Mosby's 2014 Nursing Drug Reference (138 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(do-la′se-tron)
Anzemet
Func. class.:
Antiemetic
Chem. class.:
5-HT3 receptor antagonist
Prevents nausea, vomiting by blocking serotonin peripherally, centrally, and in the small intestine
Prevention of nausea, vomiting associated with cancer chemotherapy, radiotherapy; prevention of postoperative nausea, vomiting
Unlabeled uses:
Radiotherapy-induced nausea/vomiting
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, hypokalemia, electrolyte imbalances; granisetron/ondansetron/palonosetron hypersensitivity, QT prolongation
Calculator
•
Adult: PO
100 mg 1 hr before chemotherapy
• Child 2-16 yr: PO
1.8 mg/kg before chemotherapy; max 100 mg
•
Adult: IV
12.5 mg as single dose 15 min before cessation of anesthesia;
PO
100 mg 2 hr before surgery (prevention only)
• Child 2-16 yr: IV
0.35 mg/kg as single dose 15 min before cessation of anesthesia;
PO
1.2 mg/kg 2 hr before surgery (prevention only)
Available forms:
Tabs 50, 100 mg; inj 20 mg/ml (12.5 mg/0.625 ml)
•
Do not mix product for oral administration in apple or apple-grape juice until immediately before administration; diluted product can be kept for 2 hr at room temp
•
By inj 100 mg/30 sec or more or diluted in 50 ml compatible sol; give over 15 min
•
Do not admix
CNS:
Headache
, dizziness, fatigue, drowsiness
CV:
Dysrhythmias,
ECG changes, hypo/hypertension, tachycardia, bradycardia;
ventricular tachycardia/fibrillation, QT prolongation, torsades de pointes, cardiac arrest (IV)
GI:
Diarrhea
, constipation, increased AST/ALT, abdominal pain, anorexia
GU:
Urinary retention, oliguria
MISC:
Rash,
bronchospasm
Well absorbed, metabolized to active metabolite, half-life of active metabolite 8 hr, max concentrations after 1 hr
•
QT Prolongation:
QRS, PR prolongation; do not use in those with congenital long QT syndrome, hypokalemia, hypomagnesemia, complete heart block (unless a pacemaker is in place), correct electrolytes before use, monitor ECG in elderly patients, renal cardiac disease
Increase:
dysrhythmias—antidysrhythmics
Increase:
dolasetron levels—cimetidine
Increase:
QT prolongation—thiazide/loop diuretics, antidysrhythmics—class IA, III, arsenic trioxide, chloroquine, clarithromycin, droperidol, erythromycin, halofantrine, haloperidol, levomethadyl, methadone, pentamidine, some phenothiazines, ziprasidone; occurs at higher dose of dolasetron
Decrease:
dolasetron levels—rifampin
•
For absence of nausea, vomiting during chemotherapy
•
Hypersensitivity reaction:
rash, bronchospasm
•
Cardiac conduction conditions, electrolyte imbalances, dysrhythmias, heart rate
•
Storage at room temp 48 hr after dilution
•
Therapeutic response: absence of nausea, vomiting during cancer chemotherapy
•
To report diarrhea, constipation, nausea, vomiting, rash, or changes in respirations
•
May cause headache; use analgesic
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(don-ep-ee′zill)
Aricept, Aricept ODT
Func. class.:
Anti-Alzheimer’s agent
Chem. class.:
Reversible cholinesterase inhibitor
Elevates acetylcholine concentrations (cerebral cortex) by slowing degradation of acetylcholine released in cholinergic neurons; does not alter underlying dementia
Mild to severe dementia with Alzheimer’s disease
Unlabeled uses:
Subcortical, vascular dementia; dementia with Lewy bodies
Hypersensitivity to this product or piperidine derivatives
Precautions:
Pregnancy (C), breastfeeding, children, sick sinus syndrome, history of ulcers, GI bleeding, hepatic disease, bladder obstruction, asthma, seizures, COPD, abrupt discontinuation, AV block, GI obstruction, Parkinson’s disease, surgery
Calculator
•
Adult: PO
5 mg/day at bedtime; may increase to 10 mg/day after 4-6 wk, may increase to 23 mg/day after 3 mo of 10 mg/day
Available forms:
Tabs 5, 10, 23 mg; orally disintegrating tabs (Aricept ODT) 5, 10 mg
•
Daily in the evening before bedtime; swallow whole; do not cut, break, chew, or crush tab
•
Dosage adjusted to response no more than q4-6wk; oral dosage forms are interchangeable
•
Orally disintegrating tabs:
allow to dissolve on tongue before swallowing; may be given with/without water
CNS:
Dizziness,
insomnia
, somnolence,
headache
, fatigue, abnormal dreams, syncope,
seizures,
drowsiness, agitation, depression, confusion, fever, hallucinations
CV:
Atrial fibrillation,
hypo/hypertension,
sinus bradycardia, AV block
GI:
Nausea, vomiting
, anorexia,
diarrhea
, abdominal pain,
GI bleeding,
weight loss
GU:
Urinary frequency, UTI, incontinence
INTEG:
Rash, flushing, diaphoresis, bruising
META:
Hyperlipidemia
MS:
Cramps, arthritis, arthralgia
RESP:
Rhinitis, URI, cough, pharyngitis, dyspnea
Well absorbed PO; metabolized by CYP2D6, CYP3A4; elimination half-life 10 hr single dose, 70 hr multiple doses; protein binding 96%
Increase:
donepezil effects—CYP2D6, CYP3A4 inhibitors
Increase:
synergistic effect—succinylcholine, cholinesterase inhibitors, cholinergic agonists
Increase:
gastric acid secretions—NSAIDs
Decrease:
donepezil effects—CYP2D6, CYP3A4 inducers
Decrease:
action of anticholinergics
Decrease:
donepezil effect—carBAMazepine, dexamethasone, phenytoin, PHENobarbital, rifampin
Decrease:
donepezil—St. John’s wort
•
B/P: hypo/hypertension, heart rate
•
Mental status: affect, mood, behavioral changes, depression, complete suicide assessment; neurologic status
•
GI status: nausea, vomiting, anorexia, diarrhea; monitor weight
•
GU status: urinary frequency, incontinence, I&O
•
Assistance with ambulation during beginning therapy; dizziness, ataxia may occur
•
Therapeutic response: decrease in confusion, improved mood
•
To report side effects: twitching, nausea, vomiting, sweating, dizziness; indicates cholinergic crisis or overdose
•
To use product exactly as prescribed
•
To notify prescriber of nausea, vomiting, diarrhea (dose increase or beginning treatment), or rash
•
Not to increase or abruptly decrease dose; serious consequences may result
•
That product is not a cure, relieves symptoms
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert