Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (301 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(on-dan-seh′tron)
Zofran, Zofran ODT, Zuplenz
Func. class.:
Antiemetic
Chem. class.:
5-HT
3
receptor antagonist
Do not confuse:
Zofran
/Zantac
Prevents nausea, vomiting by blocking serotonin peripherally, centrally, and in the small intestine
Prevention of nausea, vomiting associated with cancer chemotherapy, radiotherapy; prevention of postoperative nausea, vomiting
Unlabeled uses:
Pruritus (rectal use), alcoholism, hyperemesis gravidarum
Hypersensitivity; phenylketonuric hypersensitivity (oral disintegrating tab), torsades de pointes
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, granisetron hypersensitivity, QT prolongation, torsades de pointes
Calculator
• Adult and child 4-18 yr:
IV
0.15 mg/kg infused over 15 min given 30 min before start of cancer chemotherapy, max 16 mg/dose; 0.15 mg/kg given 4 hr and 8 hr after 1st dose or 16 mg as single dose; dilute in 50 ml of D
5
or 0.9% NaCl before giving;
RECT
(unlabeled) 16 mg/day 2 hr prior to chemotherapy;
PO
8 mg 1/2 hr prior to chemotherapy, repeat 4, 8 hr after 1st dose
• Child ≥4 yr:
PO
4 mg TID, first dose 1/2 hr prior to chemotherapy
• Adult:
PO
8 mg tid, may repeat q8hr
• Adult:
IV/IM
4 mg undiluted over >30 sec prior to induction of anesthesia
• Child 2-12 yr:
IV
0.1 mg/kg (≤40 kg);
IV
4 mg (≥40 kg), give over ≥30 sec
• Adult:
PO/IM/IV
Max dose 8 mg/day
• Adult:
PO/IV
4-8 mg bid-tid
• Adult:
PO
8 mg bid
• Adult:
PO
4 mcg/kg bid
Available forms:
Inj 2 mg/ml, 32 mg/50 ml (premixed); tabs 4, 8 mg; oral sol 4 mg/5 ml; oral disintegrating tabs 4, 8 mg; oral dissolving film 4, 8 mg
•
Oral disintegrating tab:
do not push through foil; gently remove, immediately place on tongue to dissolve; swallow with saliva
•
Oral dissolving film:
fold pouch along dotted line to expose tear notch; while folded, tear and remove film, place film on tongue until dissolved, swallow after dissolved; to reach desired dose, administer successive films, allowing each to dissolve before using another
•
Visually inspect for particulate or discoloration
•
May give 4 mg undiluted IM, inject deeply in large muscle mass, aspirate
•
Check for discoloration or particulate, if particulate is present, shake to dissolve
•
After diluting single dose in 50 ml NS or D
5
W, 0.45% NaCl or NS; give over 15 min
•
Do not use IV 32 mg/dose in chemotherapy nausea/vomiting due to QT prolongation, max 16 mg/dose (adult)
Y-site compatibilities:
Aldesleukin, amifostine, amikacin, aztreonam, bleomycin, CARBOplatin, carmustine, ceFAZolin, cefmetazole, cefotaxime, cefOXitin, cefTAZidime, ceftizoxime, cefuroxime, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, cladribine, clindamycin, cyclophosphamide, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin, dexamethasone, diphenhydrAMINE, DOPamine, DOXOrubicin, DOXOrubicin liposome, doxycycline, droperidol, etoposide, famotidine, filgrastim, floxuridine, fluconazole, fludarabine, gallium, gentamicin, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cilastatin, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, methotrexate, metoclopramide, miconazole, mitoMYcin, mitoXANtrone, morphine, PACLitaxel, pentostatin, piperacillin/tazobactam, potassium chloride,
prochlorperazine, promethazine, ranitidine, remifentanil, streptozocin, teniposide, thiotepa, ticarcillin, ticarcillin-clavulanate, vancomycin, vinBLAStine, vinCRIStine, vinorelbine, zidovudine
CNS:
Headache, dizziness, drowsiness, fatigue, EPS
GI:
Diarrhea, constipation
, abdominal pain, dry mouth
MISC:
Rash,
bronchospasm
(rare),
musculoskeletal pain, wound problems, shivering, fever, hypoxia, urinary retention
IV:
Mean elimination half-life 3.5-4.7 hr, plasma protein binding 70%-76%, extensively metabolized in the liver, excreted 45%-60% in urine
Increase:
unconsciousness, hypotension—apomorphine, do not use together
Increase:
QT prolongation—other products that prolong QT
Decrease:
ondansetron effect—rifampin, carBAMazepine, phenytoin
Increase:
LFTs
•
Absence of nausea, vomiting during chemotherapy
•
Hypersensitivity reaction: rash, bronchospasm (rare)
•
EPS:
shuffling gait, tremors, grimacing, rigidity periodically
•
QT prolongation:
monitoring ECG in those with cardiac disease or receiving other products that increase QT
•
Storage at room temp for 48 hr after dilution
•
Therapeutic response: absence of nausea, vomiting during cancer chemotherapy
•
To report diarrhea, constipation, rash, changes in respirations, or discomfort at insertion site
•
Headache requiring analgesic is common
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
)
(or′lih-stat)
Alli, Xenical
Func. class.:
Weight-control agent
Chem. class.:
Lipase inhibitor
Inhibits the absorption of dietary fats
Obesity management
Hypersensitivity, chronic malabsorption syndrome, cholestasis
Precautions:
Pregnancy (X), children, hypothyroidism, other organic causes of obesity, anorexia nervosa, bulimia, nephrolithiasis, GI disease, diabetes, fat-soluble vitamin deficiency, breastfeeding
Calculator
• Adult:
PO
(Alli) 60 mg, (Xenical) 120 mg tid with each main meal containing fat, max 360 mg/day
Available forms:
Caps (Alli) 60 mg, (Xenical) 120 mg
•
For obesity only if patient on weight-reduction program that includes dietary changes, exercise; patient should be on a diet with 30% of calories from fat; omit dose of orlistat if meal contains no fat
CNS:
Insomnia
, depression, anxiety, dizziness, headache, fatigue
GI:
Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, fecal incontinence, frequent defecation
, nausea, vomiting, abdominal pain, infectious diarrhea, rectal
pain, tooth disorder, hypovitaminosis,
hepatic failure, hepatitis, pancreatitis
GU:
UTI, vaginitis, menstrual irregularity
INTEG:
Dry skin, rash
MS:
Back pain, arthritis, myalgia, tendinitis
RESP:
Influenza, URI, LRI, EENT symptoms
Minimal absorption, peak 8 hr, 99% protein binding, excretion in feces, half-life 1-2 hr
Increase:
lipid-lowering effect—pravastatin
Increase:
effects of warfarin
Decrease:
absorption—fat-soluble vitamins (A, D, E, K), cycloSPORINE
•
Weight status:
before starting therapy, obtain testing to rule out physiologic reactions for weight, obtain thyroid testing, BMI, glucose; weight weekly; diabetic patients may need reduction in oral hypoglycemics
•
For misuse in certain populations (anorexia nervosa, bulimia)
Hepatotoxicity/pancreatitis:
jaundice, weakness, abdominal pain (rare)
•
Therapeutic response: decrease in weight
•
That 60-mg cap can be obtained OTC; 60 mg tid is highest OTC dose
•
That safety and effectiveness beyond 2 yr have not been determined
•
To read patient information sheet; to discuss unpleasant GI side effects
•
To take multivitamin containing fat-soluble vitamins 2 hr before or after orlistat; that psyllium taken with each dose or at bedtime may decrease GI symptoms
•
To avoid hazardous activities until stabilized on medication; to discuss unpleasant side effects
•
To notify prescriber if pregnancy is planned or suspected pregnancy (X), if breastfeeding take proper fat-soluble vitamins
Hepatotoxicity/pancreatitis:
yellowing of skin, eyes; dark urine; weakness; abdominal pain