Mosby's 2014 Nursing Drug Reference (342 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(rah-bep′rah-zole)
Aciphex, Pariet
Func. class.:
Antiulcer, proton pump inhibitor
Chem. class.:
Benzimidazole
Do not confuse:
Aciphex
/Aricept/Accupril
Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in the gastric parietal cells; characterized as a gastric acid pump inhibitor because it blocks the final step of acid production
Gastroesophageal reflux disease (GERD), severe erosive esophagitis, poorly responsive systemic GERD, pathologic hypersecretory conditions (Zollinger-Ellison syndrome, systemic mastocytosis, multiple endocrine adenomas); treatment of active duodenal ulcers with/without antiinfectives for
Helicobacter pylori;
daytime, nighttime heartburn
Unlabeled uses:
Gastric ulcer, heartburn,
H. pylori
eradication in children
Hypersensitivity to this product or proton pump inhibitors (PPIs)
Precautions:
Pregnancy (C), breastfeeding, children, Asian patients, diarrhea, geriatric patients, gastric cancer, hepatic/GI disease, IBS, osteoporosis, pseudomembranous colitis, ulcerative colitis, vit B
12
deficiency
Calculator
• Adult:
PO
20 mg/day × ≤4 wk; to be taken after breakfast
• Adult:
PO
20 mg/day × 4-8 wk
• Adolescent and child ≥12 yr:
PO
20 mg/day up to 8 wk
• Adult:
PO
60 mg/day; may increase to 120 mg in 2 divided doses
• Adult:
PO
20 mg/day after
AM
meal × 3-6 wk
• Adult:
PO
20 mg/day × ≤14 days
Available forms:
Del rel tabs 20 mg
•
PO:
Do not break, crush, chew del rel tab; after breakfast daily with full glass of water, without regard to food
CNS:
Headache, dizziness, asthenia
CV:
Chest pain, angina, tachycardia, bradycardia, palpitations, peripheral edema
EENT:
Tinnitus, taste perversion
GI:
Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid regurgitation
, abdominal swelling, anorexia, irritable colon, esophageal candidiasis, dry mouth,
pseudomembranous colitis
GU:
UTI, urinary frequency, increased creatinine,
proteinuria, hematuria,
testicular pain, glycosuria
HEMA:
Pancytopenia, thrombocytopenia, neutropenia, leukocytosis,
anemia
INTEG:
Rash
, dry skin, urticaria, pruritus, alopecia
META:
Hypoglycemia, increased hepatic enzymes, weight gain
MISC:
Back pain
, fever, fatigue, malaise,
Stevens-Johnson syndrome
RESP:
Upper respiratory tract infections, cough
, epistaxis,
pneumonia
Eliminated in urine as metabolites and in feces, terminal half-life 1-2 hr, metabolized by CYP2C19 enzyme system, protein binding 96.3%
Increase:
bleeding risk—warfarin, clopidogrel
Increase:
serum levels of RABEprazole—benzodiazepines, phenytoin, clarithromycin, antacids, other proton pump inhibitors, H
2
blockers
Increase:
levels of—digoxin, nelfinavir/omeprazole
Decrease:
levels of RABEprazole—sucralfate, calcium carbonate, vit B
12
Decrease:
levels of ketoconazole, itraconazole, iron salts, atazanavir/ritonavir, ampicillin
Decrease:
RABEprazole—St. John’s wort
Decrease:
magnesium
•
GI system: bowel sounds, abdomen for pain, swelling, anorexia, emesis/stool for occult blood
•
Pseudomembranous colitis:
may occur with most antibiotic therapy; watery diarrhea, abdominal pain, fever
•
Vit B
12
deficiency/cyanocobalamin/hypomagnesemia:
may occur after 3-12 mo of treatment; use magnesium, vit B
12
, cyanocobalamin supplement; if severe, discontinuing of product may be needed
•
Hepatic studies: AST, ALT, alk phos during treatment; CBC with differential periodically
Serious skin reactions: Stevens-Johnson syndrome
•
CBC with differential before, periodically during treatment; blood dyscrasias may occur (rare)
•
Obtain susceptibility testing if
H. Pylori
treatment is ineffective, another anti-infective may be needed
•
Therapeutic response: absence of epigastric pain, swelling, fullness; decreased symptoms of GERD after 4-8 wk
•
To report severe diarrhea or black, tarry stools; product may have to be discontinued
•
That hypoglycemia may occur if patient is diabetic
•
To avoid hazardous activities because dizziness, drowsiness may occur
•
To avoid alcohol, salicylates, NSAIDs because they may cause GI irritation; to avoid other OTC, herbal products unless approved by prescriber
•
To use as directed for length of time prescribed; to take missed dose when remembered; not to double dose
•
To notify prescriber if pregnancy planned, suspected
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(sodium iodide)
131
I (Rx)
Func. class.:
Antithyroid
Chem. class.:
Radiopharmaceutical
Converted to protein-bound iodine by thyroid gland for use when needed
High dose:
Thyroid cancer, hyperthyroidism
Low dose:
Visualization to determine thyroid cancer, diagnostic aid for thyroid function studies
Pregnancy (X), breastfeeding, age <30 yr, recent MI, large nodular goiter, vomiting/diarrhea, acute hyperthyroidism, use of thyroid products
Calculator
• Adult:
PO
50-150 mCi; may repeat, depending on clinical status
• Adult:
PO
4-10 mCi, depending on serum thyroxine level
Available forms:
Caps 1-50, 0.8-100 mCi; oral sol 7.05 mCi/ml, 3.5-150 mCi/vial; concentrated oral solution 1000 mCi/ml
•
Only after discontinuing all other antithyroid agents × 5-7 days
•
After NPO overnight; food delays action
•
During or within 10 days of menstruation
•
Do not take antithyroid agents except propranolol, which decreases hyperthyroid symptoms, until total effect of taking
131
I has occurred (about 6 wk)
CV:
Chest pain, tachycardia
EENT:
Sore throat, cough
ENDO:
Hypothyroidism,
hyperthyroid adenoma,
transient thyroiditis, goiter
GI:
Nausea, diarrhea, vomiting
HEMA:
Eosinophilia, lymphedema, leukemia, bone marrow depression, leukopenia,
anemia, lymph node swelling
INTEG:
Alopecia, rash, pruritus
RESP:
Cough
PO:
Onset 3-6 days; excreted in urine, sweat, feces, breast milk; crosses placenta; excreted in 56 days
Increase:
Hypothyroidism—lithium
Decrease:
effect of I
131
—amiodarone
Decrease:
uptake—recent intake of stable iodine, thyroid, antithyroid products
Decrease:
Hgb, T4, TSH
•
Weight daily with same clothing, scale, time of day
•
Blood work, including CBC for blood dyscrasias (leukopenia, thrombocytopenia, agranulocytosis)
•
Overdose:
peripheral edema, heat intolerance, diaphoresis, palpitations, dysrhythmias, severe tachycardia, increased temp, delirium, CNS irritability
•
Hypersensitivity:
rash, enlarged cervical lymph nodes; product may have to be discontinued
•
Hypoprothrombinemia:
bleeding, petechiae, ecchymosis
•
Clinical response: after 3 wk should include increased weight, pulse; decreased T
4
•
Bone marrow depression:
sore throat, fever, fatigue
•
Limited contact with patient: 1/2 hr/day for each person
•
Adequate rest after treatment
•
Fluids to 3-4 L/day for 48 hr to remove agent from body
•
Therapeutic response: weight gain, decreased pulse, decreased T
4
, B/P
•
To fast overnight before treatment, consume increased fluids for 48 hr after therapy
•
To empty bladder often during treatment; to avoid irradiation of gonads
•
To report redness, swelling, sore throat, mouth lesions; may indicate blood dyscrasias
•
To avoid extended contact with children, spouse for 1 wk
•
That bathroom may be used by entire family; to flush toilet several times
•
To avoid coughing, expectorating for 24 hr (saliva and vomitus highly radioactive for 6-8 hr)