Mosby's 2014 Nursing Drug Reference (273 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mye-soe-prost′ole)
Cytotec
Func. class.:
Gastric mucosa protectant, antiulcer
Chem. class.:
Prostaglandin E
1
analog
Do not confuse:
misoprostol
/metoprolol
Cytotec
/Cytoxan
Inhibits gastric acid secretion; may protect gastric mucosa; can increase bicarbonate, mucus production
Prevention of NSAID-induced gastric ulcers
Unlabeled uses:
Pregnancy termination, postpartum hemorrhage, cervical ripening/labor induction (vaginal), active duodenal/gastric ulcer, kidney transplant rejection prophylaxis
Hypersensitivity to this product or prostaglandins
Black Box Warning:
Pregnancy (X), females
Precautions:
Breastfeeding, children, geriatric patients, renal/CV disease, abnormal fetal position, cardiac/renal/inflammatory bowel disease, C-section, dehydration, diarrhea, fever, ectopic pregnancy, fetal distress, sepsis, vaginal bleeding
Calculator
• Adult:
PO
200 mcg qid with food for duration of NSAID therapy, with last dose given at bedtime; if 200 mcg is not tolerated, 100 mcg may be given
• Adult:
PO
100-200 mcg qid with meals at bedtime × 4-8 wk
• Adult:
INTRAVAGINALLY
800 mcg 5-7 days after methotrexate IM
• Adult:
INTRAVAGINALLY
25 mcg q3-6hr
Available forms:
Tabs 100, 200 mcg
•
PO with meals for prolonged product effect; avoid use of magnesium antacids
GI:
Diarrhea
, nausea, vomiting, flatulence, constipation, dyspepsia, abdominal pain
GU:
Spotting, cramps, hypermenorrhea, menstrual disorders
PO:
Peak 12 min, plasma steady state achieved within 2 days, excreted in urine
Decrease:
maximum concentrations when taken with food
•
NSAID-induced ulcer prophylaxis:
monitor GI symptoms (hematemesis, occult or frank blood in stools, gastric aspirate, cramping, severe diarrhea)
Black Box Warning:
Pregnancy (X): Obtain a negative pregnancy test; miscarriages are common
•
Storage at room temp
•
Therapeutic response: absence of pain or GI complaints; prevention of ulcers
•
To take only as directed; to read patient information leaflet
Black Box Warning:
Not to take if pregnant (can cause miscarriage) (X); not to become pregnant while taking product; if pregnancy occurs during therapy, discontinue product, notify prescriber; not to breastfeed
•
Not to give product to anyone else or to take for more than 4 wk unless directed by prescriber
•
To avoid OTC preparations: aspirin, cough, cold products; condition may worsen
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTmitoMYcin (Rx)
(mye-toe-mye′sin)
Mitosol
Func. class.:
Antineoplastic, antibiotic
Do not confuse:
mitoMYcin
/mithramycin/mitotane/mitoXANtrone
Inhibits DNA synthesis, primarily; derived from
Streptomyces caespitosus;
appears to cause cross-linking of DNA; vesicant
Pancreatic, stomach, colorectal, bladder cancer
Unlabeled uses:
Palliative treatment of anal, bladder, head, neck, colon, breast, biliary, cervical, lung malignancies; bone marrow ablation, desmoid tumor, mesothelioma, stem cell transplant preparation
Pregnancy (D) 1st trimester, breastfeeding, hypersensitivity, as single agent, coagulation disorders
Black Box Warning:
Thrombocytopenia
Precautions:
Accidental exposure, acute bronchospasm, anemia, children, dental disease/work, extravasation, females, infection, radiation therapy, surgery, vaccines, renal/respiratory disease
Black Box Warning:
Bone marrow suppression, hemolytic-uremic syndrome
Calculator
• Adult:
IV
20 mg/m
2
q6-8wk
Available forms:
Inj 5, 20, 40 mg/vial
•
Use port, or central line if possible
•
Antiemetic 30-60 min before product to prevent vomiting
•
IV after diluting 5 mg/10 ml, 20 mg/ 40 ml, 40 mg/80 ml (0.5 mg/ml) sterile water for inj; shake, allow to stand, give through
Y
-tube or 3-way stopcock; give slow IV push or infuse over 15-30 min; color of reconstituted sol is gray
•
Avoid excessive heat, store reconstituted product in refrigerator, discard after 2 wk, store unreconstituted product at room temp
Y-site compatibilities:
Amifostine, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, atenolol, bivalirudin, bleomycin, caspofungin, CISplatin, cyclophosphamide, DACTINomycin, dolasteron, DOXOrubicin, droperidol, epirubicin, ertapenem, fluorouracil, furosemide, granisetron, heparin, leucovorin, melphalan, methotrexate, metoclopramide, nesiritide, octreotide, ondansetron, oxaliplatin, PACLitaxel, palonosetron, PEMEtrexed, riTUXimab, teniposide, thiotepa, tigecycline, tirofiban, trastuzumab, vinBLAStine, vinCRIStine, voriconazole, zoledronic acid
CNS:
Fever, headache, confusion, drowsiness, syncope, fatigue
EENT:
Blurred vision
GI:
Nausea, vomiting, anorexia, stomatitis
,
hepatotoxicity,
diarrhea
GU:
Urinary retention,
renal failure,
edema
HEMA:
Thrombocytopenia, leukopenia, anemia
INTEG:
Rash
, alopecia,
extravasation,
nail discoloration
MISC:
Hemolytic uremic syndrome, CHF
RESP:
Fibrosis, pulmonary infiltrate,
dyspnea
Half-life 1 hr, metabolized in liver, 10% excreted in urine (unchanged)
Increase:
toxicity—other antineoplastics, radiation
Increase:
bleeding risk—NSAIDs, anticoagulants
•
Avoid use with vaccines
•
Avoid use with black cohosh
Black Box Warning:
Bone marrow suppression: CBC, differential, platelet count weekly; withhold product if WBC is <4000/mm
3
, serum creatinine >1.7 mg/dl, or platelet count is <100,000/mm
3
; notify prescriber; bleeding: hematuria, guaiac, bruising, petechiae, mucosa or orifices
Black Box Warning:
Fatal hemolytic-uremic syndrome:
hypertension, thrombocytopenia, microangiopathic hemolytic anemia; occurs in those receiving long-term therapy
•
Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy, adjust dose based on renal function
•
I&O ratio; report fall in urine output to <30 ml/hr
•
Monitor temp q4hr; fever may indicate beginning infection
•
Hepatic studies before, during therapy: bilirubin, AST, ALT, alk phos as needed or monthly; check for jaundiced skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
Pulmonary fibrosis:
bronchospasm, dyspnea, crackles, unproductive cough; chest pain, tachypnea, fatigue, increased pulse, pallor, lethargy; pulmonary function tests; chest x-ray before, during therapy; chest x-ray should be obtained q2wk during treatment
•
Effects of alopecia on body image; discuss feelings about body changes
•
Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
•
Local irritation, pain, burning at inj site
•
GI symptoms: frequency of stools, cramping
•
Adequate fluids 2-3 L/day unless contraindicated
•
Rinsing of mouth tid-qid with water; brushing of teeth with baking soda bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
•
Therapeutic response: decreased tumor size, spread of malignancy
•
That hair may be lost during treatment; that wig or hairpiece may make patient feel better; that new hair may be different in color, texture
•
To avoid foods with citric acid, hot or rough texture
•
To report any bleeding, white spots, ulcerations in mouth; to examine mouth daily
•
To report sign of IV site reaction, redness, inflammation, burning, pain
•
To avoid crowds, persons with infections if granulocyte count is low
•
Infection:
report fever, flulike symptoms, sore throat
•
To immediately report urine retention, absence of urine, dyspnea, bleeding, jaundice, signs of pulmonary toxicity
•
To report if pregnancy is planned or suspected; pregnancy (D) 1st trimester, do not breastfeed