Mosby's 2014 Nursing Drug Reference (403 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(tor-em′ih-feen)
Fareston
Func. class.:
Antineoplastic
Chem. class.:
Antiestrogen hormone
Inhibits cell division by binding to cytoplasmic estrogen receptors; resembles normal cell complex but inhibits DNA synthesis and estrogen response of target tissue
Advanced breast carcinoma not responsive to other therapy in estrogen-receptor–positive patients (usually postmenopausal)
Unlabeled uses:
Prostate cancer prophylaxis
Pregnancy (D), hypersensitivity, history of thromboembolism
Black Box Warning:
QT prolongation
Precautions:
Breastfeeding, children, leukopenia, thrombocytopenia, cataracts, hypercalcemia, hepatic disease, endometrial hyperplasia
Calculator
• Adult:
PO
60 mg/day
Available forms:
Tabs 60 mg
•
Antacid before oral agent; give product after evening meal, before bedtime
•
Antiemetic 30-60 min before product to prevent vomiting
CNS:
Hot flashes, headache, lightheadedness
, depression
CV:
CHF, MI, PE,
chest pain, angina
EENT:
Ocular lesions, retinopathy, corneal opacity, blurred vision (high doses)
GI:
Nausea, vomiting
, altered taste (anorexia)
GU:
Vaginal bleeding, pruritus vulvae
HEMA:
Thrombocytopenia, leukopenia, thrombosis
INTEG:
Rash, alopecia,
sweating
META:
Hypercalcemia
RESP:
Pulmonary embolism
Peak 3 hr, excreted primarily in feces, 99.5% protein binding, terminal half-life 5-6 days, metabolized by liver
•
May increase effect of warfarin
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl; CYP3A4 substrates (methadone, pimozide, QUEtia-pine, quiNIDine, risperiDONE, ziprasidone)
Increase:
toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole)
Decrease:
toremifene effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)
•
Avoid use with St. John’s wort
Increase:
serum calcium
•
CBC, differential, platelet count weekly; withhold product if WBC is <3500/mm
3
or platelet count is <100,000/mm
3
; notify prescriber; LFTs, serum calcium
•
Bleeding:
hematuria, guaiac, bruising, petechiae, mucosa or orifices q8hr
•
Effects of alopecia on body image; discuss feelings about body changes
Severe allergic reactions:
rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
Black Box Warning:
QT prolongation:
ECG, ejection fraction; assess for chest pain, palpitations, dyspnea
•
Increase fluid intake to 2-3 L/day to prevent dehydration
•
Storage in light-resistant container at room temp
•
Therapeutic response: decreased tumor size, spread of malignancy
•
That vaginal bleeding, pruritus, hot flashes are reversible after discontinuing treatment
•
To report immediately decreased visual acuity, which may be irreversible; about need for routine eye exams; that health care providers should be told about tamoxifen therapy
•
To report vaginal bleeding immediately
•
That tumor flare
—increase in size of tumor, increased bone pain—may occur and will subside rapidly; to take analgesics for pain
•
That premenopausal women must use mechanical birth control because ovulation may be induced, pregnancy (D)
•
That hair may be lost during treatment; that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tor′suh-mide)
Demadex
Func. class.:
Loop diuretic
Chem. class.:
Sulfonamide derivative
Acts on loop of Henle by inhibiting absorption of chloride, sodium, water
Treatment of hypertension and edema with CHF, ascites
Infants, hypersensitivity to sulfonamides, anuria
Precautions:
Pregnancy (B), breastfeeding, diabetes mellitus, dehydration, severe renal disease, electrolyte depletion, hypovolemia, syncope, ventricular dysrhythmias
Calculator
• Adult:
PO/IV
10-20 mg/day, may increase as needed, max 200 mg/day
• Adult:
PO/IV
20 mg/day, may increase to 200 mg/day
• Adult:
PO/IV
5-10 mg/day, may increase as needed, max 40 mg/day
• Adult:
PO
5 mg/day, may increase to 10 mg/day
Available forms:
Tabs 5, 10, 20, 100 mg; inj 10 mg/ml
•
In
AM
to avoid interference with sleep if using product as diuretic
•
With food or milk if nausea occurs; absorption may be decreased slightly
•
Visually inspect for particulate matter and discoloration before use
•
Give either slowly as an IV bolus or as a continuous IV infusion
•
Ampules are single-use containers; discard any unused portion after opening
•
No dilution is necessary if given as a slow IV injection; give over 2 min
•
If administered through an IV line, flush the line with 0.9% sodium chloride for injection before and after administration
•
If administered through an IV line, flush the line with 0.9% sodium chloride for injection before and after use
•
Stable for 24 hr at room temperature
CNS:
Headache, dizziness
, asthenia, insomnia, nervousness
CV:
Orthostatic hypotension, chest pain, ECG changes,
circulatory collapse,
ventricular tachycardia, edema
EENT:
Loss of hearing
, ear pain, tinnitus, blurred vision
ELECT:
Hypokalemia, hypochloremic alkalosis, hyponatremia
, metabolic alkalosis
ENDO:
Hyperglycemia, hyperuricemia
GI:
Nausea
, diarrhea, dyspepsia, cramps, constipation
GU:
Polyuria
,
renal failure,
glycosuria
INTEG:
Rash
, photosensitivity, pruritus
MS:
Cramps, stiffness
RESP:
Rhinitis, cough increase
PO:
Rapidly absorbed; duration 6 hr; breast milk; crosses placenta; half-life 3.5 hr; protein binding 97%-99%, cleared through hepatic metabolism
Increase:
toxicity—lithium, nondepolarizing skeletal muscle relaxants, digoxin
Increase:
action of antihypertensives, oral anticoagulants, nitrates
Increase:
ototoxicity—aminoglycosides, CISplatin, vancomycin
Decrease:
antihypertensive effect of torsemide—indomethacin, carBAMazepine, PHENobarbital, phenytoin, rifampin, NSAIDs
•
Severe photosensitivity: St. John’s wort
Increase:
BUN, creatinine, uric acid, blood glucose, cholesterol
Decrease:
potassium, magnesium, chloride sodium
•
Hearing when giving high doses
•
Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily
•
B/P lying, standing; postural hypotension may occur
•
Electrolytes: potassium, sodium, chlorine; include BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid, Ca, Mg
•
Glucose in urine of diabetic patients
•
Signs and symptoms of metabolic alkalosis:
drowsiness, restlessness
•
Signs and symptoms of hypokalemia:
postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness
•
Rashes, temp elevation daily
•
Confusion, especially in geriatric patients; take safety precautions if needed
•
Therapeutic response: improvement in edema of feet, legs, sacral area daily if medication is being used with CHF
•
To rise slowly from lying, sitting position
•
To recognize adverse reactions: muscle cramps, weakness, nausea, dizziness, tinnitus
•
To take with food or milk for GI symptoms; to limit alcohol use
•
To take early during the day to prevent nocturia
•
To use sunscreen, protective clothing to prevent sunburn
Lavage if taken orally; monitor electrolytes, administer dextrose in saline; monitor hydration, CV, renal status