Mosby's 2014 Nursing Drug Reference (187 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(foss-kar′net)
Foscavir
Func. class.:
Antiviral
Chem. class.:
Inorganic pyrophosphate organic analog
Antiviral activity is produced by selective inhibition at the pyrophosphate binding site on virus-specific DNA polymerases and reverse transcriptases at concentrations that do not affect cellular DNA polymerases
Treatment of CMV retinitis, HSV infections; used with ganciclovir for relapsing patients
Hypersensitivity, CCr <0.4 ml/min/kg
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, seizure disorders, severe anemia
Black Box Warning:
Renal disease, electrolyte/mineral imbalances
Calculator
• Adult/adolescent (unlabeled):
IV
40 mg/kg every 8–12 hr × 2–3 wk or until lesions are healed
• Adult/adolescent:
IV
90 mg/kg every 12 hr or 60 mg/kg every 8 hr × 3 wk (or until symptomatic improvement) with ganciclovir 5 mg/kg IV every 12 hr × 2–3 wk
• Adult:
IV
60 mg/kg every 8 hr or 90 mg/kg every 12 hr alone or in combination with ganciclovir 5 mg/kg IV every 12 hr
• Adult:
IV
Induction with 90 mg/kg every 12 hr or 60 mg/kg IV every 8 hr × 14–21 days, depending upon the clinical response
•
HSV induction dosage equivalent to 80 mg/kg/day (40 mg/kg IV every 12 hr)
• Adult:
IV
CCr >1.4 ml/min/kg: No change; CCr > 1–1.4 ml/min/kg: Decrease to 30 mg/kg every 12 hr; CCr >0.8–1 ml/min/kg: Decrease to 20 mg/kg every 12 hr; CCr >0.6–0.8 ml/min/kg: Decrease to 35 mg/kg every 24 hr; CCr >0.5–0.6 ml/min/kg: Decrease to 25 mg/kg every 24 hr; CCr ≥0.4–0.5 ml/min/kg: Decrease to 20 mg/kg every 24 hr; CCr <0.4 ml/min/kg: Not recommended
• Adult:
IV
CCr >1.4 ml/min/kg: No change; CCr >1–1.4 ml/min/kg: Decrease to 30 mg/kg every 8 hr; CCr >0.8–1 ml/min/kg: Decrease to 35 mg/kg every 12 hr; CCr >0.6–0.8 ml/min/kg: Decrease to 25 mg/kg every 12 hr; CCr 0.5–0.6 ml/min/kg: Decrease to 40 mg/kg every 24 hr; CCr ≥0.4–0.5 ml/min/kg: Decrease to 35 mg/kg every 24 hr; CCr <0.4 ml/min/kg: Not recommended
• Adult:
IV
CCr >1.4 ml/min/kg: No change; CCr >1–1.4 ml/min/kg: Decrease to 45 mg/kg every 8 hr; CCr
>0.8–1 ml/min/kg: Decrease to 50 mg/kg every 12 hr; CCr >0.6–0.8 ml/min/kg: Decrease to 40 mg/kg every 12 hr; CCr >0.5–0.6 ml/min/kg: Decrease to 60 mg/kg every 24 hr; CCr ≥0.4–0.5 ml/min/kg: Decrease to 50 mg/kg every 24 hr; CCr <0.4 ml/min/kg: Not recommended
• Adult:
IV
CCr >1.4 ml/min/kg: No change; CCr >1–1.4 ml/min/kg: Decrease to 70 mg/kg every 12 hr; CCr >0.8–1 ml/min/kg: Decrease to 50 mg/kg every 12 hr; CCr >0.6–0.8 ml/min/kg: Decrease to 80 mg/kg every 24 hr; CCr >0.5–0.6 ml/min/kg: Decrease to 60 mg/kg every 24 hr; CCr ≥0.4–0.5 ml/min/kg: Decrease to 50 mg/kg every 24 hr; CCr <0.4 ml/min/kg: Not recommended
Available forms:
Inj 6000 mg/250 ml, 12,000 mg/500 ml (24 mg/ml)
•
Increased fluids before and during product administration to induce diuresis, minimize renal toxicity
•
Using inf device at no more than 1 mg/kg/min; do not give by rapid or bolus IV; give by CVP or peripheral vein; standard 24 mg/ml sol may be used without dilution if using by CVP; dilute the 24 mg/ml sol to 12 mg/ml with D
5
W or NS if using peripheral vein
•
Manufacturer recommends product not be given with other medications in syringe or admixed
CNS:
Fever
, dizziness,
headache
,
seizures,
fatigue
, neuropathy, asthenia, encephalopathy, malaise, meningitis,
paresthesia
, depression,
confusion
,
anxiety
CV:
ECG abnormalities, 1st-degree AV block, nonspecific ST-T segment changes, cerebrovascular disorder,
cardiomyopathy, cardiac arrest, atrial fibrillation, CHF, sinus tachycardia
GI:
Nausea
,
vomiting, diarrhea, anorexia
, abdominal pain,
pancreatitis
GU:
Acute renal failure,
decreased CCr, increased serum creatinine, azotemia, diabetes insipidus,
renal tubular disorders
HEMA:
Anemia
,
granulocytopenia, leukopenia, thrombocytopenia, thrombosis,
neutropenia, lymphadenopathy
INTEG:
Rash
, sweating, pruritus, skin discoloration
RESP:
Coughing
,
dyspnea
, pneumonia,
pulmonary infiltration, pneumothorax, hemoptysis
SYST:
Hypokalemia
,
hypocalcemia
,
hypomagnesemia
; hypophosphatemia
14%-17% protein bound, half-life 18-88 hr in normal renal function, 79%-92% excreted via kidneys
Black Box Warning:
Increase:
nephrotoxicity—acyclovir, cidofovir, CISplatin, gold compounds, penicillamine, tacrolimus, tenofovir, vancomycin, aminoglycosides, amphotericin B, NSAIDs, lithium, cycloSPORINE
Increase:
hypocalcemia—pentamidine
Black Box Warning:
Renal tubular disorders:
I&O ratio, urine pH, serum creatinine at baseline, 3×/wk during initial therapy then 2×/wk thereafter; CCr at baseline, throughout treatment; if CCr <0.4 ml/min/kg, discontinue
•
Blood counts q2wk; watch for decreasing granulocytes, Hgb; if low, therapy may have to be discontinued and restarted after hematologic recovery; blood transfusions may be required
•
Lesions in HSV
•
Electrolytes and minerals (calcium, phosphate, magnesium, potassium); watch closely for tetany during 1st administration
•
GI symptoms: nausea, vomiting, diarrhea; severe symptoms may necessitate discontinuing product
Blood dyscrasias
(anemia, granulocytopenia): bruising, fatigue, bleeding, poor healing
•
Allergic reactions:
flushing, rash, urticaria, pruritus
•
Culture should be performed prior to treatment (blood, urine, throat); a negative culture does not rule out CMV
•
Ophthalmic exam should confirm diagnosis
•
Close monitoring during therapy for tingling, numbness, paresthesias; if these occur, stop inf, obtain lab sample for electrolytes
•
Therapeutic response: improvement in CMV retinitis
•
To call prescriber if sore throat, swollen lymph nodes, malaise, fever occur, since other infections may occur
•
To report perioral tingling, numbness in extremities, and paresthesias
•
That serious product interactions may occur if OTC products are ingested; check first with prescriber
•
That product is not a cure but will control symptoms
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(foss′in-oh-pril)
Monopril
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin-converting enzyme (ACE) inhibitor