Mosby's 2014 Nursing Drug Reference (29 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
Func. class.:
Antacid, hypophosphatemic
Chem. class.:
Aluminum product, phosphate binder
Neutralizes gastric acidity; binds phosphates in GI tract, these phosphates are then excreted
Antacid, hyperphosphatemia in chronic renal failure; adjunct in gastric, peptic, duodenal ulcers; hyperacidity, reflux esophagitis, heartburn, stress ulcer prevention in critically ill, GERD
Unlabeled uses:
GI bleeding
Hypersensitivity to product or aluminum products
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, fluid restriction, decreased GI motility, GI obstruction, dehydration, renal disease, sodium-restricted diets
Calculator
• Adult: PO
600 mg 1 hr after meals, at bedtime, max 6 doses/day
• Adult: PO
300-600 mg tid
• Child:
PO
50-150 mg/kg/day in 4-6 divided doses
Available forms:
Susp 320 mg/5 ml, 600 mg/5 ml
•
2 tsp (10 ml) will neutralize 20 mEq of acid
•
Hyperphosphatemia: give with 8 oz water, meals unless contraindicated
•
Laxatives or stool softeners if constipation occurs, especially for geriatric patients
•
After shaking susp
•
By nasogastric tube if patient unable to swallow
GI:
Constipation
, anorexia,
obstruction,
fecal impaction
META:
Hypophosphatemia
, hypercalciuria
PO:
Onset 20-40 min, duration 1-3 hr, excreted in feces
Decrease:
effectiveness of—allopurinol, amprenavir, cephalosporins, corticosteroids, delavirdine, digoxin, gabapentin, gatifloxacin, H
2
-antagonists, iron salts, isoniazid, ketoconazole, penicillamine, phenothiazines, phenytoin, quiNIDine, quinolones, tetracyclines, thyroid hormones, ticlopidine, anticholinergics; separate by at least 4-6 hr
Decrease:
product effect—high-protein meal
Decrease:
phosphate interference: Tc-99m
•
Pain:
location, intensity, duration, character, aggravating, alleviating factors
•
Phosphate, calcium levels because product is bound in GI system
•
Hypophosphatemia: anorexia, weakness, fatigue, bone pain, hyporeflexia
•
Constipation; increase bulk in diet if needed, may use stool softeners or laxatives; record amount and consistency of stools
•
Aluminum toxicity:
severe renal disease, may also be used for hyperphosphatemia
•
Therapeutic response: absence of pain, decreased acidity, healed ulcers, decreased phosphate levels
•
Not to use for prolonged periods for patients with low serum phosphate or patients on low-sodium diets, shake liquid well
•
That stools may appear white or speckled
•
To check with prescriber after 2 wk of self-prescribed antacid use
•
To separate from other medications by 2 hr
•
Hyperphosphatemia:
to avoid phosphate foods (most dairy products, eggs, fruits, carbonated beverages) during product therapy
•
To notify prescriber black tarry stools, that may indicate bleeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(al-vim′oh-pan)
Entereg
Func. class.:
Functional GI disorder agent
Chem. class.:
Peripheral mu-opioid receptor antagonist
A peripherally selective mu-opioid receptor antagonist with activity restricted to the GI tract
Prevention of postoperative ileus
Unlabeled uses:
Opiate-agonist–induced constipation
Those who have taken therapeutic doses of opioids for more than 7 consecutive days immediately before starting alvimopan, end-stage renal disease, Child–Pugh C
Precautions:
Risk for MI, surgery for complete GI obstruction, hepatic disease, renal disease, pregnancy B, breastfeeding
Calculator
• Adult/geriatric patient:
PO
12 mg 30 min-5 hr before surgery, then 12 mg bid beginning the day after surgery; max 7 days or hospital discharge; max 15 doses
• Adult: PO
0.5 mg or 1 mg every day
• Adult: PO
Do not use in end-stage renal disease or Child–Pugh Class C
Available forms:
Cap 12 mg
•
Without regard to food
Black Box Warning:
Only in a hospital setting approved for the ENTEREG Access Support and Education (E.A.S.E.) program
GI:
Constipation, dyspepsia
, flatulence, diarrhea, abdominal pain, cramping
HEMA:
Anemia
META:
Hypokalemia
MISC:
Back pain, urinary retention,
MI
Half-life 10-17 hr, extended in hepatic/renal disease, protein binding 80%-94%
Increase:
Alvimopan concentrations, toxicity—amiodarone, bepridil, cycloSPORINE, diltiazem, itraconazole, quiNIDine, quiNINE, spironolactone, verapamil
•
Do not us if opiate agonists have been used for 7 consecutive days before alvimopan
•
Do not use concurrently with other opiate antagonists
•
Blood studies: Hgb/Hct, potassium; hyperkalemia occurs
•
Recent opioid use, do not use within 7 consecutive days
•
Opioid use for chronic pain;
MI
is more common in this population
•
Storage at room temperature
•
Therapeutic response: Absence of postoperative ileus
•
To notify prescriber if pregnancy is planned or suspected, avoid breastfeeding
•
That product is only used for a limited time in a hospital setting
•
To report constipation, abdominal pain, cramping
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert