Mosby's 2014 Nursing Drug Reference (51 page)

BOOK: Mosby's 2014 Nursing Drug Reference
8.87Mb size Format: txt, pdf, ePub

Available forms:
Inj 0.05, 0.1, 0.4, 0.5, 0.8, 1 mg/ml; tabs 0.4 mg; AtroPen 0.5, 1, 2 mg inj prefilled autoinjectors

Administer:
PO route

• 
Increased bulk, water in diet if constipation occurs

• 
Without regard to meals

IM route

• 
Atropine flush may occur in children and is not harmful

AtroPen

• 
Use no more than 3 AtroPen inj unless under the supervision of trained medical provider

• 
Use as soon as symptoms appear (tearing, wheezing, muscle fasciculations, excessive oral secretions)

IV route

• 
Undiluted or diluted with 10 ml sterile water; give at 0.6 mg/min through Y-tube or 3-way stopcock; do not add to IV sol; may cause paradoxical bradycardia for 2 min

Y-site compatibilities:
Amrinone, etomidate, famotidine, heparin, hydrocortisone, meropenem, nafcillin, potassium chloride, sufentanil, vit B/C

SIDE EFFECTS

CNS:
Headache, dizziness, involuntary movement, confusion, psychosis, anxiety,
coma,
flushing, drowsiness, insomnia, weakness; delirium (geriatric patients)

CV:
Hypo/hypertension, paradoxical bradycardia, angina, PVCs,
tachycardia,
ectopic ventricular beats,
bradycardia

EENT:
Blurred vision, photophobia, glaucoma, eye pain, pupil dilation, nasal congestion

GI:
Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation,
paralytic ileus,
abdominal distention, altered taste

GU:
Retention, hesitancy, impotence, dysuria

INTEG:
Rash, urticaria, contact dermatitis, dry skin, flushing

MISC:
Suppression of lactation, decreased sweating,
anaphylaxis

PHARMACOKINETICS

Half-life 2-3 hr, terminal 12.5 hr, excreted by kidneys unchanged (70%-90% in 24 hr), metabolized in liver, 40%-50% crosses placenta, excreted in breast milk

PO:
Onset 1/2-2 hr, peak 1/2-1 hr, duration 4-6 hr, well absorbed

IM/SUBCUT:
Onset 15-50 min, peak 30 min, duration 4-6 hr, well absorbed

IV:
Peak 2-4 min, duration 4-6 hr

INTERACTIONS

Increase:
Mucosal lesions—potassium chloride tab

Increase:
anticholinergic effects—tricyclics, amantadine, antiparkinson agents

Decrease:
absorption—ketoconazole, levodopa

Decrease:
effect of atropine—antacids

NURSING CONSIDERATIONS
Assess:

• 
I&O ratio; check for urinary retention, daily output

• 
ECG
for ectopic ventricular beats, PVC, tachycardia in cardiac patients

• 
For bowel sounds, constipation

• 
Respiratory status: rate, rhythm, cyanosis, wheezing, dyspnea, engorged neck veins

• 
Increased intraocular pressure:
eye pain, nausea, vomiting, blurred vision, increased tearing

• 
Cardiac rate: rhythm, character, B/P continuously

• 
Allergic reaction: rash, urticaria

Evaluate:

• 
Therapeutic response: decreased dysrhythmias, increased heart rate, secretions; GI, GU spasms; bronchodilation

Teach patient/family:

• 
To report blurred vision, chest pain, allergic reactions, constipation, urinary retention, to use sunglasses to protect the eyes

• 
Not to perform strenuous activity in high temperatures; heat stroke may result

• 
To take as prescribed; not to skip or double doses

• 
Not to operate machinery if drowsiness occurs

• 
Not to take OTC products without approval of prescriber

• 
Not to freeze or expose to light (AtroPen)

TREATMENT OF OVERDOSE:

O
2
, artificial ventilation, ECG; administer DOPamine for circulatory depression; administer diazepam or thiopental for seizures; assess need for antidysrhythmics

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

atropine ophthalmic

See
Appendix B

 

RARELY USED
auranofin (Rx)

(au-rane′oh-fin)

Ridaura

Func. class.:
Antiinflammatory, gold compound

Do not confuse:
Ridaura
/Cardura

USES:

RA; not for 1st-line therapy

Unlabeled uses:
SLE, psoriatic arthritis, pemphigus

CONTRAINDICATIONS:

Breastfeeding, children <6 yr, hypersensitivity to gold, necrotizing enterocolitis, pulmonary fibrosis, exfoliative dermatitis, recent radiation therapy, renal/hepatic disease, marked hypertension, uncontrolled CHF

 

Black Box Warning:

Bone marrow suppression, blood dyscrasias, hematuria, anemia, diarrhea

DOSAGE AND ROUTES
Calculator

• Adult: PO
6 mg/day or 3 mg bid; may increase to 9 mg/day after 3 mo

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

avanafil

(a-van′a-fil)

Stendra

Func. class.:
Impotence agent

Chem. class.:
Phosphodiesterase type 5 inhibitor

ACTION:

Inhibits phosphodiesterase type 5 (PDE5); enhances erectile function by increasing the amount of cGMP causing smooth muscle relaxation and increasing blood flow to the corpus cavernosum

USES:

Treatment of erectile dysfunction

CONTRAINDICATIONS:

Hypersensitivity, severe renal/hepatic disease, current nitrates/nitrites, patients <18 yr

Precautions:
Pregnancy (C) although not indicated for women, anatomic penile deformities, sickle cell anemia, leukemia, multiple myeloma, renal/hepatic/CV disease, bleeding disorders, active peptic ulcer, prolonged erection, aortic stenosis, HIV, stroke, geriatric patients, tinnitus, MI, visual disturbances, retinitis pigmentosa

DOSAGE AND ROUTES
Calculator
Erectile dysfunction

• Adult: PO
100 mg 30 min before sexual activity, dose may be reduced to 50 mg or increased to 200 mg; usual max dose frequency is 1 time/day

Potent CYP3A4 inhibitors/nitrates


 
Do not use

Moderate CYP3A4 inhibitors/alpha-blockers

• Adult: PO
Max 50 mg/day

Hepatic dosage/severe renal disease

• Adult: Child–Pugh C: PO
not recommended

Available forms:
Tabs 50, 100, 200 mg

Administer
PO route

• 
May be taken 30 min before sexual activity on an as-needed basis, but no more than once per day

• 
May be used without regard to meals

• 
Products should not be used with nitrates/nitrates or strong CYP3A4 inhibitors

SIDE EFFECTS

CNS:
Headache, flushing

EENT:
Nasal congestion, nasopharyngitis

MISC:
Back pain

PHARMACOKINETICS

99% protein binding, metabolized by CYP3A4, excreted as metabolites; urine 62%; 21% feces, half-life 5 hr, peak 45 min

INTERACTIONS

Do not use with nitrates/nitrites because of unsafe drop in B/P, which could result in MI, stroke

Do not use with strong CYP3A4 inhibitors (ketoconazole, ritonavir, atazanavir, clarithromycin, indivinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin)

Increase:
Avanafil level—moderate CYP3A4 inhibitors (erythromycin, amprenavir, aprepitant, diltiazem, fluconazole, fosamprenavir, verapamil)

Decrease:
B/P—alcohol, alpha-blockers, amLODIPine

Increase:
Avanafil effect—grapefruit juice

NURSING CONSIDERATIONS
Assess:

Erectile dysfunction:
Assess for underlying cause before treatment; use of organic nitrates that should not be used with this product; any loss of vision/hearing while taking this product, hypersensitivity reactions

Evaluate:

Therapeutic response:
Ability to engage in sexual intercourse

Teach patient/family:

• 
Sexual dysfunction: May be taken 30 min before sexual activity on an as-needed basis, but no more than once per day

• 
May be used without regard to meals

 
That products should not be used with nitrates/nitrates, or strong CYP3A4 inhibitors

• 
That product does not protect against sexually transmitted disease including HIV

• 
That product has no effect in the absence of sexual stimulation, to seek help if erection lasts >4 hr

• 
To tell prescriber about all medication, vitamins, herbs being taken, especially ritonavir, indinavir, ketoconazole, itraconazole, erythromycin, nitrates, α-blockers

• 
Not to drink large amounts of alcohol

 
To notify prescriber immediately and to stop taking product if vision or hearing loss occurs, if erection lasts >4 hr, or if chest pain occurs

Other books

The Last Passenger by Manel Loureiro
Hope by A. American, G. Michael Hopf
It's All Relative by S.C. Stephens
The Wild Swans by Shea, K.M.
Holiday Havoc by Terri Reed