Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (284 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(nair′ah-trip-tan)
Amerge
Func. class.:
Antimigraine agent
Chem. class.:
5-HT
1
receptor agonist
Do not confuse:
Amerge
/Altace/Amaryl
Binds selectively to the vascular 5-HT
1
B/D receptor subtype, exerts antimigraine effect; causes vasoconstriction in cranial arteries
Acute treatment of migraine with/without aura
Hypersensitivity, angina pectoris, history of MI, documented silent ischemia, ischemic heart disease, concurrent ergotamine-containing preparations, uncontrolled hypertension, CV syndromes, hemiplegic or basilar migraines, severe renal disease (CCr <15 ml/min); severe hepatic disease (Child-Pugh grade C)
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, postmenopausal women, men >40 yr, CAD risk, hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function, peripheral vascular disease overuse
Calculator
• Adult:
PO
1 or 2.5 mg with fluids; if headache returns, repeat 1× after 4 hr; max 5 mg/24 hr
• Adult:
PO
CCr 15-39 ml/min, or mild-moderate hepatic disease max 2.5 mg/24 hr
Available forms:
Tabs 1, 2.5 mg
•
With fluids as soon as symptoms appear; may take another dose after 4 hr; do not take >5 mg during any 24-hr period
CNS:
Dizziness, sedation, fatigue
CV:
Increased B/P, palpitations,
tachydysrhythmias, PR, QTc prolongation, ST/T wave changes, PVCs, atrial flutter/fibrillation, coronary vasospasm
EENT:
EENT infections, photophobia
GI:
Nausea, vomiting
MISC:
Temperature change sensations; tightness, pressure sensations
MS:
Weakness, neck stiffness
, myalgia
Onset 2-3 hr; peak 2-3 hr; 28%-31% protein binding; half-life 6 hr; metabolized in liver (metabolite); excreted in urine, feces; may be excreted in breast milk
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs (FLUoxetine, fluvoxaMINE, PARoxetine, sertraline), SNRIs, serotonin receptor agonists, sibutramine
Increase:
vasospastic effects—ergot, ergot derivatives, other 5-HT
1
agonists
Increase:
adverse reactions risk—MAOIs; do not use together
•
Serotonin syndrome: SAM-e, St. John’s wort
•
Migraine symptoms:
aura, duration, effect on lifestyle, aggravating/alleviating factors
Serotonin syndrome, neuroleptic malignant syndrome:
increased heart rate, shivering sweating, dilated pupils, tremors, high B/P, hyperthermia, headache, confusion; if these occur, stop product, administer serotonin antagonist if needed; at least 2 wk should elapse between discontinuation of serotonergic agents and start of product
Cardiac status: ECG, increased B/P, dysrhythmias, monitor for PR, QT prolongation, ST-T wave changes, PVCs in those with cardiac disease
•
Stress level, activity, recreation, coping mechanisms
•
Neurologic status: LOC blurred vision, nausea, vomiting, tingling in extremities preceding headache
•
Quiet, calm environment with decreased stimulation (noise, bright light, excessive talking)
•
Therapeutic response: decrease in frequency, severity of headache
To report pain, tightness in chest, neck, throat, or jaw; to notify prescriber immediately if sudden, severe abdominal pain occurs
•
Not to use if another 5-HT
1
agonist or ergot preparation has been used during past 24 hr; to avoid using >2 days/wk because rebound headache may occur
•
To notify prescriber if pregnancy is planned or suspected; to avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(na-ta-liz′u-mab)
Tysabri
Func. class.:
Biologic response modifier, immunoglobulins, monoclonal antibody
Biologic-response-modifying properties mediated through specific receptors on cells, may be secondary to blockade of the interaction of inflammatory cells with vascular endothelial cells
Ambulatory patients with relapsing/remitting MS who have not responded to other treatment; those with moderate to severe Crohn’s disease
Hypersensitivity, immunocompromised individuals (HIV, AIDS, leukemia, lymphoma, transplants), PML, murine (mouse) protein allergy
Black Box Warning:
Progressive multifocal leukoencephalopathy
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, chronic progressive MS, depression, mental disorders, diabetes, TB, active infections, hepatotoxicity
Calculator
• Adult:
IV INF
300 mg q4wk; give over 1 hr; observe during and for 1 hr after inf
• Adolescent and child ≥11 yr (unlabeled):
IV INF
pediatric Crohn’s disease activity index (PCDAI) >30, 3 mg/kg q4wk
Available forms:
Single-use vial, 300 mg/100 ml 0.9% NaCl
•
Acetaminophen for fever, headache
•
Only after being enrolled in the TOUCH Prescribing Program
•
Use only clear, colorless solution, without particulates
•
Withdraw 15 ml from the vial using aseptic technique: inj conc into 100 ml 0.9% NaCl; do not use other diluents; mix completely; do not shake; inf immediately or refrigerate for ≤8 hr; warm to room temp before using; flush with 0.9% NaCl before, after inf; do not admix or use in same line with other agents
•
Withhold product at first sign of PML
•
Prescribers must be registered in the TOUCH prescribing program (1-800-456-2255)
CNS:
Headache, fatigue
, rigors, syncope, tremors,
depression
,
progressive multifocal leukoencephalopathy (PML), suicidal ideation,
anxiety
CV:
Chest discomfort, hypo/hypertension, tachycardia
GI:
Abdominal discomfort
, abnormal LFT, gastroentritis,
severe hepatic injury
GU:
Amenorrhea,
UTI, irregular menses
, vaginitis, urinary frequency
INTEG:
Rash
, dermatitis, pruritus,
skin melanoma,
infusion-related reactions
MS:
Arthralgia
, myalgia
RESP:
Lower respiratory tract infection
, dyspnea
SYST:
Anaphylaxis, angioedema
Half-life approximately 11 days
•
Do not use with vaccines
Increase:
infection—immunosuppressants, antineoplastics, immunomodulators, tumor necrosis factors
Black Box Warning:
Progressive multifocal leukoencephalopathy (weakness, paralysis, vision loss, impaired speech, cognitive deterioration; obtain gadolinium-enhanced MRI scan of the brain, possibly cerebrospinal fluid for JC viral DNA; signs, symptoms of PML (decreased cognition, vision; ataxia, dysphagia), incidences increase with number of doses, over 2 yr immunosuppressants and anti-JC virus antibody; consider testing for the anti-JC virus and periodically retest
•
Infection:
report serious opportunistic infections to the manufacturer; those with Crohn’s disease and chronic oral corticosteroids may be at greater risk of infection
•
Blood, renal, hepatic studies: CBC, differential, platelet counts, BUN, creatinine, ALT, urinalysis, antibody testing
•
CNS symptoms: headache, fatigue, depression, rigors, tremors
•
GI status: abdominal discomfort, gastroenteritis, severe hepatic injury, abnormal LFTs
•
Mental status: depression, depersonalization, suicidal thoughts, insomnia
•
MS symptoms;
product should only be used by patients who have not responded to other treatments
Anaphylaxis:
SOB, hives; swelling, tightness in throat, chest pain; usually within 2 hr of inf
•
Storage of sol in refrigerator; do not freeze or shake; protect from light; use within 8 hr of preparation
•
Therapeutic response: decreased symptoms of MS, Crohn’s disease
•
Provide patient or family member with written, detailed information about product (med guide)
•
That female patients may experience irregular menses, amenorrhea, may worsen over several days; to notify prescriber if pregnancy is suspected; to avoid breastfeeding while taking this product, if pregnant, call the Tysabri Pregnancy Exposure Registry (1-800-456-2255)
To notify prescriber of possible infection: sore throat, cough, increased temp, inf site reactions
•
That continuing follow-up will be needed at 3, 6 months after first dose, then every 6 months
•
To inform all prescribers of product use