Mosby's 2014 Nursing Drug Reference (147 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(doo-tass′ter-ide)
Avodart
Func. class.:
Androgen inhibitor
Chem. class.:
Synthetic 5α-reductase inhibitor, 4-azasteroid compound
Inhibits both type 1 and type 2 forms of a steroid enzyme that converts testosterone to 5α-dihydrotestosterone (DHT), which is responsible for the initial growth of prostatic tissue
Treatment of benign prostatic hyperplasia (BPH) in men with an enlarged prostate gland; may be used in combination with tamsulosin
Unlabeled uses:
Alopecia
Pregnancy (X), breastfeeding, women, children, hypersensitivity
Precautions:
Hepatic disease
Calculator
•
Adult: PO
0.5 mg/day
•
Adult: PO
0.5-2.5 mg/day
Available form:
Caps 0.5 mg
•
Swallow caps whole; do not break, crush, chew
•
Without regard to meals
GU:
Decreased libido, impotence, gynecomastia, ejaculation disorders (rare), mastalgia,
teratogenesis
INTEG:
Serious skin infections
Peak 2-3 hr, protein binding 99%, metabolized in liver by CYP3A4, excreted in feces, half-life 5 wk at steady state
Increase:
dutasteride concentrations—ritonavir, ketoconazole, verapamil, diltiazem, cimetidine, ciprofloxacin, antiretroviral protease inhibitors, or other products metabolized by CYP3A4
Decrease:
PSA
•
For decreasing symptoms of BPH:
decreasing urinary retention, frequency, urgency, nocturia
•
PSA levels; digital rectal, urinary obstruction; determine the absence of urinary cancer before starting treatment
•
Blood studies: ALT, AST, bilirubin, CBC with differential, serum creatinine, serum electrolytes
•
Therapeutic response: decreasing symptoms of BPH; decreased urinary retention, frequency, urgency, nocturia
•
To read patient information leaflet before starting therapy; to reread it upon prescription renewal
•
To notify prescriber if therapeutic response decreases, if edema occurs
•
Not to discontinue product abruptly
•
About changes in sex characteristics
•
That men taking dutasteride should not donate blood for at least 6 mo after last dose to prevent blood administration to pregnant female
•
That caps should not be handled by a woman who is pregnant or who may become pregnant because product can be absorbed through skin
•
That ejaculate volume may decrease during treatment; that product rarely interferes with sexual function
•
Should not be used or handled by breastfeeding women
•
Swallow whole. Do not crush, chew or open
•
May increase risk for developing high-grade prostate cancer
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ee-kal′an-tide)
Kalbitor
Func. class.:
Hematological agents
Chem. class.:
Kallikrein inhibitor
Selectively, reversibly inhibits kallikrein within the inflammatory pathways, preventing excess production of bradykinin
Acute attacks of hereditary angioedema (≥16 yr)
Hypersensitivity to the drug or its components
Black Box Warning:
Anaphylaxis has occurred after administrations (usually within first hour after dosing). Drug should be administered only by health care provider with medical support available to treat anaphylaxis and hereditary angioedema. Monitor patient closely
Precautions:
Pregnancy (C), breastfeeding, geriatric patients
Calculator
• Adult/adolescent
≥
16 yr:
SUBCUT
30 mg given as three 10-mg injections; give additional 30-mg dose within 24 hours if attack persists
Available forms:
Solution 10 mg/ml
•
Using aseptic technique, withdraw 1 ml (10 mg) using a large bore needle; change the needle on the syringe to a needle suitable for subcut inj (27 gauge recommended)
•
Inject into the skin of the abdomen, thigh, or upper arm
•
Repeat the procedure for each of the three vials (30 mg total dose); the injection site for each of the three injections may be in the same or different anatomic location (abdomen, thigh, or upper arm); there is no need for site rotation; individual injections should be separated by at least 2 inches and away from the anatomical site of attack
•
The same directions for administration apply if an additional dose is required within 24 hr; different injection sites or the same anatomical location as used for the first dose may be used
•
Visually inspect parenteral products for particulate matter and discoloration prior to administration
CNS:
Fatigue, fever, headache
EENT:
Nasopharyngitis
GI:
Abdominal pain, diarrhea, nausea, vomiting
INTEG:
Injection-site reactions, pruritus, rash, urticaria
RESP:
Upper respiratory tract infection
Black Box Warning:
Assess: anaphylaxis; usually within first hr after dosing
•
To immediately report wheezing, cough, chest tightness, trouble breathing, dizziness, fainting, throat tightness, itchiness, hives, and swelling of tongue or throat.
•
Inform patient that drug must be given by health care provider in a health care setting in case serious allergic reaction occurs
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ee-koe′na-zole)
Func. class.:
Topical antifungal
Chem. class.:
Imidazole derivative
Antifungal activity results from inhibiting cell wall permeability
Tinea corporis, cruris, pedis, versicolor; cutaneous candidiasis
Hypersensitivity
Calculator
• Adult/child:
TOP
Rub into affected areas daily × 2 wk, or × 4 wk (pedis)
• Adult/child:
Rub into affected areas bid
Available forms:
Topical cream 1%
•
Do not use products near the eyes, nose, or mouth
•
Wash hands before and after use. Wash affected area and gently pat dry
•
Cream:
Apply to the cleansed affected area. Massage gently into affected areas
INTEG:
Burning, rash, pruritus
Unknown
•
Allergic reaction
: Assess for hypersensitivity, product might need to be discontinued
•
Infection
: Assess for itching, peeling
•
Decreased itching, peeling
•
That product is for external use only; do not use skin products near the eyes, nose, or mouth
•
To wash hands before and after use; to wash affected area and gently pat dry
•
Cream:
To apply a thin film to the cleansed affected area; massage gently into affected areas
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert