Mosby's 2014 Nursing Drug Reference (402 page)

• Adult/adolescent/child
≥
10 yr:
PO
25-50 mg/day initially, titrate by 25-50 mg/wk, up to 200-400 mg/day in 2 divided doses

• Child 2-9 yr:
PO
week 1: 25 mg in
PM
, then 25 mg bid if tolerated (week 2), then increase by 25-50 mg/day each week as tolerated over 5 to 7-wk titration period, maintenance given in 2 divided doses; <11 kg, minimum 150 mg/day, max 250 mg/day; 12-22 kg, minimum 200 mg/day, max 300 mg/day; 23-31 kg, minimum 200 mg/day, max 350 mg/day; 32-38 kg, minimum 250 mg/day, max 350 mg/day; >38 kg, minimum 250 mg/day, max 400 mg/day

• Adult:
PO
25 mg/day initially, increase by 25 mg/day/wk up to 100 mg/day in 2 divided doses

• Adult:
PO
CCr <70 ml/min, give 1/2 dose

• Adult/adolescent >16 yr:
PO
50 mg/day, titrate slowly by 50 mg/wk to 100-300 mg tid

• Child 2-16 yr:
PO
0.5-1 mg/kg, max 25 mg, initially daily × 7 days then increase by 0.5-1 mg/kg/day weekly up to 3-6 mg/kg/day in divided doses

• Child:
PO
25 mg/day, may increase by 25 mg q2-3days until spasms controlled, max 24 mg/kg/day

• Adult:
PO
25 mg/day, titrated to max 300 mg/day in divided doses

• Adult:
PO
12.5-25 mg q day or bid × 4 wk then double dose q4wk to max 100-200 mg/day in divided doses

• Adult:
PO
25 mg/day then increase by 25-mg increments to 200 mg/day

• 
Swallow tabs whole; do not break, crush, or chew tabs; very bitter

• 
May take without regard to meals

• 
Sprinkle cap can be given whole or opened and sprinkled on soft food; do not chew, drink water after sprinkle

Increase:
renal stones—carbonic anhydrase inhibitors

Increase:
effect of amitriptyline

Increase:
CNS depression—alcohol, CNS depressants

Increase:
topiramate levels—metformin, hydrochlorothiazide, lamoTRIgine

Decrease:
levels of oral contraceptives, estrogen, digoxin, valproic acid, lithium, risperiDONE

Decrease:
topiramate levels—phenytoin, carBAMazepine, valproic acid, probenecid

• 
Seizures:
location, type, duration, aura

• 
Bipolar disorder:
mood, behavior

• 
Renal studies: urinalysis, BUN, urine creatinine q3mo; symptoms of renal colic

• 
Hepatic studies: ALT, AST, bilirubin if patient receiving long-term treatment

• 
CBC during long-term therapy (anemia); serum bicarbonate (metabolic acidosis)

• 
Migraines: pain location, duration; alleviating factors

 
Mental status: mood, sensorium, affect, behavioral changes,
suicidal thoughts/behaviors;
if mental status changes, notify prescriber

• 
Body weight, evidence of cognitive disorder

• 
Storage at room temp away from heat, light

• 
Assistance with ambulation during early part of treatment; dizziness occurs

• 
Seizure precautions: padded side rails, move objects that may harm patient

• 
Therapeutic response: decreased seizure activity

• 
To carry emergency ID stating patient’s name, products taken, condition, prescriber’s name and phone number

• 
To avoid driving, other activities that require alertness

• 
Not to discontinue medication quickly after long-term use

• 
To notify prescriber immediately of blurred vision, periorbital pain

• 
To maintain adequate fluid intake

• 
About administration procedure and expected results

• 
To use nonhormonal contraceptive; that effect of oral contraceptives is decreased, pregnancy (D)

• 
To drink plenty of fluids to prevent kidney stones

• 
May need to increase amount of food consumed, weight loss may occur

• Adult:
IV INF
1.5 mg/m
²
over 30 min daily × 5 days starting on day 1 of 21-day course × 4 courses; may be reduced to 0.25 mg/m
²
for subsequent courses if severe neutropenia occurs; relapsed small-cell lung cancer (SCLC) in those with a prior complete or partial response, ≥45 days from end of first-line treatment.
PO
2.3 mg/m
²
/day on days 1-5 of 21-day course

• Adult:
IV
CCr 20-39 ml/min, 0.75 mg/m
²
/day × 5 days starting on day 1 of 21-day course

Increase:
myelosuppression when used with CISplatin

Increase:
bleeding risk—NSAIDs, anticoagulants, thrombolytics, platelet inhibitors

• 
Avoid use with grapefruit juice

• 
Hepatic studies: AST, ALT, alk phos, which may be elevated; creatinine, BUN

Black Box Warning:

CBC, differential, platelet count weekly; withhold product if WBC is <3500/mm
³
or platelet count is <100,000/mm
³
; notify prescriber of results; product should be discontinued

• 
Buccal cavity for dryness, sores or ulcerations, white patches, oral pain, bleeding, dysphagia

• 
Interstitial lung disease (ILD):
fever, cough, dyspnea, hypoxia, may be fatal

• 
Storage of caps in refrigerator; IV INF unopened at room temp; protect both from light

• 
Increased fluid intake to 2-3 L/day to prevent dehydration unless contraindicated

• 
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss

• 
Therapeutic response: decreased tumor size, spread of malignancy

• 
That total alopecia may occur; that hair grows back but is different in color and texture

• 
To avoid foods with citric acid or hot or rough texture if stomatitis is present; to drink adequate fluids

• 
To report stomatitis and any bleeding, white spots, ulcerations in mouth; to examine mouth daily; to report symptoms

Black Box Warning:

To report signs of anemia: fatigue, headache, faintness, SOB, irritability

• 
To use effective contraception during treatment and for ≤6 mo after, pregnancy (D); to avoid breastfeeding

• 
To avoid OTC products without approval of prescriber

• 
To avoid driving or other activities requiring alertness

• 
To avoid vaccines, toxoids