Mosby's 2014 Nursing Drug Reference (235 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(leh-floo′noh-mide)
Arava
Func. class.:
Antirheumatic (DMARDs)
Chem. class.:
Immune modulator, pyrimidine synthesis inhibitor
Inhibits an enzyme involved in pyrimidine synthesis; has antiproliferative, antiinflammatory effect
RA: to reduce disease process and symptoms
Unlabeled uses:
Juvenile RA
Breastfeeding, hypersensitivity, jaundice, lactase deficiency, hepatic disease
Black Box Warning:
Pregnancy (X)
Precautions:
Children, renal disorders, vaccinations, infection, alcoholism, immunosuppression
Black Box Warning:
Hepatic disease
Calculator
• Adult:
PO
Loading dose 100 mg/day × 3 days, maintenance 20 mg/day; may be
decreased to 10 mg/day if not well tolerated
• Adolescent and child >40 kg:
PO
20 mg
• Adolescent and child 20-40 kg:
PO
15 mg
• Adolescent and child 10-19.9 kg:
PO
10 mg
Available forms:
Tabs 10, 20 mg
•
Give loading dose of 100 mg/day × 3, then 20 mg/day; decrease to 10 mg/day if poorly tolerated
•
With food for GI upset
•
Drug elimination:
give cholestyramine 8 g tid × 11 days, check levels
CNS:
Headache
, dizziness, insomnia, depression, paresthesia, anxiety, migraine, neuralgia
CV:
Palpitations, hypertension, chest pain, angina pectoris, peripheral edema
EENT:
Pharyngitis, oral candidiasis, stomatitis, dry mouth, blurred vision
GI:
Nausea, anorexia, vomiting, constipation, flatulence, diarrhea, elevated LFTs
,
hepatotoxicity
HEMA:
Anemia, ecchymosis, hyperlipidemia
INTEG:
Rash, pruritus, alopecia, acne, hematoma, herpes infections
RESP:
Pharyngitis, rhinitis, bronchitis, cough, respiratory infection, pneumonia, sinusitis,
interstitial lung disease
SYST:
Opportunistic/fatal infections
Metabolized in liver to active metabolite, half-life of metabolite 2 wk, excreted in urine
Increase:
NSAID effect—NSAIDs
Increase:
hepatotoxicity—hepatotoxic agents, methotrexate
Increase:
rifampin levels—rifampin
Decrease:
antibody response—live virus vaccines
Decrease:
leflunomide effect—activated charcoal, cholestyramine, use for overdose
•
Screen for latent TB before starting treatment; if TB is present, pretreat before using product
•
Interstitial lung disease:
increased or worsening cough, SOB, fever; product may need to be discontinued
•
Arthritic symptoms:
ROM, mobility, swelling of joints at baseline and during treatment
Black Box Warning:
Hepatic studies: if ALT elevations are > 2× ULN, reduce dose to 10 mg/day, monitor monthly or more frequently
•
CBC with differential monthly × 6 mo, then q 6-8 wk thereafter; pregnancy test; serum electrolytes
Infections:
fatal infections can occur
•
B/P, weight; edema can occur
Black Box Warning:
Pregnancy (X):
determine that patient is not pregnant before treatment; not to be given to women of child-bearing potential that are not using reliable contraception
•
Therapeutic response: decreased inflammation, pain in joints
•
That product must be continued for prescribed time to be effective, that up to a month may be required for improvement
•
To take with food, milk, or antacids to avoid GI upset; to take at same time of day
•
To use caution when driving because drowsiness, dizziness may occur
•
To take with a full glass of water to enhance absorption, may continue with correct prescribed treatment with other anti-inflammatories
Black Box Warning:
Not to become pregnant (X) while taking this product; not to breastfeed while taking this product; men should also discontinue product and begin leflunomide removal protocol if pregnancy is planned
•
That hair may be lost; review alternatives
•
To avoid live virus vaccinations during treatment
•
To notify prescriber of weight loss
•
Overdose treatment: give cholestyramine tid × 24 hr or activated charcoal
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(let′tro-zohl)
Femara
Func. class.:
Antineoplastic, nonsteroidal aromatase inhibitor
Binds to the heme group of aromatase; inhibits conversion of androgens to estrogens to reduce plasma estrogen levels
Early, advanced, or metastatic breast cancer in postmenopausal women who are hormone receptor positive
Unlabeled uses:
Infertility, idiopathic short stature, constitutional delayed puberty
Pregnancy (D), premenopausal females, hypersensitivity
Precautions:
Respiratory/hepatic disease, osteoporosis
Calculator
• Adult:
PO
2.5 mg/day
• Adult:
PO
2.5, 5, 7.5 mg/day × 5 days, usually days 3-7 of menstrual cycle
• Adolescent and child ≥9 (male):
PO
2.5 mg/day; use with testosterone for delayed puberty
Available forms:
Tabs 2.5 mg
•
Without regard to meals; with small glass of water
•
May administer biphosphates to increase bone density
CNS:
Headache, lethargy
, somnolence, dizziness, depression, anxiety
CV:
Angina, MI, CVA, thromboembolic events,
hypertension, peripheral edema
GI:
Nausea, vomiting, anorexia
, constipation, heartburn, diarrhea
GU:
Endometrial cancer, vaginal bleeding, endometrial proliferation disorders
INTEG:
Rash, pruritus
, alopecia, sweating
MISC:
Hot flashes, night sweats,
second malignancies, anaphylaxis, angioedema
MS:
Arthralgia, arthritis, bone fracture, myalgia, osteoporosis
RESP:
Dyspnea, cough
Metabolized in liver, excreted in urine, peak 2 days, terminal half-life 48 hr, steady state 2-6 wk
Decrease:
letrozole effect—estrogens, oral contraceptives
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly
•
Therapeutic response: decrease in size of tumor
•
To report allergic reactions (rash; hives; difficulty breathing; tightness in chest; swelling of mouth, face, lips, tongue)
•
To report vaginal bleeding, diarrhea, chest/bone pain
•
To use adequate contraception in perimenopausal, recently postmenopausal women; pregnancy (D)