Mosby's 2014 Nursing Drug Reference (94 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sin-a-kal′set)
Sensipar
Func. class.:
Calcium receptor agonist
Chem. class.:
Polypeptide hormone
Directly lowers PTH levels by increasing sensitivity of calcium-sensing receptors to extracellular calcium
Hypercalcemia with parathyroid carcinoma, secondary hyperparathyroidism with chronic kidney disease for patient on dialysis, primary hyperparathyroidism
Hypersensitivity, hypocalcemia
Precautions:
Pregnancy (C), breastfeeding, children, seizure disorders, hepatic disease
Calculator
• Adult:
PO
30 mg bid, titrate q2-4wk, with sequential doses of 30 mg bid, 60 mg bid, 90 mg bid, 90 mg tid-qid to normalize calcium levels
• Adult:
PO
30 mg/day, titrate no more frequently than q2-4wk with sequential doses of 30, 60, 90, 120, 180 mg/day
Available forms:
Tabs 30, 60, 90 mg
•
Swallow tabs whole; do not break, crush, or chew; use with food or right after a meal
•
Can be used alone or in combination with vit D sterols, phosphate binders
•
Storage at <77° F (25° C)
•
Titrate q2-4wk to target iPTH consistent with National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) for chronic kidney disease patient on dialysis of 150-300 pg/ml; if iPTH <150-300 pg/ml, reduce dose of cinacalcet and/or vit D sterols or discontinue treatment
CNS:
Dizziness, asthenia,
seizures,
tetany, hallucinations, depression
CV:
Hypertension, dysrhythmia exacerbation
GI:
Nausea, diarrhea, vomiting, anorexia
MISC:
Access infection, noncardiac chest pain, hypocalcemia
MS:
Myalgia
93%-97% bound to plasma; proteins metabolized by CYP3A4, 2D6, 1A2; half-life 30-40 hr; renal excretion of metabolites (80% renal, 15% in feces)
Increase:
cinacalcet levels: CYP3A4 inhibitors (ketoconazole, erythromycin, itraconazole)
Increase:
levels of CYP2D6 inhibitors (flecainide, vinBLAStine, thioridazine, tricyclics)
Increase:
action by high-fat meal
•
Hypocalcemia:
cramping, seizures, tetany, myalgia, paresthesia; calcium, phosphorous within 1 wk and iPTH 1-4 wk after initiation or dosage adjustment when maintenance established; measure calcium, phosphorus monthly; iPTH q1-3mo, target range 150-300 pg/ml for iPTH level; biochemical markers of bone formation/resorption; radiologic evidence of fracture; serum testosterone
•
Renal disease (without dialysis): These patients should not receive treatment with this product, high risk of hypocalcemia
•
If calcium <8.4 mg/dl, do not start therapy
•
Therapeutic response: calcium levels 9-10 mg/dl, decreasing symptoms of hypercalcemia
•
To take with food or shortly after a meal, to take tabs whole
•
To report cramping, seizures, muscle pain, tingling, tetany immediately
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(sip-ro-floks′a-sin)
Cipro, Cipro XR
Func. class.:
Antiinfective—broad spectrum
Chem. class.:
Fluoroquinolone
Do not confuse:
ciprofloxacin
/cephalexin
Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; DNA gyrase inhibitor
Infection caused by susceptible
Escherichia coli, Enterobacter cloacae, Proteus mirabilis, Klebsiella pneumoniae, Proteus vulgaris, Citrobacter freundii, Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Enterobacter, Campylobacter jejuni, Salmonella;
chronic bacterial prostatitis, acute sinusitis, postexposure inhalation anthrax, infectious diarrhea, typhoid fever, complicated intraabdominal infections, nosocomial pneumonia, urinary tract infections
Unlabeled uses:
Acinetobacter/woffii, Aeromonas hydrophila
, brucellosis,
Burkholderia, pseudomallei
, chancroid, cholera, dental infection,
Edwardsiella tarda
, endocarditis,
Enterobacter aerogenes
, granuloma inguinale,
Klebsiella oxytoca
, Legionnaire’s disease, melioidosis, meningococcal infection prophylaxis,
Pasteurella multocida
, PID, periodontitis, pharyngitis,
Salmonella sp., Stenotrophomonas maltophilia
, tularemia,
Vibrio cholerae/parahaemolyticus/vulnificus, Yersinia enterocolitica
Hypersensitivity to quinolones
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal disease, epilepsy, QT prolongation, hypokalemia
Black Box Warning:
Tendon pain/rupture, tendinitis
Calculator
• Adult:
PO
250 mg q12hr × 3 days or 500 mg q24hr × 3 days
• Adult:
PO
500 mg q12hr or 1000 mg q24hr × 7-14 days;
IV
400 mg q12hr
• Adult:
PO
1000 mg q24hr × 7-14 days q4-6wk
• Adult:
PO
500-750 mg q12hr × 7-14 days;
IV
400 mg q12hr
• Adult:
IV
400 mg q8hr × 10-14 days
• Adult:
PO
500 mg q12hr × 7-14 days;
IV
400 mg q12hr × 7-14 days, usually given with metroNIDAZOLE
• Adult:
PO
500 mg q12hr × 10 days;
IV
400 mg q12hr × 10 days
• Adult:
PO
500 mg q12hr × 60 days;
IV
400 mg q12hr × 60 days
• Child:
PO
15 mg/kg/dose q12hr × 60 days, max 500 mg/dose;
IV
10 mg/kg q12hr, max 400 mg/dose
• Adult:
PO
500 mg q12hr × 5-7 days
• Adult:
PO
500 mg q12hr × 28 days;
IV
400 mg q12hr × 28 days
• Adult:
CCr 30-50 ml/min,
PO
250-500 mg q12hr; CCr 5-29 ml/min,
PO
250-500 mg q18hr;
IV
200-400 mg q18-24hr
Available forms:
Tabs 100, 250, 500, 750 mg; ext rel tabs (XR) 500, 1000 mg; inj 200 mg/20 ml, 400 mg/40 ml, 200 mg/100 ml D
5
, 400 mg/200 ml D
5
; oral susp 250 mg, 500 mg/5 ml
•
Obtain C&S before use
•
Do not use theophylline with this product, will cause toxicity
•
Use caution when giving with antidysrhythmics IA, III
•
Do not break, crush, chew XR (ext rel) product, use adequate fluids to prevent crystalluria
•
2 hr before or 2 hr after antacids, zinc, iron, calcium
•
Do not give oral susp by GI tube
•
Over 1 hr as an inf, comes in premixed plastic inf container or diluted 20- or 40-ml vial to a final conc of 0.5-2 mg/ml of NS or D
5
W; give through
Y
-tube or 3-way stopcock
Y-site compatibilities:
Amifostine, anakinra, anidulafungin, atenolol, aztreonam, bivalirudin, bleomycin, calcium gluconate, CARBOplatin, caspofungin, cefTAZidime, cisatracurium, CISplatin, clarithromycin, codeine, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, doripenem, DOPamine, doxacurium, DOXOrubicin, epirubicin, eptifibatide, ertapenem, etoposide, fenoldopam, fludarabine, gallium, gemcitabine, gentamicin, granisetron, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, irinotecan, lidocaine, linezolid, LORazepam, LR, mechlorethamine, meperidine, methotrexate, metoclopramide, metroNIDAZOLE, midazolam, midodrine, milrinone, mitoXANtrone, mycophenolate, nesiritide, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, piperacillin, potassium acetate/chloride, promethazine, ranitidine, remifentanil, rocuronium, sodium chloride, tacrolimus, teniposide, thiotepa, tigecycline, tirofiban, TNA, tobramycin, trastuzumab, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole
CNS:
Headache
, dizziness, fatigue, insomnia, depression,
restlessness
,
seizures,
confusion
GI:
Nausea, diarrhea
, increased ALT/AST, dry mouth, flatulence, heartburn,
vomiting
, oral candidiasis, dysphagia,
pseudomembranous colitis
GU:
Crystalluria, interstitial neuritis
HEMA:
Bone marrow depression
INTEG:
Rash
, pruritus, urticaria, photosensitivity, flushing, fever, chills,
toxic epidermal necrolysis
MISC:
Anaphylaxis, Stevens-Johnson syndrome,
visual impairment,
QT prolongation, pseudotumor cerebri
MS:
Tremor, arthralgia, tendinitis,
tendon rupture
PO:
Peak 1 hr; half-life 3-4 hr; excreted in urine as active product, metabolites 35%-40%, 20%-40% protein binding
Black Box Warning:
Increase:
tendonitis, tendon rupture—Corticosteroids
Increase:
nephrotoxicity—cycloSPORINE
Increase:
ciprofloxacin levels—probenecid; monitor for toxicity
Increase:
levels of theophylline, warfarin, monitor blood levels, reduce dose
Increase:
QT prolongation—astemizole, droperidol, class IA/III antidysrhythmics, tricyclics, tetracyclines, local anesthetics, phenothiazines, haloperidol, risperiDONE, sertindole, ziprasidone, alfuzosin, arsenic trioxide, b-agonists, chloroquine, cloZAPine, cyclobenzapine, dasatinib, dolasetron, droperidol, flecainide, halogenated anesthetics, lapatinib, levomethadyl, macrolides, methadone, octreotide, ondansetron, paliperidone, palonosetron, pentamidine, propafenone, ranolazine, SUNItinib, tacrolimus, terfenadine, vardenafil, vorinostat; less likely than other quinolones
Decrease:
ciprofloxacin absorption—antacids that contain magnesium, aluminum; zinc, iron, sucralfate, enteral feedings, calcium
Increase:
effect of caffeine
Decrease:
absorption—dairy products, food
Increase:
AST, ALT, BUN, creatinine, LDH, bilirubin, alk phos, glucose, proteinuria, albuminuria
Decrease:
WBC, glucose
•
Infection:
WBC, temperature before treatment, periodically
Black Box Warning:
Myasthenia gravis:
Avoid use in these patients, increases muscle weakness
•
CNS symptoms:
headache, dizziness, fatigue, insomnia, depression
•
Renal, hepatic studies: BUN, creatinine, AST, ALT
•
I&O ratio, urine pH <5.5 is ideal
Black Box Warning:
Tendonitis, tendon rupture:
Discontinue as first sign of tendon pain, inflammation; increased in those >60 yr, those taking corticosteroids, organ transplants
Anaphylaxis:
fever, flushing, rash, urticaria, pruritus, dyspnea
•
Pseudomotor Cerebri:
May occur at excessive doses
•
Limited intake of alkaline foods, products: milk, dairy products, alkaline antacids, sodium bicarbonate; caffeine intake if excessive cardiac or CNS stimulation
•
Increase in fluids to 3 L/day to avoid crystallization in kidneys
•
Therapeutic response: decreased pain, frequency, urgency, C&S; absence of infection
•
Not to take any products that contain magnesium, calcium (such as antacids), iron, aluminum with this product or within 2 hr of product, to drink fluids to prevent crystals in urine
Black Box Warning:
To report tendon pain, chest pain, palpitations
•
To ambulate, perform activities with assistance if dizziness occurs
•
To complete full course of product therapy; not to double or miss doses
•
To notify prescriber if rash occurs, discontinue product
•
To notify prescriber if pregnancy is planned or suspected pregnancy (C), do not breastfeed
•
To frequently rinse mouth; use sugarless candy, gum for dry mouth
•
To contact prescriber if taking theophylline
