Mosby's 2014 Nursing Drug Reference (22 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(a-den′oh-seen)
Func. class.:
Antidysrhythmic
Chem. class.:
Endogenous nucleoside
Do not confuse:
adenosine
/adeosine phosphate
Slows conduction through AV node, can interrupt reentry pathways through AV node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia
PSVT, as a diagnostic aid to assess myocardial perfusion defects in CAD, Wolff-Parkinson-White syndrome
Unlabeled uses:
Wide-complex tachycardia diagnosis
Hypersensitivity, 2nd- or 3rd-degree AV block, sick sinus syndrome, atrial flutter, atrial fibrillation, ventricular tachycardia, bronchospastic lung disease, symptomatic bradycardia, bundle branch block, heart transplant, unstable angina
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, asthma
Calculator
• Adult and child
>
50 kg: IV BOL
6 mg; if conversion to normal sinus rhythm does not occur within 1-2 min, give 12 mg by rapid
IV BOL;
may repeat 12-mg dose again in 1-2 min
• Infant and child
<
50 kg: IV BOL
0.1 mg/kg; if not effective, increase dose by 0.05-0.1 mg/kg q2min to a max of 0.3 mg/kg/dose
• Neonate: IV BOL
0.05 mg/kg by rapid IV BOL, may increase by 0.05 mg/kg q2min, max 0.3 mg/kg/dose
Available forms:
3 mg/ml
•
Warm to room temp; crystals will dissolve
•
Undiluted; give 6 mg or less by rapid inj over 1-2 sec; if using an IV line, use port near insertion site, flush with NS (20 ml), then elevate arm
Y-site compatibilities:
abciximab
Solution compatibilities:
D
5
LR, D
5
W, LR, 0.9% NaCl
CNS:
Lightheadedness, dizziness, arm tingling, numbness, headache
CV:
Chest pain, pressure,
atrial tachydysrhythmias,
sweating, palpitations, hypotension,
facial flushing
,
AV block, cardiac arrest, ventricular dysrhythmias
GI:
Nausea
, metallic taste
RESP:
Dyspnea, chest pressure
, hyperventilation,
bronchospasm (asthmatics)
Cleared from plasma in <30 sec, half-life 10 sec, converted to inosine/adenosine monophosphate
Increase:
risk for higher degree of heart block—carBAMazepine
Increase:
risk for ventricular fibrillation—digoxin, verapamil
•
Smoking: increase tachycardia
Increase:
effects of adenosine—dipyridamole
Decrease:
activity of adenosine—theophylline or other methylxanthines (caffeine)
Increase:
adenosine effect—ginger
Decrease:
adenosine effect—guarana, green tea
•
Cardiopulmonary status:
B/P, pulse, respiration, rhythm, ECG intervals (PR, QRS, QT); check for transient dysrhythmias (PVCs, PACs, sinus tachycardia, AV block)
•
Respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; bilateral crackles may occur in
CHF
patient; increased respiration, increased pulse, product should be discontinued
•
CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued
•
Storage at room temperature; sol should be clear; discard unused product
•
Therapeutic response: normal sinus rhythm or diagnosis of perfusion defect
•
To report facial flushing, dizziness, sweating, palpitations, chest pain; usually transient
Defibrillation, vasopressor for hypotension, theophylline
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-fli-ber′sept)
EYLEA
Func. class.:
Biologic response modifier; signal transduction inhibitor (STIs) (Ophthalmic)
A recombinant fusion protein consisting of portions of human VEGF receptors 1 and 2 extracellular domains fused to human IgG1; acts as a soluble decoy receptor that binds vascular endothelial growth factor-A (VEGF-A) and placental growth factor (PIGF); can act as mitogenic, chemotactic, vascular permeability factors for endothelial cells; VEGF-A interacts with VEGFR-1 and VEGFR-2 on the surface of endothelial cells; results in neovascularization and vascular permeability; binding of aflibercept to VEGF-A and PIGF prevents activation of these receptors
For treatment of neovascular (wet) age-related macular degeneration (AMD), macular edema after central retinal vein
Hypersensitivity, ocular/periocular infection, active intraocular inflammation
Precautions:
Neonates, infants, children, adolescents, pregnancy (C), breastfeeding; history of glaucoma, ocular surgery; driving or operating machinery
Calculator
• Adult:Intravitreal INJ
2 mg (0.05 ml) into affected eye(s) q4wk × 12 wk, then 2 mg (0.05 ml) q8wk
Available forms:
Solution for injection 2 mg/0.05 ml
•
Visually inspect for particulate matter, discoloration before use; do not use if particulates, cloudiness, discoloration are visible; only for use by physicians trained in administration
•
Use controlled aseptic conditions (sterile gloves, sterile drape, sterile eyelid speculum); adequate anesthesia, topical broad-spectrum antiinfective should be given before use
•
Use each vial for treatment of single eye only; if other eye is being treated, use new vial and change the sterile field, syringe, gloves, drapes, eyelid speculum, filter, injection needles before administering to the other eye
•
Use aseptic technique, withdraw all of vial contents through a 5-micron 19-G filter needle attached to 1-ml syringe supplied by manufacturer; after vial contents are withdrawn, discard filter needle and replace with sterile 30-G × ½ inch needle for intravitreal injection; expel any air bubbles and contents of syringe until plunger tip is aligned with line that marks 0.05 ml
•
Immediately after the intravitreal injection, monitor patient for elevation in intraocular pressure (IOP); appropriate monitoring may consist of a check for perfusion of optic nerve head or tonometry; sterile paracentesis needle should be available if required
CV:
Thromboembolism, nonfatal stroke, nonfatal myocardial infarction, vascular death
EENT:
Ocular hemorrhage, ocular pain, cataracts, vitreous detachment, vitreous floaters
, conjunctival hyperemia, corneal erosion, detachment of retinal pigment epithelium, injection site pain, foreign body sensation, increased lacrimation, blurred vision, retinal pigment epithelium tear, injection site hemorrhage, blepharedema, corneal edema
SYST:
Hypersensitivity
Absorbed into systemic circulation; present in its unbound form and stable inactive form bound with endogenous VEGF; elimination by binding to free endogenous VEGF; metabolism by proteolysis; terminal half-life in plasma 5-6 days
•
Infection:
monitor for infection during week after injection to permit early treatment of any ocular infection that may develop; proper aseptic injection technique should be used to minimize infection
•
Increased intraocular pressure:
monitor for acute increases in intraocular pressure within 60 min of injection; sustained increases in intraocular pressure have been reported after repeated intravitreal dosing; monitor intraocular pressure and optic nerve head perfusion, a sterile paracentesis needle should be available
•
Storage: do not freeze, protect from light, refrigerate, store in original package until time of use
•
Prevention of further vision loss
To seek immediate care if symptoms of endophthalmitis or retinal detachment develop (ocular pain, hyperemia of the conjunctiva, photophobia, blurry vision)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(al-byoo′min)
Albumarc, Albuminar-5, Albutein 5%, Buminate 5%, Plasbumin-5
Albuminar-25, Albutein 25%,
Buminate 25%, Plasbumin-25
Func. class.:
Plasma volume expander