Mosby's 2014 Nursing Drug Reference (24 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(al-en-drone′ate)
Binosto, Fosamax, Fosamax plus D
Func. class.:
Bone-resorption inhibitor
Chem. class.:
Bisphosphonate
Do not confuse:
Fosamax
/Flomax
Decreases rate of bone resorption and may directly block dissolution of hydroxyapatite crystals of bone, inhibits osteoclast activity
Treatment and prevention of osteoporosis in postmenopausal women, treatment of osteoporosis in men, Paget’s disease, treatment of corticosteroid-induced osteoporosis in postmenopausal women not receiving estrogen and in men who are on continuing corticosteroid treatment with low bone mass
Hypersensitivity to bisphosphonates, delayed esophageal emptying, inability to sit or stand for 30 min, hypocalcemia
Precautions:
Pregnancy (C), breastfeeding, children, CCr <35 ml/min, esophageal disease, ulcers, gastritis, poor dental health, increased esophageal cancer risk
Calculator
• Adult and geriatic: PO
10 mg/day or 70 mg/wk
• Adult: PO
10 mg/day or 70 mg/wk
• Adult and geriatric: PO
40 mg/day × 6 mo, consider retreatment for relapse
• Adult/postmenopausal female: PO
5 mg/day or 35 mg/wk
• Adult: PO
10 mg/day
• Adult: PO
5 mg/day
• Adult: PO
CCr ≤35 ml/min, not recommended
Available forms:
Tabs 5, 10, 35, 40, 70 mg; tabs 70 mg with 2800 IU vit D
3
, 70 mg with 5600 IU Vit D
3
; oral sol 70 mg/75 ml, effervescent tab 70 mg
•
For 6 months to be effective for Paget’s disease
•
Tablet:
take with 8 oz of water 30 min before 1st food, beverage, or medication of the day
•
Do not lie down for ≥30 min after dose, do not take at bedtime or before rising
•
Liquid:
use oral syringe or calibrated device; give in
AM
with ≥2 oz of water ≥30 min before food, beverage, or medication
CNS:
Headache
GI:
Abdominal pain, constipation, nausea, vomiting, esophageal ulceration, acid reflux, dyspepsia,
esophageal perforation,
diarrhea,
esophageal cancer
META:
Hypophosphatemia, hypocalcemia
MS:
Bone pain, osteonecrosis of the jaw, bone fractures
SYST:
Angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis
Bioavailability 60%, protein binding 78%, rapidly cleared from circulation, taken up mainly by bones, eliminated primarily through kidneys; bound to bone, half-life >10 yr
Increase:
GI adverse reactions—NSAIDs, salicylates, H
2
blockers, proton pump inhibitors, gastric mucosal agents
Decrease:
absorption—antacids, calcium supplements, aminoglycosides
Decrease:
absorption when used with caffeine, orange juice, food
Decrease:
calcium, phosphate
Serious reactions: angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, atrial fibrillation
•
Hormonal status if a woman, before treatment
•
For osteoporosis:
bone density test before and during treatment
•
For Paget’s disease:
increased skull size, bone pain, headache; decreased vision, hearing
•
Electrolytes; BUN/creatinine; calcium, phosphorous, magnesium, potassium
•
For hypercalcemia:
paresthesia, twitching, laryngospasm; Chvostek’s, Trousseau’s signs
•
Alk phos levels, baseline and periodically, 2 × upper limit of normal is indicative of Paget’s disease
•
Dental status: regular dental exams should be performed; dental extractions (cover with antiinfectives before procedure)
•
Storage in cool environment, out of direct sunlight
•
Therapeutic response: increased bone mass, absence of fractures
•
To remain upright for 30 min after dose to prevent esophageal irritation; if dose is missed, skip dose, do not double doses or take later in day; to take in
AM
before food, other meds; to take with 6-8 oz of water only (no mineral water)
•
To take calcium, vit D if instructed by health care provider
•
To perform weight-bearing exercise to increase bone density
•
To let health care provider know if pregnant or if pregnancy is planned or if breastfeeding; to inform dentist of the use of this product
•
To maintain good oral hygiene
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(al-fyoo′zoe-sin)
Uroxatral
Func. class.:
Urinary tract, antispasmodic, α
1
-agonist
Chem. class.:
Quinazolone
Binds to α
1A
-adrenoceptor subtype located mainly in the prostate, relaxing smooth muscles
Symptoms of benign prostatic hyperplasia
Unlabeled uses:
Lower urinary tract symptoms, erectile dysfunction with sildenafil
Hypersensitivity, moderate to severe hepatic impairment; not indicated for use in women or children, breastfeeding
Precautions:
Pregnancy (B) but not used in females, geriatric patients; CAD, coronary insufficiency, mild hepatic disease, mild/moderate/severe renal disease, history of QT prolongation or coadministration with meds known to prolong QT interval, torsades de pointes, syncope, surgery, prostate cancer, orthostatic hypotension, ocular surgery, dysrhythmias, angina
Calculator
• Adult: PO EXT REL
10 mg/day, taken after same meal each day
Available forms:
Ext rel tabs 10 mg
•
Do not break, crush, chew tabs; give with food; take at same time each day
CNS:
Dizziness, headache
, fatigue, flushing
CV:
Postural hypotension (dizziness, lightheadedness, fainting) within a few hours of administration, chest pain, tachycardia, angina
GI:
Nausea, abdominal pain, dyspepsia, constipation, diarrhea, liver injury, jaundice
INTEG:
Rash, urticaria,
angioedema,
pruritus
GU:
Impotence, priapism
MISC:
Body pain in general, xerostomia, rhinitis
RESP:
Upper respiratory infection, pharyngitis, bronchitis, sinusitis
Peak 8 hr, elimination half-life 10 hr, extensively metabolized in liver by CYP3A4 enzyme, excreted via urine (11% unchanged), moderately protein binding (82%-90%)
•
Not to be taken with prazosin, terazosin, doxazosin
Increase:
QT prolongation (slight)—class IA/III antidysrhythmics
Increase:
effects of alfuzosin—alcohol
Increase:
effects—CYP3A4 inhibitors (ketoconazole, itraconazole, and ritonavir); do not use together
Increase:
hypotension—β-blockers, phosphodiesterase 5 inhibitors, nitrates
•
Prostatic hyperplasia:
change in urinary patterns (hesitancy, dribbling, dysuria, urgency), baseline and throughout treatment
•
Serious skin reactions:
angioedema
•
Storage in tight container in cool environment
•
Therapeutic response: decreased
symptoms of benign prostatic hyperplasia
•
To take at same time each day with food; to not double doses
•
Not to drive or operate machinery for 4 hr after 1st dose or after dosage increase, dizziness may occur
•
About orthostatic hypotension; to rise slowly from sitting or lying
•
To avoid all OTC products unless approved by prescriber
•
To notify prescriber of fainting, dizziness
•
That erectile dysfunction is a side effect and is temporary
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert