Mosby's 2014 Nursing Drug Reference (248 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(lo-zar′tan)
Cozaar
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin II receptor (type AT
1
) antagonist
Do not confuse:
losartan
/valsartan
Cozaar
/Zocor
Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT
1
receptor found in tissues
Hypertension, alone or in combination; nephropathy in type 2 diabetes; proteinuria; stroke prophylaxis for hypertensive patients with left ventricular hypertrophy
Hypersensitivity
Black Box Warning:
Pregnancy (D) 2nd/3rd trimesters
Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children, geriatric patients; hypersensitivity to ACE inhibitors; hepatic disease, angioedema, renal artery stenosis, those of African American descent
Calculator
• Adult:
PO
50 mg/day alone or 25 mg/day in combination with diuretic; maintenance 25-100 mg/day
• Child ≥6 yr:
PO
0.7 mg/kg/day, max 50 mg/day
• Adult:
PO
50 mg/day; add hydrochlorothiazide 12.5 mg/day and/or increase losartan to 100 mg/day then increase hydrochlorothiazide to 25 mg/day
• Adult:
PO
50 mg/day, may increase to 100 mg/day
• Adult:
PO
25 mg/day as starting dose
Available forms:
Tabs 25, 50, 100 mg
•
Without regard to meals
CNS:
Dizziness, insomnia
, anxiety, confusion, abnormal dreams, migraine, tremor, vertigo, headache, malaise, depression
CV:
Angina pectoris, 2nd-degree AV block,
cerebrovascular accident,
hypotension,
MI, dysrhythmias
EENT:
Blurred vision, burning eyes, conjunctivitis
GI:
Diarrhea, dyspepsia
, anorexia, constipation, dry mouth, flatulence, gastritis, vomiting
GU:
Impotence, nocturia, urinary frequency, UTI,
renal failure
HEMA:
Anemia,
thrombocytopenia
INTEG:
Alopecia, dermatitis, dry skin, flushing, photosensitivity, rash, pruritus, sweating,
angioedema
META:
Gout
MS:
Cramps, myalgia, pain, stiffness
RESP:
Cough, upper respiratory infection
, congestion, dyspnea, bronchitis
Peak 1-4 hr, extensively metabolized, half-life 2 hr, metabolite 6-9 hr, excreted in urine/feces, protein binding 98.7%
Increase:
lithium toxicity—lithium
Increase:
antihypertensive effect—fluconazole
Increase:
hyperkalemia—potassium-sparing diuretics, potassium supplements, ACE inhibitors
Decrease:
antihypertensive effect—NSAIDs, PHENobarbital, rifamycin, salicylates
•
B/P with position changes, pulse before and periodically during treatment; note rate, rhythm, quality
•
Baselines of renal, hepatic studies before therapy begins and periodically thereafter
•
Skin turgor, dryness of mucous membranes for hydration status
Angioedema: facial swelling, dyspnea, wheezing; may occur rapidly; tongue swelling (rare)
•
CHF:
jugular venous distention; edema in feet/legs, weight daily
•
Blood dyscrasias:
thrombocytopenia, anemia (rare)
Black Box Warning:
Pregnancy before starting treatment; pregnancy (D) 2nd/3rd trimester
•
Therapeutic response: decreased B/P, slowing diabetic neuropathy
•
To avoid sunlight or to wear sunscreen if in sunlight; that photosensitivity may occur
•
To comply with dosage schedule, even if feeling better; not to discontinue abruptly
•
To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain
•
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur
•
That product may cause dizziness, fainting, lightheadedness
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
Black Box Warning:
To use contraception while taking this product; pregnancy (D) 2nd/3rd trimesters
•
To avoid salt substitutes, alcohol, grapefruit juice, OTC products unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(loh-vah-stat′in)
Altoprev, Mevacor
Func. class.:
Antilipemic
Chem. class.:
HMG-CoA reductase inhibitor
Do not confuse:
lovastatin
/Lotensin/Leustatin
Mevacor
/mivacron
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
As an adjunct for primary hypercholesterolemia (types IIa, IIb), atherosclerosis; heterozygous familial hypercholesterolemia (adolescents)
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Precautions:
Children, past hepatic disease, alcoholism, severe acute infections, trauma, hypotension, uncontrolled seizure disorders, severe metabolic disorders, electrolyte imbalances, visual disorder
Calculator
• Adult:
PO
20 mg/day with evening meal; may increase to 20-80 mg/day in single or divided doses, max 60 mg/day;
EXT REL
20-60 mg/day at bedtime, max 80 mg/day
• Adolescent 10-17 yr:
PO
10-40 mg with evening meal
• Adult:
PO
CCr <30 mg/min, max 20 mg/day unless titrated
Available forms:
Tabs 10, 20, 40 mg; ext rel tab (Altocor) 10, 20, 40, 60 mg
•
In evening with meal; if dose is increased, take with breakfast and evening meal
•
Altroprev not equivalent to Mevacor
•
Do not crush, chew ext rel tab
CNS:
Dizziness, headache, tremor
, insomnia, paresthesia
EENT:
Blurred vision
, lens opacities
GI:
Flatus, nausea, constipation, diarrhea, dyspepsia, abdominal pain, heartburn
,
hepatic dysfunction,
vomiting, acid regurgitation, dry mouth, dysgeusia
HEMA:
Thrombocytopenia, hemolytic anemia, leukopenia
INTEG:
Rash, pruritus
, photosensitivity
MS:
Muscle cramps, myalgia
,
myositis, rhabdomyolysis;
leg, shoulder, or localized pain
PO:
Peak 2 hr; peak response 4-6 wk, ext rel peak 14 hr; metabolized in liver (metabolites); highly protein bound; excreted in urine 10%, feces 83%; crosses blood-brain barrier, placenta; excreted in breast milk; half-life 1 hr
Increase:
myalgia, myositis, rhabdomyolysis—azole antifungals, clarithromycin, clofibrate, cycloSPORINE, dalfopristin, danazol, diltiazem, erythromycin, gemfibrozil, niacin, protease inhibitors, quinupristin, telithromycin, verapamil, avoid concurrent use
Increase:
bleeding—warfarin
Increase:
lovastatin effects—diltiazem
Decrease:
effects of lovastatin—bile acid sequestrants, exonatide, bosentan
Decrease:
effect—pectin, St. John’s wort
Increase:
adverse reactions—red yeast rice
•
Possible toxicity: grapefruit juice
Increase:
levels of lovastatin with food; must be taken with food
Decrease:
absorption—oat bran
Increase:
CK, LFTs
•
Diet;
obtain diet history including fat, cholesterol in diet
•
Fasting cholesterol, LDL, HDL, triglycerides periodically during treatment
•
Hepatic studies at initiation, 6 wk, 12 wk after initiation or change in dose, periodically thereafter; AST, ALT, LFTs may increase
•
Renal function in patients with compromised renal system: BUN, creatinine, I&O ratio
•
Storage in cool environment in airtight, light-resistant container
•
Therapeutic response: decreased triglycerides, sLDL, total cholesterol; increased HDL; slowing CAD
•
To report suspected pregnancy (pregnancy [X]); not to breastfeed
•
That blood work, ophthalmic exam will be necessary during treatment
•
To report blurred vision, severe GI symptoms, dizziness, headache, muscle pain, weakness
•
To use sunscreen or to stay out of the sun to prevent photosensitivity
•
That previously prescribed regimen will continue: low-cholesterol diet, exercise program, smoking cessation
•
That product should be taken with food, not to crush, chew ext rel product