Mosby's 2014 Nursing Drug Reference (270 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mig′lih-tol)
Glyset
Func. class.:
Oral hypoglycemic
Chem. class.:
α-Glucosidase inhibitor
Delays digestion and absorption of ingested carbohydrates, which results in a smaller rise in blood glucose after meals; does not increase insulin production
Type 2 diabetes mellitus
Hypersensitivity, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, chronic intestinal disease, ileus
Precautions:
Pregnancy (B), breastfeeding, children, renal/hepatic disease
Calculator
• Adult:
PO
25 mg tid initially, with 1st bite of meal; maintenance dose may be increased to 50 mg tid; may be increased to 100 mg tid if needed with dosage adjustment at 4- to 8-wk intervals
Available forms:
Tabs 25, 50, 100 mg
•
Tid with first bite of each meal
GI:
Abdominal pain, diarrhea, flatulence
,
hepatotoxicity
HEMA:
Low iron
INTEG:
Rash
RESP:
Pneumatosis cystoides, intestinalis
Peak 2-3 hr, not metabolized, excreted in urine as unchanged product, half-life 2 hr
Decrease:
levels of digoxin, propranolol, ranitidine
Decrease:
miglitol levels—digestive enzymes, intestinal adsorbents; do not use together
Increase:
diarrhea—carbohydrates
•
Hypo/hyperglycemia;
even though product does not cause hypoglycemia, if patient receiving sulfonylureas or insulin, hypoglycemia may be additive (rare)
•
Blood glucose levels, hemoglobin, A1c LFTs; if hypoglycemia occurs with monotherapy, treat with glucose
•
Storage in tight container at room temp
•
Therapeutic response: decreased signs, symptoms of diabetes mellitus (polyuria, polydipsia, polyphagia; clear sensorium, absence of dizziness; stable gait); improved blood glucose, A1c
•
About the symptoms of hypo/hyperglycemia, what to do about each; that, during periods of stress, infection, or surgery, insulin may be required
•
That medication must be taken as prescribed; about consequences of discontinuing medication abruptly
•
To avoid OTC medications unless approved by health care provider
•
That diabetes is lifelong; that product is not a cure
•
To carry ID for emergency purposes
•
That diet and exercise regimen must be followed
•
About GI side effects
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTmilrinone (Rx)
(mill′rih-nohn)
Func. class.:
Inotropic/vasodilator agent with phosphodiesterase activity
Chem. class.:
Bipyridine derivative
Positive inotropic agent; increases contractility of cardiac muscle with vasodilator properties; reduces preload and afterload by direct relaxation on vascular smooth muscle
Short-term management of advanced heart failure that has not responded to other medication
Unlabeled uses:
Adolescents, children, infants
Hypersensitivity to this product, severe aortic disease, severe pulmonic valvular disease, acute MI
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal/hepatic disease, atrial flutter/fibrillation
Calculator
• Adult:
IV BOL
50 mcg/kg given over 10 min; start inf of 0.375-0.75 mcg/kg/min
• Adolescent/child/infant (unlabeled):
IV
50-75 mcg/kg over 10-60 min then 0.5-0.75 mcg/kg/min
• Adult:
IV
CCr 41-50 ml/min, 0.43 mcg/kg/min, titrate up; CCr 31-40 ml/min, 0.38 mcg/kg/min, titrate up; CCr 21-30 ml/min, 0.33 mcg/kg/min, titrate up; CCr 11-20 ml/min, 0.08 mcg/kg/min; CCr 6-10 ml/min, 0.23 mcg/kg/min; CCr ≤5 ml/min, 0.20 mcg/kg/min; max for all doses 0.75 mcg/kg/min
Available forms:
Inj 1 mg/ml; premixed inj 200 mcg/ml in D
5
W
•
Potassium supplements if ordered for potassium levels <3 mg/dl
•
Give IV loading dose undiluted over 10 min, use inf device
•
Dilute 20-mg vial with 80, 113, 180 ml of 0.45% NaCl, 0.9% NaCl, or D
5
W to a conc of 200, 150, 100 mcg/ml respectively
•
Titrate rate based on hemodynamic and clinical response, use inf device
•
Precipitation will form when furosemide is injected into line with milrinone
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, argatroban, atenolol, atracurium, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiazem, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, ertapenem, erythromycin, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, methohexital, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, mitoXANtrone, morphine, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride/phosphates, prochlorperazine, promethazine, propofol, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, torsemide, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CV:
Dysrhythmias,
hypotension, chest pain,
PVCs
GI:
Nausea, vomiting, anorexia, abdominal pain,
hepatotoxicity, jaundice
HEMA:
Thrombocytopenia
MISC:
Headache, hypokalemia, tremor, inj site reactions
IV:
Onset 2-5 min, peak 10 min, duration variable; terminal half-life 2.3 hr; metabolized in liver; excreted in urine as product (83%), metabolites (12%)
Increase:
effects of antihypertensives, diuretics
ECG continuously during IV; ventricular dysrhythmia can occur
•
B/P, pulse q5min during inf; if B/P drops 30 mm Hg, stop inf, call prescriber
•
Electrolytes: potassium, sodium, chloride, calcium; renal studies: BUN, creatinine; blood studies: platelet count
•
ALT, AST, bilirubin daily
•
I&O ratio, weight daily; diuresis should increase with continuing therapy
•
If platelets are <150,000/mm
3
, product is usually discontinued and another product started
•
Therapeutic response: increased cardiac output, decreased PCWP, adequate CVP; decreased dyspnea, fatigue, edema, ECG
•
To report angina immediately during inf
•
To report headache, which can be treated with analgesics
Discontinue product, support circulation