Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (298 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(o-flox′a-sin)
Func. class.:
Antiinfective
Chem. class.:
Fluoroquinolone
Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; inhibits DNA gyrase
Treatment of lower respiratory tract infections (pneumonia, bronchitis), genitourinary infections (prostatitis, UTIs) caused by
Escherichia coli, Klebsiella pneumoniae, Chlamydia trachomatis
, skin and skin-structure infections; otitis media, PID
Unlabeled uses:
Leprosy, anthrax, epididymitis, meningococcal infection, prophylaxis, mycobacterium avium complex (MAC), plague, proctitis, traveler’s diarrhea, typhoid fever
QT prolongation, hypersensitivity to quinolones
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal disease, seizure disorders, excessive sunlight, hypokalemia
Black Box Warning:
Tendon pain/rupture, tendinitis, myasthenia gravis
Calculator
• Adult:
PO
400 mg q12hr × 10 days
• Adult:
PO
300 mg q12hr × 7 days (non-gonococcal); 400 mg as a single dose (Gonococcal)
E. coli
• Adult:
PO
300 mg q12hr × 6 wk
• Adult:
PO
200 mg q12hr × 3-7 days depending on organism 10 days (complicated)
• Adult:
PO
400 mg q12hr × 10-14 days
• Adult:
PO
CCr 10-50 ml/min, give q24hr; CCr <10 ml/min, give 50% of dose q24hr
• Adult (child-pugh class c):
PO
max 400 mg/day
Available forms:
Tabs 200, 300, 400 mg
•
2 hr before or 2 hr after antacids, calcium, iron, zinc products, without regard to food, maintain hydration
CNS:
Dizziness, headache, fatigue, somnolence
, depression, insomnia, lethargy, malaise,
seizures,
vertigo
CV:
QT prolongation, dysrhythmias,
chest pain
EENT:
Visual disturbances
GI:
Diarrhea, nausea, vomiting
, anorexia, flatulence, heartburn, dry mouth, increased AST, ALT, abdominal pain, constipation,
pseudomembranous colitis,
abnormal taste, xerostomia
HEMA:
Blood dyscrasias
INTEG:
Rash, pruritus, photosensitivity
MS:
Tendinitis,
tendon rupture, rhabdomyolysis
SYST:
Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis
PO:
Peak 1-2 hr; half-life 4-8 hr; steady state 2 days; excreted in urine as active product, metabolites; 90%-95% bioavailability
Black Box Warning:
Increase:
tendon rupture/tendinitis—corticosteroids
•
May alter blood glucose levels: antidiabetics
•
Possible theophylline toxicity: theophylline
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, methadone, chloroquine, clarithromycin, droperidol, erythromycin, pentamidine
Increase:
CNS stimulation, seizures—NSAIDs
Increase:
anticoagulation—warfarin
Decrease:
absorption—antacids with aluminum, magnesium, iron products, sucralfate, zinc products; separate by 2 hr
Black Box Warning:
Tendon rupture/tendinitis:
more common in lung, heart, kidney transplants or geriatric patients; assess for pain or inflammation
•
Blood studies: BUN, creatinine, AST, ALT, CBC, blood glucose
•
CNS symptoms:
insomnia, vertigo, headache, agitation, confusion
Black Box Warning:
Myasthenia gravis: product may increase weakness, avoid use
•
For overgrowth of infection in long-term treatment
•
Allergic reactions:
rash, flushing, urticaria, pruritus
Black Box Warning:
Stop product if these occur
•
Storage at room temp, protect from light
•
Therapeutic response: urine culture, absence of symptoms of infection
•
That if dizziness or lightheadedness occurs, to ambulate, perform activities with assistance
•
To complete full course of therapy, take with plenty of fluids
•
To avoid iron- or mineral-containing supplements within 2 hr before or after dose, take without regard to meals
•
That allergic reactions usually occur after first dose but may occur later, stop product
•
To avoid sun exposure, photosensitivity can occur
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(oh-lanz′a-peen)
Zyprexa, Zyprexa IntraMuscular, Zyprexa Relprevv, Zyprexa Zydis
Func. class.:
Antipsychotic, neuroleptic
Chem. class.:
Thienobenzodiazepine
Do not confuse:
OLANZapine
/osalazine
Zyprexa
/Celexa/Zyrtec
May mediate antipsychotic activity by both dopamine and serotonin type 2 (5-HT2) antagonists; may antagonize muscarinic receptors, histaminic (H
1
)- and α-adrenergic receptors
Schizophrenia, acute manic episodes with bipolar disorder, acute agitation
Unlabeled uses:
Acute psychosis
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, hypertension, cardiac/renal/hepatic disease, diabetes, agranulocytosis, abrupt discontinuation, Asian patients, closed-angle glaucoma, coma, leukopenia, QT prolongation, tardive dyskinesia, torsades de pointes
Black Box Warning:
Increased mortality in elderly patients with dementia-related psychosis, postinjection delirium/sedation syndrome
Calculator
• Adult:
PO
5-10 mg/day initially, may increase dosage by 5 mg at ≥1 wk intervals;
ORALLY DISINTEGRATING
tabs: open blister pack, place tab on tongue, let disintegrate, swallow, max 20 mg/day
• Geriatric:
PO
5 mg, may increase cautiously at 1-wk intervals, max 20 mg/day
• Adolescent:
PO
2.5 or 5 mg/day, target 10 mg/day
• Child 6-12 yr (unlabeled):
PO
2.5 mg daily, may increase to 5 mg/day after 4-7 days
• Adult:
PO
10-15 mg/day, may increase dose after >24 hr by 5 mg, max 20 mg/day
• Adolescent:
PO
2.5 or 5 mg/day, target 10 mg/day, max 20 mg/day
• Adult:
IM
10 mg
• Adult:
PO
2.5-5 mg/day;
acute psychosis PO
5-10 mg every night
Available forms:
Tab
2.5, 5, 7.5, 10, 15, 20 mg;
orally disintegrating tabs
5, 10, 15, 20 mg (Zyprexia Zydis);
powder for inj
10 mg;
ext rel powder for susp for inj
210, 300, 405 mg (Zyprexa Relprevv)
•
Decreased dose in geriatric patients
•
With full glass of water, milk, food to decrease GI upset
•
Orally disintegrating tabs:
open blister pack; place tab on tongue until
dissolved; swallow; no water needed, do not break, crush, chew
•
Dissolve contents of vials with 2.1 ml sterile water for inj (5 mg/ml), use immediately
•
Do not use IV or SUBCUT
•
Inject slowly, deep into muscle mass
Black Box Warning:
Available only through restricted distribution program due to postinjection delirium/sedation syndrome, given at a facility with emergency services, continuous observation
•
Use deep IM gluteal inj only
•
Use only diluent provided in kit; give q2-4wk using 19G, 1.5-inch needle in kit, for obese patients, use 19G, 2-inch or larger needle
CNS:
EPS: (pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia),
seizures,
headache,
neuroleptic malignant syndrome (rare),
agitation, nervousness, hostility,
dizziness
, hypertonia,
tremor
, euphoria, confusion,
drowsiness
, fatigue,
abnormal gait, insomnia, fever
CV:
Hypotension, tachycardia, chest pain,
heart failure, sudden death (geriatric patients, IM),
orthostatic hypotension, peripheral edema
ENDO:
Increased prolactin levels, hypo/hyperglycemia
GI:
Dry mouth, nausea, vomiting, appetite, dyspepsia
, anorexia,
constipation
, abdominal pain,
weight gain
, jaundice,
hepatitis
GU:
Urinary retention, urinary frequency, enuresis, impotence, amenorrhea, gynecomastia, breast engorgement, premenstrual syndrome
HEMA:
Neutropenia
INTEG:
Rash
MISC:
Peripheral edema, accidental injury, hypertonia, hyperlipidemia
MS:
Joint pain
, twitching
RESP:
Cough, pharyngitis;
fatal pneumonia (geriatric patients, IM)
Well absorbed (60%), metabolized by liver, glucuronidation/oxidation by CYP1A2 and CYP2D6; excreted in urine (57%), feces (30%); 93% bound to plasma proteins; half-life 21-54 hr, extended in geriatric patients; clearance decreased in women, increased in smokers, peak PO 6 hr, IM 15-45 min
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs
Increase:
sedation—other CNS depressants, alcohol, barbiturate anesthetics, antihistamines, sedatives/hypnotics, antidepressants
Increase:
OLANZapine levels—CYP1A2 inhibitors (fluvoxaMINE)
Increase:
hypotension—antihypertensives, alcohol, diazepam
Increase:
anticholinergic effects—anticholinergics
Decrease:
OLANZapine levels—CYP1A2 inducers: carBAMazepine, omeprazole, rifampin
Decrease:
antiparkinson activity—levodopa, bromocriptine, other DOPamine agonists
Increase:
LFTs, prolactin, CPK
Black Box Warning:
Postinjection delirium/sedation syndrome (Zyprexa Relprevv); monitor continuously for ≥3 hr after injection; patient must be accompanied when leaving: sedation, coma, delirium, EPS, slurred speech, altered gait aggression, dizziness, weakness, hypertension, seizures; before leaving, confirm that patient is alert, oriented, and free of any other symptoms
•
Mental status: orientation, mood, behavior, presence of hallucinations and type before initial administration, monthly; EPS, including akathisia (in
ability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
•
I&O ratio; palpate bladder if low urinary output occurs, urinary retention may be cause, especially in geriatric patients
•
Bilirubin, CBC
•
Urinalysis recommended before, during prolonged therapy
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
•
B/P sitting, standing, lying: take pulse, respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; obtain baseline ECG
•
Dizziness, faintness, palpitations, tachycardia on rising
Geriatric patients for serious reactions:
fatal pneumonia, heart failure, stroke leading to death (IM)
Neuroleptic malignant syndrome:
hyperpyrexia, muscle rigidity, increased CPK, altered mental status, for acute dystonia (check chewing, swallowing, eyes, pill rolling)
•
Constipation, urinary retention daily; increase bulk, water in diet
•
Weight gain, hyperglycemia, metabolic changes in diabetic patients
•
Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for long periods
•
Storage in tight, light-resistant container
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusion, paranoia, reorganization of patterns of thought, speech
Black Box Warning:
About postinjection delirium/sedation syndrome: teach about all symptoms
•
To use good oral hygiene; frequent rinsing of mouth, sugarless gum, candy, ice chips for dry mouth
•
To avoid hazardous activities until product response is determined
•
That orthostatic hypotension occurs often; to rise from sitting or lying position gradually
•
To avoid hot tubs, hot showers, tub baths because hypotension may occur
•
To avoid abrupt withdrawal of this product because EPS may result; product should be withdrawn slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber because serious product interactions may occur; to avoid use with alcohol, CNS depressants because increased drowsiness may occur
•
That in hot weather, heat stroke may occur; to take extra precautions to stay cool
Lavage if orally ingested; provide airway; do not induce vomiting or use EPINEPHrine