Mosby's 2014 Nursing Drug Reference (91 page)

Black Box Warning:

Dementia. Increased mortality in geriatric patients with dementia-related psychosis

• Adult:
PO
10-50 mg q1-4hr initially then increase up to 2 g/day if necessary;
IM
10-50 mg q1-4hr, usual dose 300-800 mg/day

• Geriatric:
10-25 mg daily-bid, increase by 10-25 mg/day q4-7days, max 800 mg/day

• Child >6 mo:
PO
0.55 mg/kg q4-6hr;
IM
0.5 mg/kg q6-8hr

• Adult:
PO
10-25 mg q4-6hr prn;
IM
12.5-25 mg then 25-50 mg if no hypotension q3hr prn; q6-8hr prn, max 400 mg/day;
IV
25-50 mg daily-qid

• Child ≥6 mo:
PO
0.55 mg/kg q4-6hr;
IM
q6-8hr;
IM
≤5 yr or ≤22.7 kg, 40 mg; max
IM
5-10 yr or 22.7-45.5 kg, 75 mg

• Adult:
PO
25-50 mg tid-qid;
IM
25-50 mg (only if PO dose does not work);
IV
25-50 mg in 500-1000 ml
NS
(only for severe hiccups)

• 
Anticholinergic agent for EPS if ordered

Direct IV:
After
diluting
1 mg/1 ml with NS,
give
1 mg or less/2 min or more, never give undiluted

Syringe compatibilities:
Atropine, benztropine, butorphanol, diphenhydr
AMINE
, doxapram, droperidol, fentaNYL, glycopyrrolate, HYDROmorphone, hydrOXYzine, meperidine, metoclopramide, midazolam, morphine, pentazocine, perphenazine, prochlorperazine, promazine, promethazine, scopolamine

Y-site compatibilities:
Alfentanil, amikacin, amphotericin B lipid complex, amsacrine, anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, benztropine, bleomycin sulfate, buprenorphine, butorphanol, calcium chloride/gluconate, caspofungin, cimetidine, cisatracurium, CISplatin, cladribine, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, isoproterenol, labetalol, levofloxacin, lidocaine, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, meperidine, methicillin, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, multiple vitamins injection, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, netilmicin, nitroglycerin, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, palonosetron, pamidronate, pancuronium, papaverine, penicillin G potassium, pentamidine, pentazocine, phytonadione, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine sulfate, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, Ringer’s injection, ritodrine, riTUXimab, rocuronium, sodium acetate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, tirofiban, TNA, tolazoline, TPN, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid

Increase:
CNS depression—other CNS depressants, alcohol, barbiturate anesthetics, antihistamines, sedatives/hypnotics, antidepressants

Increase:
toxicity—EPINEPHrine

Increase:
agranulocystosis—antithyroid agents

Increase:
effects of both products—β-adrenergic blockers, alcohol

Increase:
anticholinergic effects—anticholinergics, antidepressants, antiparkinsonian agents

Increase:
valproic acid level

Decrease:
seizure threshold—anticonvulsants

Decrease:
absorption—aluminum hydroxide, magnesium hydroxide antacids

Decrease:
antiparkinson activity—levodopa, bromocriptine

Decrease:
serum chlorproMAZINE—lithium, barbiturates

Decrease:
anticoagulant effect—warfarin

Increase:
hepatic studies

Decrease:
WBC, platelets, Hgb/HcT

False positive:
pregnancy tests, PKU

• 
Mental status: orientation, mood, behavior, presence and type of hallucinations before initial administration and monthly

• 
Any potentially reversible causes of behavior problems in geriatric patients before and during therapy

• 
Swallowing of PO medication; check for hoarding or giving of medication to other patients

• 
I&O ratio; palpate bladder if low urinary output occurs, especially in geriatric patients

• 
Bilirubin, CBC, LFTs, ocular exam; agranulocytosis, glaucoma, cholestatic jaundice may occur

• 
Respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; obtain baseline ECG; Q-wave and T-wave changes

• 
Dizziness, faintness, palpitations, tachycardia on rising

 
Neuroleptic malignant syndrome:
hyperpyrexia, muscle rigidity, increased CPK, altered mental status, for acute dystonia (check chewing, swallowing, eyes, pill rolling)

• 
EPS:
akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)

• 
Constipation, urinary retention daily; increase bulk, water in diet

• 
Supervised ambulation until stabilized on medication; do not involve in strenuous exercise program because fainting is possible; patient should not stand still for long periods

• 
Increased fluids, roughage to prevent constipation

• 
Candy, gum, sips of water for dry mouth

• 
Storage in tight, light-resistant container, oral sol in amber bottle

• 
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech; increase in target behaviors

• 
To use good oral hygiene; to use frequent rinsing of mouth, sugarless gum, candy, ice chips for dry mouth

• 
To avoid hazardous activities until product response is determined

• 
That orthostatic hypotension occurs often; to rise gradually from sitting or lying position

• 
To remain lying down for at least 30 min after IM inj

• 
To avoid hot tubs, hot showers, tub baths because hypotension may occur;
that, during hot weather, heat stroke may occur; to take extra precautions to stay cool

• 
To avoid abrupt withdrawal of product or EPS may result; product should be withdrawn slowly

• 
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber since serious product interactions may occur; avoid use with alcohol, increased drowsiness may occur

• 
To use a sunscreen and sunglasses to prevent burns

• 
To take antacids 2 hr before or after this product

• 
To report sore throat, malaise, fever, bleeding, mouth sores; CBC should be drawn and product discontinued

• 
To employ contraceptive measures

• 
That urine may turn pink or reddish brown