Mosby's 2014 Nursing Drug Reference (391 page)

• Adult:
PO
(Males) 1.2-1.5 mg; (females) 1.1 mg; (pregnancy) 1.4 mg; (breastfeeding) 1.4 mg

• Child 9-13 yr:
PO
0.9 mg

• Child 4-8 yr:
PO
0.6 mg

• Child 1-3 yr:
PO
0.5 mg

• Infant 7 mo-1 yr:
PO
0.3 mg

• Neonate and infant ≤6 mo:
PO
0.2 mg

• Adult:
PO
5-30 mg daily or in 3 divided doses × 1 mo;
IM/IV
5-30 mg daily or in 3 divided doses then convert to
PO

• Infant/child:
PO
10-50 mg daily × 2 wk then 5-10 mg daily × 1 mo;
IV/IM
10-25 mg/day × 2 wk then 5-10 mg daily × 1 mo

Y-site compatibilities:
Famotidine

• 
Anaphylaxis (IV only):
swelling of face, eyes, lips, throat, wheezing

• 
Thiamine deficiency:
anorexia, weakness/pain, depression, confusion, blurred vision, tachycardia

• 
Nutritional status: yeast, beef, liver, whole or enriched grains, legumes

• 
Storage in tight, light-resistant container

• 
Application of cold to help decrease pain

• 
Therapeutic response: absence of nausea, vomiting, anorexia, insomnia, tachycardia, paresthesias, depression, muscle weakness

• 
About the necessary foods to be included in diet: yeast, beef, liver, legumes, whole grains

Black Box Warning:

Cardiac disease, dementia, AV block, bundle branch block, torsades de pointes

• Adult:
PO
25-100 mg tid, max 800 mg/day; dose gradually increased to desired response then reduced to minimum maintenance

• Adult:
PO
25 mg tid, range from 10 mg bid-qid to 50 mg tid-qid, max 800 mg/day for short period

• Geriatric:
PO
10-25 mg daily-bid, increase 4-7 days by 10-25 mg to desired dose, max 300 mg/day for short period

• Child 2-12 yr:
PO
0.5-3 mg/kg/day in divided doses, max 3 mg/kg/day

• 
Antiparkinsonian agent on order from prescriber for EPS

• 
Avoid use with CNS depressants

• 
Antacids separated by 2 hr or more

Increase:
anticholinergic effects—anticholinergics

Decrease:
antiparkinson’s agent effects

Decrease:
thioridazine effect—lithium, barbiturates

Decrease:
antihypertensive effect—centrally acting antihypertensives

Decrease:
absorption—aluminum hydroxide, magnesium hydroxide antacids

Increase:
LFTs, prolactin, bilirubin, alk phos

Decrease:
Hct/Hgb, platelets, granulocytes, leukocytes, neutrocytes, eosinophils

• 
Mental status before 1st dose

• 
I&O ratio; palpate bladder if low urinary output occurs, urinary retention may be the cause

• 
Bilirubin, CBC, LFTs monthly

• 
Urinalysis recommended before and during prolonged therapy

• 
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances

• 
B/P standing, lying; include pulse and respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg

• 
Dizziness, faintness, palpitations, tachycardia on rising

• 
EPS
including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)

 
Neuroleptic malignancy syndrome:
altered mental status, muscle rigidity, increased CPK, hyperthermia, dyspnea, fatigue

 
QT prolongation:
ECG, ejection fraction; assess for chest pain, palpitations, dyspnea

• 
Constipation, urinary retention daily; increase bulk, water in diet

• 
Supervised ambulation if needed until stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for long periods

• 
Sips of water, candy, gum for dry mouth

• 
Storage in tight, light-resistant container; avoid contact with skin

• 
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech

• 
That orthostatic hypotension occurs frequently; to rise from sitting or lying position gradually; to avoid hazardous activities until stabilized on medication

• 
To avoid hot tubs, hot showers, tub baths because hypotension may occur

• 
To avoid abrupt withdrawal of thioridazine because EPS may result; that product should be withdrawn slowly

• 
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber; that serious product interactions may occur; to avoid use with alcohol because increased drowsiness may occur

• 
To use sunscreen to prevent burns

• 
About compliance with product regimen

• 
About the necessity for meticulous oral hygiene because oral candidiasis may occur

• 
To report sore throat, malaise, fever, bleeding, mouth sores; if these occur, CBC should be drawn and product discontinued; that product may cause vision impairment, should be reported to prescriber

• 
That in hot weather, heat stroke may occur; to take extra precautions to stay cool

• 
That product may cause discoloration of urine