Mosby's 2014 Nursing Drug Reference (327 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pra′va-sta-tin)
Pravachol
Func. class.:
Antilipemic
Chem. class.:
HMG-CoA reductase enzyme
Do not confuse:
Pravachol
/Prevacid/propranolol
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
As an adjunct for primary hypercholesterolemia (types IIa, IIb, III, IV), to reduce the risk for recurrent MI, atherosclerosis, primary/secondary CV events, stroke, TIAs
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Precautions:
Past hepatic disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances
Calculator
• Adult:
PO
40 mg/day at bedtime (range 10-80 mg/day); start at 10 mg/day if patient also taking immunosuppressants
• Adolescent 14-18 yr:
PO
40 mg/day
• Child 8-13 yr:
PO
20 mg/day
• Geriatric/renal/hepatic disease:
PO
10 mg/day initially
• Adult:
PO
10-20 mg daily at bedtime, increase at 4-wk intervals
Available forms:
Tabs 10, 20, 40, 80 mg
•
Without regard to meals, at bedtime
•
Give 4 hr after bile acid sequestrants
CNS:
Headache, dizziness, fatigue
CV:
Chest pain
EENT:
Lens opacities
GI:
Nausea, constipation, diarrhea, flatus, abdominal pain, heartburn,
hepatic dysfunction,
pancreatitis,
hepatitis
GU:
Renal failure (myoglobinuria)
INTEG:
Rash, pruritus
MS:
Muscle cramps, myalgia,
myositis, rhabdomyolysis
RESP:
Common cold, rhinitis, cough
Peak 1-1½ hr; metabolized by liver; protein binding 50%; excreted in urine 20%, feces 70%, breast milk; crosses placenta; half-life 1.25-2.25 hr
Increase:
myopathy, rhabdomyolysis risk—erythromycin, niacin, cycloSPORINE, gemfibrozil, clofibrate, clarithromycin, itraconazole, protease inhibitors
Decrease:
bioavailability of pravastatin —bile acid sequestrants
Increase:
adverse reactions—red yeast rice
Increase:
hepatotoxicity—eucalyptus
Decrease:
effect—St. John’s wort
Increase:
CK, LFTs
Altered:
thyroid function tests
•
Fasting lipid profile: LDL, HDL, triglycerides, cholesterol at baseline, q12wk, then q6mo when stable; obtain diet history
•
Hepatic studies: baseline, q12wk, then q6mo for remainder of yr; AST, ALT, LFTs may increase
•
Renal studies of patients with compromised renal systems: BUN, I&O ratio, creatinine
Rhabdomyolysis:
muscle tenderness, pain; obtain CPK at baseline and if these occur, therapy should be discontinued
•
Storage in cool environment in tight container protected from light
•
Therapeutic response: decrease in LDL total cholesterol, triglycerides; increase in HDL
•
That blood work will be necessary during treatment
To report blurred vision, severe GI symptoms, dizziness, headache, muscle pain, weakness, fever
• That regimen will continue: low-cholesterol diet, exercise program
To report suspected, planned pregnancy; not to use product during pregnancy, pregnancy category (X); not to breastfeed
•
Hepatic disease:
to notify prescriber of lack of appetite, yellow sclera/skin, dark urine, abdominal pain, weakness
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(pray′zoe-sin)
Minipress
Func. class.:
Antihypertensive
Chem. class.:
α
1
-Adrenergic blocker, peripheral
Blocks α-mediated vasoconstriction of adrenergic receptors, thereby inducing peripheral vasodilation
Hypertension
Unlabeled uses:
Benign prostatic hypertrophy to decrease urine outflow obstruction, heart failure, hypertensive urgency, Raynaud’s phenomenon, posttraumatic stress disorder (PTSD)
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal/hepatic disease, prostate cancer, ocular surgery, orthostatic hypotension
Calculator
• Adult:
PO
1 mg bid or tid increasing to 20 mg/day in divided doses, if required; usual range 6-15 mg/day, max 1 mg initially; max 20 mg/day, some may require 40 mg/day
• Child (unlabeled):
PO
5 mcg/kg q6hr; max 400 mcg/kg/day or 15 mg/day
• Adult:
PO
2 mg bid
• Adult:
PO
0.5-3 mg bid
• Adult:
PO
1 mg bid-tid, may gradually increase to max 20 mg/day
• Child:
PO
5 mcg/kg q6hr, may gradually increase to 25 mcg/kg q6hr
• Adult:
PO
10-20 mg, may repeat after 30 min
Available forms:
Caps 1, 2, 5 mg
•
1st dose at bedtime to avoid fainting
•
Without regard to meals
•
Store at room temperature
CNS:
Dizziness, headache, drowsiness
, anxiety, depression, vertigo,
weakness
, fatigue
CV:
Palpitations
, orthostatic hypotension, tachycardia, edema, rebound hypertension
EENT:
Blurred vision, epistaxis, tinnitus, dry mouth, red sclera
GI:
Nausea
, vomiting, diarrhea, constipation, abdominal pain
GU:
Urinary frequency, incontinence, impotence, priapism; water, sodium retention
Onset 2 hr, peak 2-4 hr, duration 6-12 hr, half-life 2-4 hr; metabolized in liver, excreted via bile, feces (>90%), urine (<10%); protein binding 97%
Increase:
hypotensive effects—β-blockers, nitroglycerin, alcohol, phosphodiesterase inhibitors (vardenafil, tadalafil, sildenafil); diuretics, other antihypertensives, MAOIs
Decrease:
antihypertensive effect—NSAIDs
Increase:
antihypertensive effect—hawthorn
Increase:
urinary norepinephrine, VMA
•
Hypertension/CHF:
B/P (sitting, standing) during initial treatment, periodically thereafter; pulse, jugular venous distention
•
BUN, uric acid if patient receiving long-term therapy
•
Weight daily, I&O; edema in feet, legs daily
•
Benign prostatic hypertrophy (unlabeled):
urinary patterns, frequency, stream, dribbling; flow before, during, and after therapy
•
Therapeutic response: decreased B/P
•
That fainting occasionally occurs after 1st dose; to take 1st dose at bedtime; not to drive or operate machinery for 4 hr after 1st dose; that full effect may take 4-6 wk
•
To change positions slowly to prevent orthostatic hypotension
•
To avoid OTC medications unless approved by prescriber
Administer volume expanders or vasopressors, discontinue product, place patient in supine position