Mosby's 2014 Nursing Drug Reference (343 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ral-ox′ih-feen)
Evista
Func. class.:
Bone resorption inhibitor
Chem. class.:
Hormone modifier, selective estrogen receptor modulator (SERM)
Tissue-selective estrogen agonist/antagonist; agonist activity in bone and on lipid metabolism; antagonist activity on breast and uterus; reduces resorption of bone and decreases bone turnover
Prevention, treatment of osteoporosis in postmenopausal women; breast cancer prophylaxis in postmenopausal women with osteoporosis or in postmenopausal women at high risk for developing the disease
Unlabeled uses:
Uterine leiomyomata in postmenopausal women with osteoporosis or in postmenopausal women who are at high risk for developing the disease
Pregnancy (X), breastfeeding, hypersensitivity
Black Box Warning:
Women with active or history of venous thromboembolic events
Precautions:
CV/hepatic disease, cervical/uterine cancer, elevated triglycerides, pulmonary embolism
Black Box Warning:
Stroke
Calculator
• Adult:
PO
60 mg/day, max 60 mg/day
Available forms:
Tabs 60 mg
•
PO: without regard to meals, vit D
•
Add calcium supplement if inadequate
CNS:
Insomnia
CV:
Hot flashes, peripheral edema,
thromboembolism, stroke
EENT:
Retinal vein occlusion (rare)
GI:
Nausea
, vomiting, diarrhea, dyspepsia
GU:
Vaginitis, leukorrhea, cystitis,
hot flashes
, vaginal bleeding
INTEG:
Rash, sweating
META:
Weight gain, peripheral edema
MS:
Arthralgia, myalgia,
leg cramps
, arthritis
RESP:
Sinusitis, pharyngitis, increased cough, pneumonia, laryngitis, bronchitis,
pulmonary embolism,
flulike symptoms
Elimination half-life 28-32 hr; excreted in feces, breast milk; highly bound to plasma proteins
•
Administer cautiously with other highly protein-bound products, systemic estrogens
Decrease:
action of anticoagulants, dessicated thyroid, levothyroxine, liotrix
Decrease:
action of raloxifene—ampicillin, cholestyramine
Decrease:
raloxifene—soy
Increase:
apolipoprotein A-1, hormone-binding globulin
Decrease:
total cholesterol, LDL, lipoprotein, apolipoprotein B, serum calcium, albumin, total protein
Black Box Warning:
History of stroke, TIA, thrombosis, atrial fibrillation, hypertension, smoking; venous thrombosis may occur, avoid prolonged sitting; discontinue 3 days before surgery, other immobilization
•
Bone density test at baseline, throughout treatment, bone-specific alk phos, osteocalcin
•
Therapeutic response: prevention, treatment of osteoporosis in postmenopausal women; prevention of breast can
cer in postmenopausal women with osteoporosis or in those who are at high risk for developing the disease
Black Box Warning:
To discontinue product 72 hr before prolonged bedrest; to avoid staying in one position for long periods
•
To take calcium supplements, vit D if intake is inadequate
•
To increase exercise using weights
•
To stop smoking; to decrease alcohol consumption
•
That product does not help to control hot flashes
To report fever, acute migraine, insomnia, emotional distress; urinary tract infection, vaginal burning/itching; swelling, warmth, pain in calves
To notify prescriber if pregnancy planned, suspected, pregnancy category (X); to avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ral-teg′ra-vir)
Isentress
Func. class.:
Antiretroviral
Chem. class.:
HIV integrase strand transfer inhibitor (ISTIs)
Inhibits catalytic activity of HIV integrase, which is an HIV-encoded enzyme needed for replication
HIV in combination with other antiretrovirals
Breastfeeding, hypersensitivity
Precautions:
Pregnancy (C), children, geriatric patients, hepatic disease, immune reconstitution syndrome, hepatitis, antimicrobial resistance, lactase deficiency
Calculator
• Adult and adolescent ≥16 yr:
PO
400 mg bid; if using with rifampin, give 800 mg bid; max 800 mg/day with/without food
Available forms:
Tabs 400 mg
•
Do not break, crush, chew tabs
•
May give without regard to meals, with 8 oz of water
CNS:
Fatigue
, fever,
dizziness, headache
, asthenia,
suicidal ideation
CV:
MI
GI:
Nausea
, vomiting, diarrhea, abdominal pain, asthenia, gastritis,
hepatitis
GU:
Oliguria, proteinuria, hematuria, glomerulonephritis, acute renal failure, renal tubular necrosis
HEMA:
Anemia, neutropenia
INTEG:
Rash, urticaria, pruritus, pain or phlebitis at IV site, unusual sweating, alopecia
META:
Hyperamylasia, hyperglycemia
MS:
Myopathy,
rhabdomyolysis
SYST:
Immune reconstitution syndrome
Max absorption 3 hr if taken on an empty stomach; terminal half-life 9 hr; metabolized in the liver by uridine diphosphate glucuronosyltransferase (UGT A1A enzyme system); excreted in feces 51%, urine 32%
Increase:
raltegravir effect—proton pump inhibitors, H
2
blockers; UGT1A1 inhibitors (atazanavir)
Increase:
rhabdomyolysis, myopathy, elevated CPK—fibric acid derivatives, HMG-CoA reductase inhibitors
Decrease:
raltegravir levels—rifampin, efavirenz, tenofovir, tipranavir/ritonavir
Increase:
AST, ALT, GGT, total bilirubin, alk phos, amylase/lipase, CK, serum glucose, total/HDL/LDL cholesterol
Decrease:
Hgb, platelets, ANC
•
HIV infection:
CD4, T-cell count, plasma HIV RNA, viral load; resistance testing before therapy, at treatment failure
Rhabdomyolysis:
Assess for calf pain, increased CPK, product should be discontinued
•
Skin eruptions: rash, urticaria, itching
•
Suicidal thoughts/behaviors:
monitor for depression; more common in those with mental illness
• Immune reconstitution syndrome, usually during initial phase of treatment, may give anti-infective before starting
•
Monitor total/HDL/LDL cholesterol baseline and periodically, all may be elevated
•
Storage at room temp
•
Therapeutic response: improvement in CD4 counts, T-cell counts
•
To take as prescribed; if dose missed, to take as soon as remembered up to 1 hr before next dose; not to double dose; not to share with others
•
That sexual partners need to be told that patient has HIV; that product does not cure infection, just controls symptoms, does not prevent infecting others
To report sore throat, fever, fatigue (may indicate superinfection)
•
That product must be taken in equal intervals 2×/day to maintain blood levels for duration of therapy
To notify prescriber immediately of suicidal thoughts/behaviors
•
To notify prescriber if pregnancy planned, suspected; to avoid breastfeeding
•
To continue with follow-up exams, blood work