Mosby's 2014 Nursing Drug Reference (304 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ox-i-byoo′ti-nin)
Ditropan
, Ditropan XL, Gelnique, Oxytrol, Oxytrol Transdermal, Uromax
Func. class.:
Anticholinergic
Chem. class.:
Synthetic tertiary amine
Do not confuse:
Ditropan
/diazepam
Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Antispasmodic for neurogenic bladder, overactive bladder
Hypersensitivity, GI obstruction, urinary reten
tion, glaucoma, severe colitis, myasthenia gravis, unstable CV disease
Precautions:
Pregnancy (B), breastfeeding, children <12 yr, geriatric patients, suspected glaucoma, cardiac disease, dementia
Calculator
• Adult:
PO
5 mg bid-tid, max 5 mg qid;
EXT REL
5-10 mg/day, may increase by 5 mg, max 30 mg/day;
TD
apply 1 patch to abdomen, hip, buttock 2×/wk (q3-4 days);
GEL
apply contents of 1 packet to abdomen, upper arms, shoulders, thighs daily
• Geriatric:
PO
2.5-5 mg bid-tid, increase by 2.5 mg q several days
• Child >6 yr:
PO
5 mg bid, max 5 mg tid;
EXT REL
5 mg/day, max 20 mg/day
• Child 1-5 yr:
PO
0.2 mg/kg/dose bid-tid
Available forms:
Syr 5 mg/5 ml; tabs 5 mg; ext rel tabs 5, 10, 15 mg; TD 3.9 mg/day; top gel 10% (Gelnique)
•
Do not crush, break, or chew ext rel tabs
•
Without regard to meals
•
Wash hands; apply to clean, dry, intact skin on abdomen, upper arms/shoulders, thighs; avoid navel, rotate sites
•
Squeeze contents into palm of hand or directly on site, rub gently
•
Do not bathe, exercise, swim for 1 hr after application
•
Allow to dry before putting on clothing
•
Do not be near flame, fire, or smoke until gel has dried
•
Delivers 100 mg
•
Apply to clean, dry, intact skin on abdomen, hip, buttock; use firm pressure; not affected by showering/bathing; rotate sites
•
Delivers 3.9 mg/day
CNS:
Anxiety, restlessness, dizziness, somnolence, insomnia, nervousness
,
seizures,
headache,
drowsiness
, confusion
CV:
Palpitations, sinus tachycardia
, hypertension, peripheral edema,
QT prolongation
EENT:
Blurred vision, dry eyes
, increased intraocular tension,
dry mouth
, throat
GI:
Nausea, vomiting, anorexia
, abdominal pain,
constipation, dyspepsia
, diarrhea, taste perversion, GERD
GU:
Dysuria, impotence,
urinary retention, hesitancy
MISC:
Hyperthermia, anaphylaxis, angioedema
Onset 1/2-1 hr, peak 3-6 hr, duration 6-10 hr; metabolized by liver, excreted in urine; terminal half-life 2-3 hr
•
Altered pharmacokinetic parameters: CYP3A4 inhibitors
Increase:
CNS depression—benzodiazepines, sedatives, hypnotics, opioids
Increase:
levels of atenolol, digoxin, nitrofurantoin
Increase:
anticholinergic effects—antihistamines, amantidine, other anticholinergics
Increase or decrease:
levels of phenothiazines
Decrease:
levels of acetaminophen, haloperidol, levodopa
Decrease:
effects of oxybutynin—CYP3A4 inducers
•
Urinary patterns:
distention, nocturia, frequency, urgency, incontinence, I&O ratios; cystometry to diagnose dysfunction, urinary tract infections should be treated
Allergic reactions:
rash, urticaria; if these occur, product should be discontinued; angioedema
QT prolongation:
ECG for QT prolongation, ejection fraction; assess for chest pain, palpitations, dyspnea
•
CNS effects: confusion, anxiety; anticholinergic effects in geriatric patients
•
Urinary status: dysuria, frequency, nocturia, incontinence
•
To avoid hazardous activities because dizziness, blurred vision may occur
•
To avoid OTC medications with alcohol, other CNS depressants
•
To avoid hot weather, strenuous activity because product decreases perspiration
•
About the correct application of each product form
•
Transdermal:
Change patch 2×/wk, do not use same site within 7 days, dispose of and use container not accessible to pets/children
•
To open patch immediately before using
•
Do not use during MRI, remove
•
Topical gel:
Rotate sites
•
Apply to clean, dry skin on abdomen, upper arm/shoulders/thighs
•
Gel is flammable
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert