Mosby's 2014 Nursing Drug Reference (278 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mocks-ih-floks′a-sin)
Vigamox, Moxeza
Func. class.:
Ophthalmic anti-infective
Chem. class.:
Fluoroquinolone
Do not confuse:
ciprofloxacin
/gatifloxacin/levofloxacin
Inhibits DNA gyrase, thereby decreasing bacterial replication
Bacterial conjunctivitis (aerobic gram-positive/negative organisms),
Chlamydia trachomatis
Hypersensitivity to this product or fluoroquinolones
Precautions:
Pregnancy (C), breastfeeding
Calculator
• Adult/adolescent/child
≥
1 yr:
Ophthalmic SOL
1 drop in affected eye(s) bid (Moxeza) or tid (Vigamox) × 7 days
Available forms:
Ophthalmic solution 0.5%
•
Commercially available ophthalmic solutions are not for injection subconjunctivally or into the anterior chamber of the eye
•
Apply topically to the eye, taking care to avoid contamination
•
Do not touch the tip of the dropper to the eye, fingertips, or other surface
•
Apply pressure to lacrimal sac for 1 min after instillation
•
Avoid wearing contact lenses during treatment
EENT:
Hypersensitivity, pruritus, blurred vision, tearing
Half-life 13 hr
•
Allergic reaction
: Assess for hypersensitivity, discontinue product
•
Decreased ophthalmic infection
•
To apply topically to the eye, taking care to avoid contamination
•
That product is for ophthalmic use only
•
Not to touch the tip of the dropper to the eye, fingertips, or other surface
•
To apply pressure to lacrimal sac for 1 min after installation
•
To avoid wearing contact lenses during treatment
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(myoo-pihr′oh-sin)
Bactroban, Centany
Func. class.:
Topical anti-infective
Antibacterial activity results from inhibition of protein synthesis; bacteriostatic
Impetigo, skin lesions
(Staphylococcus aureus/Streptococcus pyogenes);
nasal: methicillin-resistant
S. aureus
Hypersensitivity to this product
Precautions:
Open wounds, burns, severe kidney disease, children
Calculator
• Adult/child:
TOP
apply to affected area tid × 1-2 wk
• Adult/child:
TOP
apply to affected area tid × 10 days
s. aureus
in the nose
• Adult/child ≥12 yr:
NASAL
divide ointment in single use tube in half; use in each nostril bid × 5 days
Available forms:
Topical cream, ointment 2%; intranasal ointment 2%
•
Do not use skin products near the eyes, nose, or mouth
•
Wash hands before and after use; wash affected area and gently pat dry
•
May cover treated areas with gauze dressing
•
Apply a thin film to the cleansed affected area; massage gently into affected areas
•
Nasal:
Close nostrils by squeezing and releasing and gently massaging over 1 min
CNS:
Headache
EENT:
Burning, rhinitis (nasal)
GI:
Taste change
INTEG:
Burning, rash, pruritus
Decrease:
Effect of other nasal products
•
Allergic reaction
: Assess for hypersensitivity, product may need to be discontinued
•
Infection
: Assess for number of lesions, severity in impetigo, other skin disorders
•
Decreased lesions in impetigo, other skin disorders
•
Not to use skin products near the eyes, nose, or mouth
•
To wash hands before and after use and to wash affected area and gently pat dry
•
Cream/Ointment:
To apply a thin film to the cleansed affected area; to cover treated areas with gauze dressing if desired
•
Nasal:
To close nostrils by squeezing and releasing and gently massaging over 1 min
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(mye-koe-phen′oh-late)
CellCept, Myfortic
Func. class.:
Immunosuppressant
Inhibits inflammatory responses that are mediated by the immune system
Prophylaxis for organ rejection in allogenic cardiac, hepatic, renal transplants
Unlabeled uses:
Refractory uveitis, second-line therapy for Churg-Strauss syndrome, diffuse proliferative lupus nephritis (in combination), rheumatoid arthritis, psoriasis, GVHD, kidney disease, myasthenia gravis, atopic dermatitis
Hypersensitivity to this product or mycophenolic acid
Black Box Warning:
Pregnancy (D)
Precautions:
Breastfeeding, lymphomas, neutropenia, renal disease, accidental exposure, anemia
Black Box Warning:
Infection, neoplastic disease
Calculator
• Adult:
PO
mycophenolate mofetil 1 g or 720 mg mycophenolate sodium; 1 g or 720 mg bid given to renal transplant patients in combination with corticosteroids, cycloSPORINE
• Child:
PO-ER
400 mg/m
2
bid, max 720 mg bid
• Adult:
PO/IV
GFR <25 ml/min, max 2 g/day
• Adult:
PO/IV
1.5 g bid,
IV
can be started ≤24 hr after transplant, switch to
PO
when able
• Adult:
PO
1.5 g bid;
IV
1 g over ≥2 hr
• Adult:
PO
1.5 g (Mofetil) bid
• Adult:
PO
250 mg-2 g/day (Mofetil)
• Adult:
PO
2 g/day (Mofetil) with cycloSPORINE and prednisoLONE
• Adult:
PO
1 g/day (Mofetil)
• Adult:
PO
1 g (Mofetil) bid × 6-41 mo
• Adult:
PO
1 g (Mofetil) bid × 4 wk, then 500 mg bid × 4 wk
• Adolescent/child ≥2 yr:
PO
30-50 mg/kg/day (Mofetil) in 2 divided doses
Available forms:
Caps 250 mg; tabs 500 mg; inj (powder) 500 mg/20-ml vial; powder for oral susp 200 mg/ml; ext rel tab (Myfortic) 180, 360 mg
•
May be given in combination with corticosteroids, cycloSPORINE
•
Del rel tab, cap, oral susp, tab are not interchangeable
•
Do not break, crush, or chew tabs; do not open caps
•
Give at same time each day
•
Avoid inhalation or direct contact with skin, mucous membranes; teratogenic in animals
•
Oral susp:
tap closed bottle several times to loosen powder, use 94 ml of water in graduated cylinder, add 1/2 total amount of water for constitution and shake the closed bottle, add remaining
water and shake; again, remove child-resistant cap, push adapter into neck of bottle, close tightly
•
Give alone for better absorption
•
Reconstitute each vial with 14 ml D
5
W, shake gently, further dilute to 6 mg/ml, dilute 1 g/140 ml D
5
W, 1.5 g/210 ml D
5
W; give by slow IV inf ≥2 hr, never give by bolus or rapid IV inj
•
Do not give with other medications or sol
Y-site compatibilities:
Alemtuzumab, alfentanil, amikacin, anidulafungin, argatroban, bivalirudin, caspofungin, cefepime, DAPTOmycin, DOPamine, norepinephrine, octreotide, oxytocin, tacrolimus, tigecycline, tirofiban, vancomycin
CNS:
Tremor, dizziness, insomnia, headache, fever
, anxiety, pain,
progressive multifocal leukoencephalopathy,
asthenia, paresthesia
CV:
Hypertension, chest pain
, hypotension, edema
GI:
Diarrhea, constipation, nausea, vomiting
, stomatitis,
GI bleeding,
abdominal pain, anorexia, dyspepsia
GU:
UTI, hematuria
,
renal tubular necrosis, polyomavirus-associated nephropathy
HEMA:
Leukopenia, thrombocytopenia, anemia, pancytopenia, pure red cell aplasia,
neutropenia
INTEG:
Rash
META:
Peripheral edema, hypercholesterolemia, hypophosphatemia, edema, hyperkalemia, hypokalemia, hyperglycemia
, hypocalcemia, hypomagnesemia
MS:
Arthralgia, muscle wasting, back pain, weakness
RESP:
Dyspnea, respiratory infection, increased cough, pharyngitis, bronchitis, pneumonia
,
plural effusion, pulmonary fibrosis
SYST:
Lymphoma,
nonmelanoma skin carcinoma
,
sepsis
Rapidly and completely absorbed; metabolized to active metabolite (MPA); excreted in urine, feces; protein binding (MPA) 97%; half-life (MPA) 17.9 hr
Increase:
bone marrow suppression—azaTHIOprine
•
Increased bleeding risk: anticoagulants, NSAIDs, thrombolytics, salicylates
Increase:
toxicity—acyclovir, ganciclovir, valacyclovir
Increase:
effects of phenytoin, theophylline
Increase:
mycophenolate levels—probenecid, immunosuppressives, salicylates
Decrease:
mycophenolate levels—antacids (magnesium, aluminum), cholestyramine, cycloSPORINE, rifamycin
Decrease:
protein binding of phenytoin, theophylline
Decrease:
effect of live attenuated vaccines, oral contraceptives
Interference with immunosuppression: astragalus, echinacea, melatonin
Decrease:
absorption if taken with food
Increase:
serum creatitine, BUN
•
Abnormal LFTs
Progressive multifocal leukoencephalopathy,
may be fatal; ataxia, confusion, apathy, hemiparesis, visual problems, weakness; side effects should be reported to FDA
•
Blood studies: CBC during treatment monthly
•
Hepatic studies: alk phos, AST, ALT, bilirubin
•
Renal studies: BUN, CCr, electrolytes
Black Box Warning:
Pregnancy test within 1 wk before initiation of treatment; confirm negative pregnancy test
•
Therapeutic response: absence of graft rejection
•
To report fever, rash, severe diarrhea, chills, sore throat, fatigue because serious infections may occur
•
To reduce risk of infection by avoiding crowds
•
About the need for repeated lab tests
Black Box Warning:
To use 2 forms of contraception before, during, and for 6 wk after therapy
•
To take at same time each day
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert