Mosby's 2014 Nursing Drug Reference (325 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Lugol’s, SSKI, Strong Iodine
Func. class.:
Thyroid hormone antagonist
Chem. class.:
Iodine product
Inhibits secretion of thyroid hormone, fosters colloid accumulation in thyroid follicles, decreases vascularity of gland
Preparation for thyroidectomy, thyrotoxic crisis, neonatal thyrotoxicosis, radiation protectant, thyroid storm
Unlabeled uses:
Erythema multiforme, erythema nodosum leprosum (ENL), sporotrichosis, thyroid involution induction
Pregnancy (D), pulmonary edema, pulmonary TB, bronchitis, hypersensitivity to iodine
Precautions:
Breastfeeding, children
Calculator
• Adult and child:
PO
(SSKI) 250 mg tid × 10-14 days preoperatively
• Adult and child:
PO
3-5 gtt strong iodine sol tid or 1-5 drops SSKI in water tid after meals for 10 days prior to surgery
• Adult:
PO
130 mg/day (distribution by government/public health officials or OTC purchase)
• Child
≥
3 yr:
PO
65 mg q day
• Child/infant
>
1 mo-3 yr:
PO
32 mg/day
• Neonate:
PO
16 mg/day
Available forms:
Oral sol (Lugol’s solution) iodine 5%/potassium iodide 10%; oral sol (SSKI) 1 g/ml
•
Products are not interchangeable
•
Strong iodine solution after diluting with water or juice to improve taste
•
Through straw to prevent tooth discoloration
•
With meals to decrease GI upset
•
At same time each day to maintain product level
•
At lowest dose that relieves symptoms; discontinue before RAIU
CNS:
Headache, confusion, paresthesias
EENT:
Metallic taste, stomatitis, salivation, periorbital edema, sore teeth and gums, cold symptoms
ENDO:
Hypothyroidism, hyperthyroid adenoma
GI:
Nausea, diarrhea, vomiting
, small-bowel lesions, upper gastric pain, metallic taste
INTEG:
Rash, urticaria,
angioneurotic edema,
acne, mucosal hemorrhage, fever
MS:
Myalgia, arthralgia, weakness
PO:
Onset 24-48 hr, peak 10-15 days after continuous therapy, uptake by thyroid gland or excreted in urine, crosses placenta
•
Hypothyroidism: lithium, other antithyroid agents
Increased:
hyperkalemia—angiotensin II receptor antagonist, ACE inhibitors, potassium salts, potassium-sparing diuretics
Interference:
urinary 17-OHCS
•
Pulse, B/P, temp; serum potassium
•
I&O ratio; check for edema: puffy hands, feet, periorbit; indicate hypothyroidism
•
Weight daily; same clothing, scale, time of day
•
T
3
, T
4
, which is increased; serum TSH, which is decreased; free thyroxine index, which is increased if dosage is too low; discontinue product 3-4 wk before RAIU
Overdose: peripheral edema, heat intolerance, diaphoresis, palpitations, dysrhythmias, severe tachycardia, fever, delirium, CNS irritability
• Hypersensitivity:
rash; enlarged cervical lymph nodes may indicate product should be discontinued
•
Hypoprothrombinemia:
bleeding, petechiae, ecchymosis
•
Clinical response: after 3 wk should include increased weight, pulse; decreased T
4
•
Fluids to 3-4 L/day unless contraindicated
•
Therapeutic response: weight gain; decreased pulse, T
4
, size of thyroid gland
•
To abstain from breastfeeding after delivery
•
To keep graph of weight, pulse, mood
•
To avoid OTC products that contain iodine
•
That seafood, other iodine products may be restricted
•
Not to discontinue product abruptly; that thyroid crisis may occur as part of stress response
•
That response may take several mo if thyroid is large
•
To discontinue product, notify prescriber of fever, rash, metallic taste, swelling of throat; burning of mouth, throat; sore gums, teeth; severe GI distress, enlargement of thyroid, cold symptoms
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(pra-mi-pex′ol)
Mirapex, Mirapex ER
Func. class.:
Antiparkinson agent
Chem. class.:
DOPamine-receptor agonist, non-ergot
Selective agonist for D
2
receptors (presynaptic/postsynaptic sites); binding at D
3
receptor contributes to antiparkinson effects
Idiopathic Parkinson’s disease, restless leg syndrome
Hypersensitivity
Precautions:
Pregnancy (C), cardiac/renal disease, MI with dysrhythmias, affective disorders, psychosis, preexisting dyskinesias, history of falling asleep during daily activities
Calculator
• Adult:
PO
0.125 mg tid; increase gradually by 0.125 mg/dose at 5- to 7-day intervals until total daily dose of 4.5 mg/day reached; ER 0.375 mg daily initially then up to 0.75 mg/day, may increase by 0.75 mg/day no more than q5-7days as needed, max 4.5 mg/day
• Adult:
PO
0.125 mg 2-3 hr prior to bedtime, increase gradually, max 0.5 mg/day
• Adult: PO
CCr 35-59 ml/min, 0.125 mg bid, may increase q5-7days to 1.5 mg bid if required; CCr 15-34 ml/min, 0.125 mg/day, increase q5-7days to 1.5 mg/day
Available forms:
Tabs 0.125, 0.25, 0.5, 1, 1.5 mg; ER tab 0.375, 0.75, 1.5, 3.0, 4.5 mg
•
Adjust dosage to patient response, titrate slowly, taper when discontinuing
•
With meals to minimize GI symptoms
•
Do not crush, chew, or break ext rel product
CNS:
Agitation, insomnia
, psychosis, hallucinations, depression, dizziness, headache, confusion, amnesia, dream disorder, asthenia, dyskinesia, hypersomnolence,
sudden sleep onset,
impulse control disorders
CV:
Orthostatic hypotension
, edema, syncope, tachycardia, increased B/P, heart rate,
heart failure
EENT:
Blurred vision, retinal/vision deterioration
GI:
Nausea, anorexia
, constipation, dysphagia, dry mouth
GU:
Impotence, urinary frequency
HEMA:
Hemolytic anemia, leukopenia, agranulocytosis
INTEG:
Pruritus
Minimally metabolized, peak 2 hr, half-life 8 hr, 8.5-12 hr in geriatric patients
Increase:
pramipexole levels—levodopa, cimetidine, ranitidine, diltiazem, triamterene, verapamil, quiNIDine
Decrease:
pramipexole levels—DOPamine antagonists, phenothiazines, metoclopramide, butyrophenones
•
Parkinson’s disease:
involuntary movements: bradykinesia, tremors, staggering gait, muscle rigidity, drooling
•
B/P, ECG, respiration during initial treatment; hypo/hypertension should be reported
•
Mental status: affect, mood, behavioral changes, depression; complete suicide assessment, worsening of symptoms of restless leg syndrome, impulse control disorders
Sleep attacks:
may fall asleep during activities without warning; may need to discontinue medication
•
Assistance with ambulation during beginning therapy
•
Testing for diabetes mellitus, acromegaly if patient receiving long-term therapy
•
Therapeutic response: movement disorder improves
•
That therapeutic effects may take several weeks to a few months
•
To change positions slowly to prevent orthostatic hypotension
•
To use product exactly as prescribed: if product is discontinued abruptly, parkinsonian crisis may occur; to avoid alcohol, OTC sleeping products
•
To notify prescriber if pregnancy is planned or suspected
•
To notify prescriber of impulse control disorders: shopping