Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (294 page)
HIGH ALERT(nye-troe-pruss′ide)
Nitropress
Func. class.:
Antihypertensive, vasodilator
Directly relaxes arteriolar, venous smooth muscle, thereby resulting in reduction in cardiac preload and afterload
Hypertensive crisis; to decrease bleeding by creating hypotension during surgery; acute CHF
Unlabeled uses:
Postoperative hypertension, mitral regurgitation
Hypersensitivity, hypertension (compensatory) due to aortic coarctation or AV shunting, acute CHF associated with reduced pe
ripheral vascular resistance, AV shunt, Leber’s disease, toxic amblyopia
Black Box Warning:
Cyanide toxicity
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, fluid, electrolyte imbalances, renal/hepatic disease, hypothyroidism
Black Box Warning:
Hypotension
Calculator
• Adult and child:
IV INF
0.25-10 mcg/kg/min; max 10 mcg/kg/min
• Adult:
IV INF
CCr <60 ml/min, maintain doses <3 mcg/kg/min to reduce thiocyanate accumulation
Available forms:
Inj 50 mg/2 ml
•
Antidote is sodium thiosulfate
•
Depending on B/P reading q15min
•
Reconstitute 50 mg/2-3 ml of D
5
W, further dilute in 250, 500, or 1000 ml of D
5
W to 200, 100, 50 mcg/ml, respectively; use inf pump only; wrap bottle with aluminum foil to protect from light; observe for color change in inf; discard if highly discolored (blue, green, dark red); titrate to patient response
Y-site compatibilities:
Alfentanil, alprostadil, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid compex, amphotericin B liposome, anidulafungin, argatroban, atenolol, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, chloramphenicol, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiazem, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, inamrinone, indomethacin, insulin (regular), isoproterenol, ketorolac, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, micafungin, miconazole, midazolam, milrinone, minocycline, morphine, moxalactam, multiple vitamins injection, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, penicillin G potassium/sodium, pentamidine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride/phosphates, procainamide, propofol, propranolol, protamine, pyridoxine, ranitidine, ritodrine, rocuronium, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, zoledronic acid
CNS:
Dizziness, headache
, agitation, twitching, decreased reflexes, restlessness
CV:
Bradycardia, ECG changes, tachycardia, hypotension
GI:
Nausea, vomiting, abdominal pain
INTEG:
Pain, irritation at inj site, sweating
MISC:
Cyanide, thiocyanate toxicity,
flushing, hypothyroidism
IV:
Onset 1-2 min, duration 1-10 min, half-life 3 days in patients with abnormal renal function, circulating half-life 2 min; metabolized in liver, excreted in urine
Increase: severe hypotension—ganglionic blockers, volatile liquid anesthetics, halothane, enflurane, circulatory depressants
Increase:
antihypertensive effect—hawthorn
•
Electrolytes: potassium, sodium, chloride, CO
2
, CBC, serum glucose, serum methemoglobin if pulmonary O
2
levels are decreased; use IV 1-2 mg/kg methylene blue given over several min for methemoglobinemia
•
Renal studies: catecholamines, BUN, creatinine
•
Hepatic studies: AST, ALT, alk phos
Black Box Warning:
Hypotension:
B/P by direct means if possible; check ECG continuously; pulse, jugular venous distention; PCWP; rebound hypertension may occur after nitroprusside is discontinued, give only with emergency equipment nearby, rapid decrease in B/P may occur
•
Weight daily, I&O
Thiocyanate, lactate, cyanide toxicity:
obtain levels daily if inf >3 mcg/kg/min; thiocyanate level should be ≤1 mmol/L; thiocyanate toxicity includes confusion, weakness, seizures, hyperreflexia, psychosis, tinnitus, coma
•
Nausea, vomiting, diarrhea
•
Edema in feet, legs daily; skin turgor, dryness of mucous membranes for hydration status
•
Crackles, dyspnea, orthopnea q30min
•
For decrease in bicarbonate, P
CO
2
blood pH, acidosis
•
Therapeutic response: decreased B/P, decreasing symptoms of cardiogenic shock or cardiac pump failure
•
To report headache, dizziness, loss of hearing, blurred vision, dyspnea, faintness, pain at IV site
•
About the reason for giving product and expected results
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
, Rx)
(ni-za′ti-deen)
Axid, Axid AR
Func. class.:
H
2
-receptor antagonist
Chem. class.:
Substituted thiazole
Blocks H
2
-receptors, thereby reducing gastric acid output
Benign gastric and duodenal ulceration, prevention of duodenal ulcer recurrence, symptomatic relief of gastroesophageal reflux, heartburn prevention
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, renal/hepatic impairment (reduce dose in renal impairment)
Calculator
• Adult:
PO
300 mg at night or 150 mg bid for 4-8 wk; maintenance 150 mg at night
• Adult:
PO
150 mg/day at bedtime
• Adult and child ≥12 yr:
PO
150 mg bid × ≤12 wk, max 300 mg/day
• Adult:
PO
75 mg before eating bid
• Adult:
PO
CCr 20-50 ml/min, give 150 mg every other day; CCr <20 ml/min, give 150 mg q72hr
Available forms:
Caps 150, 300 mg; tabs 75 mg
•
With meals for prolonged product effect; antacids 1 hr before or 1 hr after product; at bedtime if taken daily
CNS:
Headache, somnolence, confusion, abnormal dreams, dizziness
CV:
Cardiac dysrhythmias, cardiac arrest
ENDO:
Gynecomastia
GI:
Elevated hepatic enzymes,
hepatitis,
jaundice, nausea
HEMA:
Thrombocytopenia, agranulocytosis, aplastic anemia
INTEG:
Pruritus, sweating, urticaria,
exfoliative dermatitis
METAB:
Hyperuricemia
MS:
Myalgia
RESP:
Bronchospasm, laryngeal edema, pneumonia
Partially metabolized by liver, excreted by kidneys, plasma half-life 1-2.8 hr, 70% absorbed orally, small amount (0.1% of plasma concentration) enters breast milk, 35% bound to plasma proteins
Increase:
GI obstruction risk—NIFEdipine (ext rel tabs)
Increase:
effect of—mefloquine
Decrease:
effect of—ketoconazole, itraconazole, atazanavir, cefditoren, cefpodoxime, delavirdine, gefitinib, raltegravir
Increase:
ALT, AST, serum creatinine
False negative:
allergy skin tests
•
GI pain:
epigastric, abdominal, character, alleviating factors, hematemesis, occult blood in stool, heartburn, GERD
Agranulocytosis:
CBC with differential if patient receiving long-term therapy
•
Decreased GI pain, heartburn, GERD; resolution of gastric, duodenal ulcers
•
That gynecomastia, impotence may occur, are reversible
•
To avoid driving or other hazardous activities until stabilized on product; that dizziness may occur
•
To avoid black pepper, caffeine, alcohol, harsh spices, extremes in temp of food
•
To avoid OTC preparations: aspirin, cough, cold preparations
Symptomatic and supportive therapy is recommended; activated charcoal, emesis, or lavage may reduce absorption