Mosby's 2014 Nursing Drug Reference (225 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(eye-soe-nye′a-zid)
Isotamine
Func. class.:
Antitubercular
Chem. class.:
Isonicotinic acid hydrazide
Bactericidal interference with lipid, nucleic acid biosynthesis
Treatment, prevention of TB
Hypersensitivity
Black Box Warning:
Acute hepatic disease
Precautions:
Pregnancy (C), renal disease, diabetic retinopathy, cataracts, ocular defects, IV drug users, >35 yr, postpartum, HIV, neuropathy
Black Box Warning:
Alcoholism, females (African descent/Hispanic patients)
Calculator
• Adult/adolescent with/without HIV: PO/IM
5 mg/kg/day ≤300 mg/day or 15 mg/kg 2-3×/wk, max 900 mg 2-3×/wk
• Child/infant with HIV: PO/IM
10-15 mg/kg/day, max 300 mg/day
Available forms:
Tabs 100, 300 mg; inj 100 mg/ml
•
PO with meals to decrease GI symptoms; better to take on empty stomach 1 hr before or 2 hr after meals
•
IM deep in large muscle mass; massage; rotate inj site; warm inj to room temp to dissolve crystals
CNS:
Peripheral neuropathy, dizziness
, memory impairment,
toxic encephalopathy, seizures,
psychosis, slurred speech
EENT:
Blurred vision, optic neuritis
GI:
Nausea, vomiting
, epigastric distress,
jaundice, fatal hepatitis
HEMA:
Agranulocytosis, hemolytic, aplastic anemia, thrombocytopenia, eosinophilia, methemoglobinemia
Hypersensitivity:
Fever, skin eruptions, lymphadenopathy, vasculitis
MISC:
Dyspnea, B
6
deficiency, pellagra, hyperglycemia, metabolic acidosis, gynecomastia, rheumatic syndrome, SLE-like syndrome
Metabolized in liver, excreted in urine (metabolites), crosses placenta, excreted in breast milk, half life 1-4 hr
PO:
Peak 1-2 hr
IM:
Peak 45-60 min
Increase:
toxicity—tyramine foods, alcohol, cycloSERINE, ethionamide, rifampin, carBAMazepine, phenytoin, benzodiazepines, meperidine
Increase:
serotonin syndrome—SSRIs, SNRIs
Decrease:
absorption—aluminum antacids
Decrease:
effectiveness of BCG vaccine, ketoconazole
•
Do not give with high-tyramine foods, alcohol
Increase:
LFTs, bilirubin, glucose
Decrease:
platelets granulocytes
Black Box Warning:
Hepatic studies weekly: baseline in all patients, those >35 yr and all women should be monitored periodically; ALT, AST, bilirubin; increased test results may indicate hepatitis; hepatic status: decreased appetite, jaundice, dark urine, fatigue, those with fast acetylation (genetic) may metabolize product more than 5 times faster (black, Asian patients are at greater risk) some Caucasian patients; fatal hepatitis is at greater risk in black/Hispanic patients after birth
•
Mental status often: affect, mood, behavioral changes; psychosis may occur
•
Paresthesia in hands, feet
•
Therapeutic response: decreased symptoms of TB
•
That compliance with dosage schedule, duration is necessary; not to skip or double dose
•
That scheduled appointments must be kept or relapse may occur
To avoid alcohol while taking product; may increase risk for hepatic injury
•
That, if diabetic, to use blood glucose monitor to obtain correct result
To report weakness, fatigue, loss of appetite, nausea, vomiting, jaundice of skin or eyes, tingling/numbness of hands/feet
Black Box Warning:
Fatal hepatitis:
to notify prescriber immediately of yellow skin/eyes, dark urine, loss of appetite
Pyridoxine
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(eye-soe-sor′bide)
Apo-ISDN, Dilatrate-SR, Isochron, IsoDitrate, Isordil
Apo-ISMN, Imdur
Func. class.:
Antianginal, vasodilator
Chem. class.:
Nitrate
Do not confuse:
Imdur
/Imuran/Inderal/K-Dur
Relaxation of vascular smooth muscle, which leads to decreased preload, afterload, which is responsible for decreasing left ventricular end-diastolic pressure, systemic vascular resistance, and reducing cardiac oxygen demand
Treatment, prevention of chronic stable angina pectoris
Unlabeled uses:
Diffuse esophageal spasm, heart failure (dinitrate)
Hypersensitivity to this product or nitrates; severe anemia, increased intracranial pressure, cerebral hemorrhage, acute MI
Precautions:
Pregnancy (C), breastfeeding, children, postural hypotension, MI, CHF, severe renal/hepatic disease
Calculator
• Adult: PO
5-20 mg bid-tid initially, maintenance 10-40 mg bid-tid;
SL,
buccal 2.5-5 mg, may repeat q5-10min × 3 doses;
EXT REL
40-80 mg q8-12hr, max 160 mg/day
• Adult: PO
(Monoket) 10-20 mg bid, 7 hr apart; (Imdur) initiate at 30-60 mg/day as a single dose, increase q3days as needed, may increase to 120 mg/day, max 240 mg/day
Available forms:
Dinitrate:
sus rel caps (SR) 40 mg, SR tabs 40 mg; tabs 5, 10, 20, 30, 40 mg; SL tabs 2.5, 5 mg;
mononitrate:
tabs (Monoket) 10, 20 mg; ext rel (Imdur) 30, 60, 120 mg
•
Do not break, crush, or chew sus rel caps, SL tabs
•
After checking expiration date
•
PO with 8 oz water on empty stomach
•
SL tabs should be placed under the tongue until dissolved; avoid smoking, eating, drinking until dissolved
CNS:
Vascular headache, flushing, dizziness
, weakness, faintness
CV:
Postural hypotension
, tachycardia,
collapse,
syncope, palpitations
GI:
Nausea, vomiting, diarrhea
INTEG:
Pallor, sweating, rash
MISC:
Twitching,
hemolytic anemia, methemoglobinemia,
tolerance
Metabolized by liver, excreted in urine as metabolites (80%-100%)
PO:
Onset 15-30 min, duration 4-6 hr, half-life 5-6 hr
SUS REL:
Onset ≤4 hr, duration 6-8 hr
SL:
Onset 2-5 min, duration 1-4 hr, half-life 2 hr
SUS REL:
Onset 30-60 min, peak 1-4 hr, duration 6-8 hr, half-life 5 hr
Fatal hypotension: sildenafil, tadalafil, vardenafil, do not use together
Increase:
hypotension—β-blockers, diuretics, antihypertensives, alcohol, calcium channel blockers, phenothiazines
•
Anginal pain:
duration, time started, activity being performed, character
•
Methemoglobinemia (rare):
Cyanosis of lips, nausea/vomiting, coma, shock, usually caused by high dose of product but may occur with normal dosing
•
B/P, pulse, respirations during beginning therapy and periodically thereafter
•
Tolerance if taken over long period, to prevent, allow intervals of 12-14 hr/day without product
•
Headache, lightheadedness, decreased B/P; may indicate a need for decreased dosage, treat headache with OTC analgesics
•
Therapeutic response: decrease or prevention of anginal pain
•
To leave tabs in original container
•
To avoid alcohol, OTC products unless approved by prescriber
•
That product may cause headache; that taking with meals may reduce or eliminate headache; to take no later than 7
PM
(last dose)
•
To avoid hazardous activities if dizziness occurs
•
About the importance of complying with complete medical regimen
•
To make position changes slowly to prevent orthostatic hypotension
•
Not to use with sildenafil, tadalafil, vardenafil with nitrates, may cause serious drop in B/P
•
Not to discontinue abruptly, may cause heart attack
•
To use at beginning of angina symptoms, may repeat every 15 mins; if no relief, seek medical attention immediately