose should be adjusted slowly, with at least 3 days between changes, monitor ECG for QT interval
•
Monitor electrolytes (hypokalemia, hypomagnesia) may increase dysrhythmias
•
Storage in dry area at room temp; do not freeze
•
Therapeutic response: absence of life-threatening dysrhythmias
•
Not to discontinue product abruptly; to taper over 2 wk or may precipitate angina; to take exactly as prescribed
•
Not to use antacids or OTC products containing α-adrenergic stimulants (nasal decongestants, OTC cold preparations) unless directed by prescriber
•
To report bradycardia, dizziness, confusion, depression, fever
•
To take pulse at home; advise patient when to notify prescriber
•
To avoid alcohol, smoking, sodium intake
•
To carry emergency ID to identify product being taken, allergies
•
To avoid hazardous activities if dizziness present
•
To report symptoms of CHF including difficulty breathing, especially on exertion or when lying down; night cough, swelling of extremities
•
To wear support hose to minimize effects of orthostatic hypotension
•
To monitor blood glucose if diabetic
•
That hospitalization will be required for ≥3 days
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O
2
, diuretic for cardiac failure; hemodialysis is useful for removal; administer vasopressor (norepinephrine) for hypotension, isoproterenol for heart block
