Mosby's 2014 Nursing Drug Reference (118 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(da-ree-fen′ah-sin)
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Func. class.:
Antispasmodic/Guanticholinergic
Bladder smooth muscle relaxation by decreasing the action of muscarinic receptors, thereby relieving overactive bladder
Urge incontinence, frequency, urgency in overactive bladder
Hypersensitivity, urinary retention, narrow-angle glaucoma (uncontrolled)
Precautions:
Severe hepatic disease (Child-Pugh C), GI/GU obstruction, controlled narrow-angle glaucoma, ulcerative colitis, myasthenia gravis, moderate hepatic disease (Child-Pugh B), elderly
Calculator
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Adult: PO
7.5 mg/day, initially, may increase to 15 mg/day after 14 days if needed
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Adult: PO
max 7.5 mg/day
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Adult: PO
(Child-Pugh B) max 7.5 mg/day
Available forms:
Tabs, ext rel 7.5, 15 mg
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Without regard to meals, do not crush, break, chew extended-release tabs
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Store at room temperature
CNS:
Dizziness, headache
EENT:
Blurred vision, drying eyes, sinusitis, rhinitis
GI:
Constipation, dry mouth, abdominal pain, nausea, vomiting, dyspepsia
GU:
UTI, urine retention, vaginosis
INTEG:
rash, pruritus, skin drying
MISC:
Bronchitis, flulike symptoms
Peak 7 hr, half-life 12-19 hr
Increase:
level of—digoxin
Increase:
anticholinergic effect—anticholinergics
Increase:
darifenacin level—CYP3A4 inhibitors
Increase:
levels of—drugs metabolized by CYP2D6
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Urinary function: urgency, frequency, retention in bladder-outflow obstruction
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Constipation, may add bulk in the diet
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Decreasing urgency, frequency of urination
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To take without regard to meals; do not crush, break, chew extended-release tabs
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To store at room temperature
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To avoid breastfeeding; to notify prescriber if pregnancy (C) is planned or suspected
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About anticholinergic symptoms (dry mouth, constipation, dry eyes, heat prostration), not to become overheated
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To avoid hazardous activities until reaction is known, dizziness, blurred vision can occur
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(dar-ue′na-vir)
Prezista
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
Inhibits human immunodeficiency virus (HIV-1) protease; this prevents maturation of the virus
HIV-1 in combination with ritonavir and other antiretrovirals
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, renal/hepatic disease, history of renal stones, diabetes, hypercholesterolemia, sulfonamide hypersensitivity, antimicrobial resistance, bleeding, immune reconstitution syndrome, pancreatitis
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Adult: PO
800 mg with ritonavir 100 mg daily
• Adult/adolescent >40 kg/child ≥6 yr: PO
600 mg bid; with ritonavir 100 mg bid with food; 800 mg daily with ritonavir 100 mg with food (without darunavir resistance)
• Adolescent ≥30 kg, <40 kg and child ≥6 yr: PO
450 mg bid with ritonavir 60 mg bid
• Adolescent ≥20 kg, <30 kg and child ≥6 yr: PO
375 mg bid with ritonavir 50 mg bid
• Child 3 to <6 yr (14 kg to <15 kg: PO
280 mg (with ritonavir 48 mg) bid with food
• Child 3 to <6 yr (13 kg to <14 kg: PO
260 mg (with ritonavir 40 mg) bid with food
• Child 3 to <6 yr (12 kg to <13 kg: PO
240 mg (with ritonavir 40 mg) bid with food
• Child 3 to <6 yr (11 kg to <12 kg: PO
220 mg (with ritonavir 32 mg) bid with food
• Child 3 to <6 yr (10 kg to <11 kg: PO
200 mg (with ritonavir 32 mg) bid with food
Available forms:
Tabs 75, 150, 400, 600 mg
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With food and ritonavir
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Tab should be swallowed whole
CNS:
Headache, insomnia
, dizziness, somnolence
GI:
Diarrhea, abdominal pain, nausea, vomiting
, anorexia, dry mouth,
hepatitis, hepatotoxicity
GU:
Nephrolithiasis
INTEG:
Rash,
angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, exanthematous pustulosis
MS:
Pain
OTHER:
Asthenia,
insulin-resistant hyperglycemia,
hyperlipidemia,
ketoacidosis,
lipodystrophy
95% protein binding; metabolized by CYP3A; peak 2.5-4 hr; terminal half-life 15 hr; excreted in feces 79.5%, urine 13.9%
Life-threatening dysrhythmias: ergots, midazolam, rifampin, pimozide, triazolam; do not use concurrently
Increase:
myopathy, rhabdomyolysis—HMG-CoA reductase inhibitors (atorvastatin, lovastatin, simvastatin)
Increase:
darunavir levels—CYP3A4 inhibitors: (ketoconazole, itraconazole)
Increase:
levels of both products—clarithromycin, zidovudine
Increase:
levels of telapravir, rilpivarine, monitor for adverse reactions
Decrease:
darunavir levels—CYP3A4 inducers (carBAMazepine, phenytoin, fosphenytoin, PHENobarbital), rifamycins, fluconazole, nevirapine, efavirenz
Decrease:
levels of oral contraceptives
Decrease:
levels of both products—tenofovir, avoid concurrent use
Decrease:
darunavir levels—St. John’s wort; avoid concurrent use
Increase:
myopathy, rhabdomyolysis risk—red yeast rice
Increase:
darunavir absorption
Increase:
LFTs, bilirubin, uric acid
Decrease:
WBC, neutrophils, platelets
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Complaints of lower back, flank pain; indicates kidney stones
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Signs of infection, anemia, the presence of other sexually transmitted diseases
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Serious skin reactions:
angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis; discontinue immediately, notify prescriber
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Hepatoxicity:
hepatic studies (ALT, AST, bilirubin, amylase); all may be elevated in those with underlying liver disease, product should be discontinued in those with increased LFTs
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Viral load, CD4, HIV RNA during treatment
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Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
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Hyperlipidemia:
cholesterol, triglycerides, LDL may be elevated; monitor serum cholesterol, lipid panel throughout treatment
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Therapeutic response: decreased viral load, increased CD4 count
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To use nonhormonal birth control; not to breastfeed
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To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
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That product must be taken at same time of day to maintain blood levels for duration of therapy
That
hyperglycemia
may occur; watch for increased thirst, weight loss, hunger, dry, itchy skin; to notify prescriber if these occur
•
To increase fluids to prevent kidney stones; if stone formation occurs, that treatment may need to be interrupted
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That product does not cure AIDS, only controls symptoms; not to donate blood; not to share; to notify all health care providers of use; not to use with any other products without prescriber’s approval
