Mosby's 2014 Nursing Drug Reference (387 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(ter-byoo′ta-leen)
Bricanyl
Func. class.:
Selective β
2
-agonist; bronchodilator
Chem. class.:
Catecholamine
Do not confuse:
terbutaline
/TOLBUTamide/terbinafine
Relaxes bronchial smooth muscle by direct action on β
2
-adrenergic receptors through the accumulation of cAMP at β-adrenergic receptor sites; bronchodilation, diuresis, CNS, cardiac stimulation occur; relaxes uterine smooth muscle
Bronchospasm
Unlabeled uses:
Premature labor, nonresponsive status asthmaticus in children (IV)
Hypersensitivity to sympathomimetics, closed-angle glaucoma, tachydysrhythmias
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, cardiac disor
ders, hyperthyroidism, diabetes mellitus, prostatic hypertension, hypertension, seizure disorder
Black Box Warning:
Labor
Calculator
• Adult and child >12 yr:
PO
2.5-5 mg q8hr;
SUBCUT
0.25 mg q15-30min, max 0.5 mg in 4 hr
• Adolescent ≤15 yr and child ≥12 yr:
PO
2.5 mg tid, max 7.5 mg/day
• Child 6-11 yr (unlabeled):
PO
0.05 mg/kg q8hr, may increase slowly
• Adult:
PO
CCr 10-50 ml/min, 50% of dose; CCr <10 ml/min, avoid use
• Adult:
SUBCUT
0.25 mg q20min to 6 hr, hold if pulse >120 bpm
Available forms:
Tabs 2.5, 5 mg; inj 1 mg/ml
•
With food; may be crushed
•
2 hr before bedtime to avoid sleeplessness
•
Only used if subcut is ineffective
•
IV after diluting each 5 mg/1 L D
5
W for inf
•
IV, run 5 mcg/min; may increase 5 mcg q10min, titrate to response; after 1/2-1 hr, taper dose by 5 mcg; switch to PO as soon as possible
Y-site compatibilities:
Insulin (regular)
CNS:
Tremors, anxiety, insomnia, headache, dizziness, stimulation
CV:
Palpitations, tachycardia, hypertension, dysrhythmias,
cardiac arrest, QT prolongation
GI:
Nausea, vomiting
META:
Hypokalemia, hyperglycemia
RESP:
Paradoxical bronchospasm, dyspnea
PO:
Onset 1/2 hr, peak 1-2 hr, duration 4-8 hr, half-life 3.4 hr
SUBCUT:
Onset 6-15 min, peak 1/2-1 hr, duration 1½-4 hr, half-life 5.7 hr
•
Hypertensive crisis: MAOIs
Increase:
effects of both products—other sympathomimetics
Decrease:
action—β-blockers; do not use together
Increase:
effect—green tea (large amounts), guarana
•
Respiratory function: vital capacity, forced expiratory volume, ABGs, B/P, pulse, respiratory pattern, lung sounds, sputum before and after treatment
•
Tolerance in patients receiving long-term therapy; dose may have to be changed; monitor for rebound bronchospasm
Paradoxical bronchospasm:
dyspnea, wheezing; keep emergency equipment nearby
•
Labor:
maternal heart rate, B/P, contraction, fetal heart rate; can inhibit uterine contractions, labor; monitor for hypoglycemia
•
Storage at room temp; do not use discolored sol
•
Increase in fluids of >2 L/day
•
Therapeutic response: absence of dyspnea, wheezing
•
Not to use OTC medications because extra stimulation may occur
•
About all aspects of product; to avoid smoking, smoke-filled rooms, persons with respiratory infections
•
To increase fluids by >2 L/day; to allow 15 min between inhalation of product and inhaled product containing steroid
•
To take on time; if missed, not to make up after 1 hr, to wait until next dose
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tah-ree-par′ah-tide)
Forteo
Func. class.:
Parathyroid hormone (rDNA)
Chem. class.:
Teriparatide
Contains human recombinant parathyroid hormone to stimulate new bone growth
Postmenopausal women with osteoporosis, men with primary or hypogonadal osteoporosis who are at high risk for fracture, glucocorticoid-induced osteoporosis
Unlabeled uses:
Hypoparathyroidism
Hypersensitivity, increased baseline risk for osteosarcoma (Paget’s disease, open epiphyses; previous bone radiation), bone metastases, history of skeletal malignancies, other metabolic bone diseases, preexisting hypercalcemia
Precautions:
Pregnancy (C), breastfeeding, children, urolithiasis, hypotension, use >2 yr, cardiac disease
Black Box Warning:
Secondary malignancy
Calculator
• Adult:
SUBCUT
20 mcg/day up to 2 yr (osteoporosis); long-term/lifetime use is recommended (glucocorticoid-induced osteoporosis)
Available forms:
Prefilled pen delivery device (delivers 20 mcg/day)
•
Give by SUBCUT using disposable pen only; inject in thigh or abdomen; lightly pinch fold of skin; insert needle; release skin; inject at 90-degree angle over 5 sec; rotate inj sites
•
Have patient sit or lie down; orthostatic hypotension may occur
•
Protect from freezing, light; refrigerate pen
CNS:
Dizziness, headache, insomnia, depression, vertigo
CV:
Hypertension, angina, syncope
GI:
Nausea, diarrhea, dyspepsia, vomiting, constipation
INTEG:
Rash, sweating
MISC:
Pain, asthenia, hyperuricemia
MS:
Arthralgia, leg cramps, back/leg pain, weakness,
osteosarcoma (rare)
RESP:
Rhinitis, cough, pharyngitis, pneumonia, dyspnea
SUBCUT:
Extensively and rapidly absorbed, metabolized by liver, excreted by kidneys, terminal half-life 1 hr, onset rapid, peak 1/2 hr, duration 3 hr
Increase:
digoxin toxicity: digoxin
Increase:
calcium, uric acid, urinary calcium
Decrease:
phosphorous, magnesium
Black Box Warning:
Secondary malignancy: osteosarcoma, dependent on length of treatment; those at higher risk for osteosarcoma should not use this product
•
Uric acid, magnesium, creatinine, BUN, urine pH, vit D, phosphate for normal serum levels; serum calcium may be transiently increased after dosing (max at 4-6 hr after dose)
•
Bone pain, headache, fatigue, changes in LOC, leg cramps
•
Signs of persistent hypercalcemia:
nausea, vomiting, constipation, lethargy, muscle weakness
•
Nutritional status: diet for sources of vit D (milk, some seafood), calcium (dairy products, dark green vegetables), phosphates (dairy products)
•
Store refrigerated, do not freeze; may be used for 28 days after first inj
•
Therapeutic response: increased bone mineral density
•
About the symptoms of hypercalcemia
•
About foods rich in calcium, vit D
•
How to use delivery device, dispose of needles; not to share pen with others, to use at same time of day
•
To sit or lie down if dizziness or fast heartbeat occurs after 1st few doses
•
To rotate administration sites
•
To store pen in refrigerator, pen may be used for 28 days