Mosby's 2014 Nursing Drug Reference (116 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(dan′troe-leen)
Dantrium, Revonto
Func. class.:
Skeletal muscle relaxant, direct acting
Chem. class.:
Hydantoin
Do not confuse:
Dantrium
/danazol
Interferes with intracellular release of calcium from the sarcoplasmic reticulum necessary to initiate contraction; slows catabolism in malignant hyperthermia
Spasticity in multiple sclerosis, stroke, spinal cord injury, cerebral palsy, malignant hyperthermia
Unlabeled uses:
Neuroleptic malignant syndrome
Hypersensitivity, compromised pulmonary function, impaired myocardial function
Black Box Warning:
Active hepatic disease
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, peptic ulcer disease, cardiac/renal/hepatic disease, stroke, seizure disorder, diabetes mellitus, ALS, COPD, MS, mannitol/gelatin hypersensitivity, labor, lactase deficiency, extravasation
Black Box Warning:
Females >35 yr, with MS, or taking estrogens
Calculator
•
Adult: PO
25 mg/day; may increase to 25-100 mg bid-qid, max 400 mg/day
• Child: PO
0.5 mg/kg/day given in divided doses bid; dosage may increase gradually, max 400 mg/day
• Adult and child: PO
4-8 mg/kg/day in 3-4 divided doses × 1-2 days prior to procedure, give last dose 4 hr preop;
IV
2.5 mg/kg before anesthesia
• Adult and child: IV
1-2.5 mg/kg, may repeat to total dose of 10 mg/kg;
PO
4-8 mg/kg/day in 4 divided doses × 1-3 days
•
Adult: PO
100-300 mg/day in divided doses;
IV
1.25-1.5 mg/kg
Available forms:
Caps 25, 50, 100 mg; powder for inj 20 mg/vial
•
Avoid use with other CNS depressants
•
Do not crush or chew caps
•
Caps may be opened, mixed with juice and swallowed
•
With meals for GI symptoms
•
IV after diluting 20 mg/60 ml sterile water for inj without bacteriostatic agent (333 mcg/ml); shake until clear; give by rapid IV push through
Y
-tube or 3-way stopcock; follow with prescribed doses immediately; may also give by intermittent inf over 1 hr before anesthesia
•
Considered incompatible in sol or syringe; compatibility unknown
•
Storage in tight container at room temp; protect diluted sol from light, use reconstituted sol within 6 hr
CNS:
Dizziness, weakness, fatigue, drowsiness
, headache, disorientation, insomnia, paresthesias, tremors,
seizures
CV:
Hypotension, chest pain, palpitations
EENT:
Nasal congestion, blurred vision, mydriasis
GI:
Hepatic injury,
nausea
, constipation, vomiting, increased AST, alk phos, abdominal pain, dry mouth, anorexia, hepatitis, dyspepsia
GU:
Urinary frequency, nocturia, impotence, crystalluria,
hepatitis
HEMA:
Eosinophilia, aplastic anemia, leukopenia, thrombocytopenia/lymphoma
INTEG:
Rash, pruritus, photosensitivity, extravasation (tissue necrosis)
RESP:
Pleural effusion,
pulmonary edema
PO:
Peak 5 hr, highly protein bound, half-life 8 hr, metabolized in liver, excreted in urine (metabolites), absorption poor (35%)
Increase:
dysrhythmias—verapamil
Increase:
hepatotoxicity—estrogens, other hepatotoxics
Increase:
CNS depression—alcohol, tricyclics, opiates, barbiturates, sedatives, hypnotics, antihistamines
•
Seizures:
increased seizure activity, ECG in epilepsy patient; poor seizure control has occurred
•
I&O ratio; check for urinary retention, frequency, hesitancy, especially geriatric patients
Black Box Warning:
Active hepatic disease:
hepatic function by frequent determination of AST, ALT, bilirubin, alk phos, GGTP; renal function studies, BUN, creatinine, CBC
•
Allergic reactions:
rash, fever, respiratory distress
•
Severe weakness, numbness in extremities; prescriber should be notified and product discontinued
•
Tolerance: increased need/more frequent requests for medication, increased pain
•
CNS depression: dizziness, drowsiness, insomnia, psychiatric symptoms
Signs of hepatotoxicity:
jaundice, yellow sclera, pain in abdomen, nausea, fever; prescriber should be notified, product discontinued
•
Therapeutic response: decreased pain, spasticity
•
Not to discontinue medication quickly because hallucinations, spasticity, tachycardia will occur; product should be tapered off over 1-2 wk; to notify prescriber of abdominal pain, jaundiced sclera, clay-colored stools, change in color of urine
•
That if improvement does not occur within 6 wk, prescriber may discontinue product
•
To avoid hazardous activities if drowsiness, dizziness occurs
•
To avoid using OTC medications: cough preparations, antihistamines, other CNS depressants, alcohol unless directed by prescriber
•
To use sunscreen or stay out of the sun to prevent burns
Activated charcoal, supportive care
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(dap′toe-mye-sin)
Cubicin
Func. class.:
Antiinfective—miscellaneous
Chem. class.:
Lipopeptides
A new class of antiinfective; it binds to the bacterial membrane and results in a rapid depolarization of the membrane potential, thereby leading to inhibition of DNA, RNA, and protein synthesis
Complicated skin, skin-structure infections caused by
Staphylococcus aureus
including methicillin-resistant strains,
Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae, Enterococcus faecalis
(vancomycin-susceptible strains)
Unlabeled uses:
Bacteremia, endocarditis, UTI, vancomycin-resistant enterococci (VRE),
Corynebacterium jeikeium, Staphylococcus haemolyticus, Enterococcus facium
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, GI/renal disease, myopathy, ulcerative/pseudomembranous colitis, rhabdomyolysis, eosinophilic pneumonia
Calculator
•
Adult: IV INF
4 mg/kg over 1/2 hr diluted in 0.9% NaCl, give q24hr × 7-14 days; some indications may use up to 6 mg/kg
•
Adolescent/child/infant ≥5 mo (unlabeled): IV
4-6 mg/kg/day
•
Adult: IV INF
CCr <30 ml/min, hemodialysis, CAPD 4 mg/kg q48hr
•
Adult: IV
6 mg/kg/day
•
Adult: IV
4 mg/kg/day
Available forms:
Lyophilized powder for inj 500 mg
•
After reconstitution with 5 ml 0.9% NaCl (250 mg/5 ml) or 10 ml 0.9% NaCl (500 mg/10 ml); further dilution is needed with 0.9 NaCl; infuse over 1/2 hr or give reconstituted sol (50 mg/ml) by IV inj over 2 min, do not use dextrose-containing solutions
Y-site compatibilities:
Alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B liposome, ampicillin, ampicillin-sulbactam, argatroban, arsenic trioxide, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, dacarbazine, DACTINomycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPI
NEPHrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, midazolam, milrinone, mitoXANtrone, mivacurium, morphine, moxifloxacin, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, niCARdipine, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, PHENobarbital, phenylephrine, piperacillin-tazobactam, polymyxin B, potassium acetate/chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin-dalfopristin, ranitidine, rocuronium, sodium acetate/bicarbonate/citrate/phosphates, succinylcholine, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trimethobenzamide, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
Solution compatibilities:
0.9% NaCl, LR
CNS:
Headache, insomnia, dizziness, confusion, anxiety, fatigue, fever
CV:
Hypo/hypertension,
heart failure,
chest pain
GI:
Nausea, constipation, diarrhea, vomiting, dyspepsia,
pseudomembranous colitis,
abdominal pain
GU:
Nephrotoxicity
HEMA:
Leukocytosis, anemia, thrombocytopenia
INTEG:
Rash, pruritus
MISC:
Fungal infections, UTI, anemia, hypoglycemia
MS:
Muscle pain or weakness, arthralgia, pain, myopathy
RESP:
Cough,
eosinophilic pneumonia
SYST:
Anaphylaxis
Site of metabolism unknown, protein binding 92%, terminal half-life 8-9 hr, 78% excreted unchanged (urine), breast milk
Increase:
myopathy—HMG-CoA reductase inhibitors
Increase:
CPK, AST, ALT, BUN, creatinine, albumin
Increase/Decrease:
glucose
•
Eosinophilic pneumonia:
dyspnea, fever, cough, shortness of breath; if left untreated, can lead to respiratory failure and death
Nephrotoxicity:
any patient with compromised renal system, toxicity may occur; BUN, creatinine
•
I&O ratio: report hematuria, oliguria, nephrotoxicity may occur
•
Blood studies: CBC, CPK
•
C&S; product may be given as soon as culture taken
•
B/P during administration; hypo/hypertension may occur
•
Signs of infection
•
Allergies before treatment, reaction of each medication
•
Myopathy:
assess for muscle pain, weakness; CPK >10× ULN; symptoms resolve after 3 days and CPK return to normal within 7-10 days after stopping product
•
Pseudomembranous colitis:
assess for diarrhea with mucous, pus, product should be discontinued; if moderate to severe, provide fluids, electrolytes, protein supplements, and an antibacterial
•
Therapeutic response: negative culture
•
About allergies before treatment, reaction to each medication
•
To report sore throat, fever, fatigue; could indicate superinfection; diarrhea; muscle weakness, pain
•
Avoid breastfeeding