Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (48 page)
INTEG:
Rash, fever, alopecia
RESP:
Bronchospasm,
dyspnea, wheezing, pulmonary edema
PO:
Peak 2-4 hr; onset 1 hr; duration 24 hr; half-life 6-9 hr; excreted unchanged in urine, feces (50%); protein binding 5%-15%
•
Mutual inhibition: sympathomimetics (cough, cold preparations)
Increase:
hypotension, bradycardia—reserpine, hydrALAZINE, methyldopa, prazosin, anticholinergics, digoxin, diltiazem, verapamil, cardiac glycosides, antihypertensives
Increase:
hypoglycemia—insulins, oral antidiabetics
Increase:
hypertension—amphetamines, ePHEDrine, pseudoephedrine
Decrease:
effect—insulin, oral antidiabetic agents, theophylline, DOPamine, MAOIs
Increase:
atenolol effect—hawthorn
Decrease:
atenolol effect—ephedra (ma huang)
Increase:
blood glucose, BUN, potassium, triglycerides, uric acid, ANA titer
•
I&O, weight daily; watch for CHF (rales/crackles, jugular vein distention, weight gain, edema)
•
Hypertension:
B/P, pulse q4hr; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes (<50 bpm); ECG
•
Hypotension:
may be caused in hemodialysis
•
Hypoglycemia:
may be masked in diabetes mellitus
•
Baselines in renal/hepatic studies before therapy begins
Black Box Warning:
Taper gradually do not discontinue abruptly
•
Storage protected from light, moisture; place in cool environment
•
Therapeutic response: decreased B/P after 1-2 wk, increased activity tolerance, decreased anginal pain
Black Box Warning:
Not to discontinue product abruptly, taper over 2 wk (angina); to take at same time each day as directed
•
Not to use OTC products unless directed by prescriber
•
To report bradycardia, dizziness, confusion, depression, fever
•
To take pulse at home; advise when to notify prescriber
•
To limit alcohol, smoking, sodium intake
•
To comply with weight control, dietary adjustments, modified exercise program
•
To carry emergency ID to identify product, allergies, conditions being treated
•
To avoid hazardous activities if dizziness is present
•
To change position slowly
•
That product may mask symptoms of hypoglycemia in diabetic patients
•
To use contraception while taking this product, pregnancy category (D), avoid breastfeeding
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, dextrose for hypoglycemia, digoxin, O
2
, diuretic for cardiac failure, hemodialysis
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(at-o-mox′eh-teen)
Strattera
Func. class.:
Psychotherapeutic—miscellaneous
Chem. class.:
Selective norepinephrine reuptake inhibitor
Selective norepinephrine reuptake inhibitor; may inhibit the presynaptic norepinephrine transporter
Attention deficit hyperactivity disorder
Hypersensitivity, angle-closure glaucoma, arteriosclerosis, cardiac disease, cardiomyopathy, heart failure, jaundice, MAOI therapy, history of pleochromocytoma
Precautions:
Pregnancy (C), breastfeeding, hepatic disease, angioedema, bipolar disorder, dysrhythmias, CAD, hypo/hypertension
Black Box Warning:
Children <6 yr, suicidal ideation
Calculator
• Child ≤70 kg >6 yrs: PO
0.5 mg/kg/day, increase after 3 days to target daily dose of 1.2 mg/kg in
AM
or evenly divided doses
AM,
late afternoon; max 1.4 mg/kg/day or 100 mg/day, whichever is less
• Adult and child >70 kg: PO
40 mg/day, increase after 3 days to target daily dose of 80 mg in
AM
or evenly divided doses
AM,
late afternoon; max 100 mg/day
• Adolescent ≤15 yr and child ≥6 yr: PO
1.2-1.8 mg/kg/day
• Adult and child >6 yr weighing >70 kg: PO
40 mg/day each
AM
or 2 evenly divided doses, titrate to target of 80 mg/day if symptoms do not improve after 4 wk and dose is well tolerated
•
Child-Pugh B: reduce dose by 50%; Child-Pugh C: reduce dose by 75%
Caps 10, 18, 25, 40, 60, 80, 100 mg
•
Whole; do not break, crush, chew
•
Gum, hard candy, frequent sips of water for dry mouth
•
Without regard to food
CNS:
Insomnia
, dizziness, headache, irritability, crying, mood swings, fatigue, hypoesthesia, lethargy, paresthesia
CV:
Palpitations
, hot flushes, tachycardia, increased B/P
ENDO:
Growth retardation
GI:
Dyspepsia, nausea, anorexia, dry mouth, weight loss, vomiting, diarrhea, constipation,
hepatic injury
GU:
Urinary hesitancy, retention, dysmenorrhea, erectile disturbance, ejaculation failure, impotence, prostatitis, abnormal orgasm, male pelvic pain
INTEG:
Exfoliative dermatitis,
sweating, rash
MISC:
Cough, rhinorrhea, dermatitis, ear infection
Peak 1-2 hr, metabolized by liver, excreted by kidneys, 98% protein binding
Increase:
hypertensive crisis—MAOIs or within 14 days of MAOIs, vasopressors
Increase:
cardiovascular effects of albuterol, pressor agents
Increase:
effects of atomoxetine—CYP2D6 inhibitors (amiodarone, cimetidine [weak], clomipramine, delavirdine, gefitinib, imatinib, propafenone, quiNIDine [potent], ritonavir, citalopram, escitalopram, FLUoxetine, sertraline, PARoxetine, thioridazine, venlafaxine)
•
VS, B/P; check patients with cardiac disease more often for increased B/P
•
Hepatic injury:
May cause liver failure: monitor LFT; assess for jaundice, pruritus, flulike symptoms, upper right quadrant pain
Mental status: mood, sensorium, affect, stimulation, insomnia, aggressiveness, suicidal ideation in children/young adults
•
Appetite, sleep, speech patterns
•
For increased attention span, decreased hyperactivity with ADHD, growth rate weight, therapy may need to be discontinued
•
Therapeutic response: decreased hyperactivity (ADHD)
•
To avoid OTC preparations unless approved by prescriber, no tapering needed when discontinuing product
•
To avoid alcohol ingestion
•
To avoid hazardous activities until stabilized on medication
•
To get needed rest; patients will feel more tired at end of day; not to take dose late in day, insomnia may occur
Black Box Warning:
To report suicidal ideation
•
To notify prescriber immediately if erection >4 hr
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-tore′va-stat-in)
Lipitor
Func. class.:
Antilipidemic
Chem. class.:
HMG-CoA reductase inhibitor (statin)