Mosby's 2014 Nursing Drug Reference (247 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
, Rx)
(lor-a′ti-deen)
Alavert, Claritin, Claritin Children’s, Claritin RediTabs, Clear-Atadine, Dimetapp, Equaline Non-Drowsy, Equate Allergy Relief, Good Sense Non-Drowsy, Leader Allergy Relief, Tavist ND, Wal-itin Aller-Melts, Wal-vert
Func. class.:
Antihistamine, 2nd generation
Chem. class.:
Selective histamine (H
1
)-receptor antagonist
Do not confuse:
loratadine
/lovastatin/LORazepam/losartan
Binds to peripheral histamine receptors, thereby providing antihistamine action without sedation
Seasonal rhinitis, chronic idiopathic urticaria for those ≥2 yr
Hypersensitivity, acute asthma attacks, lower respiratory tract disease
Precautions:
Pregnancy (B), breastfeeding, increased intraocular pressure, bronchial asthma, hepatic/renal disease
Calculator
• Adult and child ≥6 yr:
PO
10 mg/day
• Child 2-5 yr:
PO
5 mg/day
• Adult:
PO
CCr <30 ml/min or hepatic disease, 10 mg every other day
Available forms:
Tabs 10 mg; rapid-disintegrating tabs 10 mg; orally disintegrating tabs 10 mg; syr 1 mg/ml; susp 5 mg/ml, ext rel tab 10 mg
•
Rapid-disintegrating tabs
by placing on tongue, to be swallowed after disintegrated with/without water
•
Use within 6 mo of opening pouch and immediately after opening blister pack
•
On empty stomach daily
•
Do not break, crush, or chew
CNS:
Sedation (more common with increased doses), headache, fatigue, restlessness
EENT:
Dry mouth
Onset 1-3 hr, peak 8-10 hr, duration 24 hr, metabolized in liver to active metabolites, excreted in urine, active metabolite desloratadine half-life 20 hr
Increase:
antihistamine effects—MAOIs
Increase:
CNS depressant effects—alcohol, antidepressants, other antihistamines, sedative/hypnotics
Increase:
loratadine level—cimetidine, ketoconazole, macrolides (clarithromycin, erythromycin)
False negative:
skin allergy tests (discontinue antihistamine 3 days before testing)
•
Allergy:
hives, rash, rhinitis; monitor respiratory status
•
Storage in tight container at room temp
•
Therapeutic response: absence of running or congested nose, other allergy symptoms
•
To avoid driving, other hazardous activities if drowsiness occurs
•
To avoid use of other CNS depressants
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(lor-a′ze-pam)
Ativan
Func. class.:
Sedative, hypnotic; antianxiety
Chem. class.:
Benzodiazepine, short acting
Do not confuse:
LORazepam
/ALPRAZolam/clonazePAM
Potentiates the actions of GABA, especially in the limbic system and the reticular formation
Anxiety, irritability with psychiatric or organic disorders, preoperatively; insomnia; adjunct for endoscopic procedures, status epilepticus
Unlabeled uses:
Antiemetic before chemotherapy, rectal use, alcohol withdrawal, seizure prophylaxis, agitation, insomnia, sedation maintenance
Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, benzyl alcohol; closed-angle glaucoma, psychosis, history of drug abuse, COPD, sleep apnea
Precautions:
Children <12 yr, geriatric patients, debilitated, renal/hepatic disease, addiction, suicidal ideation, abrupt discontinuation
Calculator
• Adult/adolescent:
PO
2-3 mg/day in divided doses, max 10 mg/day
• Geriatric:
PO
1-2 mg/day in divided doses or 0.5-1 mg at bedtime
• Adult:
IM
50 mcg/kg 2 hr prior to surgery;
IV
44 mcg/kg 15-20 min prior to surgery, max 2 mg 15-20 min prior to surgery
• Child ≥12 yr:
IV
0.05 mg/kg
• Neonate:
IV
0.05 mg/kg
• Child:
IV
0.1 mg/kg up to 4 mg/dose;
RECT
(unlabeled) 0.05-0.1 mg × 2; wait 7 min before giving 2nd dose
• Adult:
PO
2 mg q6hr × 4 doses then 1 mg q6hr for 8 doses
• Adult:
PO
2-4 mg at bedtime; only minimally effective after 2 wk continuous therapy
• Geriatric:
PO
0.5-1 mg initially
Available forms:
Tabs 0.5, 1, 2 mg; inj 2, 4 mg/ml; conc oral sol 2 mg/ml
•
With food or milk for GI symptoms; crushed if patient is unable to swallow medication whole
•
Sugarless gum, hard candy, frequent sips of water for dry mouth
•
Give largest dose before bedtime if giving in divided doses
•
Concentrate:
use calibrated dropper; add to food/drink; consume immediately
•
Deep into large muscle mass
•
Use this route when IV is not feasible
•
Prepare immediately before use; short stability time
•
IV after diluting in equal vol sterile water, 5% dextrose, or 0.9% NaCl for inj; give through
Y
-tube or 3-way stopcock; give at ≤2 mg/1 min, do not give rapidly
•
Do not use in neonates (benzyl alcohol)
Y-site compatibilities:
Acyclovir, albumin, allopurinol, amifostine, amikacin, amoxicillin, amoxicillin/clavulanate, amphotericin B cholesteryl, amsacrine, atenolol, atracurium, bivalirudin, bleomycin, bumetanide, butorphanol, calcium chloride/gluconate, CARBOplatin,
ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamycin, cloNIDine, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, diltiazem, DOBUTamine, DOCEtaxel, DOPamine, doripenem, DOXOrubicin, DOXOrubicin liposomal, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, erythromycin, esmolol, etomidate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, melphalan, meropenem, metaraminol, methadone, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, minocycline, mitoXANtrone, morphine, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, PENTobarbital, PHENobarbital, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, propofol, ranitidine, remifentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, TPN, trastuzumab, trimethobenzamide, trimethoprim-sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine
CNS:
Dizziness, drowsiness
, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, weakness, unsteadiness
CV:
Orthostatic hypotension
,
ECG changes, tachycardia,
hypotension;
apnea, cardiac arrest (IV, rapid)
EENT:
Blurred vision
, tinnitus, mydriasis
GI:
Constipation, dry mouth, nausea, vomiting, anorexia, diarrhea
INTEG:
Rash, dermatitis, itching
MISC:
Acidosis
Metabolized by liver; excreted by kidneys; crosses placenta, excreted in breast milk; half-life 42 hr (neonates), 10.5 hr (older child), 12 hr (adult), 91% protein bound
PO:
Onset 1/2 hr, peak 1-6 hr, duration 12-24 hr
IM:
Onset 15-30 min, peak 1-1½ hr, duration 6-8 hr
IV:
Onset 5-15 min, peak unknown, duration 6-8 hr
Increase:
LORazepam effects—CNS depressants, alcohol, disulfiram
Decrease:
LORazepam effects—valproic acid, oral contraceptives
Increase:
CNS depression—chamomile, kava, valerian
Increase:
AST, ALT
Anxiety:
decrease in anxiety; mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, suicidal tendencies
•
Renal/hepatic/blood status if receiving high-dose therapy
•
Physical dependency, withdrawal symptoms:
headache, nausea, vomiting, muscle pain, weakness, tremors, seizures, after long-term, excessive use
•
Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs
•
Check to confirm that PO medication has been swallowed
•
Refrigerate parenteral form
•
Therapeutic response: decreased anxiety, restlessness, insomnia
•
That product may be taken with food
•
Not to use product for everyday stress or for >4 mo unless directed by prescriber
•
Not to take more than prescribed amount; may be habit forming
•
To avoid OTC preparations (cough, cold, hay fever) unless approved by prescriber
•
To avoid driving, activities that require alertness, since drowsiness may occur
•
To avoid alcohol, other psychotropic medications unless directed by prescriber
•
Not to discontinue medication abruptly after long-term use
•
To rise slowly because fainting may occur, especially among geriatric patients
•
That drowsiness may worsen at beginning of treatment
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (D), do not breastfeed
Lavage, VS, supportive care, flumazenil