Mosby's 2014 Nursing Drug Reference (229 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(kee′toe-role-ak)
Acular, Acular PF, Acular LS, Acuvail
Func. class.:
Antiinflammatory (ophthalmic)
Chem. class.:
Nonsteroidal antiinflammatory drug
Inhibits miosis by inhibiting the biosynthesis of ocular prostaglandins; prostaglandins play a role in the miotic response produced during ocular surgery by constricting the iris sphincter independently of cholinergic mechanisms
Pain and inflammation after cataract surgery, refractive surgery, seasonal allergic conjunctivitis
Hypersensitivity to this product, sulfites, NSAIDs, salicylates
Precautions:
Bleeding disorders, complicated ocular surgery, corneal denervation, diabetes mellitus, rheumatoid arthritis, dry eye syndrome, pregnancy (C), breastfeeding, children, contact lens
Calculator
• Adult/child
≥
3 yr:
Instill 1 drop into affected eye qid
• Adult:
OPHTH
1 drop in affected eye qid beginning 24 hr after surgery × 2 wk
• Adult:
OPHTH
1 drop in affected eye qid × ≤4 days
•
Incision refraction surgery, pain, photophobia (Acular PF)
• Adult:
OPHTH
1 drop qid in affected eye × 3 days
• Adult:
OPHTH
1 drop bid in affected eye, starting 1 day before surgery, on the day of surgery, × 2 wks after surgery
Available forms:
Ophthalmic solution Acular (0.5%), Acular PF (0.5%), Acular LS (0.4%), Acuvail (0.45%)
•
Apply topically to the eye, separate by ≥5 min when using with other ophthalmics
•
Remove contact lenses before instillation of solution
•
Instruct patient on proper instillation of eye solution
•
Do not touch the tip of the dropper to the eye, fingertips, or other surface
•
Do not share bottle with other patients
CNS:
Headache
EENT:
Abnormal sensation in eye, conjunctival hyperemia, ocular irritation, ocular pain, ocular pruritus, conjunctival hyperemia, iritis, keratitis
•
Eyes: For pain, inflammation, burning, redness after cataract surgery
•
Decreased pain and inflammation after cataract surgery, refractive surgery, seasonal allergic conjunctivitis
•
To apply topically to the eye
•
To remove contact lenses before instillation of solution
•
Proper instillation of eye solution
•
Not to touch the tip of the dropper to the eye, fingertips, or other surface
•
Not to share bottle with other patients
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(kee-toe′role-ak)
Toradol
, Sprix
Func. class.:
Nonsteroidal antiinflammatory/nonopioid analgesic
Chem. class.:
Acetic acid
Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic effects
Mild to moderate pain (short term); seasonal allergic conjunctivitis (ophthalmic)
Pregnancy (D) 3rd trimester, hypersensitivity, asthma, hepatic disease, peptic ulcer disease, CV bleeding
Black Box Warning:
Breastfeeding, severe renal disease, L&D, perioperative pain in CABG, before major surgery, epidural/intrathecal administration, GI bleeding, hypovolemia
Precautions:
Pregnancy (C), GI/cardiac disorders, hypersensitivity to other antiinflammatory agents, CCr <25 ml/min
Black Box Warning:
Children, geriatric patients, bleeding, MI, stroke
Calculator
• Adult/adolescent >17 yr and ≥50 kg:
PO
continuation from
IM/IV
only 20 mg then 10 mg q4-6hr prn, max 40 mg/day;
NASAL
1 spray (15.75 mg spray) in each nostril (31.5 mg/spray) q6-8hr; max 4 doses/day × 5 days
• Adult/adolescent >17 yr and <50 kg:
IM
(single dose) 30-60 mg,
IV
15-30 mg;
IM/IV
(multiple dosing) 15-30 mg q6hr, max 60 mg/day × 5 days combined either
PO/IM/IV; NASAL
1 spray (15.75 mg/spray) in 1 nostril q6-8hr, max 4 doses/day × 5 days
•
Do not use in advanced renal disease
Available forms:
Inj 15, 30 mg/ml (prefilled syringes); tab 10 mg; nasal spray 15.75 mg/spray
•
Not to exceed 5 days
•
IM inj deeply in large muscle mass
•
Prime pump before using for the first time, point away from person/pets, pump activator 5 times, no need to reprime
•
For single use only, discard 24 hr after opening if not used
•
Do not share with others
•
Have patient blow nose, sit upright to spray
•
Give undiluted over ≥15 sec
Solution compatibility:
D
5
W, 0.9% NaCl, LR, D
5
, Plasma-Lyte A
Syringe compatibilities:
SUFentanil
Y-site compatibilities:
Cisatracurium, remifentanil, SUFentanil
CNS:
Dizziness,
drowsiness,
tremors,
seizures
CV:
Hypertension, flushing, syncope, pallor, edema, vasodilation,
CV thrombotic events, MI, stroke
EENT:
Tinnitus, hearing loss, blurred vision
GI:
Nausea, anorexia, vomiting, diarrhea, constipation, flatulence, cramps, dry mouth, peptic ulcer,
GI bleeding, perforation,
taste change,
hepatitis, hepatic failure
GU:
Nephrotoxicity: dysuria, hematuria, oliguria, azotemia
HEMA:
Blood dyscrasias,
prolonged bleeding
INTEG:
Purpura, rash, pruritus, sweating,
angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis
Half-life 6 hr, enters breast milk, <50% metabolized by liver, excreted by kidneys
PO:
Peak 2-3 hr, duration 4-6 hr
IM:
Peak 50 min
Nasal:
Peak 1/2-2 hr, duration 6-8 hr
Increase:
toxicity—methotrexate, lithium, cycloSPORINE, pentoxifylline, probenecid
Increase:
bleeding risk—anticoagulants, cefamandole, cefoperazone, cefoTEtan, clopidogrel, eptifibatide, plicamycin, salicylates, ticlopidine, tirofiban, thrombolytics, valproic acid, SSRIs, SNRIs
Increase:
renal impairment—ACE inhibitors
Increase:
ketorolac levels—aspirin, other NSAIDs; contraindicated
Increase:
GI effects—corticosteroids, alcohol, aspirin, NSAIDs
Decrease:
effects—antihypertensives, diuretics
Increase:
AST, ALT, LDH, bleeding time
•
Aspirin sensitivity, asthma:
patients may be more likely to develop hypersensitivity to NSAIDs; monitor for hypersensitivity
•
Pain:
type, location, intensity, ROM before and 1 hr after treatment
Black Box Warning:
Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb before treatment, periodically thereafter; check for dehydration
Black Box Warning:
Bleeding times; check for bruising, bleeding, occult blood in urine
Black Box Warning:
Do not use epidurally, intrathecally, alcohol is present in the solution
•
Eye/ear problems: blurred vision, tinnitus (may indicate toxicity)
Hepatic dysfunction: jaundice, yellow sclera and skin, clay-colored stools
Black Box Warning:
CV thrombotic events: MI, stroke, do not use in perioperative pain in CABG
•
Audiometric, ophthalmic exam before, during, after treatment
•
Storage at room temp, protect from light
•
Therapeutic response: decreased pain, stiffness, swelling in joints, ability to move more easily
•
To report blurred vision, ringing/roaring in ears (may indicate toxicity)
•
To avoid driving, other hazardous activities if dizziness or drowsiness occurs
Black Box Warning:
To report change in urine pattern, weight increase, edema; pain increase in joints, fever, blood in urine (indicates nephrotoxicity); bruising, black tarry stools (indicates bleeding);
pruritus, jaundice, nausea, right upper quadrant pain, abdominal pain (hepatotoxicity); to notify prescriber immediately
•
To avoid alcohol, salicylates, other NSAIDs, acetaminophen
•
To report product use to all health care providers, not to use with other products unless approved by prescriber; use for ≤5 days
Black Box Warning:
Not to breastfeed
•
Nasal:
to discard within 24 hr of opening; may cause irritation, may drink water after dose
•
To report if pregnancy is planned or suspected pregnancy (C) systemic, do not breastfeed