Mosby's 2014 Nursing Drug Reference (27 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(al-pray′zoe-lam)
Apo-Alpraz
, Niravam, Xanax, Xanax XR
Func. class.:
Antianxiety
Chem. class.:
Benzodiazepine (short/intermediate acting)
Do not confuse:
ALPRAZolam
/LORazepam
Xanax
/Lanoxin/Tylox/Zantac
Depresses subcortical levels of CNS, including limbic system, reticular formation
Anxiety, panic disorders with or without agoraphobia, anxiety with depressive symptoms
Unlabeled uses:
Premenstrual dysphoric disorders, insomnia, PMS, alcohol withdrawal syndrome
Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, closed-angle glaucoma, psychosis, addiction
Precautions:
Geriatric patients, debilitated patients, hepatic disease, obesity, severe pulmonary disease
Calculator
• Adult: PO
0.25-0.5 mg tid, may increase q3-4days if needed, max 4 mg/day in divided doses
• Geriatric: PO
0.125-0.25 mg bid; increase by 0.125 as needed
• Adult: PO
0.5 mg tid, may increase up to 1 mg/day q3-4days, max 10 mg/day;
EXT REL
(Xanax XR) give daily in
AM,
0.5-1 mg initially, maintenance 3-6 mg/day
•
Reduce dose
• Adult: PO
0.25 mg bid-qid starting on day 16-18 of menses, taper over 2-3 days when menses occurs, max 4 mg/day
• Adult: PO
0.25-0.5 mg at bedtime
Available forms:
Tabs 0.25, 0.5, 1, 2 mg; ext rel tabs (Xanax XR) 0.5, 1, 2, 3 mg; orally disintegrating tabs 0.25, 0.5, 1, 2 mg; oral sol 1 mg/ml
•
Tabs may be crushed, mixed with food, fluids if patient is unable to swallow medication whole; do not break, crush, chew ext rel (XR), give ext rel tab in
AM
•
With food or milk for GI symptoms; high-fat meal will decrease absorption
•
To discontinue, decrease by 0.5 mg q3days
•
May divide total daily doses into more times/day if anxiety occurs between doses
•
Orally disintegrating tabs on tongue to dissolve and swallow, protect from moisture
CNS:
Dizziness, drowsiness
, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, memory impairment, poor coordination,
suicide
CV:
Orthostatic hypotension
,
ECG changes, tachycardia,
hypotension
EENT:
Blurred vision
, tinnitus, mydriasis
GI:
Constipation, dry mouth, nausea, vomiting, anorexia, diarrhea, weight gain/loss, increased appetite
GU:
Decreased libido
INTEG:
Rash, dermatitis, itching,
angioedema
PO:
Well absorbed; widely distributed; onset 30 min; peak 1-2 hr; duration 4-6 hr;
oral disintegrating tab
peak 1.5-2 hr; therapeutic response 2-3 days; metabolized by liver (CYP3A4), excreted by
kidneys; crosses placenta, breast milk; half-life 12-15 hr, protein binding 80%
Increase:
ALPRAZolam action—CYP3A4 inhibitors (cimetidine, disulfiram, erythromycin, FLUoxetine, isoniazid, itraconazole, ketoconazole, metoprolol, propoxyphene, propanolol, valproic acid)
Increase:
CNS depression—anticonvulsants, alcohol, antihistamines, sedative/hypnotics, opioids
Decrease:
sedation—xanthines
Decrease:
ALPRAZolam action—CYP3A4 inducers (barbiturates, rifampin)
Decrease:
action of levodopa
Decrease:
product level—cigarette smoking
Increase:
CNS depression—kava, melatonin, St. John’s wort, valerian
Increase:
product level—grapefruit juice, avoid concurrent use
Increase:
AST/ALT, alk phos
•
Mental status: anxiety, mood, sensorium, orientation, affect, sleeping pattern, drowsiness, dizziness, especially in geriatric patients both before and during treatment,
suicidal thoughts, behaviors
•
B/P lying, standing; pulse; if systolic B/P drops 20 mm Hg, hold product, notify prescriber
•
Hepatic, blood studies: AST, ALT, bilirubin, creatinine, LDH, alk phos, CBC; may cause neutropenia, decreased Hct, increased LFTs
Physical dependency, withdrawal symptoms:
anxiety, panic attacks, agitation, seizures, headache, nausea, vomiting, muscle pain, weakness; withdrawal seizures may occur after rapid decrease in dose or abrupt discontinuation; because duration of action is short, considered to be the product of choice for geriatric patients
•
Pregnancy: if planned or suspected, pregnancy (D), to avoid breastfeeding
•
Therapeutic response: decreased anxiety, restlessness, sleeplessness
•
Not to double doses; take exactly as prescribed; if dose is missed, take within 1 hr as scheduled; that product may be taken with food
•
Not to use for everyday stress or for more than 4 mo unless directed by prescriber; not to take more than prescribed amount; that product may be habit forming; that memory impairment is a result of long-term use
•
To avoid OTC preparations unless approved by prescriber
•
Not to use during pregnancy (D), avoid breastfeeding
•
Not to discontinue medication abruptly after long-term use
•
To avoid driving, activities that require alertness because drowsiness may occur
•
To avoid alcohol, other psychotropic medications unless directed by prescriber
•
To rise slowly or fainting may occur, especially among geriatric patients
•
That drowsiness may worsen at beginning of treatment
Lavage, VS, supportive care, flumazenil
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
alprostadil (Rx)
(al-pros′ta-dil)
Caverject, Caverject Impulse, Edex, Muse, Prostin VR Pediatric
Func. class.:
Hormone
To maintain patent ductus arteriosus (temporary treatment), erectile dysfunction
Hypersensitivity, respiratory distress syndrome, those at risk for priapism
Calculator
• Infant: IV INF
0.05-0.1 mcg/kg/min until desired response, then reduce to lowest effective amount, max 0.4 mcg/kg/min
• Men: INTRACAVERNOSAL
2.5 mcg, may increase by 2.5 mcg, may then increase by 5-10 mcg until adequate response occurs (max 60 mcg/dose);
INTRAURETHRAL
125-250 mcg, max 2 doses/24 hr, max dose 1000 mcg; administer as needed to achieve erection
