Mosby's 2014 Nursing Drug Reference (299 page)

• Adult:
PO
Single agent 20 mg/day initially in patients who are not volume depleted, may be increased to 40 mg/day if needed after 2 wk

• Child ≥6 yr/adolescents ≤16 yr weighing ≥35 kg:
PO
20 mg/day, may increase to max 40 mg/day after 2 wk

• Child ≥6 yr/adolescents ≤16 yr weighing 20-<35 kg:
PO
10 mg daily, may increase to max 20 mg/day after 2 wk

• 
Without regard to meals, refrigerate susp and store up to 1 mo, shake susp before use

Increase:
antihypertensive effects—other antihypertensives, diuretics

Increase:
hyperkalemia—potassium supplements, potassium-sparing diuretics

Increase:
effect of lithium, antioxidants

Decrease:
antihypertensive effect—NSAIDs, colesevelan

Increase:
antihypertensive effect—hawthorn

Decrease:
antihypertensive effect—ephedra

Black Box Warning:

Pregnancy;
product can cause fetal death when given during pregnancy (D) 2nd/3rd trimesters

• 
Response, adverse reactions, especially in renal disease

• 
Hypertension:
B/P, pulse q4hr; note rate, rhythm, quality; electrolytes: sodium, potassium, chloride; baselines for renal, hepatic studies before therapy begins

• 
Hypotension:
place supine, may occur with hyponatremia or those with volume depletion, more common in those taking a diuretic also

• 
Therapeutic response: decreased B/P

• 
To comply with dosage schedule, even if feeling better

• 
To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain

• 
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur

• 
That product may cause dizziness, fainting, lightheadedness

• 
To rise slowly to sitting or standing position to minimize orthostatic hypotension

Black Box Warning:

To notify prescriber immediately if pregnant; not to use during breastfeeding

• 
To avoid all OTC medications unless approved by prescriber

• 
That blood glucose may increase and antidiabetic product may need dosage change

• 
To inform all health care providers of medication use

• 
To use proper technique for obtaining B/P, acceptable parameters

• Adult:
PO
500 mg bid, max 3 g/day

• 
Total daily dose evenly spaced to minimize GI intolerance, give with food

Increase:
azaTHIOprine toxicity—azaTHIOprine

Increase:
myelosuppression—mercaptopurine, thioguanine

Increase:
PT, INR—warfarin

Increase:
AST, ALT

• 
Colitis:
bowel pattern, number of stools, consistency, frequency, pain, mucus before treatment and periodically

 
Blood dyscrasias:
skin rash, fever, sore throat, bruising, bleeding, fatigue, joint pain (rare); CBC before treatment and periodically

• 
Allergic reaction:
rash, dermatitis, urticaria, pruritus, dyspnea, bronchospasm; allergy to salicylates

• 
Storage in tight, light-resistant container at room temp

• 
Therapeutic response: absence of fever, mucus in stools, decreased diarrhea, abdominal pain

• 
To report diarrhea, rash, bleeding, bruising, fever, hallucinations

• 
That product may cause dizziness; to avoid hazardous activities until reaction is known

• 
To take even if feeling better; to take as directed; to take missed dose when remembered; but not to double