Mosby's 2014 Nursing Drug Reference (115 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Metabolized by liver; excreted in urine; half-life 35 min, terminal 5 hr, 5% protein bound
Black Box Warning:
Toxicity, bone marrow suppression:
bone marrow suppressants, radiation, other antineoplastics
•
Bleeding: salicylates, anticoagulants
Increase:
adverse reaction; decrease antibody reaction—live virus vaccines
Increase:
nephrotoxicity—aminoglycosides
Increase:
ototoxicity—loop diuretics
Decrease:
dacarbazine effect—phenytoin, PHENobarbital
Black Box Warning:
Bone marrow suppression:
CBC, differential, platelet count weekly; notify prescriber of results
•
Monitor temp; may indicate beginning infection
Black Box Warning:
Secondary malignancy: assess for secondary malignancy that may occur with this product
•
Bleeding: hematuria, guaiac, bruising, petechiae of mucosa or orifices q8hr
•
Effects of alopecia on body image, discuss feelings about body changes
Black Box Warning:
Hepatic disease:
jaundice of skin, sclera; dark urine; clay-colored stools; itchy skin; abdominal pain; fever; diarrhea; hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly
•
Inflammation of mucosa, breaks in skin
Hypersensitivity reactions, anaphylaxis,
discontinue product, administer meds for anaphylaxis
•
Storage in light-resistant container in a dry area
•
Increased fluid intake to 2-3 L/day to prevent urate deposits, calculi formation
•
Warm compresses at inf site for inflammation
•
Therapeutic response: decreased tumor size, spread of malignancy
•
That patient should avoid prolonged exposure to sun, wear sunscreen
•
That hair may be lost during treatment; that a wig or hairpiece may make the patient feel better; that new hair may be different in color, texture
•
To report signs of
infection:
fever, sore throat, flulike symptoms
•
To report signs of
anemia:
fatigue, headache, faintness, SOB, irritability
•
To report bleeding; to avoid use of razors, commercial mouthwash
•
Pregnancy:
to notify prescriber if pregnancy is planned or suspected pregnancy (D)
•
To avoid aspirin products or ibuprofen
Black Box Warning:
To use reliable contraceptives during and for several months after therapy; not to breastfeed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(dal-fam′pri-deen)
Ampyra
Func. class.:
Neurological agent—MS
Chem. class.:
Broad spectrum potassium channel blocker
Mechanism of action is not fully understood; a broad-spectrum potassium channel blocker that inhibits potassium channels and increased action potential conduction in demyelinated axions
For improved walking in patients with multiple sclerosis
Renal failure (CCr <50 ml/min), seizures
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, renal disease
Calculator
•
Adult: PO
10 mg q12hr
•
Adult: PO
CCr 51-80 ml/min, no dosage adjustment needed but seizure risk unknown; CCr ≤50 ml/min, do not use
Available forms:
Ext rel tab 10 mg
•
Do not break, crush, or chew; give without regard to meals
•
Do not give closer together than q12hr; seizures may occur
•
Do not double doses; if a dose is missed, skip it
CNS:
Seizures,
paresthesias, headache, dizziness, asthenia, insomnia
GI:
Nausea, constipation, dyspepsia
GU:
Urinary tract infection
MS:
Back pain
Bioavailability 96%; peak 3-4 hr (fasting), longer if taken with food; largely unbound to plasma proteins; 96% recovered in urine
•
Do not use with fampridine, other 4-aminopyridine (4-AP)–containing products
•
Multiple sclerosis:
improved walking, including speed
•
Seizures:
more common in those with previous seizure disorder
•
Therapeutic response: ability to walk at improved speed in MS
•
To notify prescriber if pregnancy is planned or suspected; not to breastfeed
•
Expected results; side effects, including seizures
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTdalteparin (Rx)
(dahl′ta-pear-in)
Fragmin
Func. class.:
Anticoagulant
Chem. class.:
Low-molecular-weight heparin
Inhibits factor Xa/IIa (thrombin), resulting in anticoagulation
Unstable angina/non–Q-wave MI; prevention of deep venous thrombosis in abdominal surgery, hip replacement, or in those with restricted mobility during acute illness, PE
Unlabeled uses:
Antiphospholipid antibody, arterial thromboembolism (after heart valve surgery), cerebral thromboembolism
Hypersensitivity to this product, heparin, or pork products, benzyl alcohol; active major bleeding, hemophilia, leukemia with bleeding, thrombocytopenic purpura, cerebrovascular hemorrhage, cerebral aneurysm; those undergoing regional anesthesia for unstable angina, non–Q-wave MI, dalteparin-induced thrombocytopenia
Precautions:
Pregnancy (B), breastfeeding, children, recent childbirth, geriatric patients; hepatic disease; severe renal disease; blood dyscrasias; bacterial endocarditis; acute nephritis; uncontrolled hypertension; recent brain, spine, eye surgery; congenital or acquired disorders; severe cardiac disease; peptic ulcer disease; hemorrhagic stroke; history of HIT; pericarditis; pericardial effusion; recent lumbar puncture; vasculitis; other diseases in which bleeding is possible
Black Box Warning:
Epidural anesthesia
Calculator
•
Adult: SUBCUT
2500 international units 2 hr before surgery and 2nd dose in the evening on the day of surgery (4-8 hr postop), then 5000 international units
SUBCUT
1st postop day and daily × 5-10 days
•
Adult: SUBCUT
120 international units/kg q12hr × 5-8 days, max 10,000 international units q12hr × 5-8 days with concurrent aspirin; continue until stable
•
Adult: SUBCUT
2500 international units 1-2 hr before surgery; repeat daily × 5-10 days; for high-risk patients, 5000 international units should be used
•
Adult: SUBCUT
200 international units/kg daily during 1st month (max single dose 18,000 international units), then 150 international units/kg daily for months 2-6 (max single dose 18,000 international units), use prefilled syringe that is closest to calculated dose; if platelets are 50,000-100,000/mm
3
, reduce dose by 2500 international units until platelets ≥100,000 mm
3
; if platelets <50,000/mm
3
, discontinue until >50,000/mm
3
•
Adult: SUBCUT
cancer patient with CCr <30 ml/min, monitor anti-factor Xa during extended treatment
•
Adult (female): SUBCUT
Antepartum 5000 international units/day with aspirin; maintain anti-factor Xa of 0.2-0.6 international units/ml
•
Adult: SUBCUT
LMWH in combination with oral anticoagulants until INR is in therapeutic range × 2 consecutive days
Available forms:
Prefilled syringes, 2500, 5000 international units/0.2 ml; 7500 international units/0.3 ml; 10,000, 25,000 international units/ml
•
Cannot be used interchangeably (unit for unit) with unfractionated heparin or other LMWHs
•
Do not give IM or IV product route; approved is SUBCUT only; do not mix with other inj or sol
•
Have patient sit or lie down; SUBCUT inj may be 2 inches from umbilicus in a
U
-shape, upper outer side of thigh, around navel, or upper outer quadrangle of the buttocks; rotate inj sites
•
Changing needles not recommended; change inj site daily; use at same time of day
CNS:
Intracranial bleeding
HEMA:
Thrombocytopenia
INTEG:
Pruritus, superficial wound infection, skin necrosis, inj site reaction
SYST:
Hypersensitivity,
hemorrhage, anaphylaxis
possible,
hematoma
87% absorbed, excreted by kidneys, elimination half-life 3-5 hr, peak 4 hr, onset 1-2 hr, duration >12 hr
Increase:
bleeding risk—aspirin, oral anticoagulants, platelet inhibitors, NSAIDs, salicylates, thrombolytics
Increase:
AST, ALT
•
Blood studies (Hct/Hgb, CBC, platelets, anti-Xa, stool guaiac) during treatment because bleeding can occur
Bleeding:
Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, B/P; may indicate bleeding, possible hemorrhage; notify prescriber immediately, product should be discontinued
Black Box Warning:
Epidural anesthesia:
Neurologic impairment frequently in those when neuraxial anesthesia has been used, spinal/epidural hematomas can occur, with paralysis
•
Hypersensitivity:
fever, skin rash, urticaria; notify prescriber immediately
•
Needed dosage change q1-2wk; dose may need to be decreased if bleeding occurs
•
Therapeutic response: absence of DVT
•
To avoid OTC preparations that contain aspirin; other anticoagulants, serious product interaction may occur unless approved by prescriber
•
To use soft-bristle toothbrush to avoid bleeding gums; to avoid contact sports; use electric razor; to avoid IM inj
•
To report any signs of bleeding (gums, under skin, urine, stools), unusual bruising
Protamine sulfate 1% given IV; 1 mg protamine/100 anti-Xa international units of dalteparin given
