Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (287 page)
(ne-veer′a-peen)
Viramune, Viramune XR
Func. class.:
Antiretroviral
Chem. class.:
Nonnucleoside reverse transcriptase inhibitor (NNRTI)
Do not confuse:
nevirapine
/nelfinavir
Viramune
/Viracept
Binds directly to reverse transcriptase and blocks RNA, DNA, thus causing a disruption of the enzyme’s site
HIV-1 in combination with other highly active antiretroviral therapy (HAART)
Black Box Warning:
Hypersensitivity, hepatic disease
Precautions:
Pregnancy (B), breastfeeding, children, renal disease, Hispanic patients
Black Box Warning:
Females, hepatitis
Calculator
• Adult and adolescent:
PO
200 mg/day × 2 wk then 200 mg bid in combination;
EXT REL
tab (adults not currently taking immediate rel nevirapine) 200 mg/day (immediate rel tab) × 14 days with other antiretrovirals; if rash develops during lead-in periods and persists beyond 14 days, do not use ext rel tab; if no consistent rash present, then give 400 mg/day ext rel tab with other antiretrovirals; if interrupted >7 days, restart 14 day lead-in dosing; for adults switched from immediate rel tab, give 400 mg/day ext rel tab
• Child/adolescent ≥6 yr:
PO EXT REL
not currently taking immediate release 150 mg/m
2
(immediate release) daily (max 200 mg/day) × 14 days then BSA 0.58-0.83 m
2
200 mg/day; BSA 0.84-1.16 m
2
300 mg/day
• Child/infant/neonate ≥15 days old:
PO
150 mg/m
2
/day × 14 days then 150 mg/m
2
bid, max 400 mg/day
• Females with no previous antiretroviral therapy:
PO
200 mg as a single dose at onset of labor with zidovudine 2 mg/kg over 1 hr followed by zidovudine 1 mg/kg/hr until delivery
• Neonate ≥34 wk gestation:
PO
Nevirapine 12 mg (>2 kg) or 8 mg (1.5-2 kg) × 3 doses; 1st dose 48 hr after birth, 2nd dose 48 hr after 1st dose, 3rd dose 96 hr after 2nd dose and
PO
zidovudine
• Adult:
PO
Do not use with Child-Pugh grade B or C
Available forms:
Tabs 200 mg; oral susp 50 mg/5 ml; ext rel 400 mg
• Do not initiate treatment in females when CD4 counts >250 cells/mm
3
or in males when >400 cells/mm
3
unless benefits outweigh risks
•
Without regard to meals
•
Use in combination with at least 1 other antiretroviral
•
Oral susp
should be shaken before giving
CNS:
Paresthesia, headache, fever, peripheral neuropathy
GI:
Diarrhea
, abdominal pain,
nausea, stomatitis
,
hepatotoxicity, hepatic failure
HEMA:
Neutropenia, anemia, thrombocytopenia
INTEG:
Rash
,
toxic epidermal necrolysis
MISC:
Stevens-Johnson syndrome, anaphylaxis
MS:
Pain, myalgia,
rhabdomyolysis
Rapidly absorbed, peak 4 hr, 60% bound to plasma proteins, metabolized by liver; metabolized by hepatic P450 enzyme system, excreted 91% in urine, terminal half-life 25-30 hr, 50% removed by peritoneal dialysis; with hepatic disease and in Hispanic patients, African American patients, slower rate of clearance
Increase:
nevirapine levels—cimetidine, macrolide antiinfectives
Decrease:
effects of protease inhibitors, oral contraceptives, ketoconazole, methadone, itraconazole
Decrease:
nevirapine levels—rifamycins, anticonvulsants, clonazePAM, diazepam, warfarin
Decrease:
action of antiretroviral—St. John’s wort; do not use concurrently
Increase:
ALT, AST, GGT, bilirubin, Hgb
Decrease:
neutrophil count
•
Resistance testing before therapy and when therapy fails
Signs of infection, anemia, hepatotoxicity, immune reconstitution syndrome; hepatitis B or C, liver toxicity may occur
•
HIV:
blood studies during treatment: ALT, AST, viral load, CD4, plasma HIV RNA, renal studies; if LFTs elevated significantly, product should be withheld; glucose levels in diabetic patients, if treatment is interrupted by >1 wk, restart at initial dose
Rhabdomyolysis:
pain, tenderness, weakness, edema; product should be discontinued
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
Stevens-Johnson syndrome, toxic epidermal necrolysis,
allergies before treatment, reaction to each medication; skin eruptions; rash, urticaria, itching; if rash is severe or systemic symptoms occur, discontinue immediately
•
Therapeutic response: absence of AIDS-defining symptoms, improvement in quality of life; decreased viral load, increase in CD4 count
To report any right quadrant pain, yellowing of eyes or skin, dark urine, nausea, anorexia, muscle pain or tenderness, rash immediately
•
That product may be taken with food, antacids
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
That product is not a cure, does not prevent transmission; controls symptoms of HIV
•
To avoid OTC agents unless approved by prescriber
•
To use a nonhormonal form of contraception during treatment in those using contraceptives
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
, Rx)
(nye′a-sin)
Equaline Niacin, Niaspan, Ni-Odan
, Slo-Niacin
OTC
, Rx)
Func. class.:
Vit B
3
, antihyperlipidemic
Chem. class.:
Water-soluble vitamin
Needed for conversion of fats, protein, carbohydrates by oxidation reduction; acts directly on vascular smooth muscle, thus causing vasodilation; reduces total cholesterol, LDL, VLDL, triglycerides; increases HDL
Pellagra, hyperlipidemias (types 4, 5), peripheral vascular disease that presents a risk for pancreatitis
Breastfeeding, hypersensitivity, peptic ulcer, hepatic disease, hemorrhage, severe hypotension
Precautions:
Pregnancy (C), breastfeeding, glaucoma, cardiovascular disease, CAD, diabetes mellitus, gout, schizophrenia
Calculator
• Adult:
PO
100-500 mg/day in divided doses;
IM/SUBCUT
5-100 mg ≥5×/day;
IV
25-100 mg bid or tid
• Child:
PO
≤300 mg/day in divided doses
• Adult:
PO
250 mg after evening meal; may increase dose at 1-4 wk intervals to 1-2 g tid, max 6 g/day;
EXT REL
500 mg at bedtime × 4 wk then 1000 mg at bedtime for wk 5-8; do not increase by >500 mg q4wk, max 2000 mg/day
• Adult:
PO
300-500 mg/day in divided doses;
IM
50-100 mg 5×/day or
IV
25-100 mg bid by slow
IV INF
• Child:
PO
100-300 mg/day in divided doses;
IV
≤300 mg/day by slow
IV/INF
• Adult:
PO
250-800 mg/day in 3-5 divided doses
Available forms:
Niacin:
tabs 50, 100, 250, 500, mg; ext rel caps 250, 500 mg; ext rel tab 250, 500, 750, 1000 mg;
niacinamide:
tab 100, 500 mg
•
Do not break, crush, or chew ext rel tabs, caps
•
With meals for GI symptoms; with 81-325 mg aspirin or NSAIDs 30 min before dose to decrease flushing
CNS:
Paresthesias, headache, dizziness, anxiety
CV:
Postural hypotension, vasovagal attacks, dysrhythmias, vasodilation
EENT:
Blurred vision, ptosis
GI:
Nausea, vomiting, anorexia,
jaundice, hepatotoxicity,
diarrhea, peptic ulcer, dyspepsia,
hepatitis
GU:
Hyperuricemia,
glycosuria, hypoalbuminemia
INTEG:
Flushing, dry skin, rash, pruritus, itching, tingling
PO:
Peak 30-70 min (depends on formulation), half-life 45 min; metabolized in liver; 30% excreted unchanged in urine
Increase:
postural hypotension—ganglionic blockers
Increase:
myopathy, rhabdomyolysis—HMG-CoA reductase inhibitors
Increase:
flushing, pruritus—alcohol, avoid use
Increase:
myopathy, rhabdomyolysis—red yeast rice
Increase:
bilirubin, alk phos, hepatic enzymes, LDH, uric acid, glucose
Decrease:
cholesterol
False increase:
urinary catecholamines
False positive:
urine glucose