Mosby's 2014 Nursing Drug Reference (374 page)

Black Box Warning:

Secondary malignancy

• Adult:
PO
25-200 mg/day in 1-2 divided doses

• Adult:
PO
12.5-25 mg/day; max 50 mg/day

• Child:
PO
1.5-3.3 mg/kg/day as single dose or in divided doses

• Child (unlabeled):
PO
1.5-3.3 mg/kg/day in divided doses

• Adult:
PO
25-100 mg/day; if
PO,
potassium supplements must not be used

• Adult:
PO
400 mg/day × 4 days or 4 wk depending on test, then 100-400 mg/day maintenance

• Adult:
PO
100 mg/day given as single dose or in divided doses, titrate to response

• Child:
PO
1.5-3.3 mg/kg/day or 60 mg/m
²
/day given daily or in 2-4 divided doses

• Adult:
PO
CCr 10-50 ml/min; give dose q12-24hr; CCr <10 ml/min, avoid use

• Adult:
PO
50-200 mg in 1-2 divided doses

• 
In
AM
to avoid interference with sleep

• 
With food; if nausea occurs, absorption may be decreased slightly

• 
Effect may take 2 wk

Increase:
action of antihypertensives, digoxin, lithium

Increase:
hyperchloremic acidosis in cirrhosis—cholestyramine

Increase:
hyperkalemia—potassium-sparing diuretics, potassium products, ACE inhibitors, salt substitutes

Decrease:
effect of anticoagulants, monitor INR/PT

Decrease:
effect of spironolactone—ASA, NSAIDs

Increase:
hyperkalemia—potassium rich foods, potassium salt substitutes

Increase:
hypotension—hawthorn, horse chestnut

Decrease:
antihypertensive effect—ephedra

Increase:
severe photosensitivity—St. John’s wort

Increase:
BUN, potassium

Decrease:
sodium, magnesium

Interference:
17-OHCS, 17-KS, radioimmunoassay, digoxin assay

• 
Hypokalemia:
polyuria, polydipsia; dysrhythmias, inluding a U wave on ECG

• 
Hyperkalemia:
weakness, fatigue, dyspnea, dysrhythmias, confusion, fatigue

• 
Electrolytes: sodium, chloride, potassium, BUN, serum creatinine, ABGs, CBC

• 
Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily; ECG periodically with long-term therapy

• 
Signs of metabolic acidosis: drowsiness, restlessness

• 
Confusion, especially in geriatric patients; take safety precautions if needed

• 
Hydration:
skin turgor, thirst, dry mucous membranes

• 
Therapeutic response: improvement in edema of feet, legs, sacral area daily if medication is being used in CHF

• 
To avoid foods with high potassium content: oranges, bananas, salt substitutes, dried apricots, dates; to avoid potassium salt substitutes

• 
That drowsiness, ataxia, mental confusion may occur; to observe caution when driving

• 
To notify prescriber of cramps, diarrhea, lethargy, thirst, headache, skin rash, menstrual abnormalities, deepening voice, breast enlargement

• 
To take in
AM
, to prevent sleeplessness

• 
To avoid hazardous activities until reaction is known

• 
To notify prescriber if pregnancy is planned or suspected, pregnancy (C), do not breastfeed

Black Box Warning:

Pregnancy (C), hepatic disease, pancreatitis

• Adult >60 kg:
PO
40 mg q12hr

• Adult <60 kg:
PO
30 mg q12hr

• Child <30 kg:
PO
1 mg/kg q12hr

• Child ≥30 kg, ≤60 kg:
PO
30 mg q12hr

• Child >60 kg:
PO
40 mg q12hr

• Adult:
PO
CCr 26-50 ml/min, reduce by 50%, give q12hr; CCr 10-25 ml/min, reduce by 50%, give q24hr

• 
With/without meals; absorption does not appear to be lowered when taken with food

• 
Use after hemodialysis

• 
Every 12 hr around the clock

• 
Shake suspension well before using

Increase:
myelosuppression—other myelosuppressants

Increase:
peripheral neuropathy—lithium, dapsone, chloramphenicol didanosine, ethambutol, hydrALAZINE, phenytoin, vinCRIStine, zalcitabine

Increase:
stavudine levels—probenecid

Decrease:
stavudine effect—methadone, zidovudine

Black Box Warning:

Lactic acidosis and severe hepatomegaly with steatosis:
death may result

 
Pancreatitis:
severe upper abdominal pain, radiating to back, nausea, vomiting usually when used in combination with didanosine

• 
Blood studies: WBC, differential, RBC, Hct, Hgb, platelets, serum amylase, lipase

• 
Renal tests: urinalysis, protein, blood, serum creatinine

• 
C&S before product therapy; product may be given as soon as culture taken

• 
Bowel pattern before, during treatment

• 
Weakness, tremors, confusion, dizziness; product may have to be decreased, discontinued

• 
Viral load, CD4 counts, plasma HIV RNA at baseline and throughout treatment

• 
Peripheral neuropathy:
tingling, pain in extremities; discontinue product

• 
Therapeutic response: decreased symptoms of HIV

• 
About the signs of peripheral neuropathy:
burning, weakness, pain, prickling feeling in extremities

• 
That product should not be given with antineoplastics

• 
That product is not a cure for AIDS but will control symptoms

• 
To notify prescriber if sore throat, swollen lymph nodes, malaise, fever occur; that other products may be needed to prevent other infections

• 
That, even with use of product, patient may pass AIDS virus to others

• 
That follow-up visits are necessary; that serious toxicity may occur; that blood counts must be done q2wk

 
That serious product interactions may occur if other medications are ingested; to see prescriber before taking chloramphenicol, dapsone, CISplatin, didanosine, ethambutol, lithium, antifungals, antineoplastics

Black Box Warning:

To notify prescriber if pregnancy is planned or suspected, fatal lactic acidosis may occur, pregnancy (C), avoid breastfeeding

• 
That product may cause fainting or dizziness