Mosby's 2014 Nursing Drug Reference (63 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(be-than′e-kole)
Urecholine
Func. class.:
Urinary tract stimulant, cholinergic
Chem. class.:
Synthetic choline ester
Stimulates muscarinic ACH receptors directly; mimics effects of parasympathetic nervous system stimulation; stimulates gastric motility, micturition; increases lower esophageal sphincter pressure
Urinary retention (postoperative, postpartum), neurogenic atony of bladder with retention
Unlabeled uses:
Ileus, GERD, anticholinergic syndrome
Hypersensitivity, severe bradycardia, asthma, severe hypotension, hyperthyroidism, peptic ulcer, parkinsonism, seizure disorders, CAD, COPD, coronary occlusion, mechanical obstruction, peritonitis, recent urinary/GI surgery, GI/GU obstruction
Precautions:
Pregnancy (C), breastfeeding, children <8 yr, hypertension
Calculator
• Adult: PO
10-50 mg bid-qid
• Child (unlabeled): PO
0.6 mg/kg/day in 3-4 divided doses
• Adult: PO
10-20 mg tid-qid before meals
Available forms:
Tabs 5, 10, 25, 50 mg
•
To avoid nausea, vomiting, take on an empty stomach
•
Only after all other cholinergics have been discontinued
CNS:
Dizziness, headache, malaise
CV:
Hypotension, bradycardia, reflex tachycardia,
cardiac arrest, circulatory collapse
EENT:
Miosis, increased salivation, lacrimation, blurred vision
GI:
Nausea, bloody diarrhea, belching, vomiting, cramps, fecal incontinence
GU:
Urgency
INTEG:
Rash, urticaria, flushing, increased sweating
RESP:
Acute asthma, dyspnea, bronchoconstriction
PO:
Onset 30-90 min, duration 6 hr
Increase:
severe hypotension—ganglionic blockers
Increase:
action or toxicity—cholinergic agonists, anticholinesterase agents
Decrease:
action of anticholinergics, procainamide, quiNIDine
Increase:
AST, lipase/amylase, bilirubin
•
Urinary patterns:
retention, urgency
•
B/P, pulse: observe after parenteral dose for 1 hr; may need to use atropine subcut 0.6 mg or IV push slowly for bronchoconstriction
•
I&O ratio: check for urinary retention, urge incontinence
•
Toxicity:
bradycardia, hypotension, bronchospasm, headache, dizziness, seizures, respiratory depression; product should be discontinued if toxicity occurs
•
Storage at room temp
•
Therapeutic response: absence of urinary retention, abdominal distention
•
To take product exactly as prescribed; 1 hr before meals or 2 hr after meals
•
To make position changes slowly; orthostatic hypotension may occur
•
To avoid driving, hazardous activities until effects are known
Administer atropine 0.6-1.2 mg IV or IM (adult)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTbevacizumab (Rx)
(beh-va-kiz′you-mab)
Avastin
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Monoclonal antibody
Do not confuse:
Avastin
/Astelin
DNA-derived monoclonal antibody selectively binds to and inhibits activity of human vascular endothelial growth factor (VEGF) to reduce microvascular growth and metastatic disease progression
Non–small-cell lung cancer (NSCLC), metastatic carcinoma of the colon or rectum in combination with 5-FU IV; renal cell carcinoma, glioblastoma
Unlabeled uses:
Adjunctive for pancreatic/neovascular/ovarian cancer; (wet) macular degeneration
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, CHF, blood dyscrasias, CV disease, hypertension, surgery, thromboembolic disease, hamster protein/murine hypersensitivity
Black Box Warning:
GI perforation, wound dehiscence
Calculator
• Adult: IV
15 mg/kg over 60-90 min with CARBOplatin and paclitaxel q3wk
• Adult: IV INF
5-10 mg/kg q14days given over 90 min; if well tolerated, next inf may be given over 60 min; if 60-min infs well tolerated, subsequent inf may be given over 30 min
• Adult: IV
10 mg/kg q2wk with interferon alfa 9 million units SUBCUT 3×/wk up to 52 wk
• Adult: IV
10 mg/kg q2wk given over 60-90 min; 28-day cycle
• Adult: IV
10 mg/kg on days 1, 15 with gemcitabine 1000 mg/m
2
on days 1, 8, 15 in 28-day cycle
• Adult: IV
15 mg/kg on day 1 with docetaxel 100 mg/m
2
q3wk, up to 9 cycles (those who have not received previous chemotherapy)
• Adult (single agent): IV
10 mg/kg over 60-90 min q2wk; may be given in combination with other products
• Adult: IV
15 mg/kg q21days until unacceptable toxicity, disease progression
• Adult: INTRAVITREOUS INJ
1.25 mg monthly
Available forms:
Inj 25 mg/ml
•
Do not give by IV bolus, IV push; do not shake vial
•
Withdraw amount of product to be given, dilute in 100 ml 0.9% NaCl, discard any unused portion
Black Box Warning:
Wound dehiscence:
do not give for ≥28 days after surgery; make sure wound is healed before giving product
•
Give as IV inf over 90 min for 1st dose and 60 min thereafter if well tolerated; subsequent inf may be given over 30 min; do not admix with dextrose
•
Rapid infusion rate (unlabeled):
give at rate of 0.5 mg/kg/min for all doses including initial inf (5 mg/kg over 10 min; 10 mg/kg over 20 min; 15 mg/kg over 30 min)
CNS:
Asthenia, dizziness
,
intracranial hemorrhage
(malignant glioma), headache, fatigue, confusion
CV:
Deep vein thrombosis,
hypo/hypertension,
hypertensive crisis,
heart failure
GI:
Nausea, vomiting,
anorexia, diarrhea
, constipation,
abdominal pain
, colitis, stomatitis,
GI hemorrhage/perforation
GU:
Proteinuria, urinary frequency/urgency,
nephrotic syndrome,
ovarian failure
HEMA:
Leukopenia, neutropenia, thrombocytopenia, microangiopathic hemolytic anemia, thromboembolism, bleeding
META:
Bilirubinemia, hypokalemia
MISC:
Exfoliative dermatitis, hemorrhage,
non-GI fistula formation,
alopecia, impaired wound healing
,
osteonecrosis of the jaw
RESP:
Dyspnea, upper respiratory tract infection
Half-life 20 days, steady-state 100 days
•
Avoid concurrent use with
SUNItinib;
microangiopathic hemolytic anemia may occur
•
B/P; take frequently if hypertension develops
•
For symptoms of infection; may be masked by product
•
CNS reaction:
dizziness, confusion
•
CHF:
crackles, jugular venous distention, dyspnea during treatment
GU status
(proteinuria): nephrotic syndrome may occur; monitor urinalysis for increasing protein level; product should be held if protein ≥2 g/24 hr; resume when <2 g/24 hr
Black Box Warning:
Wound dehiscence: Hold for ≥28 days until incision is healed
Black Box Warning:
GI perforation, serious bleeding, nephrotic syndrome, hypertensive crisis;
product should be discontinued permanently, surgery should be postponed
•
Reversible posterior leukoencephalopathy syndrome (RPLS): Discontinue if this disorder develops
•
Therapeutic response: decrease in size of tumors
•
To avoid hazardous tasks because confusion, dizziness may occur
•
To report signs of infection: sore throat, fever, diarrhea, vomiting
•
Not to become pregnant while taking this product or for several months after discontinuing treatment
•
To report bleeding, changes in urinary patterns, edema, abdominal pain
•
To avoid immunizations