Mosby's 2014 Nursing Drug Reference (66 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(bis-oh′pro-lole)
Zebeta
Func. class.:
Antihypertensive
Chem. class.:
β
1
-Blocker
Do not confuse:
Zebeta
/DiaBeta/Zetia
Preferentially and competitively blocks stimulation of β
1
-adrenergic receptors within cardiac muscle (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, which decreases O
2
consumption in myocardium; decreases renin-angiotensin-aldosterone system; inhibits β
2
-receptors in bronchial and vascular smooth muscle at high doses
Mild to moderate hypertension
Unlabeled uses:
Stable angina, stable CHF
Hypersensitivity to β-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, CHF, cardiac failure
Precautions:
Pregnancy (C), breastfeeding, children, major surgery, diabetes mellitus, thyroid/renal/hepatic disease, COPD, asthma, well-compensated heart failure, aortic or mitral valve disease, peripheral vascular disease, myasthenia gravis
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult: PO
2.5-5 mg/day; may increase to 20 mg/day if necessary; max 20 mg/day
• Adult: PO
CCr <40 ml/min 2.5 mg, titrate upward
• Adult: PO
5-20 mg/day
• Adult: PO
1.25 mg/day × 48 hr, then 2.5 mg/day for 1st mo, then 5 mg/day; max 10 mg/day
Available forms:
Tabs 5, 10 mg
•
Product before meals, bedtime; tab may be crushed, swallowed whole; may give without regard to meals
•
Reduced dosage with renal/hepatic dysfunction
CNS:
Vertigo, headache, insomnia, fatigue, dizziness, mental changes, memory loss, hallucinations, depression, lethargy,
drowsiness, strange dreams, catatonia, peripheral neuropathy
CV:
Ventricular dysrhythmias, profound hypotension, bradycardia, CHF,
cold extremities, postural hypotension,
2nd- or 3rd-degree heart block
EENT:
Sore throat; dry, burning eyes
ENDO:
Increased hypoglycemic response to insulin
GI:
Nausea, diarrhea, vomiting,
mesenteric arterial thrombosis,
ischemic colitis, flatulence, gastritis, gastric pain
GU:
Impotence, decreased libido
HEMA:
Agranulocytosis, thrombocytopenia,
purpura, eosinophilia
INTEG:
Rash, flushing, alopecia, pruritus, sweating
MISC:
Facial swelling, weight gain, decreased exercise tolerance
MS:
Joint pain, arthralgia
RESP:
Bronchospasm,
dyspnea, wheezing, cough, nasal stuffiness
Peak 2-4 hr, half-life 9-12 hr, 50% excreted unchanged in urine, protein binding 30%-36%, metabolized in liver to inactive metabolites
Increase:
hypotension—reserpine, guanethidine
Increase:
myocardial depression—calcium channel blockers
Increase:
antihypertensive effect—ACE inhibitors, α-blockers, calcium channel blockers, diuretics
Increase:
bradycardia—digoxin, amiodarone
Increase:
peripheral ischemia—ergots
Increase:
antidiabetic effect—antidiabetics
Decrease:
antihypertensive effect—NSAIDs, salicylates
Increase:
β-blocking effect—hawthorn
Decrease:
β-blocking effect—ephedra
Increase:
AST, ALT, ANA titer, blood glucose, BUN, uric acid, potassium, lipoprotein
Interference:
glucose/insulin tolerance tests
•
Hypertension:
B/P during beginning treatment, periodically thereafter; pulse q4hr: note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes (pulse <50 bpm)
•
Baselines of renal, hepatic studies before therapy begins
•
CHF:
I&O, weight daily; increased weight, jugular venous distention, dyspnea, crackles, edema in feet, legs daily
•
Skin turgor, dryness of mucous membranes for hydration status, especially for geriatric patients
•
Storage protected from light, moisture; place in cool environment
•
Therapeutic response: decreased B/P after 1-2 wk
Black Box Warning:
Not to discontinue product abruptly; may cause precipitate angina, rebound hypertension; evaluate noncompliance
•
Not to use OTC products that contain α-adrenergic stimulants (e.g., nasal decongestants, OTC cold preparations) unless directed by prescriber
•
To report bradycardia, dizziness, confusion, depression, fever, cold extremities
•
To take pulse at home; advise when to notify prescriber
•
To avoid alcohol, smoking, sodium intake
•
To comply with weight control, dietary adjustments, modified exercise program
•
To carry emergency ID to identify product, allergies
•
To avoid hazardous activities if dizziness is present
To report symptoms of CHF: difficulty breathing, especially on exertion or when lying down, night cough, swelling of extremities
•
That, if diabetic, product may mask signs of hypoglycemia or alter blood glucose levels
Lavage, IV atropine for bradycardia; IV theophylline for bronchospasm; digoxin, O
2
, diuretic for cardiac failure; hemodialysis, IV glucose for hypoglycemia; IV diazepam or phenytoin for seizures
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTbivalirudin (Rx)
(bye-val-i-rue′din)
Angiomax
Func. class.:
Anticoagulant
Chem. class.:
Thrombin inhibitor
Direct inhibitor of thrombin that is highly specific; able to inhibit free and clot-bound thrombin
Unstable angina in patients undergoing percutaneous transluminal coronary angioplasty (PTCA), used with aspirin; heparin-induced thrombocytopenia, with/without thrombosis syndrome
Unlabeled uses:
Acute MI, DVT prophylaxis
Hypersensitivity, active bleeding, cerebral aneurysm, intracranial hemorrhage, recent surgery, CVA
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, renal function impairment, hepatic disease, asthma, blood dyscrasias, thrombocytopenia, GI ulcers, hypertension
Calculator
• Adult: IV BOL
0.75 mg/kg then
IV INF
1.75 mg/kg/hr for 4 hr; another
IV INF
may be used at 0.2 mg/kg/hr for ≤20 hr; this product is intended to be used with aspirin (325 mg/day) adjusted to body weight
• Adult: IV
CCr ≥30 ml/min no adjustment; CrL 10-29 ml/min consider reducing to 1 mL/kg/hr
• Adult: IV BOL
0.25 mg/kg then
CONT IV INF
0.5 mg/kg/hr × 12 hr
• Adult: SUBCUT
1 mg/kg q8hr for those undergoing orthopedic surgery
Available forms:
Inj, lyophilized 250 mg/vial
•
Before PTCA; give with aspirin (325 mg)
•
Dilute by adding 5 ml of sterile water for inj/250 mg bivalirudin, swirl until dissolved, further dilute in 50 ml of D
5
W or 0.9% NaCl (5 mg/ml), give by bolus inj 0.75 mg/kg, then intermittent inf
•
To each 250-mg vial add 5 ml of sterile water for inj, swirl until dissolved, further dilute in 500 ml D
5
W or 0.9% NaCl (0.5 mg/ml); give inf after bolus dose at a rate of 1.75 mg/kg/hr; may give an additional inf at 0.2 mg/kg/hr
•
Do not mix other IV medications with bivalirudin or provide via the same IV line as bivalirudin
Y-site compatibilities:
Abciximab, acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, argatroban, arsenic trioxide, atenolol, atracurium, atropine, azithromycin, aztreonam, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, capreomycin, CARBOplatin, carmustine, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine,
DACTINomycin, DAPTOmycin, DAUNOrubicin, DAUNOrubicin liposome, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, dolasetron, DOPamine, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoprostenol, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mitoXANtrone, mivacurium, morphine, moxifloxacin, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, polymyxin B, potassium acetate/chloride/phosphates, procainamide, promethazine, propranolol, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, topotecan, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, warfarin, zidovudine, zoledronic acid
•
May be used for DVT prophylaxis
CNS:
Headache, insomnia, anxiety, nervousness
CV:
Hypo/hypertension, bradycardia
GI:
Nausea, vomiting, abdominal pain, dyspepsia
HEMA:
Hemorrhage, thrombocytopenia
MISC:
Pain at inj site, pelvic pain, urinary retention, fever,
anaphylaxis
MS:
Back pain
Excreted in urine, half-life 25 min, duration 1 hr, no protein binding
Increase:
bleeding risk—anticoagulants, aspirin, treprostinil, thrombolytics
Increase:
bleeding risk—agrimony, alfalfa, angelica, anise, bilberry, black haw, bogbean, buchu, cat’s claw, chamomile, chondroitin, devil’s claw, dong quai, evening primrose, fenugreek, feverfew, fish oil, garlic, ginger, ginkgo, ginseng, horse chestnut, Irish moss, kava, kelp, kelpware, khella, licorice, lovage, lungwort, meadowsweet, motherwort, mugwort, nettle, papaya, parsley (large amts), pau d’arco, pineapple, poplar, prickly ash, red clover, safflower, saw palmetto, senega, skullcap, tonka bean, turmeric, wintergreen, yarrow
Decrease:
anticoagulant effect—coenzyme Q10, flax, glucomannan, goldenseal, guar gum
•
Baseline and periodic ACT, APTT, PT, INR, TT, platelets, Hgb, Hct
Bleeding:
check arterial and venous sites, IM inj sites, catheters; all punctures should be minimized; fall in B/P or Hct
may indicate hemorrhage, hematoma, hemorrhage at puncture site are more common in the elderly
•
Fever, skin rash, urticaria
•
CV status: B/P, watch for hypo/hypertension, bradycardia
•
Neurologic status: any focal or generalized deficits should be reported immediately
•
PCI use: possible thrombosis, stenosis, unplanned stent, prolonged ischemia, decreased reflow
•
Storage of reconstituted vials in refrigerator for up to 24 hr; store diluted conc at room temp for 24 hr
•
Therapeutic response: anticoagulation with PTCA; resolution of heparin-induced thrombocytopenia, thrombosis syndrome
•
About the reason for the product and expected results
•
To report black, tarry stools; blood in urine; difficulty breathing
•
Not to use any OTC, herbal product unless approved by prescriber
•
Not to use hard-bristle toothbrush, regular razor to avoid any injury, hemorrhage may result
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTbleomycin (Rx)
(blee-oh-mye′sin)
Blenoxane
Func. class.:
Antineoplastic, antibiotic
Chem. class.:
Glycopeptide
Inhibits synthesis of DNA, RNA, protein; derived from
Streptomyces verticillus;
phase specific to the G
2
and M phases; a nonvesicant, sclerosing agent
Cancer of head, neck, penis, cervix, vulva of squamous cell origin; Hodgkin’s/non-Hodgkin’s disease; testicular carcinoma; as a sclerosing agent for malignant pleural effusion
Unlabeled uses:
Cutaneous T-cell lymphoma (CTCL), hemangioma, Kaposi’s sarcoma, malignant ascites, verruca plantaris/vulgaris, osteogenic sarcoma
Pregnancy (D), breastfeeding, hypersensitivity, prior idiosyncratic reaction
Precautions:
Patients >70 yr old, renal/hepatic disease, respiratory disease
Black Box Warning:
Idiosyncratic reaction, pulmonary fibrosis
Calculator
• Adult and child (unlabeled): IM/IV/SUBCUT
≤2 units for first 2 doses followed by 24 hr of observation
• Adult and child: SUBCUT/IV/IM
0.25-0.5 units/kg 1-2 ×/wk or 10-20 units/m
2
, then 1 unit/day or 5 units/wk; may also be given by
CONT INF;
do not exceed total dose of 400 units during lifetime
• Adult/child:
CCr 40-50 ml/min reduce dose by 30%; CCr 30-39 ml/min reduce dose by 40%; CCr 20-29 ml/min reduce dose by 45%; CCr 10-19 ml/min reduce dose by 55%; CCr 5-10 ml/min reduce dose by 60%
• Adult: IV
15 units twice weekly with vinBLAStine and predniSONE
• Adult: IV
15 units q2wk with DOXOrubicin and vinCRIStine
Available forms:
Powder for inj, 15, 30 units/vial
•
Antiemetic 30-60 min before giving product to prevent vomiting; continue antiemetics 6-10 hr after treatment
•
Topical or systemic analgesics for pain of stomatitis as ordered; antihistamines and antipyretics for fever, chills
•
May be given IM, subcut, IV, intrapleurally, intralesionally, intraarterially
•
After reconstituting 15 units/1-5 ml or 30 mg/2-10 ml of 0.9% NaCl or bacteriostatic water for inj, rotate inj sites; do not use products that contain benzyl alcohol when giving to neonates or that contain dextrose because of loss of potency
•
60 units/100 ml of 0.9% NaCl administered by MD through thoracostomy tube
•
Use cytotoxic handling procedures
•
After reconstituting 15- or 30-unit vial with 5 or 10 ml of NS, respectively, inj slowly over 10 min or after further dilution with 50-100 ml 0.9% NaCl; give 15 units or less over 10 min through
Y
-tube or 3-way stopcock
•
For patients with lymphoma, give 2 test doses of 2-5 units before initial dose; monitor for anaphylaxis
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, codeine, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone sodium succinate, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methohexital, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANtrone, mivacurium, morphine, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, quiNIDine, ranitidine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tirofiban, tobramycin, tolazoline, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine
CNS:
Pain at tumor site, headache, confusion
CV:
MI, stroke
GI:
Nausea, vomiting, anorexia, stomatitis, weight loss
, ulceration of mouth, lips
GU:
Hemolytic-uremic syndrome
IDIOSYNCRATIC REACTION:
Hypotension,
confusion, fever
, chills, wheezing
INTEG:
Rash, hyperkeratosis, nail changes, alopecia
, pruritus, acne, striae, peeling, hyperpigmentation, phlebitis
RESP:
Fibrosis, pneumonitis,
wheezing,
pulmonary toxicity
SYST:
Anaphylaxis,
radiation recall, Raynaud’s phenomenon
Half-life 2 hr; when CCr is >35 ml/min, half-life is increased with lower clearance; metabolized in liver; 50% excreted in urine (unchanged)
•
Avoid live virus vaccines concurrently
Increase:
toxicity—other antineoplastics, radiation therapy, general anesthesia, filgrastim, sargramostim
Decrease:
serum phenytoin levels—phenytoin, fosphenytoin
Increase:
uric acid
•
IM test dose in patients with lymphoma of 1-2 units before 1st 2 doses
Black Box Warning:
Pulmonary toxicity/fibrosis:
pulmonary function tests; chest x-ray before, during therapy, should be obtained q2wk during treatment; pulmonary diffusion capacity for carbon monoxide (DLCO) monthly, if <40% of pretreatment value, stop treatment; treat pulmonary infection before treatment; dyspnea, crackles, unproductive cough, chest pain, tachypnea, fatigue, increased pulse, pallor, lethargy, more common in the elderly, radiation therapy, pulmonary disease
•
Temp; fever may indicate beginning infection
•
Renal status: serum creatinine/BUN; CBC
•
Effects of alopecia, skin color alterations on body image; discuss feelings about body changes
•
Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
•
Local irritation, pain, burning, discoloration at inj site
Anaphylaxis:
rash, pruritus, urticaria, purpuric skin lesions, itching, flushing, wheezing, hypotension; have emergency equipment available
Black Box Warning:
Idiosyncratic reaction:
hypotension, mental confusion, fever, chills, wheezing
•
Storage for 2 wk after reconstituting if refrigerated or for 24 hr at room temp; discard unused portions
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth with baking soda bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
•
Therapeutic response: decrease in size of tumor
•
To report any changes in breathing, coughing, fever
•
That hair may be lost during treatment and that wig or hairpiece may make patient feel better; that new hair may be different in color, texture
•
To avoid foods with citric acid, hot or rough texture
•
To report any bleeding, white spots, ulcerations in mouth; to examine mouth daily and report symptoms
•
To use contraception during treatment (pregnancy D), avoid breastfeeding
•
Not to receive vaccines during treatment