Mosby's 2014 Nursing Drug Reference (90 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(klor′oh-kwin)
Aralen
Func. class.:
Antimalarial
Chem. class.:
Synthetic 4-amino-quinoline derivative
Inhibits parasite replication, transcription of DNA to RNA by forming complexes with DNA of parasite
Malaria of
Plasmodium vivax, P. malariae, P. ovale, P. falciparum
(some strains); amebiasis
Unlabeled uses:
Discoid lupus erythematosus, polymorphous light eruption, rheumatoid arthritis, ulcerative colitis
Hypersensitivity, retinal field changes
Precautions:
Pregnancy (C), breastfeeding, children, blood dyscrasias, severe GI disease, neurologic disease, alcoholism, hepatic disease, G6PD deficiency, psoriasis, eczema, seizures, preexisting auditory damage, torsades de pointes
Black Box Warning:
Infection
Calculator
• Adult:
PO
1000 mg (600-mg base), then 500 mg (300-mg base) in 6-8 hr, then 500 mg (300-mg base) daily × 2 days for a total of 2.5 g (1.5-g base) in 3 days
• Adult/adolescent of low body weight, child/infant:
PO
16.5 mg (10-mg base)/kg, max 600-mg base; then 8.3 mg (5-mg base)/kg, max 300-mg base 6 hr after 1st dose; then 8.3 mg (5-mg base)/kg, max 300-mg base 24 hr after 1st dose; then 8.3 mg (5-mg base)/kg, max 300-mg base 36 hr after 1st dose
P. falciparum)
• Adult:
PO
500 mg (300-mg base) weekly on same day of each wk starting 2 wk before travel and for 8 wk after leaving
• Adult:
PO
1 g (600-mg base) daily × 2 days, then 500 mg (300-mg base) for ≥2-3 wk
• Child (unlabeled):
PO
16.6 mg (10-mg base)/kg (max 300-mg base) daily × 2-3 wk
• Adult:
PO
250 mg (150-mg base) daily
Available forms:
Tabs 250 mg (150-mg base), 500 mg (300-mg base) phosphate
•
Product in mg or base; they are different
•
Before or after meals at same time each day to maintain product level
CNS:
Headache, stimulation, fatigue,
seizures,
psychosis, hallucinations, insomnia
CV:
Hypotension,
heart block, asystole with syncope,
ECG changes, cardiomyopathy
EENT:
Blurred vision, corneal changes, retinal changes, difficulty focusing
, tinnitus, vertigo, deafness, photophobia, corneal edema
GI:
Nausea, vomiting, anorexia
, diarrhea, cramps
HEMA:
Thrombocytopenia, agranulocytosis, hemolytic anemia, leukopenia
INTEG:
Pruritus, pigmentary changes, skin eruptions, lichen-planus–like eruptions, eczema,
exfoliative dermatitis
Metabolized in liver; excreted in urine, feces, breast milk; crosses placenta
PO:
Peak 1-3 hr, half-life 3-5 days
•
Reduced oral clearance and metabolism of chloroquine: cimetidine
Increase:
QT prolongation, torsades de pointes—class IA, III antidysrhythmics
Increase:
effects—2D6 inhibitors (amiodarone, chlorpheniramine, FLUoxetine, haloperidol, ritonavir, PARoxetine, terbinafine, ticlopidine); CYP3A4 inhibitors (diltiazem, verapamil, itraconazole, ketoconazole, erythromycin, doxycycline, clarithromycin)
Decrease:
action of chloroquine—magnesium, aluminum compounds, kaolin; do not use concurrently
Decrease:
effects of ampicillin, rabies vaccine (ID)
Decrease:
Hgb, platelets, WBC
Black Box Warning:
Infection:
resistance is common, not to be used for
P. falciparum
acquired in areas of resistance or where prophylaxis has failed
•
Ophthalmic test if long-term treatment or dosage of >150 mg/day, baseline and periodically
•
Blood studies: CBC, since blood dyscrasias occur
•
ECG
during therapy; watch for depression of T waves, widening of QRS complex
•
Allergic reactions:
pruritus, rash, urticaria
•
Blood dyscrasias:
malaise, fever, bruising, bleeding (rare)
•
For ototoxicity
(tinnitus, vertigo, change in hearing); audiometric testing should be done before, after treatment
For toxicity:
blurring vision; difficulty focusing; headache; dizziness; decreased knee, ankle reflexes; seizures, CV collapse; product should be discontinued immediately and IV fluids given
•
Storage in tight, light-resistant container at room temp; keep inj in cool environment
•
Therapeutic response: decreased symptoms of infection
•
To take with meals or immediately after meals
•
To use sunglasses in bright sunlight to decrease photophobia
•
That urine may turn rust or brown color
•
To report hearing, visual problems; fever, fatigue, bruising, bleeding; may indicate blood dyscrasias
Administer barbiturate (ultrashort-acting), vasopressor; tracheostomy may be necessary
•
Keep away from pets, children, overdose is fatal
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(
OTC
, Rx)
(klor-fen-ir′a-meen)
AHIST, Aller-Chlor, Allergy, Chlor-Pheniton, Chlor-Trimeton, Diabetic Tussin Allergy Relief, ED-Chlor-Tann, Equaline Allergy, Equate Chlortabs Allergy, Good Sense Allergy, Leader Allergy, P-Tann, Tana Hist-PD, Teldrin, Top Care Allergy, Wal-finate Allergy
Func. class.:
Antihistamine (1st generation, nonselective)
Chem. class.:
Alkylamine, H
1
-receptor antagonist
Do not confuse:
Teldrin
/Tedral
Acts on blood vessels, GI system, respiratory system by competing with histamine for H
1
-receptor site; decreases allergic response by blocking histamine
Allergy symptoms, rhinitis, conjunctivitis (allergic)
Unlabeled uses:
Nausea, vomiting due to motion sickness, pruritus, urticaria
Newborns/neonates
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, increased intraocular pressure, cardiac/renal disease, hypertension, asthma, seizure disorder, hyperthyroidism, prostatic hypertrophy, GI obstruction, peptic ulcer disease, emphysema, hypersensitivity to H
1
-receptor antagonists, lower respiratory tract disease, stenosed peptic ulcers, bladder neck obstruction, closed-angle glaucoma
Calculator
• Adult and child ≥12 yr:
PO
4 mg tid-qid, max 24 mg/day;
EXT REL
8-12 mg bid-tid, max 24 mg/day
• Child 6-12 yr:
PO
2 mg q4-6hr, max 12 mg/day;
EXT REL
8 mg bedtime or daily,
EXT REL
not recommended for child <6 yr
Available forms:
Chewable tabs 2 mg; tabs 4, 8, 12 mg; ext rel tabs 8, 12 mg; ext rel caps 8, 12 mg; syr 1 mg/5 ml, 2 mg/5 ml, 2.5 mg/5 ml
•
Avoid concurrent use with other CNS depressants
•
Do not break, crush, or chew ext rel forms
•
Without regard to meal
•
Avoid use in children <6 yr
•
Syrup:
Use dosing utensil to measure correct dose
CNS:
Dizziness, drowsiness
, poor coordination, fatigue, anxiety, euphoria, confusion, paresthesia, neuritis
EENT:
Blurred vision; dilated pupils; tinnitus; nasal stuffiness; dry nose, throat, mouth
GI:
Nausea, anorexia, diarrhea
GU:
Retention
, dysuria, urinary frequency
HEMA:
Thrombocytopenia, agranulocytosis, hemolytic anemia
INTEG:
Photosensitivity
RESP:
Increased thick secretions, wheezing, chest tightness
Detoxified in liver, excreted by kidneys (metabolites/free drug), half-life 12-15 hr
PO:
Onset 1/2 hr, duration 4-12 hr
PO-ER:
Duration 8-24 hr
Increase:
CNS depression—barbiturates, opiates, hypnotics, tricyclics, alcohol
Increase:
effect of chlorpheniramine—MAOIs
Increase:
anticholinergic action—atropine, phenothiazines, quiNIDine, haloperidol
False negative:
skin allergy tests
•
Be alert for urinary retention, frequency, dysuria; product should be discontinued
•
Respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness
•
Hard candy, gum, frequent rinsing of mouth for dryness
•
Storage in tight container at room temp
•
Therapeutic response: absence of running, congested nose, rashes, conjunctivitis
•
About all aspects of product use; to notify prescriber of confusion, sedation, hypotension, difficulty voiding
•
To avoid driving, other hazardous activity if drowsiness occurs, especially geriatric patients
•
To avoid concurrent use of alcohol
Administer diazepam, vasopressors, phenytoin IV
