Mosby's 2014 Nursing Drug Reference (133 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
, Rx)
(dye-men-hye′dri-nate)
Apo-Dimenhydrinate
, Dramamine, Driminate, Gravol
TripTone, Wal-Dram
Func. class.:
Antiemetic, anti-histamine, anticholinergic
Chem. class.:
H
1
-receptor antagonist, ethanolamine derivative
Do not confuse:
dimenhyDRINATE
/diphenhydrAMINE
Competes with histamine for H
1
receptors in GI tract, blood vessels,
respiratory tract; central anticholinergic activity, which results in decreased vestibular stimulation and blockade of chemoreceptor trigger zone
Motion sickness, nausea, vomiting, vertigo
Unlabeled uses:
Hyperemesis gravidarum, Ménière’s syndrome
Hypersensitivity, infants, neonates, tartrazine dye hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, cardiac dysrhythmias, asthma, prostatic hypertrophy, bladder-neck obstruction, closed-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction
Calculator
•
Adult: PO
50-100 mg q4hr;
IM/IV
50 mg q4hr as needed (Canada only)
• Child 6-12 yr: PO
25-50 mg q6-8hr prn, max 150 mg/day
• Child 2-5 yr: PO
12.5-25 mg q6-8hr, max 75 mg/day
Available forms:
Tabs 50 mg; inj 50 mg/ml; elixir 15 mg/5 ml; chew tabs 50 mg
•
IM inj in large muscle mass; aspirate to avoid IV administration (Canada only)
•
Tablets may be swallowed whole, chewed, or allowed to dissolve
•
After diluting 50 mg/10 ml of NaCl inj, give ≤50 mg over 2 min
CNS:
Drowsiness
, restlessness, headache, dizziness, insomnia, confusion, nervousness, tingling, vertigo
CV:
Hypertension,
hypotension
, palpitation
EENT:
Dry mouth
, blurred vision, diplopia, nasal congestion, photosensitivity, xerostomia
GI:
Nausea, anorexia, vomiting,
constipation
INTEG:
Rash, urticaria, fever, chills, flushing
MISC:
Anaphylaxis
PO/IM:
Onset 15-30 min, duration 4-6 hr
Increase:
effect—alcohol, anticholinergic, tricyclics, MAOIs, opiates, sedative/hypnotics, other CNS depressants
False negative:
allergy skin testing
•
VS, B/P; check patients with cardiac disease more often
•
Signs of toxicity
of other products or masking of symptoms of disease: brain tumor, intestinal obstruction
•
Observe for drowsiness, dizziness
•
Therapeutic response: absence of nausea, vomiting, or vertigo
•
To avoid hazardous activities, activities requiring alertness because dizziness may occur; to request assistance with ambulation
•
To avoid alcohol, other CNS depressants
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(dye-noe-prost′one)
Cervidil, Prepidil, Prostin E-2
Func. class.:
Oxytocic, abortifacient
Chem. class.:
Prostaglandin E
2
Do not confuse:
Prepidil
/bepridil
Stimulates uterine contractions, causing abortion; acts within 30 hr for complete abortion
Abortion during 2nd trimester, benign hydatidiform mole, expulsion of
uterine contents in fetal deaths to 28 wk, missed abortion, to efface and dilate the cervix in pregnancy at term
Hypersensitivity, C-section, surgery, fetal distress, multiparity, vaginal bleeding, cephalopelvic disproportion
Precautions:
Pregnancy (C), cardiac/renal/hepatic disease, asthma, anemia, jaundice, diabetes mellitus, seizure disorders, hypertension, glaucoma, uterine fibrosis, cervical stenosis, pelvic surgery, pelvic inflammatory disease, respiratory disease
Black Box Warning:
Requires a specialized setting and an experienced clinician
Calculator
•
Adult: VAG SUPP
20 mg, repeat q3-5hr until abortion occurs, max dose is 240 mg
•
Adult: GEL
0.5 mg vag gel placed in cervical canal, may repeat after 6 hr, max 1.5 mg/24 hr; vag insert 10 mg high in vagina, remove at onset of active labor or within 12 hr
Available forms:
VAG SUPP 20 mg; gel 0.5 mg/3 g (prefilled syringe); vag insert 10 mg
•
By gel:
after warming to room temp, remove seal from end of syringe, remove protective end cap and insert into plunger stopper assembly; make sure patient is in dorsal position;
insert:
must be kept frozen until use
•
Antiemetic/antidiarrheal before administration of this product
CNS:
Headache
, dizziness, chills, fever, flushing
CV:
Hypotension,
dysrhythmias, DIC
EENT:
Blurred vision
SYST:
Anaphylactoid syndrome of pregnancy
FETAL:
Bradycardia (i.e., deceleration)
GI:
Nausea, vomiting, diarrhea
GU:
Vaginitis, vaginal pain, vulvitis, vaginismus
INTEG:
Rash, skin color changes
MS:
Leg cramps, joint swelling
, weakness
GEL:
Uterine contractile abnormality, GI side effects, back pain, fever
INSERT:
Uterine hyperstimulation, fever, nausea, vomiting, diarrhea, abdominal pain
SUPPOSITORY:
Uterine rupture, anaphylaxis
Increase:
effect—other oxytocics
Decrease:
oxytocic effect—alcohol
Metabolized in spleen, kidney, lungs; excreted in urine
GEL:
Onset 10 min, peak 30-45 min
SUPP:
Onset 10 min, duration 2-3 hr
Black Box Warning:
Specialized setting, specialized clinician: use only with emergency equipment nearby, by a clinician experienced when used in pregnancy termination; complete abortion should result within 17 hr
•
Cervical ripening:
dilation, effacement of cervix and uterine contraction, fetal heart tones, check for contractions over 1 min
•
For fever that occurs 1/2 hr after suppository insertion (abortion)
•
Respiratory rate, rhythm, depth; notify prescriber of abnormalities, pulse, B/P, temp
•
Vaginal discharge:
check for itching, irritation; indicates vaginal infection
•
Therapeutic response: expulsion of fetus
•
To remain supine for 10-15 min after
insertion of supp, 2 hr after insert, 15-30 min after gel
•
To report excessive cramping, bleeding, chills, fever
•
About some methods of pain, comfort control
•
To avoid intercourse, tub baths, douches, tampon use for at least 2 wk