Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (411 page)
(trose′pee-um)
Sanctura, Sanctura XR
Func. class.:
Anticholinergic, urinary antispasmodic
Chem. class.:
Muscarinic receptor antagonist
Relaxes smooth muscles in bladder by inhibiting acetylcholine effect on muscarinic receptors
Overactive bladder (urinary frequency, urgency)
Hypersensitivity, uncontrolled closed-angle glaucoma, urinary retention, gastric retention, myasthenia gravis
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal/hepatic disease, controlled closed-angle glaucoma, ulcerative colitis, intestinal atony, bladder outflow obstruction
Calculator
• Adult
<
75 yr:
PO
20 mg bid 1 hr before meals or on empty stomach;
ER
60 mg in
AM
• Geriatric
≥
75 yr:
PO
titrate down to 20 mg/day based on response and tolerance
• Adult:
PO
CCr <30 ml/min, 20 mg/day at bedtime, ext rel product not recommended
Available forms:
Tabs 20 mg; caps ext rel 60 mg
•
1 hr before meals or on empty stomach (reg rel); in
AM
(ext rel) ≥1 hr before meal
CNS:
Fatigue, dizziness, headache
CV:
Tachycardia
EENT:
Dry eyes, vision abnormalities
GI:
Flatulence, abdominal pain,
constipation, dry mouth
, dyspepsia
GU:
Urinary retention, UTI
INTEG:
Dry skin,
angioedema
MISC:
Heat stroke, fever
Rapidly absorbed (10%); peak 5-6 hr; protein bound (50%-85%); extensively metabolized; excreted in urine, feces; excreted in urine by active tubular secretion; half-life 20 hr
Increase:
drowsiness—CNS depressants, alcohol
Increase or decrease:
trospium effect—products excreted by active renal secretion (aMILoride, digoxin, morphine), metformin, quiNIDine, procainamide, ranitidine, tenofovir, triamterene, vancomycin
Decrease:
absorption—high-fat meal
•
Urinary patterns:
distention, nocturia, frequency, urgency, incontinence, voiding patterns
•
Therapeutic response: correction of urinary status: absence of dysuria, frequency, nocturia, incontinence
•
To avoid hazardous activities because dizziness may occur
•
That alcohol may increase drowsiness
•
About anticholinergic effects that may occur
•
That overheating may occur with strenuous exercise
•
To avoid all other products unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(us′te-kin′ue-mab)
Stelara
Func. class.:
Antipsoriatic agent
Interleukin (IL)-12, IL-23 Antagonist
Plaque psoriasis
Hypersensitivity, sepsis, active infections
Precautions:
Pregnancy (B), breast-feeding, children ≤18 yr, geriatric patients, surgery, TB, diabetes mellitus, immunosuppression
Calculator
• Adult
≥
100 kg:
SUBCUT
90 mg, repeat in 4 wk, then 90 mg q12wk starting wk 16
• Adult
≤
100 kg:
SUBCUT
45 mg, repeat in 4 wk, then 45 mg q12wk starting wk 16
Available forms:
Solutions for inj 45 mg/0.5 mc
•
Visually inspect for particulate matter or discoloration; solution should be slightly yellow and may contain a few small translucent or white particles; do not use if discolored, cloudy or if foreign
particulate matter is present; do not shake
•
Use at 27 G, 0.5 inch needle
•
May be administered subcut into upper arm, abdomen, or thigh; rotate inj sites
CNS:
Headache, leukoencephalopathy
HEMA:
Bleeding
INTEG:
Inj site reaction
, pruritus, skin irritation, erythema
SYST:
Serious infections, malignancies
Maximum serum concentration: 13.5 days after a single 45 mg subcut dose, 7 days after a single 90 mg subcut dose; half-life 14.9-45.6 days
•
Do not give concurrently with vaccines; immunizations should be brought up to date before treatment
•
Avoid use with immunosuppressives
•
For inj site pain, swelling
•
Therapeutic response: decreased plaque psoriasis
•
That product must be continued for prescribed time to be effective
•
Not to receive live vaccinations during treatment
•
To notify prescriber of possible infection (upper respiratory or other)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(val-a-sye′kloh-vir)
Valtrex
Func. class.:
Antiviral
Chem. class.:
Synthetic purine nucleoside analog
Do not confuse:
valACYclovir
/valGANciclovir
Valtrex
/Valcyte
Interferes with DNA synthesis by conversion to acyclovir, thereby causing decreased viral replication, time of lesional healing
Treatment or suppression of herpes zoster (shingles), genital herpes, herpes labialis (cold sores), varicella, varicella-zoster
Unlabeled uses:
CMV with advanced HIV, posttransplant patients, Bell’s palsy, herpes simplex virus prophylaxis, acute retinal necrosis (ARN), encephalitis
Hypersensitivity to this product or acyclovir, valGANciclovir
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, hepatic/renal disease, electrolyte imbalance, dehydration, penciclovir, famciclovir, ganciclovir, hypersensitivity, varicella
Calculator
• Adult:
PO
1 g tid × 1 wk
• Adult:
PO
1 g bid × 10 days initially
• Adult:
PO
500 mg bid × 3 days
• Adult:
PO
1 g/day with normal immune function; 500 mg/day for those with ≤9 recurrences/yr; 500 mg bid for HIV-infected patients with CD4 count ≥100
• Adult:
PO
500 mg/day for source partner
• Adult:
PO
2 g bid × 1 day at 1st sign of lesions
• Adolescent and child ≥2 yr:
PO
20 mg/kg/dose tid × 5 days, max 3 g/day; start at 1st sign, preferably within 24 hr of rash
• Adult:
PO
CCr 30-49 ml/min, 1 g q12hr (for regimens 1 g q8hr); 1 g q12hr × 1 day (herpes labialis); CCr 10-29 ml/min, 1 g q24hr (genital herpes/herpes zoster); 500 mg q24hr (recurrent genital herpes); CCr <10 ml/min, 500 mg q24hr (genital herpes/herpes zoster), 500 mg q24hr (recurrent genital herpes)
Available forms:
Tabs 500 mg, 1 g
•
As soon as possible (herpes labialis, genital herpes); within 24 hr of rash (varicella)
•
Within 72 hr of outbreak (herpes zoster)
•
Without regard to food
•
Caps may be made into susp by pharmacy
CNS:
Tremors, lethargy,
dizziness, headache
, weakness, depression
ENDO:
Dysmenorrhea
GI:
Nausea
, vomiting, diarrhea, abdominal pain, constipation,
increased AST
HEMA:
Thrombocytopenic purpura, hemolytic uremic syndrome
INTEG:
Rash
Onset unknown; terminal half-life 2½-3½ hr; converted to acyclovir that crosses placenta, enters breast milk; excreted in urine primarily as acyclovir; protein binding 13.5%-17.9%
Increase:
blood levels of valACYclovir—cimetidine, probenecid; only significant with renal disease
Increase:
LFTs, creatinine
Decrease:
WBC, platelets
•
Infection;
characteristics of lesions; therapy should be started at 1st sign or symptom of herpes; most effective within 72 hr of outbreak
Thrombocytopenic purpura, hemolytic uremic syndrome; may be fatal
•
C&S before product therapy; product may be taken as soon as culture is taken; repeat C&S after treatment; determine presence of other sexually transmitted diseases
•
Bowel pattern before, during treatment
•
Skin eruptions: rash
•
Allergies before treatment, reaction of each medication
•
Storage at room temp; protect from light, moisture
•
Therapeutic response: absence of itching, painful lesions; crusting and healed lesions
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 2 hr before next dose; not to double dose
•
That product may be taken orally before infection occurs; that product should be taken when itching or pain occurs, usually before eruptions
•
That partners need to be told that patient has herpes because they can become infected; that condoms must be worn to prevent reinfections
•
That product does not cure infection, just controls symptoms; that product does not prevent infection of others
