Mosby's 2014 Nursing Drug Reference (261 page)

• Adult:
PO
≤6 g/day in divided doses

• Child 6-12 yr:
PO
3 g/day in divided doses

Decrease:
absorption—digoxin, nitrofurantoin, salicylates, tetracyclines, oral anticoagulants

Increase:
laxative action—flax senna

• 
Blood, urine electrolytes if used often

• 
I&O ratio to identify fluid loss

• 
Cause of constipation; lack of fluids, bulk, exercise, constipating products

• 
Cramping, rectal bleeding, nausea, vomiting; product should be discontinued

• 
Therapeutic response: decrease in constipation

• 
To mix powder in water, take with full glass of water

• 
To increase fluid intake

• 
That normal bowel movements do not always occur daily

• 
Not to use in presence of abdominal pain, nausea, vomiting

• 
To notify prescriber if constipation unrelieved or if symptoms of electrolyte imbalance occur: muscle cramps, pain, weakness, dizziness, excessive thirst

• Adult:
PO
250-500 mg bid or tid then adjusted q2days as needed, 0.5-2 g/day in 2-4 divided doses (maintenance), max 3 g/day;
IV
250-500 mg in 100 ml D
₅
W q6hr, run over 30-60 min, max 1 g q6hr, switch to oral as soon as possible

• Geriatric:
PO
125 mg bid-tid, increase q2days as needed, max 3 g/day

• Child:
PO
10 mg/kg/day in 2-4 divided doses, max 65 mg/kg or 3 g/day, whichever is less;
IV
20-40 mg/kg/day in 4 divided doses, max 65 mg/kg or 3 g, whichever is less

Y-site compatibilities:
Alfentanil, amikacin, aminophylline, anidulafungin, ascorbic acid, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, chlorproMAZINE, cimetidine, clindamycin, cyanocobalamin, cycloSPORINE, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, DOPamine, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, insulin (regular), irinotecan, isoproterenol, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methoxamine, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentazocine, phentolamine, phenylephrine, phytonadione, piperacillin, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, ritodrine,
sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinorelbine, voriconazole, zoledronic acid

Increase:
hypotension, CNS toxicity—levodopa

Increase:
hypotension—diuretics, other antihypertensives

Increase:
psychosis—haloperidol

Increase:
CNS depression—alcohol, antihistamines, antidepressants, analgesics, sedative/hypnotics

Increase:
B/P—phenothiazines, β-blockers, amphetamines, NSAIDs, tricyclics, barbiturates

Increase:
hypoglycemia—TOLBUTamide

Decrease:
methyldopa absorption—iron

Increase:
creatinine, LFTs

Decrease:
platelets, WBC, Hgb/HcT

Interference:
urinary uric acid, serum creatinine, AST

False increase:
urinary catecholamines

• 
Blood studies: neutrophils, decreased platelets

• 
Hemolytic anemia:
Direct Coombs’ test before, after 6, 12 mo of therapy, a positive test may indicate hemolytic anemia; usually reverses within weeks to months after discontinuing treatment, monitor Hgb/HcT and RBC; do not start therapy in those with hemolytic anemia

• 
Baselines of renal, hepatic studies before therapy begins

• 
Hypertension:
B/P when beginning treatment, periodically thereafter; report significant changes

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

• 
CNS symptoms, especially in geriatric patients; depression, change in mental status

• 
CHF:
edema, dyspnea, wet crackles, B/P

• 
Renal symptoms: polyuria, oliguria, urinary frequency; I&O ratio, weight; report weight gain >5 lb

• 
Product tolerance:
may occur within 3 mo of starting treatment, a dosage change and other products may be needed

• 
Therapeutic response: decrease in B/P with hypertension

• 
To avoid hazardous activities

• 
Not to discontinue product abruptly because withdrawal symptoms may oc
cur: anxiety, increased B/P, headache, insomnia, increased pulse, tremors, nausea, sweating

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

• 
To rise slowly to sitting or standing position to minimize orthostatic hypotension

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

• 
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber

• 
That dizziness, fainting, lightheadedness may occur during first few days of therapy

• 
That compliance is necessary; not to skip or stop product unless directed by prescriber

• 
That product may cause skin rash or impaired perspiration