Mosby's 2014 Nursing Drug Reference (93 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sih-los′tah-zol)
Pletal
Func. class.:
Platelet aggregation inhibitor
Chem. class.:
Quinolinone derivative
Do not confuse:
Pletal
/Plendil
Reversibly inhibits cellular phosphodiesterase; inhibits platelet aggregation induced by thrombin, ADP, collagen, arachidonic acid, EPINEPHrine, stress
Intermittent claudication
Unlabeled uses:
Buerger’s disease, percutaneous coronary intervention (PCI)
Hypersensitivity, acute MI, active bleeding conditions, hemostatic conditions
Black Box Warning:
CHF
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, previous hepatic disease, cardiac/renal disease, increased bleeding risk, low platelet count, platelet dysfunction
Calculator
• Adult:
PO
100 mg bid taken ≥30 min before or 2 hr after breakfast and dinner or 50 mg bid if using products that inhibit CYP3A4 and CYP2C19; 12 wk of treatment may be needed for beneficial effect
• Adult:
PO
100 mg bid
Available forms:
Tabs 50, 100 mg
•
Give bid 30 min before or 2 hr after meals; do not give with grapefruit juice
CNS:
Dizziness
, headache
CV:
Palpitations, tachycardia
, nodal dysrhythmia, postural hypotension
EENT:
Blindness, diplopia, ear pain, tinnitus, retinal hemorrhage
GI:
Nausea
, vomiting,
diarrhea
, GI discomfort, colitis, cholelithiasis, ulcer, esophagitis, gastritis, anorexia,
flatulence, dyspepsia
GU:
Cystitis, frequency, vaginitis,
vaginal hemorrhage,
hematuria
HEMA:
Bleeding (epistaxis, hematuria, retinal hemorrhage, GI bleeding), thrombocytopenia,
anemia,
polycythemia, aplastic anemia
INTEG:
Rash
, urticaria, dry skin,
Stevens-Johnson syndrome
MISC:
Back pain, headache, infection, myalgia, peripheral edema
, chills, fever, malaise, diabetes mellitus
RESP:
Cough, pharyngitis, rhinitis
, asthma, pneumonia
95%-98% protein binding; metabolism: hepatic extensively by CYP3A4, 2C19 enzymes; excreted in urine (74%), feces (20%); half-life 11-13 hr
Increase:
bleeding tendencies—anticoagulants, NSAIDs, thrombolytics, abciximab, eptifibatide, tirofiban, ticlopidine
Increase:
cilostazol levels—CYP3A4, CYP2C19 inhibitors; diltiazem, erythromycin, clarithromycin, verapamil, protease inhibitors, omeprazole; exercise caution when coadministering with fluvoxaMINE, FLUoxetine, ketoconazole, isoniazid, gemfibrozil, omeprazole, itraconazole, voriconazole, fluconazole; reduce dose to 50 mg bid
Decrease:
cilostazol levels—CYP3A4 inducers
Decrease:
action—chamomile, coenzyme Q10, flax, goldenseal, St. John’s wort
•
Do not use with grapefruit juice, toxicity may occur
Black Box Warning
For underlying CV disease because CV risk is great; for CV lesions with repeated oral administration; do not administer to patients with CHF of any severity; for severe headache, signs of toxicity
•
Blood studies: CBC q2wk, Hct, Hgb, PT
•
Therapeutic response: improved walking distance, duration; decreased pain
•
To avoid hazardous activities until effect is known
•
To report any unusual bleeding
•
To report side effects such as diarrhea, skin rashes, subcutaneous bleeding
•
That effects may take 2-4 wk; treatment of up to 12 wk may be required for necessary effect
•
That reading the patient package insert is necessary
•
That it is best to discontinue tobacco use, not to use grapefruit juice
•
That there are many drug and herb interactions; obtain approval from prescriber before use
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
, Rx)
(sye-met′i-deen)
Acid Reducer, Equaline Acid Reducer, Good Sense Heartburn Relief, Nu-Cimet
, Tagamet, Tagamet HB
Func. class.:
H
2
-histamine receptor antagonist
Chem. class.:
Imidazole derivative
Inhibits histamine at H
2
-receptor site in the gastric parietal cells, which inhibits gastric acid secretion
Short-term treatment of duodenal and gastric ulcers and maintenance; management of GERD (PO) and Zollinger-Ellison syndrome; prevention of upper GI bleeding; prevent, relieve heartburn, acid indigestion, upper GI bleeding
Unlabeled uses:
Prevention of aspiration pneumonitis, stress ulcers, angioedema, molluscum contagiosum, NSAID-induced ulcer prophylaxis, verruca vulgaris
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children <16 yr, geriatric patients, organic brain syndrome, renal/hepatic disease
Calculator
• Adult/adolescents ≥16 yr:
PO
300 mg qid with meals, at bedtime × 8 wk or 400 mg bid, 800 mg at bedtime; after 8
wk, give bedtime dose only;
IV BOL
300 mg/20 ml 0.9% NaCl over 1-2 min q6hr;
IV INF
300 mg/50 ml D
5
W over 15-20 min;
IM
300 mg q6hr, max 2400 mg/day
• Child:
PO
20-40 mg/kg/day;
IM/IV
5-10 mg/kg q6-8hr
• Adult and child >16 yr:
400 mg at bedtime or 300 mg bid
• Adult:
PO
800-1600 mg/day in divided doses × up to 12 wk
• Adult:
PO/IM/IV
300-600 mg q6hr; may increase to 12 g/day if needed; OTC use ≤200 mg daily or bid, max 2×/wk
• Adult:
IV
50 mg/hr; lowered in renal disease
• Adult/child ≥12 yrs:
PO
200 mg Tagamet Hb up to BID, may use before eating, max 400 mg/day, max daily use up to 2 wk
• Adult:
PO/IV
CCr <30 ml/min, 300 mg q12hr
• Child:
PO
30-40 mg/kg/day × 2 mo
Available forms:
Tabs 100, 200, 300, 400, 800 mg; liq 200, 300 mg/5 ml; inj 300 mg/2 ml, 300 mg/50 ml 0.9% NaCl
•
With meals for prolonged product effect; antacids 1 hr before or 1 hr after cimetidine
•
May give undiluted
•
Give at end of dialysis
•
Inject deeply in large muscle mass, aspirate
•
After
diluting
300 mg/20 ml of 0.9% NaCl for inj; give by
direct IV over
≥5 min;
Intermittent IV INF
may be
diluted
300 mg/50 ml of D
5
W;
run
≥30 min; or total daily dose (900 mg) diluted in 100-1000 ml D
5
W given over 24 hr
Continuous IV INF
•
Storage of diluted sol at room temp up to 48 hr
Y-site compatibilities:
Acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex/liposome, anakinra, anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chlorproMAZINE, cisatracurium, CISplatin, cladribine, clarithromycin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin, DOXOrubicin liposome, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, gallium, gatifloxacin, gemcitabine, gentamicin, gycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, meropenem, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactum, multiple vitamin injection, mycopheno
late, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, PEMEtrexed, penicillin G sodium/potassium, pentamidine, pentazocine, phenylephrine, phytonadione, pipercillin, piperacillin/tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, Ringers’ ritodrine, riTUXimab, rocuronium, sargramostim, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, topotecan, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Confusion, headache
, depression, dizziness, anxiety, weakness, psychosis, tremors,
seizures
CV:
Bradycardia, tachycardia,
dysrhythmias
GI:
Diarrhea
, abdominal cramps,
paralytic ileus, jaundice
GU:
Gynecomastia, galactorrhea, impotence, increase in BUN, creatinine
HEMA:
Agranulocytosis, thrombocytopenia, neutropenia, aplastic anemia, increase in PT
INTEG:
Urticaria, rash, alopecia, sweating, flushing,
exfoliative dermatitis
RESP:
Pneumonia
Half-life 1½-2 hr; 30%-40% metabolized by liver, excreted in urine (unchanged), crosses placenta, enters breast milk
PO:
Onset 30 min, peak 45-90 min; duration 4-5 hr, well absorbed
IM/IV:
Onset 10 min, peak 1/2 hr, duration 4-5 hr, well absorbed (IM)
Increase:
toxicity due to CYP450 pathway—benzodiazepines, β-blockers, calcium channel blockers, carBAMazepine, chloroquine, lidocaine, metroNIDAZOLE, moricizine, phenytoin, quiNIDine, quiNINE, sulfonylureas, theophylline, tricyclics, valproic acid, warfarin
Increase:
bone marrow suppression-carmustine
Decrease:
absorption of cimetidine—antacids, sucralfate
Decrease:
absorption—ketoconazole, itraconazole
Increase:
alk phos, AST, creatinine, prolactin
False positive:
gastroccult, hemoccult tests
False negative:
TB skin tests
•
Ulcer symptoms:
epigastric pain, duration, intensity; aggravating, ameliorating factors
•
Therapeutic response: decreased pain in abdomen; healing of ulcers; absence of gastroesophageal reflux, gastric pH of 5
•
That gynecomastia, impotence may occur, are reversible
•
To avoid driving, other hazardous activities until stabilized on this medication; drowsiness or dizziness may occur
•
To avoid OTC preparations: aspirin; cough, cold preparations; condition may worsen
•
That smoking decreases effectiveness of product
•
That product must be taken exactly as prescribed and continued for prescribed time to be effective; not to double dose
•
To report bruising, fatigue, malaise; blood dyscrasias may occur
•
To report diarrhea, black tarry stools, sore throat, rash to prescriber