Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (137 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
OTC
)
(dok′yoo-sate cal′see-um)
Kao-Tin, Stool Softener DC, Sur-Q-Lax, Walgreen’s Stool Softener
OTC
)
Colace, Correctol, Diocto, Doc-Q-Lace, Docu DOK, Doculace, Enemeez, Equaline Stool Softener, Good Sense Stool Softener, Leader Stool Softener, Phillip’s Stool Softener, Regulex
, Select Brand Docusate Sodium, Selex, Silace, Soflax, Top Care Stool Softener, Walgreen’s Stool Softener
Func. class.:
Laxative, emollient; stool softener
Chem. class.:
Anionic surfactant
Increases water, fat penetration in intestine; allows for easier passage of stool
Prevention of dry, hard stools
Hypersensitivity, obstruction, fecal impaction, nausea/vomiting
Precautions:
Pregnancy (C), breastfeeding
Calculator
•
Adult: PO
50-300 mg/day (sodium) or 240 mg (calcium) prn;
ENEMA
4 ml
• Child >12 yr: ENEMA
2 ml
• Child 6-12 yr: PO
40-150 mg/day (sodium) in divided doses
• Child 3-6 yr: PO
20-60 mg/day (sodium) in divided doses
• Child <3 yr: PO
10-40 mg/day (sodium) in divided doses
Available forms:
Calcium:
240 mg;
sodium:
caps 50, 100, 250 mg; tabs 100 mg; syr 20 mg/5 ml, 50 mg/15 ml, 100
mg/30 ml, 150 mg/15 ml; oral sol 10, 50 mg/ml; enema 283 mg/3.9 cap
•
Swallow tabs whole; do not break, crush, or chew
•
Oral sol: diluted in milk, fruit juice to decrease bitter taste
•
In morning or evening (oral dose)
EENT:
Bitter taste, throat irritation
GI:
Nausea, anorexia, cramps, diarrhea
INTEG:
Rash
Onset 12-72 hr
•
Toxicity:
mineral oil
Increase:
laxative action—flax, senna
•
Cause of constipation;
identify whether fluids, bulk, or exercise missing from lifestyle; constipating products
•
Cramping, rectal bleeding, nausea, vomiting; if these occur, product should be discontinued
•
Storage in cool environment; do not freeze
•
Therapeutic response: decrease in constipation
•
That normal bowel movements do not always occur daily
•
Not to use in presence of abdominal pain, nausea, vomiting
•
To notify prescriber if constipation unrelieved or if symptoms of electrolyte imbalance occur: muscle cramps, pain, weakness, dizziness, excessive thirst
•
That product may take up to 3 days to soften stools
•
To take oral preparations with a full glass of water (unless on fluid restrictions) and to increase fluid intake
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Tikosyn
Func. class.:
Antidysrhythmic (Class III)
Blocks cardiac ion channel carrying the rapid component of delayed potassium current; no effect on sodium channels
Atrial fibrillation, flutter, maintenance of normal sinus rhythm
Children, hypersensitivity, digoxin toxicity, aortic stenosis, pulmonary hypertension, severe renal disease
Black Box Warning:
QT prolongation, torsades de pointes, renal failure
Precautions:
Pregnancy (C), breastfeeding, AV block, bradycardia, electrolyte imbalance
Black Box Warning:
Renal disease, arrhythmias
Calculator
•
Adult: PO
Individualize dosage based on renal function and QTc in a monitored facility. Refer to the step-by-step procedure for determining the initial dosage of dofetilide
•
Adult: PO
Continue dosage at discharge as from initial dosage titration. Individualize dosage based on renal function and QTc, which should be re-evaluated every 3 months or as medically warranted; if the QTc >500 msec (550 msec in patients with ventricular conduc
tion abnormalities) at any time, discontinue; carefully monitor until QTc returns to baseline; if renal function deteriorates, adjust the dosage as described in the dosage guidelines for patients with renal impairment.
•
Adult: PO
Discontinue dofetilide for ≥2 days before starting a potentially interacting drug
•
Adult: PO
CCr >60 ml/min, 500 mcg bid; CCr 40-60 ml/min, 250 mcg bid; CCr 20-39 ml/min, 125 mcg bid; CCr <20 ml/min, do not use
Available forms:
Caps 125, 250, 500 mcg
Black Box Warning:
Step 1: Assess cardiac conduction:
Before first dose, the QTc interval must be determined using an average of 5–10 beats; if the QTc interval is >440 msec (or >500 msec in ventricular conduction abnormalities), do not use. If baseline heart rate is <60 bpm, then the QT interval should be used
Black Box Warning:
Step 2: Assess renal function:
Before first dose, determine renal function using the Cockroft-Gault equation, use actual body weight to calculate creatinine clearance
Black Box Warning:
Step 3: Adjust starting dose according to renal function:
Refer to the “Patients with renal impairment” section (below) to determine the appropriate initial dosage
Black Box Warning:
Step 4: ECG monitoring:
Begin continuous ECG monitoring starting with the first dose
Black Box Warning:
Step 5: Dosage adjustments:
Approximately 2–3 hr after the first dose, determine the QTc interval. If the QTc interval has increased by >15% (compared to baseline), or if the QTc interval is >500 msec (>550 msec in patients with ventricular conduction abnormalities), the initial dosage should be reduced by half as follows:
•
Decrease an initial dose of 500 mcg bid to 250 mcg bid
•
Decrease an initial dose of 250 mcg bid to 125 mcg bid
•
Decrease an initial dose of 125 mcg bid to 125 mcg/day
Black Box Warning:
Step 6: Reassess QTc interval:
Reassess the QTc interval 2–3 hr after each subsequent dose; if the QTc interval lengthens to >500 msec (or >550 msec in patients with ventricular conduction abnormalities),
discontinue
Black Box Warning:
Step 7: ECG monitoring:
Monitor continuous ECG for a minimum of 3 days or for 12 hr after conversion to normal sinus rhythm, whichever is greater
CNS:
Syncope, dizziness
, headache,
stroke
CV:
Hypotension, postural hypotension, bradycardia
, angina, PVCs, substernal pressure, transient hypertension, precipitation of angina,
QT prolongation, torsades de pointes, ventricular dysrhythmias
GI:
Nausea, vomiting
, severe diarrhea, anorexia
MISC:
Angioedema
RESP:
Dyspnea, respiratory infections
Well absorbed, max plasma conc 2-3 hr, steady state 2-3 days, half-life 10 hr, metabolized by liver, excreted by kidneys
•
Do not use with cimetidine, ketoconazole, verapamil, prochlorperazine, trimethoprim-sulfamethoxazole, megestrol, hydrochlorothiazide
Increase:
QT prolongation, torsades de pointes—class IA/III antidysrhythmics, arsenic trioxide, chloroquine, clarithromycin, droperidol, erythromycin, halofantrine, haloperidol, levomethadyl, methadone, pentamidine, some phenothiazines, ziprasidone
Increase:
hypokalemia—potassium-depleting diuretics
Increase:
toxicity—amiloride metFORMIN, entecavir, lamiVUDine, memantine, triamterene, procainamide, trospium
Increase:
dofetilide levels—antiretroviral protease inhibitors
•
Do not use with grapefruit juice
•
AF patients should receive anticoagulation prior to cardioversion
•
Cardiac status: rate, rhythm, character, continuously; B/P
Black Box Warning:
Severe renal impairment CCr <20 ml/min:
do not use for mild to moderate renal disease; monitor BUN/creatinine; adjust dose based on creatinine clearance
•
Place patient in supine position unless otherwise ordered; assist with ambulation
•
Therapeutic response: control of atrial fibrillation
•
To make position changes slowly; orthostatic hypotension may occur
•
To notify prescriber if fast heartbeats with fainting or dizziness occur
•
To notify all prescribers of all medications, supplements taken
•
That if dose is missed, not to double; to take next dose at usual time
•
To avoid breastfeeding