Mosby's 2014 Nursing Drug Reference (125 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ophthalmic)
(dex-a-meth′a-sone)
Maxidex
Func. class.:
Ophthalmic antiinflammatory
Chem. class.:
Corticosteroid
Do not confuse:
dexamethasone
/desoximetasone
Exact mechanism of antiinflammatory action unknown; inhibits multiple inflammatory cytokines; decreases inflammation, collagen deposits, capillary dilation, edema
Treatment of corticosteroid-responsive ophthalmic disorders
Hypersensitivity to this product or sulfites, ocular TB, acute herpes simplex (superficial), fungal/viral infections of the eye, posterior lens capsule rupture
Precautions:
Corneal infected abrasions, glaucoma, pregnancy (C), breastfeeding, migration of intravitreal implant risk, children
Calculator
•
Adult:
Instill 1 or 2 drops of 0.1% ophthalmic sol or susp every hour during the day and every 2 hr at night; reduce application to every 4 hr after response occurs
Available forms:
Ophthalmic solution, suspension 0.1%
•
For ophthalmic use only
•
Instruct patient on proper instillation of eye ointment or solution. Do not touch the tip of the dropper to the eye, fingertips, or other surface, wait ≥15 min before inserting soft contact lens
EENT:
Burning, stinging, poor vision, corneal ulcerations, increased IOP, optic nerve damage
•
Corneal effects:
ulcerations, infections can worsen with this product
•
Decreased corneal inflammation
•
How to use products
•
Not to share with others or use for other conditions
•
To notify prescriber immediately if vision changes or if condition worsens
•
To take as prescribed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(dex-lan-so-prey′zole)
Dexilant
Func. class.:
Antiulcer, proton-pump inhibitor
Chem. class.:
Benzimidazole
Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump in
hibitor because it blocks final step of acid production
Gastroesophageal reflux disease (GERD), severe erosive esophagitis, heartburn
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, proton-pump hypersensitivity, gastric cancer, hepatic disease, vit B
12
deficiency
Calculator
•
Adult: PO
60 mg daily for up to 8 wk; maintenance:
PO
30 mg daily for up to 6 mo
•
Adult: PO
30 mg daily × 4 wk
•
Adult: PO
(Child-Pugh B): max 30 mg/day
Available forms:
Del rel caps 30, 60 mg
•
Swallow caps whole; do not crush, chew caps; caps may be opened, contents sprinkled on food, use immediately; do not chew contents of capsule, give without regard to food
CNS:
Headache, dizziness, confusion, agitation, amnesia, depression,
anxiety, seizures,
insomnia, migraine
CV:
Chest pain, angina, bradycardia, palpitations,
CVA
, hypertension,
MI
EENT:
Tinnitus
GI:
Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, colitis, dysgeusia
HEMA:
Anemia,
neutropenia, thrombocytopenia, pernicious anemia, thrombosis
INTEG:
Rash, urticaria, pruritus
META:
Gout
MS:
Arthralgia, mylagia
RESP:
Upper respiratory infections, cough, epistaxis, dyspnea,
pneumonia
SYST:
Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
Absorption 57%-64%; plasma half-life 1-2 hr; protein binding 96.1%-98.8%; extensively metabolized in liver; excreted in urine, feces; clearance decreased in geriatric patients, renal/hepatic impairment; peak dual 1-2 hr, 4-5 hr
Increase:
dexlansoprazole effect—CYP2C19, 3A4 inhibitors (fluvoxamine, voriconazole)
•
Dexlansoprazole absorption: sucralfate
Decrease:
absorption of ketoconazole, itraconazole, iron, delavirdine, ampicillin, calcium carbonate
Increase:
LFTs, bilirubin, creatinine, glucose, lipids
Decrease:
platelets, magnesium
•
GI system: bowel sounds q8hr, abdomen for pain, swelling, anorexia, monitor serum magnesium
•
Hepatotoxicity (rare):
hepatitis, jaundice, monitor hepatic studies (AST, ALT, alk phos) if hepatic adverse reactions occur
•
Hypomagnesemia:
usually 3 mo to 1 yr after beginning therapy; monitor magnesium level, assess for irregular heart beats, muscle spasms; in children, fatigue, upset stomach, dizziness; magnesium supplement may be used
•
Anaphylaxis (rare), serious skin disorders:
require emergency intervention
•
Therapeutic response: absence of epigastric pain, swelling, fullness
•
To report severe diarrhea; product may have to be discontinued
•
That diabetic patient should know that hypoglycemia may occur
•
To avoid hazardous activities; dizziness may occur
•
To avoid alcohol, salicylates, ibuprofen; may cause GI irritation
•
To report allergic reactions, symptoms of low magnesium levels
•
To notify prescriber if pregnancy is planned or suspected, not to breastfeed
•
To swallow cap whole, not to chew, crush
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert