Mosby's 2014 Nursing Drug Reference (71 page)

• Adult and child >12 yr: SPRAY/INH
256 mcg/day (2 sprays in each nostril
AM, PM
or 4 sprays in each nostril
AM
)

• Adult: INH
360 mcg bid, max 720 mcg bid

• Adult: PO
9 mg/day
AM
× 8 wk

Increase:
budesonide effect, CYP3A inhibitors, dose adjustment may be needed

• 
Respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness; provide fluids to 2 L/day to decrease thickness of secretions; check for oral candidiasis

• 
Bronchospasm:
stop treatment, give bronchodilator

• 
Viral infections: corticosteroid use can mask infections

• 
Increased intraocular pressure: discontinue use if this occurs

• 
Storage at 59° F-86° F (15° C-30° C); keep away from heat, open flame

• 
Therapeutic response: absence of asthma, rhinitis

• 
To notify prescriber of pharyngitis, nasal bleeding, oral candidiasis

• 
Not to exceed recommended dose because adrenal suppression may occur

• 
To carry emergency ID that identifies steroid use

• 
To read and follow package directions

• 
To prevent exposure to infections (especially viral)

• 
To use good oral hygiene if using nebulizer or inhaler

• 
To avoid breastfeeding

• 
That burning or stinging may occur with first few doses of inhalation use

• 
That product is not a bronchodilator and not to be used for asthma; to use regularly

• 
Teach how to use as described in “administer”

• 
To notify prescriber if symptoms persist after wks, that results usually take 2 wk

• 
To notify prescriber if exposure to measles, chickenpox occurs

Black Box Warning:

Dehydration

• Adult and adolescent: PO
0.5-2.0 mg/day; may give 2nd or 3rd dose at 4-5 hr intervals, max 10 mg/day; may be given on alternate days or intermittently;
IV/IM
0.5-1.0 mg; may give 2nd or 3rd dose at 2-3 hr intervals, not to exceed 10 mg/day

• Child and infant (unlabeled): PO/IM/IV
0.015-0.1 mg/kg daily or every other day, max 10 mg/day

• Adult: IV
1-2 mg q1-4hr to maintain urine output of 200-250 ml/hr; give saline before 1st dose of this product

• Adult and adolescent: PO
0.5-2 mg/day, max 10 mg/day in 2 divided doses

• 
In
AM
to avoid interference with sleep if using product as a diuretic; without regard to meals

• 
Potassium replacement if potassium is <3.0

Syringe compatibilities:
Doxapram

Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amoxicillin, amphotericin B lipid complex (Abelcet), amphotericin B liposome (AmBisome), anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefepime, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, cimetidine, cisatracurium, CISplatin, cladribine, clarithromycin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone sodium succinate, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, micafungin, miconazole, milrinone, mitoXANtrone, morphine, moxalactam, multiple vitamins injection, mycophenolate, nafcillin, nalbuphine, naloxone, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, palonosetron, pamidronate, pan
curonium, pantoprazole, PEMEtrexed, penicillin G potassium/sodium, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, rifampin, ritodrine, riTUXimab, rocuronium, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, traMADol, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole

Increase:
toxicity—lithium, digoxin

Increase:
diuresis, electrolyte loss—metolazone

Decrease:
diuretic effect—indomethacin, NSAIDs, probenecid

Decrease:
antidiabetic effects—antidiabetics

Increase:
effect—hawthorn, horse chestnut

Decrease:
effect of bumetanide—ginseng, ephedra

• 
For tinnitus; obtain audiometric testing for long-term IV treatment

• 
Weight, I&O daily to determine fluid loss; if urinary output decreases or azotemia occurs, product should be discontinued; safest dosage schedule is alternate days

• 
B/P lying, standing; postural hypotension may occur

Black Box Warning:

Electrolyte imbalances:
Potassium, sodium, calcium; include BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid, calcium, magnesium; severe electrolyte imbalances should be corrected before starting treatment

• 
Blood glucose if patient is diabetic; blood uric acid levels in those with gout

• 
Improvement in edema of feet, legs, sacral area daily if medication is being used for CHF

• 
Signs of metabolic alkalosis: drowsiness, restlessness

• 
Hypokalemia:
postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness

• 
Rashes, temp elevation daily

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

• 
Digoxin toxicity
in patients taking digoxin products: anorexia, nausea, vomiting, confusion, paresthesia, muscle cramps;
lithium toxicity
in those taking lithium

• 
Therapeutic response: decreased edema, B/P

• 
To increase fluid intake to 2-3 L/day unless contraindicated; to take potassium supplement; to rise slowly from lying or sitting position

• 
To recognize adverse reactions: muscle cramps, weakness, nausea, dizziness

• 
To take with food, milk for GI symptoms; to avoid alcohol

• 
To take early in day to prevent nocturia

• 
To use sunscreen to prevent photosensitivity