Mosby's 2014 Nursing Drug Reference (23 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Exerts oncotic pressure, which expands volume of circulating blood and maintains cardiac output
Restores plasma volume after burns, hyperbilirubinemia, shock, hypoproteinemia, prevention of cerebral edema, cardiopulmonary bypass procedures, ARDS, nephrotic syndrome
Hypersensitivity, CHF, severe anemia, renal insufficiency, pulmonary edema
Precautions:
Pregnancy (C), decreased salt intake, decreased cardiac reserve, lack of albumin deficiency, renal/hepatic disease, chronic anemia
Calculator
•Adult: IV
dose to maintain plasma albumin at 3-4 mg/dl
•Adult: IV
rapidly give 5% sol, when close to normal inf at ≤2-4 ml/min (25% sol ≤1 ml/min)
• Child:
IV
0.5-1 g/kg/dose 5% sol, may repeat as needed, max 6 g/kg/day
•Adult: IV
100-200 ml of 25% and loop diuretic × 7-10 days
•Adult: IV
25 g, may repeat in 15-30 min, or 50-75 g of 25% albumin infused at ≤2 ml/min
• Child and infant: IV
0.5-1 g/kg/dose over 2-4 hr, may repeat q1-2days
• Infant: IV
1 g/kg 1-2 hr before transfusion
Available forms:
Inj (5%) 50 mg/ml, (25%) 250 mg/ml
•
Slowly, to prevent fluid overload; dilute with NS for injection or D
5
W; 5% is given undiluted; 25% may be given diluted or undiluted; give over 30-60 min, use inf pump, use large-gauge needle; inf must be completed within 4 hr
•
5% solution may be used with hypovolemic/intravascular depletion
•
25% solution may be used with sodium/fluid restrictions
Solution compatibilities:
LR, NaCl, Ringer’s, D
5
W, D
10
W, D
2
1/2
W, NaCl 0.9%, dextrose/Ringer’s, dextrose/LR
Y-site compatibilities:
Diltiazem, LORazepam
CNS:
Fever, chills, flushing, headache
CV:
Fluid overload, hypotension, erratic pulse, tachycardia
GI:
Nausea, vomiting, increased salivation
INTEG:
Rash, urticaria
RESP:
Altered respirations,
pulmonary edema
In hyponutrition states, metabolized as protein/energy source; terminal half-life 21 days
Increase:
serum albumin
•
Blood studies Hct, Hgb; if serum protein declines, dyspnea, hypoxemia can result
•
Decreased B/P, erratic pulse, respiration
•
I&O ratio: urinary output may decrease
Circulatory/pulmonary overload
:
CVP, pulmonary wedge pressure distended neck veins indicate circulatory overload; shortness of breath, anxiety, insomnia, expiratory crackles, frothy blood-tinged cough, cyanosis indicate pulmonary overload
•
Allergy: fever, rash, itching, chills, flushing, urticaria, nausea, vomiting, hypotension, requires discontinuation of inf, use of new lot if therapy reinstituted; premedicate with diphenhydrAMINE
•
Adequate hydration before, during administration
•
Check type of albumin; some stored at room temp, some need to be refrigerated, use within 4 hr of opening
•
Therapeutic response: increased B/P, decreased edema, increased serum albumin levels, increased plasma protein
•
Reason for product; to report hypersensitivity
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(al-byoo′ter-ole)
Accuneb, Airomir
, Apo-Salvent, Gen-Salbutamol, Proair HFA, Proventil, Proventil HFA, ReliOn, Ventolin HFA, VoSpire ER
Func. class.:
Adrenergic β
2
-agonist, sympathomimetic, bronchodilator
Do not confuse:
albuterol
/atenolol/Albutein
Ventolin
/Vantin
Proventil
/Prinivil
Causes bronchodilation by action on β
2
(pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscle; produces bronchodilation, CNS, cardiac stimulation as well as increased diuresis and gastric acid secretion; longer acting than isoproterenol
Prevention of exercise-induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis, or other reversible airway obstruction
Unlabeled uses:
Hyperkalemia in dialysis patients
Hypersensitivity to sympathomimetics, tachydysrhythmias, severe cardiac disease, heart block
Precautions:
Pregnancy (C), breastfeeding, cardiac/renal disease, hyperthyroidism, diabetes mellitus, hypertension, prostatic hypertrophy, angle-closure glaucoma, seizures, exercise-induced bronchospasm (aerosol) in children <12 yr, hypoglycemia
Calculator
• Adult and child
≥
4 yr: INH
(metered-dose inhaler) 2 puffs q4-6hr as needed
• Adult and child ≥12 yr: INH
(metered-dose inhaler) 1 puff q4-6hr;
PO
2-4 mg tid-qid, max 32 mg;
NEB/IPPB
2.5 mg tid-qid
• Geriatric: PO
2 mg tid-qid, may increase gradually to 8 mg tid-qid
• Child 2-12 yr: INH
(metered-dose inhaler) 0.1 mg/kg tid (max 2.5 mg tid-qid);
NEB/IPPB
0.1-0.15 mg/kg/dose tid-qid or 1.25 mg tid-qid for child 10-15 kg or 2.5 mg tid-qid for child >15 kg
• Adult:ORAL INH
(albuterol nebulizer sol) 10-20 mg
Available forms:
Aerosol 90 mcg/actuation; oral syr 2 mg/5 ml; tabs 2, 4 mg; ext rel 4, 8 mg; INH sol 0.5, 0.83, 1, 2, 5 mg/ml; powder for INH (Ventodisk) 200, 400 mcg; INH cap 200 mcg; 100 mcg/spray, 80 INH/canister, 200 INH/canister
•
Do not break, crush, or chew ext rel tabs; give with meals to decrease gastric irritation
•
Oral sol
to children (no alcohol, sugar)
•
For geriatric patients and children, a spacing device is advised
•
After shaking metered-dose inhaler, exhale, place mouthpiece in mouth, inhale slowly while depressing inhaler, hold breath, remove, exhale slowly; give INH at least 1 min apart
•
NEB/IPPB
diluting 5 mg/ml sol/2.5 ml 0.9% NaCl for INH; other sol do not require dilution; for neb O
2
flow or compressed air 6-10 L/min
CNS:
Tremors, anxiety
, insomnia, headache, dizziness, stimulation,
restlessness
, hallucinations, flushing, irritability
CV:
Palpitations, tachycardia, angina, hypo/hypertension, dysrhythmias
EENT:
Dry nose, irritation of nose and throat
GI:
Heartburn, nausea, vomiting
MISC:
Flushing, sweating, anorexia, bad taste/smell changes, hypokalemia, metabolic acidosis
MS:
Muscle cramps
RESP:
Cough, wheezing, dyspnea,
paradoxical bronchospasm,
dry throat
Extensively metabolized in the liver and tissues, crosses placenta, breast milk, blood-brain barrier
PO:
Onset 1/2 hr, peak 2-3 hr, duration 4-6 hr, half-life 2.7-6 hr, well absorbed
PO-ER:
Onset 1/2 hr; peak 2-3 hr; duration 8-12 hr
INH:
Onset 5-15 min, peak 1-1½ hr, duration 3-6 hr, half-life 4 hr
Increase:
QTc prolongation—other drugs that increase QT prolongation
Increase:
digoxin level—digoxin
Increase:
CNS stimulation—CNS stimulants
Increase:
ECG changes/hypokalemia—potassium-losing diuretics
Increase:
severe hypotension—oxytocics
Increase:
toxicity—theophylline
Increase:
action of aerosol bronchodilators
Increase:
action of albuterol—tricyclics, MAOIs, other adrenergics; do not use together
Increase:
CV effects—atomoxetine, selegiline
Decrease:
albuterol—other β-blockers
Increase:
stimulation—caffeine (cola nut, green/black tea, guarana, yerba maté, coffee, chocolate)
Decrease:
potassium
•
Respiratory function:
vital capacity, forced expiratory volume, ABGs; lung sounds, heart rate and rhythm, B/P, sputum (baseline and peak); whether pa
tient has not received theophylline therapy before giving dose
•
Patient’s ability to self-medicate
•
For evidence of allergic reactions
•
For paradoxical bronchospasm; hold medication, notify prescriber if bronchospasm occurs
•
Storage in light-resistant container; do not expose to temperatures of more than 86° F (30° C)
•
Therapeutic response: absence of dyspnea, wheezing after 1 hr, improved airway exchange, improved ABGs
•
To use exactly as prescribed; to take missed dose when remembered, alter dosing schedule; not to use OTC medications; that excess stimulation may occur
•
About use of inhaler: review package insert with patient; use demonstration; return demonstration; shake, prime before 1st use and when not used for >2 wk; release 4 test sprays into air, away from the face
•
To avoid getting aerosol in eyes (blurring of vision may result) or using near flames or sources of heat
•
To wash inhaler in warm water daily and dry; to track number of inhalations used and to discard product when labeled inhalations have been used
•
To avoid smoking, smoke-filled rooms, persons with respiratory infections
That
paradoxical bronchospasm
may occur; to stop product immediately, call prescriber
•
To limit caffeine products such as chocolate, coffee, tea, colas
Administer β
1
-adrenergic blocker, IV fluids