Mosby's 2014 Nursing Drug Reference (239 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(lee-voe-doe′pa)-(kar-bi-doe′pa)
Apo-Levocarb
, Atamet, Parcopa, Sinemet, Sinemet CR
Func. class.:
Antiparkinson agent
Chem. class.:
Catecholamine
Decarboxylation of levodopa in periphery is inhibited by carbidopa; more levodopa is made available for transport to the brain and for conversion to dopamine in the brain
Parkinson’s disease, parkinsonism resulting from carbon monoxide, chronic manganese intoxication, cerebral arteriosclerosis
Unlabeled uses:
Restless leg syndrome
Hypersensitivity, malignant melanoma, history of malignant melanoma or undiagnosed skin lesions resembling melanoma
Precautions:
Pregnancy (C), breastfeeding, diabetes, closed-angle glaucoma, respiratory/cardiac/renal/hepatic disease, MI with dysrhythmias, seizures, peptic ulcer, depression
Calculator
• Adult:
PO
25 mg carbidopa/100 mg levodopa tid, may increase daily or every other day by 1 tab to desired response (8 tabs/day);
EXT REL
tabs 50 mg carbidopa/200 mg levodopa bid
•
50 mg carbidopa/200 mg levodopa bid
•
Begin treatment with 10% more levodopa/day given q4-8hr, may increase or decrease dose q3days
• Adult:
PO
25 mg carbidopa/100 mg levodopa tid-qid, may increase daily to desired response
• Adult:
PO
25 mg carbidopa/250 mg levodopa tid-qid, may increase daily to desired response
• Adult:
PO
25 mg carbidopa/100 mg levodopa, 1 tab at bedtime, may repeat if awakening within 2 hr or 50 mg carbidopa/200 mg levodopa sus rel tab 1-2 tabs 1 hr before bedtime
Available forms:
Tabs 10 mg carbidopa/100 mg levodopa, 25 mg carbidopa/100 mg levodopa, 25 mg carbidopa/250 mg levodopa; ext rel tab 25 mg/100 mg, 50 mg carbidopa/200 mg levodopa (Sinemet CR); oral disintegrating tab (Parcopa) 10 mg carbidopa/100 mg levodopa, 25 mg carbidopa/100 mg levodopa; 25 mg carbidopa/250 mg levodopa
•
Pyridoxine (B
6
) not effective for reversing Sinemet or Sinemet CR
•
Do not crush or chew
ext rel tabs;
they may be broken in half; adjust dosage to response
•
Oral disintegrating tab
by gently removing from bottle, placing on tongue and swallowing with saliva; after tab dissolves, liquid is not necessary
•
With meals if GI symptoms occur; limit protein taken with product
•
Only after nonselective MAOIs have been discontinued for 2 wk; if patient has been previously treated with levodopa, discontinue for at least 12 hr before change to carbidopa-levodopa
CNS:
Involuntary choreiform movements, hand tremors, fatigue, headache, anxiety, twitching, numbness, weakness, confusion, agitation, insomnia, nightmares
, psychosis, hallucination, hypomania, severe depression, dizziness, impulsive behaviors,
neuroleptic malignant syndrome
CV:
Orthostatic hypotension
, tachycardia, hypertension, palpitation
EENT:
Blurred vision, diplopia, dilated pupils
GI:
Nausea, vomiting, anorexia, abdominal distress, dry mouth, flatulence, dysphagia
, bitter taste, diarrhea, constipation
HEMA:
Hemolytic anemia, leukopenia, agranulocytosis
INTEG:
Rash, sweating, alopecia
MISC:
Urinary retention, incontinence, weight change, dark urine
PO:
Onset 30 min, peak 1-3 hr, excreted in urine (metabolites)
EXT REL:
Onset 4-6 hr
•
Hypertensive crisis: nonselective MAOIs
Increase:
effects of levodopa—antacids, metoclopramide
Decrease:
effects of levodopa—anticholinergics, hydantoins, papaverine, pyridoxine, benzodiazepines, antipsychotics
Increase:
BUN, AST, ALT, bilirubin, alk phos, LDH, serum glucose
Decrease:
BUN, creatinine, uric acid
False positive:
urine ketones (dipstick), Coombs’ test
False negative:
urine glucose
False increase:
urine protein
Decrease:
absorption of levodopa—protein
•
Parkinson’s symptoms:
tremors, pill rolling, drooling, akinesia, rigidity, shuffling gait before, during treatment
•
B/P, respiration; orthostatic B/P
•
Mental status: affect, mood, behavioral changes, depression, complete suicide assessment
•
Toxicity:
muscle twitching, blepharospasm
•
Renal, hepatic, hematopoietic tests; also for diabetes, acromegaly if on long-term therapy
•
Therapeutic response: decrease in akathisia/bradykinesis, tremor, rigidity, improved mood
•
To change positions slowly to prevent orthostatic hypotension
•
To report side effects: twitching, eye spasms because these indicate overdose
•
To use product as prescribed; if discontinued abruptly, parkinsonian crisis, neuroleptic malignant syndrome (NMS) may occur; to gradually taper
•
That urine, sweat may darken
•
To use physical activities to maintain mobility, lessen spasms
•
That improvement may not occur for 2-4 mo; about “on-off phenomenon”
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(lee-voh-floks′a-sin)
Levaquin
Func. class.:
Antiinfective
Chem. class.:
Fluoroquinolone
Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; DNA gyrase inhibitor; inhibits topoisomerase IV
Acute sinusitis, acute chronic bronchitis, community-acquired pneumonia, uncomplicated skin infections, UTI, cellulitis, prostatitis, inhalational anthrax (postexposure); acute pyelonephritis caused by
Streptococcus pneumoniae, Haemophilus influenzae, Haemophilis parainfluenzae, Moraxella catarrhalis, Escherichia coli, Serratia marcescens, Klebsiella pneumoniae, Chlamydia pneumoniae, Legionella pneumophilia, Mycoplasma pneumoniae, Enterococcus faecalis, Staphylococcus epidermidis, Staphylococcus pyogenes;
inhalation anthrax in children
Unlabeled uses:
Adnexitis, Bartholin abscess, bartholinitis, cervicitis, epididymis, gastroenteritis,
H. pylori
eradication, mastitis, MAC, nongonococcal urethritis, obstetric infections, PID, plague, SARS, shigellosis, TB, typhoid fever, gonococcal infections, disseminated; otitis media, otitis externa, tonsillitis, pharyngitis, sialadenitis
Hypersensitivity to quinolones
Precautions:
Pregnancy (C), breastfeeding, children, photosensitivity, acute MI, atrial fibrillation, colitis, dehydration, diabetes, QT prolongation, myasthenia gravis, renal disease, seizure disorder, syphilis
Black Box Warning:
Tendon pain/rupture, tendinitis
Calculator
• Adult:
PO/IV
500 mg q24hr × 7 days
• Adult:
PO
500 mg q24hr × 10-14 days or 750 mg q24hr × 5 days
• Adult:
PO
250 mg q24hr × 10 days or 750 mg q24hr × 5 days
• Adult:
PO
500 mg q24hr × 28 days
• Adult/adolescent/child >50 kg:
PO/IV
500 mg q24hr × 60 days
• Infant >6 mo/child <50 kg:
IV
8 mg/kg q12hr × 60 days, max 250 mg/dose
• Adult:
PO/IV
500 mg q24hr × 7-14 days or 750 mg q24hr × 5 days
• Adult:
PO/IV
750 mg q24hr × 7-14 days
• Adult:
PO/IV
750 mg q24hr × 7-14 days
• Adult:
PO
500 mg q24hr × 7-10 days
• Adult:
PO/IV
250 mg q24hr × 10 days
• Adult:
PO
250 mg q24hr × 3 days
(y. pestis)
• Adult:
PO/IV
500 mg q24hr × 10-14 days, with pneumonia 750 mg q24hr
• Child/adolescent <50 kg:
PO/IV
8 mg/kg (max 250 mg/dose) q12hr × 10-14 days
• Adult:
IV
250 mg q24hr × 24-48 hr then
PO
500 mg/day × 7 days
• Adult:
IV
500 mg q24hr × 14 days
• Adult:
PO
100-200 mg bid-tid × 3-14 days
• Child 6 mo-14 yr:
PO
10 mg/kg bid × ≥10 days
• Adult:
PO/IV
CCr 20-49 ml/min, initial 500 mg then 250 mg q24hr; CCr 10-19 ml/min, 500-700 mg, depending on condition, then 250-500 mg q48hr
Available forms:
Single-use vials 500, 750 mg; premixed flexible containers 250 mg/50 ml D
5
W, 500 mg/100 ml D
5
W, 750 mg/150 ml D
5
W; tabs 250, 500, 750 mg; oral sol 25 mg/ml
•
Obtain C&S before treatment and periodically
•
PO 4 hr before or 2 hr after antacids, iron, calcium, zinc, give fluids
•
Do not use theophylline with this product; toxicity may result
•
Oral solution:
Give 1 hr before or 2 hr after food
•
Discard any unused sol in single-dose vial
•
Dilute with 0.9% NaCl, D5W to 5 mg/ml; give over 60 min/250 mg or 90 min/750 mg or using premix; tear outer wrap at notch and remove sol container; check for leaks; close control clamps; remove cover from port at bottom of container; insert pin into port with a twist; suspend container from hanger; squeeze, release drip chamber to proper fluid level; open flow control to expel air, close clamp; regulate rate with flow control clamps
Y-site compatibilities:
Alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, ampicillin, anidulafungin, atenolol, atracurium, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, caffeine citrate, calcium gluconate, CARBOplatin, carmustine, caspofungin, cefepime, cefoTEtan, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, floxuridine, fluconazole, fludarabine, fosphenytoin, gemcitabine, gentamicin, granisetron, haloperidol, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem-cilastatin, isoproterenol, labetalol, leucovorin, levorphanol, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methylPREDNISolone, metoclopramide, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mitoXANtrone, morphine, nalbuphine, naloxone, nesiritide, octreotide, ondansetron, oxacillin, oxaliplatin,
oxytocin, PACLitaxel, palonosetron, pancuronium, PEMEtrexed, penicillin G sodium, pentamidine, phenylephrine, plicamycin, potassium chloride, promethazine, propranolol, ranitidine, remifentanil, rocuronium, sargramostim, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiotepa, tirofiban, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine
Solution compatibilities:
0.9% NaCl, D
5
W, D
5
/0.9% NaCl, D
5
LR, D
5
/0.45% NaCl, sodium lactate, plasma-lyte 56/D
5
W
CNS:
Headache
, dizziness,
insomnia
, anxiety,
seizures,
encephalopathy
, paresthesia,
pseudotumor cerebri
CV:
Chest pain, palpitations, vasodilation,
QT prolongation
EENT:
Dry mouth, visual impairment
GI:
Nausea
, flatulence,
vomiting
, diarrhea, abdominal pain,
pseudomembranous colitis, hepatotoxicity
GU:
Vaginitis, crystalluria
HEMA:
Eosinophilia,
hemolytic anemia,
lymphopenia
INTEG:
Rash, pruritus,
photosensitivity
,
epidermal necrolysis
MISC:
Hypoglycemia, hypersensitivity, tendinitis,
tendon rupture
RESP:
Pneumonitis
SYST:
Anaphylaxis, multisystem organ failure, Stevens-Johnson syndrome
Metabolized in liver, excreted in urine unchanged, half-life 6-8 hr, peak 1-2 hr
Black Box Warning:
Increase:
tendon rupture—corticosteroids
•
Do not use with magnesium in same IV line
Increase:
levofloxacin levels—probenecid
Increase:
CNS stimulation, seizures—NSAIDs, foscarnet
Increase:
bleeding risk—warfarin
Decrease:
levofloxacin absorption—antacids containing aluminum, magnesium; sucralfate, zinc, iron, calcium
Decrease:
clearance of theophylline; toxicity may result
Decrease:
glucose, lymphocytes
•
Previous sensitivity reaction
•
Signs, symptoms of infection:
characteristics of sputum, WBC >10,000/mm
3
, fever; obtain baseline information before, during treatment
•
C&S before beginning product therapy to identify if correct treatment initiated
Allergic reactions, anaphylaxis:
rash, urticaria, pruritus, chills, fever, joint pain; may occur a few days after therapy begins; EPINEPHrine and resuscitation equipment should be available for anaphylactic reaction
•
Pseudomembranous colitis:
bowel pattern daily; if severe diarrhea, fever occurs, product should be discontinued
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
•
Renal function (BUN/creatinine)
Black Box Warning:
Tendon rupture:
discontinue product at first sign of tendon pain or inflammation, usually the Achilles tendon is affected; can occur up to few months after treatment and may require surgical repair; steroids may increase risk
•
Increased fluid intake to 2 L/day to prevent crystalluria
•
Therapeutic response: absence of signs, symptoms of infection (WBC <10,000/mm
3
, temp WNL)
•
To contact prescriber if vaginal itching; loose, foul-smelling stools; furry tongue occur (may indicate superinfection); to report itching, rash, pruritus, urticaria
•
To notify prescriber of diarrhea with blood or pus
•
To take product 4 hr before or 2 hr after antacids, iron, calcium, zinc products
•
To complete full course of therapy
•
To avoid hazardous activities until response is known
•
To use frequent rinsing of mouth, sugarless candy or gum for dry mouth
•
To avoid other medication unless approved by prescriber
•
To prevent sun exposure or to use sunscreen to prevent phototoxicity
Black Box Warning:
To notify prescriber of tendon pain, inflammation; avoid corticosteroids with this product