Mosby's 2014 Nursing Drug Reference (209 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ee-brit-u-moe′mab)
Zevalin
Func. class.:
Radiopharmaceutical
Chem. class.:
Monoclonal antibody
High affinity for indium-111, yttrium-90; induces CD20+ B-cell lines
Non-Hodgkin’s lymphoma, B-cell NHL
Pregnancy (D), hypersensitivity to murine proteins, prior murine antibody exposure
Black Box Warning:
Hypersensitivity to this product, neutropenia, thrombocytopenia
Precautions:
Breastfeeding, children, geriatric patients, cardiac conditions, immunizations after therapy
Black Box Warning:
Altered biodistribution, infusion-related reaction
Calculator
• Adult: IV
riTUXimab 250 mg/m
2
given first; premedicate with acetaminophen 650 mg and diphenhydrAMINE 50 mg
• Adult (baseline platelets ≥150,000/mm
3
):
7-9 days after step 1, give a second dose of riTUXimab 250 mg/m
2
; within 4 hr of completing riTUXimab inf, give Y-90 ibritumomab tiuxetan 0.4 mCi/kg (14.8 MBq/kg) IV over 10 min, the dose given should be within 10% of actual prescribed dose of Y-90 ibritumomab tiuxetan, total dose given max 32 mCi (1184 MBq) regardless of patient’s weight
• Adult (baseline platelets 100,000-149,000/mm
3
):
7-9 days after step 1, give a second dose of riTUXimab 250 mg/m
2
IV; within 4 hr of completing riTUXimab inf, give Y-90 ibritumomab tiuxetan 0.3 mCi/kg (11.1 MBq/kg) IV over 10 min;
the dose given should be within 10% of actual prescribed dose of Y-90 ibritumomab tiuxetan, total dose given max 32 mCi (1184 MBq) regardless of patient’s weight
• Adult (baseline platelets <100,000/mm
3
):
do not use
Available forms:
Inj 3.2 mg/2 ml
•
Do not use as bolus or direct IV
•
See manufacturer’s product labeling for preparation
CV:
Cardiac dysrhythmias
GI:
Nausea, vomiting, anorexia
, abdominal pain, diarrhea
GU:
Renal failure
HEMA:
Leukopenia, neutropenia, thrombocytopenia,
anemia
INTEG:
Irritation at site, rash
,
fatal mucocutaneous infections (rare)
OTHER:
Fever, chills, asthenia, headache,
angioedema,
hypotension, myalgia,
bronchospasm, hemorrhage,
infections, cough, dyspnea, dizziness, anxiety
SYST:
Stevens-Johnson syndrome, secondary malignancies (AML, MDS), fatal infections
Half-life 30 hr
Black Box Warning:
Fatal inf reaction:
hypoxia, pulmonary infiltrates, ARDS, MI, ventricular fibrillation, cardiogenic shock; most fatal inf reactions occur with 1st inf; potentially fatal
•
Biodistribution: 1st image 2-24 hr, 2nd image 48-72 hr, 3rd image 90-120 hr (optimal)
•
For infection; murine antibody titers
Black Box Warning:
Severe mucocutaneous reactions:
Stevens-Johnson syndrome, lichenoid dermatitis, toxic epidermal lysis; occur 1-13 wk after product given
Black Box Warning:
Tumor lysis syndrome:
acute renal failure requiring hemodialysis, hyperkalemia, hypocalcemia, hyperuricemia, hyperphosphatemia
Black Box Warning:
Bone marrow depression:
CBC, differential, platelet count weekly; withhold product if WBC <3500/mm
3
, or platelet count <150,000/mm
3
; notify prescriber
•
GI symptoms: frequency of stools
•
Signs of dehydration: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
•
Increased fluid intake to 2-3 L/day to prevent dehydration unless contraindicated
•
Emergency equipment nearby with EPINEPHrine, antihistamines, corticosteroids
•
Therapeutic response: improvement in blood counts, decreased evidence of disease
•
To report adverse reactions
•
To use contraception during and for 12 months after therapy; pregnancy (D)
•
About radiation safety precautions, disposal of bodily fluids
•
About symptoms of infection
•
About neutropenia and bleeding precautions
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
, Rx)
(eye-byoo-proe′fen)
Advil, Advil Children’s, Advil Infants’ Concentrated, Advil Junior Strength, Caldolor, ElixSure IB, Genpril, Ibren, IBU, Infants Leader Ibu-drops, Midol Cramps and Body Aches Formula, Motrin
, Motrin IB, Motrin Infant’s, Motrin Junior Strength, Pamprin IB, Samson-8 Select Brand, Top Care Infant, Wal-Profen
NeoProfen
Func.class.:
Nonsteroidal antiinflammatory, antipyretic, nonopioid analgesics
Chem. class.:
Propionic acid derivative
Do not confuse:
Nuprin
/Lupron
Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflammatory, antipyretic
Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, fever, migraine
Unlabeled uses:
Ankylosing spondylitis, bone pain, cystic fibrosis, gouty arthritis, psoriatic arthritis
Pregnancy (D) IV after 30 wks; hypersensitivity to this product, NSAIDs, salicylates; asthma; severe renal/hepatic disease
Black Box Warning:
Perioperative pain in CABG
Precautions:
Pregnancy (C) 1st and 2nd trimesters, breastfeeding, children, geriatric patients, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents, CHF, CCr <25 ml/min
Black Box Warning:
GI bleeding, MI, stroke
Calculator
• Adult/adolescent: PO
(OTC product) 200 mg q4-6hr, may increase to 400 mg q4-6hr if needed, max 1200 mg/day
• Adult: PO
200-400 mg q4-6hr, max 3.2 g/day; OTC use max 1200 mg/day
• Child: PO
4-10 mg/kg/dose q6-8hr
• Adult: IV
400-800 mg q6hr as an adjunct to opiate-agonist therapy
• Adult: PO
400 mg q4hr, max 1200 mg/day
• Child 6 mo-12 yr: PO
5 mg/kg (temp <102.5° F or 39.2° C), 10 mg/kg (temp >102.5° F), may repeat q6-8hr, max 40 mg/kg/day
• Adult: PO
400-800 mg tid-qid, max 3.2 g/day
• Child: PO
30-40 mg/kg/day in 3-4 divided doses, max 50 mg/kg/day
• Premature neonate ≤32 wk gestation who weighs 500-1500 g: IV
10 mg/kg initially, then, if needed, 2 doses of 5 mg/kg at 24-hr intervals; if oliguria occurs, hold dose
Available forms:
Tabs 100, 200, 400, 600, 800 mg; cap, liq gels 200 mg; oral susp 100 mg/5 ml; liq 100 mg/5 ml; chew tabs 50, 100 mg; drops 50 mg/1.25 ml; inj 10 mg/ml (NeoProfen); inj (Caldolor) 100 mg/ml
•
With food, milk, or antacid to decrease GI symptoms; if nausea and vomiting occur or persist, notify prescriber
•
Shake susp well before use
•
Do not use in pregnancy after 30 wks gestation
•
Patient must be well hydrated prior to administration
•
Dilute to ≤4 mg/ml with 0.9% NaCl, LR, D
5
; infuse over ≥30 min; do not give IM
•
Discard unused portion
•
Visually inspect for particulate
•
Ibuprofen lysine:
dilute with dextrose or saline to appropriate volume (10 mg/kg of ibuprofen is recommended); give within 30 min of preparation; give via IV port nearest insertion site; give over 15 min
•
Check for extravasation; do not give in same line with TPN; interrupt TPN for 15 min before and after product administration
CNS:
Headache
, dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression
CV:
Tachycardia, peripheral edema, palpitations, dysrhythmias,
CV thrombotic events, MI, stroke
EENT:
Tinnitus, hearing loss, blurred vision
GI:
Nausea,
anorexia
, vomiting, diarrhea, jaundice,
hepatitis,
constipation, flatulence, cramps, dry mouth, peptic ulcer,
GI bleeding, ulceration, necrotizing enterocolitis, GI perforation
GU:
Nephrotoxicity:
dysuria, hematuria, oliguria, azotemia
HEMA:
Blood dyscrasias,
increased bleeding time
INTEG:
Purpura, rash, pruritus, sweating, urticaria,
nectrotizing fasciitis,
photosensitivity, photophobia
META:
Hyperkalemia, hyperuricemia, hypoglycemia, hyponatremia
SYST:
Anaphylaxis, Stevens-Johnson syndrome
PO:
Onset 1/2 hr, peak 1-2 hr, half-life 1.8-2 hr, metabolized in liver (inactive metabolites), excreted in urine (inactive metabolites), 90%-99% plasma protein binding, does not enter breast milk, well absorbed
Increase:
bleeding risk—valproic acid, thrombolytics, antiplatelets, anticoagulants, salicylates
Increase:
blood dyscrasia risk—antineoplastics, radiation
Increase:
toxicity—lithium, oral anticoagulants, cycloSPORINE, methotrexate
Increase:
GI reactions—aspirin, corticosteroids, NSAIDs, alcohol, tobacco
Increase:
hypoglycemia—oral antidiabetics
Decrease:
effect of antihypertensives, thiazides, furosemide
Decrease:
ibuprofen action—aspirin
Increase:
bleeding risk—feverfew, garlic, ginger, ginkgo, ginseng
(Panax)
Increase:
BUN, creatinine, LFTs
Decrease:
Hgb/Hct, blood glucose, WBC, platelets
•
Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb, stool guaiac, before treatment, periodically thereafter, monitor electrolytes as needed
Black Box Warning:
Perioperative pain in CABG: MI, and stroke can result for 10-14 days, can be fatal
•
Pain:
note type, duration, location, intensity with ROM 1 hr after administration
•
Audiometric, ophthalmic exam before, during, after long-term treatment; for
eye, ear problems: blurred vision, tinnitus; may indicate toxicity
•
Infection,
may mask symptoms; fever: temp before and 1 hr after administration
•
Cardiac status: edema (peripheral), tachycardia, palpitations; monitor B/P, pulse for character, quality, rhythm, especially in patients with cardiac disease, geriatric patients
•
For history of peptic ulcer disorder; asthma, aspirin, hypersensitivity; check closely for hypersensitivity reactions
Black Box Warning:
GI bleeding/perforation: chronic use can cause gastritis with or without bleeding, those with a prior history of peptic ulcer disease or GI bleeding, initiate treatment at lower dose; geriatric patients are at greater risk and those who consume >3 alcohol drinks/day
•
Storage at room temp
•
Therapeutic response: decreased pain, stiffness in joints; decreased swelling in joints; ability to move more easily; reduction in fever or menstrual cramping
•
To use sunscreen, sunglasses, and protective clothing to prevent photosensitivity, photophobia
•
To report blurred vision, ringing, roaring in ears (may indicate toxicity); that eye and hearing tests should be done during long-term therapy
•
To avoid driving, other hazardous activities if dizziness or drowsiness occurs
Nephrotoxicity:
to report change in urinary pattern, increased weight, edema, increased pain in joints, fever, blood in urine; monitor fluid status, BUN, creatinine
•
That therapeutic antiinflammatory effects may take up to 1 mo
To avoid alcohol, NSAIDs, salicylates; bleeding may occur
•
To report use of this product to all health care providers
•
Pregnancy:
notify prescriber if pregnancy (C) is planned or suspected, avoid during 3rd trimester pregnancy (D) IV after 30 wk
Lavage, activated charcoal, induce diuresis