Mosby's 2014 Nursing Drug Reference (393 page)

Black Box Warning:

Coronary artery bypass graft surgery (CABG), surgery

• Adult:
PO
loading dose 180 mg with aspirin (usually 325 mg PO); then, give 90 mg bid with aspirin 75-100 mg/day, do not give maintenance doses of aspirin >100 mg/day

• 
May be taken without regard to food

• 
Discontinue 5-7 days before surgery

• 
May be crushed (90 mg tab) and mixed with purified water, 100 mg (PO) or 50 ml (NG)

Increase:
bleeding risk—CYP3A4 inhibitors (ketoconazole, itraconazole, voriconazole, clarithromycin, telithromycin, nefazodone, ritonavir, lopinavir, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir, delavirdine, isoniazid, dalfopristin, quinupristin, tipranavir

Decrease:
ticagrelor action—CYP3A4 inducers (rifampin, dexamethasone, phenytoin, carBAMazepine, PHENobarbital)

Increase:
effect of—simvastatin lovastatin

Increase:
bleeding risk—NSAIDs, anticoagulants, platelet inhibitors

Increase or decrease:
digoxin

Increase:
serum creatinine

• 
Thromboembolism:
Monitor CBC with differential with platelet count baseline and periodically during treatment

Black Box Warning:

Bleeding:
Assess for bleeding that may occur when aspirin is combined with this product, some bleeding can be fatal

• 
Abrupt discontinuation:
Do not discontinue abruptly, may increase risk for MI, stent thrombosis, death

• 
Storage at room temperature, in original container in dry place

• 
Prevention of thromboembolism

• 
To take only as prescribed, not to skip or double doses; if a dose is missed, to take next dose at scheduled time

Black Box Warning:

To notify prescriber of chills, fever, bruising, bleeding

• 
Not to use any prescription, OTC products, herbs without approval of prescriber; products with aspirin, NSAIDs may cause bleeding

• 
To notify all health care providers of product use

• 
That product can be taken without regard to meals

• 
That it may take longer for bleeding to stop

• Adult ≥60 kg:
IV INF
3.1 g q4-6hr

• Adult <60 kg:
IV INF
200-300 mg/kg/day q4-6hr

• Child >60 kg:
IV INF
3.1 g q4-6hr

• Child <60 kg:
IV INF
300 mg/kg/day q4hr

• Full-term neonates/infants <3 mo (unlabeled):
IV
50 mg/kg q4hr for severe infections;
IV
50 mg/kg q6hr for mild to moderate infections

• Child ≥60 kg:
IV INF
3.1 g q6hr

• Child <60 kg:
IV INF
200 mg/kg/day q6hr

• Adult:
IV INF
loading dose 3.1 g; CCr 60 ml/min, 3.1 g q4hr; CCr 30-60 ml/min, 2 g q4hr; CCr 10-30 ml/min, 2 g q8hr; CCr <10 ml/min, 2 g q12hr; CCr <10 ml/min with hepatic dysfunction, 2 g q24hr

• 
Product after C&S, give ≥q1hr before bactericidal anti-infectives, change IV site q48hr

Y-site compatibilities:
Allopurinol, amifostine, amikacin, anidulafungin, atropine, aztreonam, bivalirudin, bumetanide, ceFAZolin, cefepime, cefotaxime, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, cimetidine, clindamycin, cyclophosphamide, cycloSPORINE, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, DOPamine, DOXOrubicin liposome, doxycycline, enalaprilat, EPINEPHrine, esmolol, etoposide phosphate, famotidine, fenoldopam, filgrastim, fluconazole, furosemide, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone, HYDROmorphone, imipenem/cilastatin, insulin, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, melphalan, meperidine, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, palonosetron, pantoprazole, PEMEtrexed, penicillin G potassium, perphenazine, phenylephrine, procainamide, propofol, propranolol, ranitidine, remifentanil, sargramostim, sodium bicarbonate, tacrolimus, teniposide, theophylline, thiotepa, tirofiban, tobramycin, vasopressin, verapamil, vinorelbine, voriconazole

Increase:
methotrexate level—methotrexate, uric acid, bilirubicin, BUN, creatining, alk, phos, LDH

Increase:
ticarcillin concentrations—probenecid, sulfipyrazone

Decrease:
antimicrobial effect of ticarcillin—tetracyclines, aminoglycosides IV, chloramphenicol, macrolides, sulfonamides

Decrease:
effect—
oral contraceptives,
erythromycin

False positive:
urine glucose, urine protein, Coombs’ test

Increase:
LFTs, sodium, eosinophils, INR bleeding time

Decrease:
Hgb, potassium, platelets, WBC, granulocytes

• 
Infection: WBC, wound, temperature, sputum, urine, baseline and periodically

 
Pseudomembranous colitis:
diarrhea, abdominal pain, fever, fatigue, anorexia; possible anemia, elevated WBC count, low serum albumin; stop product; usually either vancomycin or IV metroNIDAZOLE is given

 
Serious skin reactions:
Stevens-Johnson syndrome, toxic epidermal necrolysis; anaphylaxis: wheezing, rash, laryngeal edema; have emergency equipment nearby

• 
Hepatic studies: AST, ALT

• 
Blood studies: WBC, RBC, Hct, Hgb, bleeding time, platelets, baseline and periodically

• 
Renal studies: BUN, creatinine, sodium, potassium

• 
Bowel pattern before, during treatment

• 
Skin eruptions after administration of penicillin to 1 wk after discontinuing product

• 
EPINEPHrine, suction, tracheostomy set, endotracheal intubation equipment

• 
Storage of reconstituted sol 12-24 hr at room temp, or 3-7 days refrigerated

• 
Therapeutic response: Resolution of infection

• 
To report persistent diarrhea with blood, pus, mucous, or fever

• 
That culture may be taken after completed course of medication

• 
To report sore throat, fever, fatigue (may indicate superinfection); CNS effects (anxiety, depression, hallucinations, seizures)

• 
To wear or carry emergency ID if allergic to penicillins

• 
To use alternative birth control method instead of hormonal