Mosby's 2014 Nursing Drug Reference (262 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(meth-ill-er-goe-noe′veen)
Func. class.:
Oxytocic
Chem. class.:
Ergot alkaloid
Stimulates uterine, vascular, and smooth muscle, thereby causing contractions; decreases bleeding; arterial vasoconstriction
Treatment of hemorrhage postpartum or postabortion, uterine contractions
Pregnancy (other than obstetric delivery/abortion), hypertension, preeclampsia, eclampsia, elective induction of labor, hypersensitivity to ergot preparations
Precautions:
Severe renal/hepatic disease, jaundice, diabetes mellitus, seizure disorders, sepsis, CAD, last stage of labor
Calculator
• Adult:
PO
200 mcg tid-qid × ≤7 days;
IM/IV
200 mcg q2-4hr × 1-5 doses
Available forms:
Inj 200 mcg/ml; tabs 200 mcg
•
Do not exceed dosage limits
•
Store tabs at room temperature
•
Give with water
•
Only during 4th stage of labor; not to be used to augment labor
•
Protect from light
•
IM in deep muscle mass; rotate inj sites for additional doses, aspirate
•
Undiluted through
Y
-tube or 3-way stopcock; give ≤0.2 mg/min or diluted in 5 ml 0.9% NaCl given through
Y
-site
•
With crash cart available on unit; IV route used only in emergencies
•
Refrigerated storage of ampules; protect from light; give only if solution is clear; colorless
Y-site compatibilities:
Heparin, hydrocortisone sodium succinate, potassium chloride, vit B/C
CNS:
Headache, dizziness
,
seizures, hallucinations; stroke (IV)
CV:
Hypotension,
chest pain, palpitation,
hypertension, dysrhythmias, CVA (IV)
EENT:
Tinnitus
GI:
Nausea, vomiting
GU:
Cramping
INTEG:
Sweating, rash, allergic reactions
MS:
Leg cramps
RESP:
Dyspnea
Metabolized in liver, excreted in urine
PO:
Onset 5-25 min, duration 3 hr
IM:
Onset 2-5 min, duration 3 hr
IV:
Onset immediate, duration 45 min
Increase:
vasoconstriction—DOPamine, ergots, anesthetics (regional), vasopressors, nicotine
Increase:
ergot toxicity—CYP3A4 inhibitors, do not use together
•
B/P, pulse, character and amount of vaginal bleeding; watch for indications of hemorrhage
•
Uterine relaxation; observe for severe cramping
Ergot toxicity:
tinnitus, hypertension, palpitations, chest pain, nausea, vomiting, weakness; cold, numb extremities
•
Therapeutic response: absence of hemorrhage
•
To report increased blood loss, severe abdominal cramps, fever or foul-smelling lochia
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(meth-il-nal-trex′one)
Relistor
Func. class.:
Opioid antagonist
Peripheral μ-opioid receptor antagonist that reduces constipation associated with opiate agonists
Treatment of opioid-induced constipation in patients with advanced illness who are receiving palliative care when response to laxative therapy has been insufficient
Unlabeled uses:
Pruritus; nausea, vomiting related to morphine; urinary retention from opioids
Hypersensitivity, GI obstruction, IV route
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, renal disease, diarrhea, driving, operating machinery, neoplastic disease, Crohn’s disease, peptic ulcer, ulcerative colitis
Calculator
• Adult >114 kg:
SUBCUT
0.15 mg/kg every other day prn
• Adult 62-114 kg:
SUBCUT
12 mg every other day prn
• Adult 38-<62 kg:
SUBCUT
8 mg every other day prn
• Adult <38 kg:
SUBCUT
0.15 mg/kg every other day prn
• Adult:
SUBCUT
CCr <30 ml/min, reduce normal adult dose by 50%
• Adult:
PO
19.2 mg/kg 20 min prior to morphine
Available forms:
Sol for inj 12 mg/0.6 ml
•
SUBCUT only; oral dose investigational, not currently available
•
Do not give IV; IV dosing for urinary retention investigational
•
Inspect sol before use; should be clear, colorless to pale yellow aqueous sol; do not use if particulate matter or discoloration are present
•
Withdraw needed amount of sol into sterile syringe; if immediate administration is impossible, syringe may be kept at room temp for ≤24 hr; syringe does not need to be kept away from light during the 24-hr period; immediately discard any unused portion in vial; no preservatives are present
•
Administer into upper arm, abdomen, or thigh ≤1×/24 hr; rotate inj sites; do not inject same spot each time; do not inject into areas where skin is tender,
bruised, red, or hard; avoid areas with scars or stretch marks
•
If using with retractable needle, slowly push down on plunger past resistance point until the syringe is empty and click is heard
CNS:
Dizziness
GI:
Nausea, vomiting, diarrhea, flatulence, abdominal pain
INTEG:
Hyperhidrosis
Terminal half-life 8 hr, protein binding 11%-15.3%; renal impairment has marked effect on renal excretion of methylnaltrexone; dose adjustment is required for patients with CCr <30 ml/min; renal clearance decreased and total systemic exposure increased in patients with severe renal impairment who receive single SUBCUT dose of 0.3 mg/kg
SUBCUT:
Peak 30 min
•
Serum creatinine
•
Opioid-induced constipation:
stool characteristics, bowel sounds during treatment
•
Storage at 59° F-86° F (15° C-30° C); do not freeze
•
Storage away from light
•
Therapeutic response: decreasing constipation
•
That, after 30 min, to remain near toilet facilities because bowel relaxation occurs, not to use more than 1 dose in 24 hr
•
To notify prescriber of abdominal pain, continuous or severe diarrhea, nausea, vomiting
•
Avoid use in pregnancy unless absolutely necessary; avoid in breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert