Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (107 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(kon-ih-vap′tan)
Vaprisol
Func. class.:
Vasopressin receptor antagonist
Dual arginine vasopressin (AVP) antagonist with affinity for V
1A
, V
2
receptors; level of AVP in circulating blood is critical for regulation of water, electrolyte balance and is usually elevated in euvolemic/hypervolemic hyponatremia
Euvolemia hyponatremia in hospitalized patients; not indicated for CHF, hypervolemic hyponatremia
Hypersensitivity, hypovolemia
Precautions:
Pregnancy (C), breastfeeding, orthostatic disease, renal disease, heart failure, rapid correction of serum sodium
Calculator
• Adult:
IV INF
loading dose 20 mg given over 30 min then
CONT IV
over 24 hr; after 1 day, give for an additional 1-3 days as a
CONT INF
of 20 mg/day total; can be titrated up to 40 mg/day if serum sodium is not rising at desired rate; max time 4 days
• Adult:
IV Child-Pugh A-C or CCr 30-60 ml/min:
give IV loading dose over 10 min then
CONT IV INF
10 mg over 24 hr × 2-4 days
Available forms:
5 mg/ml (20 mg/4 ml) in single-use ampule; 20 mg/100 ml in D
5
for inj
•
Withdraw 4 ml (20 mg), add to 100 ml D
5
W, gently invert several times to mix, give over 30 min; in large vein, change site every 24 hr to minimize vascular irritation
•
Withdraw 4 ml (20 mg), add to 250 ml D
5
W, gently invert several times to mix, give over 24 hr; or give 40 mg in 250 ml D
5
W, gently invert several times to mix, give over 24 hr
CNS:
Headache, confusion, insomnia
CV:
Atrial fibrillation,
hypo/hypertension,
orthostatic hypotension
, phlebitis
GI:
Nausea, vomiting, constipation, dry mouth
GU:
Hematuria, polyuria, UTI, pollakiuria
HEMA:
Anemia
INTEG:
Erythemia, inj site reaction
META:
Dehydration, hypo/hyperglycemia, hypokalemia, hypomagnesia, hyponatremia
MISC:
Oral candidiasis, pain, peripheral edema, pneumonia
Protein binding 99%, metabolized by CYP3A4, terminal half-life 5 hr
Increase:
effect of—CYP3A4 substrates (alfuzosin, ARIPiprazole, bexarolene, bortezomib, bosentan, bupivacaine, buprenorphine, carBAMazepine, cevimeline, cilostazol, cinacalcet, clopidogrel, colchicine, cyclobenzaprine, dapsone, darifenacin, disopyramide, DOCEtaxel, donepezil, DOXOrubicin, dutasteride, eletriptan, eplerenone, ergots, erlotinib, eszopiclone, ethinyl estradiol, ethosuximide, etoposide, fentaNYL, galantamine, gefitinib, halofantrine, ifosfamide, irinotecan, levobupivacaine, levomethadyl, lidocaine, loperimide, loratadine, mefloquine, methadone, modafinil, PACLitaxel, paricalcitrol, pimozide, praziquantel, quiNIDine, quiNINE, ramelteon, reboxetine, repaglinide, rifabutin, sibutramine, sildenafil, sirolimus, SUFentanil, sunitinib, tacrolimus, tamoxifen, teniposide, testosterone, tiagabine, tinidazole, trimetrexate, vardenafil, vinca alkaloids, ziprasidone, zolpidem, zonisamide); do not use concurrently
•
Renal, hepatic function
•
Frequent sodium volume status; overly rapid correction of sodium concentration (>12 mEq/L per 24 hr) may result in osmotic demyelination syndrome
•
Neurologic status: confusion, headache
•
CV status: atrial fibrillation, hypo/hypertension, orthostatic hypotension; monitor B/P, pulse
•
Monitor other electrolytes (magnesium and potassium)
•
Therapeutic response: correction of serum sodium levels
•
To report neurologic changes: headache, insomnia, confusion
•
About administration procedure and expected results
•
To report inj site pain, redness, swelling
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HORMONAL
desogestrel (Rx)
Apri, Cesia, Desogen, Kariva, Mircette, Ortho-Cept, Reclipsen, Solia, Velivet
drospirenone (Rx)
Yasmin, Yaz 28, Ocella
ethynodiol (Rx)
Kelnor 1/35, Zovia 1/35, Zovia 1/50
levonorgestrel (Rx)
Alesse, Aviane-28, Enpresse, Jolessa, Lessina, Levlen, Levlite, Levora, Lutera, Nordette, Portia, Quasense, Seasonique, Sronyx
norethindrone (Rx)
Brevicon, Genora 1/35, Junel 21 1/20, Junel 21 1.5/20, Loestrin 21 1.5/30, Loestrin 21 1/20, Microgestin, Modicon, N.E.E 1/35, Necon 0.5/35, Norcept-E 1/35, Norinyl 1+35, Nortrel 1/35, Nortrel 7/7/7
norgestimate (Rx)
MonoNessa, Ortho-Cyclen, Previfem, Sprintec, Tri-Sprintec
norgestrel (Rx)
Cryselle, Lo/Ovral, Low-Ogestrel, Ogestrel, Ovral
norethindrone (Rx)
Norinyl 1+50
norethindrone (Rx)
Ortho-Novum 10/11
desogestrel (Rx)
Cyclessa
norethindrone (Rx)
Nortrel 7/7/7, Ortho-Novum 7/7/7, Tri-Norinyl
norgestimate (Rx)
Ortho Tri-Cyclen, Ortho Tri-Cyclen Lo
levonorgestrel (Rx)
Enpresse, Tri-Levlen, Triphasil
levonorgestrel (Rx)
Seasonale
Errin, Ortho Micronor, Camila, Jolivette, Nor-Q D
norethindrone acetate (Rx)
Estrostep, Estrostep Fe
estradiol (Rx)
Preven
Plan B
Depo-Provera
Mirena
Implanon
etonogestrel (Rx)
Nuva Ring
norelgestromin (Rx)
Ortho Evra
Prevents ovulation by suppressing FSH and LH;
monophasic:
estrogen/progestin (fixed dose) used during a 21-day cycle; ovulation is inhibited by suppression of FSH and LH; thickness of cervical mucus and endometrial lining prevents pregnancy;
biphasic:
ovulation is inhibited by suppression of FSH and LH; alteration of cervical mucus,
endometrial lining prevents pregnancy;
triphasic:
ovulation is inhibited by suppression of FSH and LH; change of cervical mucus, endometrial lining prevents pregnancy; variable doses of estrogen/progestin combinations may be similar to natural hormonal fluctuations;
extended cycle:
estrogen/progestin continuous for 84 days, off for 7 days, results in 4 menstrual periods/yr;
progressive estrogen:
constant progestin with 3 progressive doses of estrogen;
progestin-only pill, implant, intrauterine:
change of cervical mucus and endometrial lining prevents pregnancy; ovulation may be suppressed
To prevent pregnancy, regulation of menstrual cycle, treatment of acne in women >14 yr for whom other treatment has failed, emergency contraception;
injection:
inhibits gonadotropin secretion, ovulation, follicular maturation;
emergency:
inhibits ovulation and fertilization, decreases transport of sperm and egg from fallopian tube to uterus;
vaginal ring, transdermal:
inhibits ovulation, prevents sperm entry into uterus;
antiacne:
may decrease sex hormone binding globulin, results in decreased testosterone
Pregnancy (X), breastfeeding, women ≥40 yr, reproductive cancer, thrombophlebitis, MI, hepatic tumors, hepatic disease, CAD, CVA, breast cancer, jaundice, stroke, vaginal bleeding
Precautions:
Depression, hypertension, renal disease, seizure disorders, lupus erythematosus, rheumatic disease, migraine headache, amenorrhea, irregular menses, gallbladder disease, diabetes mellitus, heavy smoking, acute mononucleosis, sickle cell disease
Black Box Warning:
Tobacco smoking
Calculator
• Adult:
PO
Take first tab on Sunday after start of menses × 21 days; skip 7 days, then repeat cycle; start on 1st day of menses × 21 days; skip 7 days, then repeat cycle; may contain 7 placebo tabs when 1 tab is taken daily
• Adult:
PO
Take 10 days of small progestin, then large progestin; estrogen is the same during cycle; skip 7 days, then repeat cycle; may contain 7 placebo tabs when 1 tab is taken daily
• Adult:
PO
Estrogen dose remains constant, progestin changes throughout 21-day cycle, some products contain 28 tabs per month
• Adult:
PO
Start taking on 1st day of menses; continue for 84 days of active tab, then 7 days of placebo; repeat cycle
• Adult:
PO
Start on 1st day of menses, then daily and continuously
• Adult:
PO
Progestin dose remains constant, estrogen increases q7days throughout 21-day cycle, may include 7 placebo tabs for 28-day cycle
• Adult/adolescent:
Give within 72 hr of intercourse, repeat 12 hr later;
Plan B
1 tab, then 1 tab 12 hr later;
Preven
2 tab, then 2 tab 12 hr later;
Ovral (unlabeled)
2 white tabs;
Lo/Ovral (unlabeled)
4 white tabs;
Levlen (unlabeled), Nordette (unlabeled)
4 orange tabs;
Triphasil (unlabeled), Tri-Levlen (unlabeled)
4 yellow tabs
• Adult:
IM (Depo-Provera)
150 mg within 5 days of start of menses or within 5 days postpartum (must not be breastfeeding); if breastfeeding, give 6 wk postpartum, repeat q3mo
• Adult:
To be inserted using the levonorgestrel-releasing intrauterine system
(LRIS) by those trained in procedure; inserted into uterine cavity within 7 days of the onset of menstruation; use should not exceed 5 yr per implant
• Adult:
VAG
Insert 1 ring on or prior to day 5 of cycle, leave in place 3 wk; remove for 1 wk, then repeat
• Adult:
TD
Apply patch within 7 days of menses, change weekly × 3 wk; no patch wk 4, repeat cycle
• Adult:
SUBDERMAL
In inner side of upper arm on days 1-5 of menses, replace q3yr
• Adult:
PO (Ortho Tri-Cyclen)
Take daily × 21 days, off 7 days
•
PO with food for GI symptoms; give at same time each day
•
Subdermal implant of 6 caps effective for 5 yr, then should be removed
•
IM inj deep in large muscle mass after shaking suspension; ensure patient not pregnant if inj are 2 wk or more apart
CNS:
Depression, fatigue, dizziness, nervousness, anxiety, headache
CV:
Increased B/P,
cerebral hemorrhage, thrombosis, pulmonary embolism,
fluid retention, edema, MI
EENT:
Optic neuritis, retinal thrombosis, cataracts
ENDO:
Decreased glucose tolerance, increased TBG, PBI, T
4
, T
3
, temporary infertility
GI:
Nausea
, vomiting, cramps, diarrhea, bloating, constipation, change in appetite,
cholestatic jaundice,
weight change
GU:
Breakthrough bleeding, amenorrhea, spotting, dysmenorrhea, galactorrhea, endocervical hyperplasia, vaginitis, cystitis-like syndrome, breast changes
HEMA:
Increased fibrinogen, clotting factor
INTEG:
Chloasma, melasma
, acne, rash, urticaria, erythema, pruritus, hirsutism, alopecia, photosensitivity
Excreted in breast milk
Decrease:
oral contraceptives effectiveness—anticonvulsants, rifampin, analgesics, antibiotics, antihistamines, griseofulvin
Decrease:
oral anticoagulants action
•
Altered action: black cohosh
Decrease:
oral contraceptives effect—saw palmetto, St. John’s wort
Increase:
peak level—grapefruit juice
Increase:
PT; clotting factors VII, VIII, IX, X; TBG, PBI, T
4
, platelet aggregability, BSP, triglycerides, bilirubin, AST, ALT
Decrease:
T
3
, antithrombin III, folate, metyrapone test, GTT, 17-OHCS
•
Glucose, thyroid function, LFTs, BP
•
Reproductive changes: changes in breasts, tumors; positive Pap smear; product should be discontinued
•
Therapeutic response: absence of pregnancy, endometriosis, hypermenorrhea
•
About detection of clots using Homan’s sign
•
To use sunscreen or avoid sunlight; photosensitivity can occur
•
To take at same time each day to ensure equal product level
•
To report GI symptoms that occur after 4 mo
•
To use another birth control method during 1st week of oral contraceptive use
•
To take another tablet as soon as possible if one is missed
•
That, after product is discontinued, pregnancy may not occur for several months
•
To report abdominal pain, change in vision, shortness of breath, change in menstrual flow, spotting, breakthrough bleeding, breast lumps, swelling, headache, severe leg pain
•
That continuing medical care is needed: Pap smear and gynecologic examinations q6mo
•
To notify health care providers and dentists of oral contraceptive use
Black Box Warning:
Do not smoke, increased risk of CV side effects