Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (413 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(val′sahr-tan)
Diovan
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin II receptor antagonist (Type AT
1
)
Do not confuse:
Diovan
/Dioval
Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT
1
receptor found in tissues
Hypertension, alone or in combination in patients >6 yr, CHF, post MI with left ventricular dysfunction/failure in stable patients
Hypersensitivity, severe hepatic disease, bilateral renal artery stenosis
Black Box Warning:
Pregnancy (D) 2nd/3rd trimester
Precautions:
Breastfeeding, children, geriatric patients, hypersensitivity to ACE inhibitors; CHF, hypertrophic cardiomyopathy aortic/mitral valve stenosis, CAD, angioedema, renal/hepatic disease, hyperkalemia, hypovolemia
Calculator
• Adult:
PO
80 or 160 mg/day alone or in combination with other antihypertensives, may increase to 320 mg/day
• Geriatric:
PO
adjust on clinical response, may start with lower dose
• Child and adolescent 6-16 yr:
PO
1.3 mg/kg/day, max 40 mg/day
• Adult:
PO
40 mg bid, up to 160 mg bid
• Adult:
PO
20 mg bid as early as 12 hr post MI, may be titrated within 7 days to
40 mg bid, then titrate to maintenance of 160 mg bid
Available forms:
Tabs 40, 80, 160, 320 mg
•
Without regard to meals
CNS:
Dizziness, insomnia
, drowsiness, vertigo, headache, fatigue
CV:
Angina pectoris, 2nd-degree AV block,
cerebrovascular accident,
hypotension,
MI,
dysrhythmias
EENT:
Conjunctivitis
GI:
Diarrhea
, abdominal pain, nausea,
hepatotoxicity
GU:
Impotence,
nephrotoxicity
HEMA:
Anemia
, neutropenia
META:
Hyperkalemia
MISC:
Vasculitis,
angioedema
MS:
Cramps, myalgia, pain, stiffness
RESP:
Cough
Onset up to 2 hr; peak 4-6 hr; duration 24 hr; extensively metabolized; protein binding 95%; half-life 6 hr; excreted in feces, urine, breast milk
•
Do not use with aliskiren
Increase:
effects of lithium, antidiabetics
Increase:
hyperkalemia—potassium-sparing diuretics, potassium supplements, ACE inhibitors, cycloSPORINE
Increase:
Valsartan level—rifampin, ritonavir, gemfibrozil, telithromycin
Decrease:
antihypertensive effects—NSAIDs, salicylates
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra, ma huang
Increase:
hyperkalemia—salt substitutes with potasssium
Decrease:
AUC by 40%
•
B/P, pulse q4hr lying, sitting, standing; note rate, rhythm, quality periodically
•
Blood studies; BUN, creatinine, LFTs, potassium total/direct bilirubin before treatment
•
Angioedema:
facial swelling; SOB; edema in feet, legs daily
•
Skin turgor, dryness of mucous membranes for hydration status; correct volume depletion before initiating therapy
•
Therapeutic response: decreased B/P
•
To comply with dosage schedule, even if feeling better; that, if dose is missed, to take it as soon as possible unless it is within 1 hr of next dose
•
To notify prescriber of fever, swelling of hands or feet, irregular heartbeat, chest pain, dizziness, persistent cough
•
That excessive perspiration, dehydration, diarrhea may lead to fall in blood pressure; to consult prescriber if these occur
•
That product may cause dizziness, fainting, lightheadedness; to rise slowly to sitting or standing position to minimize orthostatic hypotension; to take B/P readings
Black Box Warning:
Not to take product if pregnant (D) or breastfeeding
•
Overdose symptoms:
bradycardia or tachycardia, circulatory collapse
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(van-koe-mye′sin)
Vancocin
Func. class.:
Antiinfective—miscellaneous
Chem. class.:
Tricyclic glycopeptide
Inhibits bacterial cell wall synthesis, blocks glycopeptides
Resistant staphylococcal infections, pseudomembranous colitis, staph
ylococcal enterocolitis, endocarditis prophylaxis for dental procedures, diphtheroid endocarditis
Hypersensitivity to this product or corn
Precautions:
Pregnancy (B) PO, (C) IV; breastfeeding, neonates, geriatric patients, renal disease, hearing loss
Calculator
• Adult:
IV
500 mg q6-8hr or 1 g q12hr
• Child:
IV
40-60 mg/kg/day divided q6-8hr
• Neonate:
IV
15 mg/kg initially, then 10 mg/kg q8-24hr
• Adult:
PO
125 mg qid × 10-14 days
• Child:
PO (unlabeled)
40 mg/kg/day divided q6hr × 7-10 days, max 2 g/day
• Adult:
IV
1 g over 1 hr given 1 hr before procedure
• Child:
IV
20 mg/kg over 1 hr given 1 hr prior to procedure
• Adult:
IV
CCr >70 ml/min, no dosage adjustment; CCr 50-70 ml/min, loading dose of 15 mg/kg, reduce dose to 750 mg-1 g q18-24 hr; CCr <49 ml/min, initial loading dose of 15 mg/kg, with subsequent dosing based on concentration, may be q24-72hr or longer
Available forms:
Cap 125, 250 mg; powder for inj 500 mg, 1, 5, 10 g
•
Use only for susceptible organisms to prevent product-resistant bacteria
•
Antihistamine if red-man syndrome occurs: decreased B/P, flushing of neck, face
•
Dose based on serum concentration
•
Use preservative-free 0.9% NaCl (2-5 mg/ml final conc), instill into ventricular cerebrospinal fluid
•
After reconstitution with 10 ml sterile water for inj (500 mg/10 ml); further dilution is needed for IV, 500 mg/100 ml 0.9% NaCl, D
5
W given as intermittent inf over 1 hr; decrease rate of inf if red-man syndrome occurs
•
May infuse 1-2 g in volume to give over 24 hr if intermittent IV route cannot be used
Y-site compatibilities:
Acyclovir, allopurinol, amifostine, amiodarone, amsacrine, atracurium, cisatracurium, cyclophosphamide, diltiazem, DOXOrubicin liposome, enalaprilat, esmolol, filgrastim, fluconazole, fludarabine, gallium, granisetron, HYDROmorphone, insulin (regular), labetalol, LORazepam, magnesium sulfate, melphalan, meperidine, meropenem, midazolam, morphine, ondansetron, PACLitaxel, pancuronium, perphenazine, propofol, remifentanil, sodium bicarbonate, tacrolimus, teniposide, theophylline, thiotepa, tolazoline, vecuronium, vinorelbine, warfarin, zidovudine
CV:
Cardiac arrest, vascular collapse (rare),
hypotension
EENT:
Ototoxicity, permanent deafness
, tinnitus, nystagmus
GI:
Nausea, pseudomembranous colitis
GU:
Nephrotoxicity,
increased BUN, creatinine, albumin
,
fatal uremia
HEMA:
Leukopenia, eosinophilia, neutropenia
INTEG:
Chills, fever, rash, thrombophlebitis at inj site, urticaria, pruritus, necrosis (red-man syndrome), skin/subcutaneous tissue disorders
RESP:
Wheezing, dyspnea
SYST:
Anaphylaxis, superinfection
PO:
Absorption poor
IV:
Onset rapid, peak 1 hr, half-life 4-8 hr, excreted in urine (active form)
Increase:
ototoxicity or nephrotoxicity—aminoglycosides, cephalosporins, colistin, polymyxin, bacitracin, CISplatin, amphotericin B, cidofovir
Increase:
neuromuscular effects—nondepolarizing muscle relaxants
Increase:
BUN/creatinine, eosinophils
Decrease:
WBC
•
Infection:
WBC, urine, stools, sputum, characteristics of wound throughout treatment
•
I&O ratio; report hematuria, oliguria; nephrotoxicity may occur, BUN, creatinine
•
Serum levels: peak 1 hr after 1-hr inf 25-40 mg/L, trough before next dose 5-10 mg/L, especially in renal disease
•
C&S
•
Auditory function during, after treatment; hearing loss, ringing, roaring in ears; product should be discontinued
•
B/P during administration; sudden drop may indicate red-man syndrome
•
Skin eruptions
•
Red man syndrome:
flushing of neck, face, upper body, arms, back, may lead to anaphylaxis; slow IV infusion to >1 hr
•
Storage at room temp for ≤2 wk after reconstitution
•
EPINEPHrine, suction, tracheostomy set, endotracheal intubation equipment on unit; anaphylaxis may occur
•
Adequate intake of fluids (2 L/day) to prevent nephrotoxicity
•
Therapeutic response: absence of fever, sore throat; negative culture
•
About all aspects of product therapy; about the need to complete entire course of medication to ensure organism death (7-10 days); that culture may be taken after completed course of medication
•
To report sore throat, fever, fatigue; could indicate superinfection
•
That product must be taken in equal intervals around the clock to maintain blood levels
