Mosby's 2014 Nursing Drug Reference (103 page)

Do not confuse:
cloNIDine
/KlonoPIN/clonazePAM
Catapres
/Cataflam/Catarase

Unlabeled uses:
Opioid withdrawal, prevention of vascular headaches, treatment of menopausal symptoms, dysmenorrhea, attention-deficit/hyperactivity disorder (ADHD), autism, cycloSPORINE nephrotoxicity prophylaxis, diabetic neuropathy, ethanol withdrawal, Tourette’s syndrome, hypertensive emergency

Black Box Warning:

Labor

• Adult:
PO/TRANSDERMAL
0.1 mg bid then increase by 0.1-0.2 mg/day at weekly intervals until desired response; range 0.2-0.6 mg/day in divided doses

• Geriatric:
PO
0.1 mg at bedtime, may increase gradually

• Child:
PO
5-10 mcg/kg/day in divided doses q8-12hr, max 0.9 mg/day

• Adult:
CONT EPIDURAL INF
30 mcg/hr

• Child:
CONT EPIDURAL INF
0.5 mcg/kg/hr then titrate to response

• Adult:
PO
0.3-1.2 mg/day; may decrease by 50% × 3 days then decrease by 0.1-0.2 mg/day or discontinue

• Adolescent/child ≥6 yr:
PO
0.05 mg/kg/day in 3-4 divided doses × 8 wk, max 0.4 mg/day (unlabeled); ext rel 0.1 mg at bedtime, increase dose by 0.1 mg/day up to 0.4 mg/day

• Adult:
TRANSDERMAL
0.1-mg patch q1wk;
PO
0.05-0.4 mg/day

• Adult:
PO
0.15-0.2 mg/day

• Adult:
PO
0.1-0.2 mg q1hr to a total of 0.6 mg

• 
Store patches in cool environment, tablets in tight container

Increase:
CNS depression—opiates, sedatives, hypnotics, anesthetics, alcohol

Increase:
hypotensive effects—diuretics, other antihypertensive nitrates

Decrease:
hypotensive effects—tricyclics, MAOIs, appetite suppressants, amphetamines, prazosin, antipsychotics

Decrease:
effect of levodopa

Increase:
antihypertensive effect—hawthorn

Decrease:
antihypertensive effect—ephedra, ginseng

Increase:
blood glucose

Decrease:
VMA, urinary catecholamines, aldosterone

• 
Hypertension:
B/P, pulse; report significant changes

• 
Opiate withdrawal (unlabeled):
fever, diarrhea, nausea, vomiting, cramps, insomnia, shivering, dilated pupils

• 
Cancer pain:
location, intensity, character; alleviating, aggravating factors at baseline and frequently

• 
Edema in feet, legs daily; monitor I&O; check for falling output

• 
Allergic reaction:
rash, fever, pruritus, urticaria; product should be discontinued if antihistamines fail to help

• 
CHF:
edema, dyspnea, wet crackles, B/P, more common in geriatric patients

• 
Renal symptoms: polyuria, oliguria, frequency

• 
Therapeutic response: decrease in B/P with hypertension, decrease in withdrawal symptoms (opioid), decrease in pain

• 
To avoid hazardous activities, since product may cause drowsiness

• 
To notify all health care providers of medication use

• 
Not to discontinue product abruptly or
withdrawal symptoms
may occur: anxiety, increased B/P, headache, insomnia, increased pulse, tremors, nausea, sweating; to comply with dosage schedule even if feeling better

• 
Not to use OTC (cough, cold, or allergy) products unless directed by prescriber

• 
To rise slowly to sitting or standing position to minimize orthostatic hypotension, especially among geriatric patients

• 
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, signs of
angioedema

• 
About excessive perspiration, dehydration, vomiting; diarrhea may lead to fall in B/P; consult prescriber if these occur; that product may cause dizziness, fainting; that lightheadedness may occur during first few days of therapy

• 
That product may cause dry mouth; to use hard candy, saliva product, sugarless gum, or frequent rinsing of mouth

• 
That compliance is necessary; not to skip or stop product unless directed by prescriber; tolerance may develop with long-term use

• 
Transdermal:
How to use patch; that patch comes in two parts: product patch and overlay to keep patch in place; not to trim or cut patch; that response may take 2-3 days if product is given transdermally; on administration of patch, if switching from tabs to patch, to taper tabs to avoid withdrawal