Mosby's 2014 Nursing Drug Reference (397 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ty-oh′tro-pee-um)
Spiriva HandiHaler
Func. class.:
Anticholinergic, bronchodilator
Chem. class.:
Synthetic quaternary ammonium compound
Do not confuse:
Spiriva
/Inspra
Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, thereby resulting in decreased cGMP and bronchodilation
COPD; for the long-term treatment and once-daily maintenance of bronchospasm associated with COPD, including chronic bronchitis and emphysema
Hypersensitivity to this product, atropine or its derivatives
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, closed-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, renal disease
Calculator
• Adult:
INH
content of 1 cap/day (18 mcg) using HandiHaler inhalation device
Available forms:
Powder for INH 18 mcg in blister packs containing 6 caps with inhaler; 30 caps with inhaler
•
Caps are for INH only; do not swallow
•
Immediately before administration, peel back foil until cap is visible and to “stop” line; remove cap from blister cavity; open dust cap of HandiHaler by pulling upward, then open mouthpiece; place cap in center chamber; firmly close mouthpiece until it clicks, leaving dust cap open
•
When finished taking dose, remove used capsule and dispose of it; close mouthpiece and dust cap; store
•
Rinse mouth after use
CNS:
Depression, paresthesia
CV:
Chest pain, increased heart rate
EENT:
Dry mouth, blurred vision, glaucoma
GI:
Vomiting, abdominal pain, constipation, dyspepsia
GU:
Urinary difficulty, urinary retention, UTI
INTEG:
Rash,
angioedema
MISC:
Candidiasis, flulike syndrome, herpes zoster, infections, angina pectoris
MS:
Arthritis myalgic leg/skeletal pain
RESP:
Cough, sinusitis, upper respiratory tract infection
, epistaxis, pharyngitis
Half-life 5-6 days in animals, does not cross blood-brain barrier, very little metabolized in the liver, excreted in urine, 72% protein binding
•
Anticholinergics: avoid use with other anticholinergics
Increase:
cholesterol, glucose
•
Respiratory status:
dyspnea, rate, breath sounds before and during treatment; pulmonary function tests at baseline and periodically; upper respiratory infections, cough, sinusitis
•
Tolerance over long-term therapy; dose may have to be increased or changed
•
Patient’s ability to use HandiHaler
•
Therapeutic response: ability to breathe easier
•
Signs of closed-angle glaucoma (eye pain, blurred vision, visual halos)
•
That product is used for long-term maintenance, not for immediate relief of breathing problems; that effect takes 20 min, lasts 24 hr
•
To avoid getting the powder in the eyes; may cause blurred vision and pupil dilation
•
To hold HandiHaler with mouthpiece upward; to press button in once, completely, and release; this allows for medication to be released
•
To breathe out completely; not to breathe into mouthpiece at any time
•
To raise device to mouth and close lips tightly around mouthpiece
•
With head upright, to breathe in slowly and deeply, but allow the cap to vibrate; to breathe until the lungs fill; to hold breath and remove mouthpiece; to resume normal breathing
•
To rinse mouth after use; to use hard candy or regular oral hygiene to reduce dry mouth
•
To report immediately blurred vision, eye pain, halos
•
To keep caps in sealed blisters before use, store at room temperature
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ti-pran′a-veer)
Aptivus
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
Inhibits human immunodeficiency virus (HIV) protease, thereby preventing the maturation of the virus
HIV in combination with other antiretrovirals
Hypersensitivity
Black Box Warning:
Hepatic disease (Child-Pugh B, C)
Precautions:
Pregnancy (C), breastfeeding, children, renal disease, history of renal stones, sulfa allergy, hemophilia, diabetes mellitus, pancreatitis, alcoholism, immune reconstitution syndrome, surgery, trauma, infection
Black Box Warning:
Intracranial bleeding, hepatitis
Calculator
Reduce dose with mild to moderate hepatic impairment and ketoconazole coadministration
• Adult:
PO
500 mg coadministered with ritonavir 200 mg bid with food
• Adolescent and child
≥
2 yr:
PO
14 mg/kg given with ritonavir 6 mg/kg bid or 375 mg/m
2
given with ritonavir 150 mg/m
2
bid, max 500 mg with ritonavir 200 mg bid
Available forms:
Caps 250 mg; oral sol 100 mg/ml
•
Swallow cap whole; do not break, crush, chew
•
After meals
•
In equal intervals around the clock to maintain blood levels
•
Give oral sol using calibrated dosing syringe or 5-ml oral syringe provided
CNS:
Headache, insomnia
, dizziness, somnolence, fatigue,
fever
,
intracranial bleeding
GI:
Diarrhea, abdominal pain, nausea, vomiting
, anorexia, dry mouth,
hepatitis B or C, fatalities when given with ritonavir, pancreatitis
GU:
Nephrolithiasis
INTEG:
Rash
, urticaria, lipodystrophy,
serious rash
MS:
Pain
OTHER:
Asthenia,
insulin-resistant hyperglycemia,
hyperlipidemia
,
ketoacidosis
Terminal half-life 6 hr, peak 3 hr, plasma protein binding 99.9%, steady state 7-10 days, metabolism CYP3A4, 80% fecal excretion
Life-threatening dysrhythmias:
amiodarone, astemizole, cisapride, ergots, flecainide, midazolam, pimozide, propafenone, quiNIDine, rifabutin, rifampin, terfenadine, triazolam
Increase:
myopathy, rhabdomyolysis
—HMG-CoA reductase inhibitors (lovastatin, simvastatin)
Increase:
tipranavir levels—ketoconazole, delavirdine, itraconazole
Increase:
levels of both products—clarithromycin, zidovudine
Increase:
levels of tipranavir—oral contraception
Decrease:
tipranavir levels—rifamycins, fluconazole, nevirapine, efavirenz
Decrease:
tipranavir levels—St. John’s wort; avoid concurrent use
Decrease:
tipranavir absorption—grapefruit juice; high-fat, high-protein foods
Increase:
AST/ALT, cholesterol, blood glucose, amylase, lipase, triglycerides
•
Signs of infection, anemia; presence of other sexually transmitted diseases
Black Box Warning:
Hepatic studies: ALT, AST; total bilirubin, amylase; all may be elevated, discontinue in those with hepatic insufficiency or hepatitis or AST/ALT 10 × upper limit or AST/ALT 5-10 × ULN and total bilirubin 2.5 × ULN
•
HIV:
Viral load, CD4, plasma HIV RNA, serum cholesterol profile, serum triglycerides during treatment
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
•
Serious rash:
if serious rash occurs, product should be discontinued
•
Immune reconstitution syndrome: has been reported with combination antiretroviral therapy, patients may develop pain (MAC, CMV, PcP, TB) and autoimmune disease months after treatment
•
Intracranial bleeding: more common in those with trauma, surgery, or those taking antiplatelets or anticoagulants
•
Cushingoid symptoms: buffalo hump, facial/peripheral wasting, breast enlargement, central obesity
•
Storage for caps in refrigerator before use; after opening, store at room temp; use within 60 days
•
Storage for oral sol at room temp; use within 60 days after opening bottle
•
Therapeutic response: improving CD4 counts, viral load
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
That product must be taken in equal intervals around the clock to maintain blood levels for duration of therapy
That hyperglycemia may occur; to watch for increased thirst, weight loss, hunger, dry, itchy skin; to notify prescriber
•
That product does not cure AIDS, only controls symptoms; not to donate blood