Mosby's 2014 Nursing Drug Reference (26 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-moh-trip′tan)
Axert
Func. class.:
Antimigraine agent, abortive
Chem. class.:
5-HT
1
-receptor agonist, triptan
Do not confuse:
Axert
/Antivert
Binds selectively to the vascular 5-HT
1B/1D/1F
-receptors, exerts antimigraine effect
Acute treatment of migraine with or without aura (adult/adolescent/child ≥12 yr)
Hypersensitivity, acute MI, angina, CV disease, CAD, stroke, vasospastic angina, ischemic heart disease or risk for, peripheral vascular syndrome, uncontrolled hypertension, basilar or hemiplegic migraine
Precautions:
Pregnancy (C), postmenopausal women, men >40 yr, breastfeeding, children <18 yr, geriatric patients, risk factors for CAD, MI; hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function, sulfonamide hypersensitivity, cardiac dysrhythmias, Raynaud’s disease, tobacco smoking, Wolff-Parkinson-White syndrome
Calculator
• Adult, adolescent, and child
≥
12 yr: PO
6.25-12.5 mg; may repeat dose after 2 hr; max 2 doses/24 hr, 25 mg/day or 4 treatment cycles within any 30-day period
• Adult: PO
6.25 mg initially, max 12.5 mg
Available forms:
Tabs 6.25, 12.5 mg
•
Avoid using more than 2 ×/wk; rebound headache may occur
•
Swallow tabs whole; do not break, crush, chew, without regard to food
CNS:
Tingling, hot sensation, burning, feeling of pressure, tightness, numbness, dizziness, sedation
, headache, anxiety, fatigue, cold sensation,
seizures
CV:
Flushing
, palpitations, tachycardia,
coronary artery vasospasm, MI, ventricular fibrillation, ventricular tachycardia
EENT:
Throat, mouth, nasal discomfort; vision changes
GI:
Nausea, xerostomia
INTEG:
Sweating
MS:
Weakness, neck stiffness
, myalgia
RESP:
Chest tightness, pressure
Onset of pain relief 2 hr; peak 1-3 hr; duration 3-4 hr; bioavailability 70%; protein binding 35%; metabolized in the liver (metabolite), metabolized by MAO-A, CYP2D6, CYP3A4; excreted in urine (40%), feces (13%); half-life 3-4 hr
Increase:
serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists, sibutramine
Increase:
vasospastic effects—ergot, ergot derivatives, other 5-HT
1
agonists; avoid concurrent use
Increase:
almotriptan effect—MAOIs, do not use together
Increase:
plasma concentration of almotriptan—(CYP3A4 inhibitors) itraconazole, ritonavir, erythromycin, ketoconazole, avoid concurrent use in renal/hepatic disease
•
Avoid use with feverfew
Increase:
serotonin syndrome—St. John’s wort
•
Migraine:
pain location, aura, duration, intensity, nausea, vomiting
•
Serotonin syndrome:
occurs in those taking SSRIs, SNRIs; agitation, confusion, hallucinations, diaphoresis, hypertension, diarrhea, fever, tremor, usually occurs when dose is increased
•
B/P; signs/symptoms of coronary vasospasms
•
For stress level, activity, recreation, coping mechanisms
•
Neurologic status: LOC, blurring vision, nausea, vomiting, tingling, hot sensation, burning, feeling of pressure, numbness, flushing preceding headache
•
Tyramine foods
(pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artificial sweeteners, chocolate, caffeine, which may precipitate these types of headaches
•
Quiet, calm environment with decreased stimulation from noise, bright light, excessive talking
•
Therapeutic response: decrease in severity of migraine
•
To report chest pain, drowsiness, dizziness, tingling, flushing
•
To use contraception while taking product, to notify prescriber if pregnancy is planned or suspected, to avoid breastfeeding
•
That if one dose does not relieve migraine to take another after 2 hr
•
That product does not prevent or reduce number of migraine attacks; use to relieve attack only
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ah-loss′a-tron)
Lotronex
Func. class.:
Antidiarrheal, anti-IBS agent
Chem. class.:
Serotonin receptor antagonist
A potent and selective antagonist at serotonin 5-HT
3
receptors, which are extensively distributed on enteric neurons in GI tract. Antagonism at these receptors in the GI tract modulates the regulation of visceral pain, colonic transit, and GI secretions
Severe, chronic, diarrhea-predominant irritable bowel syndrome (IBS) in women who have failed conventional therapy
Crohn’s disease, severe hepatic disease, diverticulitis, toxic megacolon, GI adhesions/strictures/obstruction/perforation, thrombophlebitis, ulcerative colitis
Black Box Warning:
Ischemic colitis, severe constipation
Precautions:
Breastfeeding, pregnancy (B), child <18 yr
Calculator
• Adult woman: PO
0.5 mg bid, may increase to 1 mg bid after 4 wk if well tolerated, if symptoms are not controlled after 4 wks of treatment with 1 mg bid, discontinue
Available forms:
Tab 0.5 mg, 1 mg
•
Without regard to meals
Black Box Warning:
Only after “Physician–Patient Agreement Form” is signed and patient receives official Medication Guide
CNS:
Fatigue, headache
GI:
Constipation, abdominal pain, distention, reflux, nausea,
obstruction,
impaction,
ischemic colitis, ileus perforation, small-bowel mesenteric ischemia
GU:
Urinary tract infection
MS:
Muscle spasm
RESP:
Cough, nasopharyngitis, upper respiratory tract infection
Peak 1 hr, half-life 1½ hr, metabolized extensively in the liver
•
Do not use with fluvoxaMINE
Increase:
Alosetron metabolism—CYP3A4, 1A2, 2C9 inducers
Increase:
serious adverse reactions, drugs that decrease GI motility—drugs with anticholinergic such as TCAs, H
1
-blockers, orphenadrine, OLANZapine, maprotiline, disopyramide, cyclobenzaprine, cloZAPine, buPROPion, amoxapine, amantadine
Decrease:
Alosetron metabolism—CYP3A4, 1A2, 2C9 inhibitors, hydrALAZINE, procainamide
Increase:
ALT
Black Box Warning:
Irritable bowel syndrome—constipation, diarrhea, abdominal pain, fecal incontinence, discontinue immediately if bloody diarrhea, severe constipation, rectal bleeding, or severe abdominal pain occur
Black Box Warning:
Only clinicians enrolled in the Prometheus Prescribing Program for Lotronex should use this product
•
Geriatric women can experience more severe side effects
•
Storage at room temperature, protect from light and moisture
•
Therapeutic response: Decreasing symptoms of IBS
Black Box Warning:
Immediately report severe constipation, bloody diarrhea, rectal bleeding, or worsening abdominal pain
•
Not to double doses, if a dose is missed skip it
•
That product may be taken without regard to food
•
That product does not cure disorder, only controls symptoms
•
Provide medication guide and clarify, if needed, that improvement in symptoms can take 1-4 wks
•
That product is only used for women with IBS
•
To report if pregnancy is planned or suspected, product should not be used during pregnancy, effects are unknown