Mosby's 2014 Nursing Drug Reference (185 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
9
) (
OTC
)
(foe′lik a′sid)
Equaline Folic Acid, Folacin, Vitamin B
9
, Walgreens Gold Seal Folic Acid
Func. class.:
Vit B complex group, water-soluble vitamin
Needed for erythropoiesis; increases RBC, WBC, platelet formation with megaloblastic anemias
Megaloblastic or macrocytic anemia caused by folic acid deficiency; hepatic disease, alcoholism, hemolysis, intestinal obstruction, pregnancy to reduce risk for neural tube defects
Unlabeled uses:
Reduce risk for heart disease, stroke, methotrexate toxicity prophylaxis
Hypersensitivity
Precautions:
Pregnancy (A), anemias other than megaloblastic/macrocytic anemia, vit B
12
deficiency anemia, uncorrected pernicious anemia
Calculator
• Adult and child ≥14 yr:
PO
400 mcg
• Adult (pregnant/lactating):
PO
600 mcg/day
• Child 9-13 yr:
PO
300 mcg
• Child 4-8 yr:
PO
200 mcg
• Child 1-3 yr:
PO
150 mcg
• Infant 6 mo-1 yr:
PO
80 mcg
• Neonate/infant <6 mo:
PO
65 mcg
• Pregnant/lactating:
PO
800-1000 mcg
• Adult and child:
PO/IM/SUBCUT/IV
up to 1 mg/day
• Adult and child >4 yr:
PO/IM/SUBCUT/IV
0.4 mg/day
• Pregnant and lactating:
PO/IM/SUBCUT/IV
0.8-1 mg/day
• Child <4 yr:
PO/IM/SUBCUT/IV
up to 0.3 mg/day
• Infant:
PO/IM/SUBCUT/IV
up to 0.1 mg/day
• Adult:
PO
0.6 mg/day
• Adult:
PO/IM/SUBCUT
up to 1 mg/day during pregnancy
• Adult:
PO
3-15 mg/day
Available forms:
Tabs 0.1, 0.4, 0.8, 1, 5 mg; inj 5, 10 mg/ml
•
Do not inject intradermally
•
Inject deeply in large muscle mass, aspirate
•
Direct undiluted ≤5 mg/1 min or more
•
May be added to most IV sol or TPN
Y-site compatibilities:
Alfentanil, aminophylline, ascorbic acid injection, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bumetanide, calcium gluconate, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, cimetidine, clindamycin, cyanocobalamin, cycloSPORINE, dexamethasone, digoxin, diphenhydrAMINE, DOPamine, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, erythromycin, esmolol, famotidine, fentaNYL, fluconazole, furosemide, ganciclovir, glycopyrrolate, heparin, hydrocortisone, hydrOXYzine, imipenem-cilastatin, indomethacin, insulin (regular), ketorolac, labetalol, lidocaine, LR, magnesium sulfate, mannitol, meperidine, methicillin, methylPREDNISolone, metoclopramide, metoprolol, mezlocillin, midazolam, moxalactam, multiple vitamins injection, naloxone, nitroglycerin, nitroprusside, ondansetron, oxacillin, oxytocin, penicillin G potassium/sodium, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, potassium chloride, procainamide, propranolol, ranitidine, Ringer’s, ritodrine, sodium bicarbonate, succinylcholine, SUFentanil, theophylline, ticarcillin, ticarcillin-clavulanate, TPN, trimetaphan, urokinase, vancomycin, vasopressin
CNS:
Confusion, depression, excitability, irritability
GI:
Anorexia, nausea
INTEG:
Pruritus, rash, erythema
RESP:
Bronchospasm
SYST:
Anaphylaxis (rare)
PO:
Peak 1/2-1 hr, bound to plasma proteins, excreted in breast milk, metabolized by liver, excreted in urine (small amounts)
Increase:
need for folic acid—estrogen, hydantoins, carBAMazepine, glucocorticoids
Decrease:
folate levels—methotrexate, sulfonamides, sulfaSALAzine, trimethoprim
Decrease:
phenytoin levels, fosphenytoin, may increase seizures
•
Megaloblastic anemia: fatigue, dyspnea, weakness
•
Hgb, Hct, reticulocyte count
•
Nutritional status: bran, yeast, dried beans, nuts, fruits, fresh vegetables, asparagus
•
Products currently taken: estrogen, carBAMazepine, glucocorticoids, hydantoins; these products may cause increased folic acid use by body and con
tribute to a deficiency if taking other neurotoxic products
•
Storage in light-resistant container
•
Therapeutic response: increased weight, oriented, well-being; absence of fatigue; increase in reticulocyte count within 5 days of beginning treatment, absence of neural tube defect
•
To take product exactly as prescribed; that periodic lab work is required
•
To alter nutrition to include high–folic-acid foods: organ meats, vegetables, fruit
•
That urine will turn bright yellow
•
To notify prescriber of allergic reaction
•
To avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTfondaparinux (Rx)
(fon-dah-pair′ih-nux)
Arixtra
Func. class.:
Anticoagulant, antithrombotic
Chem. class.:
Synthetic, selective factor Xa inhibitor
Do not confuse:
Arixtra
/Anti-Xa
Acts by antithrombin III (ATIII)-mediated selective inhibition of factor Xa; neutralization of factor Xa interrupts blood coagulation and inhibits thrombin formation; does not inactivate thrombin (activated factor II) or affect platelets
Prevention/treatment of deep venous thrombosis, PE in hip and knee replacement, hip fracture or abdominal surgery
Unlabeled uses:
Acute coronary syndrome
Hypersensitivity to this product; hemophilia, leukemia with bleeding, peptic ulcer disease, hemorrhagic stroke, surgery, thrombocytopenic purpura, weight <50 kg, severe renal disease (CCr <30 ml/min), active major bleeding, bacterial endocarditis
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, alcoholism, hepatic disease (severe), blood dyscrasias, heparin-induced thrombocytopenia, uncontrolled severe hypertension, subacute bacterial endocarditis, acute nephritis, mild to moderate renal disease
Black Box Warning:
Spinal/epidural anesthesia, lumbar puncture
Calculator
• Adult <50 kg:
SUBCUT
5 mg/day × ≥5 days until INR 2-3; may give warfarin within 72 hr of fondaparinux
• Adult 50-100 kg:
SUBCUT
7.5 mg/day × ≥5 days until INR 2-3; may give warfarin within 72 hr of fondaparinux
• Adult >100 kg:
SUBCUT
10 mg/day × ≥5 days until INR 2-3; may give warfarin within 72 hr of fondaparinux
• Adult:
SUBCUT
2.5 mg/day given 6 hr after surgery; continue for 5-9 days; for hip surgery, up to 32 days; for abdominal surgery, up to 24 days
• Adult:
SUBCUT
2.5 mg until hospital discharge or ≤8 days with standard treatment
• Adult:
SUBCUT
CCr <30 ml/min, do not use
Available forms:
Inj 2.5 mg/0.5 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml, 10 mg/0.8 ml prefilled syringes
•
Alone; do not mix with other products or solutions; cannot be used interchangeably (unit to unit) with other anticoagulants
•
For 5-9 days
•
Only after screening patient for bleeding disorders
•
SUBCUT only; do not give IM; do not give <6 hr after surgery
•
Check for discolored sol or sol with particulate; if present, do not give
•
Administer 6-8 hr after surgery; administer to recumbent patient, rotate inj sites (left/right anterolateral, left/right posterolateral abdominal wall)
•
Wipe surface of inj site with alcohol swab, twist plunger cap and remove, remove rigid needle guard by pulling straight off needle; do not aspirate, do not expel air bubble from surface
•
Insert whole length of needle into skinfold held with thumb and forefinger
•
When product is injected, a soft click may be felt or heard
•
Give at same time each day to maintain steady blood levels; observe inj site
•
Avoid all IM inj that may cause bleeding
Administer only this product when ordered; not interchangeable with heparin
CNS:
Fever
, confusion, headache, dizziness,
insomnia
GI:
Nausea, vomiting
, diarrhea, dyspepsia,
constipation
, increased AST, ALT
GU:
UTI, urinary retention
HEMA:
Anemia
, minor bleeding, purpura, hematoma,
thrombocytopenia, major bleeding (intracranial, cerebral, retroperitoneal hemorrhage), postoperative hemorrhage, heparin-induced thrombocytopenia
INTEG:
Increased wound drainage, bullous eruption, local reaction—
rash
, pruritus, inj site bleeding
META:
Hypokalemia
OTHER:
Hypotension, pain,
edema
Rapidly, completely absorbed; peak steady state 3 hr; distributed primarily in blood; does not bind to plasma proteins except 94% to ATIII; metabolism unknown; eliminated unchanged in urine within 72 hr with normal renal function; terminal half-life 17-21 hr
Increase:
bleeding risk—salicylates, NSAIDs, abciximab, eptifibatide, tirofiban, clopidogrel, dipyridamole, quiNIDine, valproic acid
Increase:
bleeding risk—feverfew, garlic, ginger, ginkgo, ginseng, green tea, horse chestnut, kava
Black Box Warning:
Monitor patients who have received epidural/spinal anesthesia or lumbar puncture for neurological impairment
•
Blood studies (CBC, anti-Xa, Hgb/Hct, prothrombin time, platelets, occult blood in stools), thrombocytopenia may occur; if platelets <100,000/mm
3
, treatment should be discontinued; renal studies: BUN, creatinine
•
For bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria; decreased Hct, notify prescriber
•
For risk of hemorrhage if coadministering with other products that may cause bleeding
•
For hypersensitivity: rash, fever, chills; notify prescriber
•
Storage at 77° F (25° C); do not freeze
•
Therapeutic response: prevention of DVT
•
To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor
•
To report any signs of bleeding: gums, under skin, urine, stools
•
To avoid OTC products containing aspirin, NSAIDs
