Mosby's 2014 Nursing Drug Reference (51 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Available forms:
Inj 0.05, 0.1, 0.4, 0.5, 0.8, 1 mg/ml; tabs 0.4 mg; AtroPen 0.5, 1, 2 mg inj prefilled autoinjectors
•
Increased bulk, water in diet if constipation occurs
•
Without regard to meals
•
Atropine flush may occur in children and is not harmful
•
Use no more than 3 AtroPen inj unless under the supervision of trained medical provider
•
Use as soon as symptoms appear (tearing, wheezing, muscle fasciculations, excessive oral secretions)
•
Undiluted or diluted with 10 ml sterile water; give at 0.6 mg/min through Y-tube or 3-way stopcock; do not add to IV sol; may cause paradoxical bradycardia for 2 min
Y-site compatibilities:
Amrinone, etomidate, famotidine, heparin, hydrocortisone, meropenem, nafcillin, potassium chloride, sufentanil, vit B/C
CNS:
Headache, dizziness, involuntary movement, confusion, psychosis, anxiety,
coma,
flushing, drowsiness, insomnia, weakness; delirium (geriatric patients)
CV:
Hypo/hypertension, paradoxical bradycardia, angina, PVCs,
tachycardia,
ectopic ventricular beats,
bradycardia
EENT:
Blurred vision, photophobia, glaucoma, eye pain, pupil dilation, nasal congestion
GI:
Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation,
paralytic ileus,
abdominal distention, altered taste
GU:
Retention, hesitancy, impotence, dysuria
INTEG:
Rash, urticaria, contact dermatitis, dry skin, flushing
MISC:
Suppression of lactation, decreased sweating,
anaphylaxis
Half-life 2-3 hr, terminal 12.5 hr, excreted by kidneys unchanged (70%-90% in 24 hr), metabolized in liver, 40%-50% crosses placenta, excreted in breast milk
PO:
Onset 1/2-2 hr, peak 1/2-1 hr, duration 4-6 hr, well absorbed
IM/SUBCUT:
Onset 15-50 min, peak 30 min, duration 4-6 hr, well absorbed
IV:
Peak 2-4 min, duration 4-6 hr
Increase:
Mucosal lesions—potassium chloride tab
Increase:
anticholinergic effects—tricyclics, amantadine, antiparkinson agents
Decrease:
absorption—ketoconazole, levodopa
Decrease:
effect of atropine—antacids
•
I&O ratio; check for urinary retention, daily output
•
ECG
for ectopic ventricular beats, PVC, tachycardia in cardiac patients
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For bowel sounds, constipation
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Respiratory status: rate, rhythm, cyanosis, wheezing, dyspnea, engorged neck veins
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Increased intraocular pressure:
eye pain, nausea, vomiting, blurred vision, increased tearing
•
Cardiac rate: rhythm, character, B/P continuously
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Allergic reaction: rash, urticaria
•
Therapeutic response: decreased dysrhythmias, increased heart rate, secretions; GI, GU spasms; bronchodilation
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To report blurred vision, chest pain, allergic reactions, constipation, urinary retention, to use sunglasses to protect the eyes
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Not to perform strenuous activity in high temperatures; heat stroke may result
•
To take as prescribed; not to skip or double doses
•
Not to operate machinery if drowsiness occurs
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Not to take OTC products without approval of prescriber
•
Not to freeze or expose to light (AtroPen)
O
2
, artificial ventilation, ECG; administer DOPamine for circulatory depression; administer diazepam or thiopental for seizures; assess need for antidysrhythmics
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
auranofin (Rx)
(au-rane′oh-fin)
Ridaura
Func. class.:
Antiinflammatory, gold compound
Do not confuse:
Ridaura
/Cardura
RA; not for 1st-line therapy
Unlabeled uses:
SLE, psoriatic arthritis, pemphigus
Breastfeeding, children <6 yr, hypersensitivity to gold, necrotizing enterocolitis, pulmonary fibrosis, exfoliative dermatitis, recent radiation therapy, renal/hepatic disease, marked hypertension, uncontrolled CHF
Black Box Warning:
Bone marrow suppression, blood dyscrasias, hematuria, anemia, diarrhea
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-van′a-fil)
Stendra
Func. class.:
Impotence agent
Chem. class.:
Phosphodiesterase type 5 inhibitor
Inhibits phosphodiesterase type 5 (PDE5); enhances erectile function by increasing the amount of cGMP causing smooth muscle relaxation and increasing blood flow to the corpus cavernosum
Treatment of erectile dysfunction
Hypersensitivity, severe renal/hepatic disease, current nitrates/nitrites, patients <18 yr
Precautions:
Pregnancy (C) although not indicated for women, anatomic penile deformities, sickle cell anemia, leukemia, multiple myeloma, renal/hepatic/CV disease, bleeding disorders, active peptic ulcer, prolonged erection, aortic stenosis, HIV, stroke, geriatric patients, tinnitus, MI, visual disturbances, retinitis pigmentosa
Calculator
• Adult: PO
100 mg 30 min before sexual activity, dose may be reduced to 50 mg or increased to 200 mg; usual max dose frequency is 1 time/day
•
Do not use
• Adult: PO
Max 50 mg/day
• Adult: Child–Pugh C: PO
not recommended
Available forms:
Tabs 50, 100, 200 mg
•
May be taken 30 min before sexual activity on an as-needed basis, but no more than once per day
•
May be used without regard to meals
•
Products should not be used with nitrates/nitrates or strong CYP3A4 inhibitors
CNS:
Headache, flushing
EENT:
Nasal congestion, nasopharyngitis
MISC:
Back pain
99% protein binding, metabolized by CYP3A4, excreted as metabolites; urine 62%; 21% feces, half-life 5 hr, peak 45 min
Do not use with nitrates/nitrites because of unsafe drop in B/P, which could result in MI, stroke
Do not use with strong CYP3A4 inhibitors (ketoconazole, ritonavir, atazanavir, clarithromycin, indivinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin)
Increase:
Avanafil level—moderate CYP3A4 inhibitors (erythromycin, amprenavir, aprepitant, diltiazem, fluconazole, fosamprenavir, verapamil)
Decrease:
B/P—alcohol, alpha-blockers, amLODIPine
Increase:
Avanafil effect—grapefruit juice
Erectile dysfunction:
Assess for underlying cause before treatment; use of organic nitrates that should not be used with this product; any loss of vision/hearing while taking this product, hypersensitivity reactions
Therapeutic response:
Ability to engage in sexual intercourse
•
Sexual dysfunction: May be taken 30 min before sexual activity on an as-needed basis, but no more than once per day
•
May be used without regard to meals
That products should not be used with nitrates/nitrates, or strong CYP3A4 inhibitors
•
That product does not protect against sexually transmitted disease including HIV
•
That product has no effect in the absence of sexual stimulation, to seek help if erection lasts >4 hr
•
To tell prescriber about all medication, vitamins, herbs being taken, especially ritonavir, indinavir, ketoconazole, itraconazole, erythromycin, nitrates, α-blockers
•
Not to drink large amounts of alcohol
To notify prescriber immediately and to stop taking product if vision or hearing loss occurs, if erection lasts >4 hr, or if chest pain occurs