Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (237 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(lev-al-byoo′ter-ole)
Xopenex, Xopenex HFA
Func. class.:
Bronchodilator, adrenergic β
2
-agonist
Causes bronchodilation by action on β
2
(pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscle; produces bronchodilation, CNS, cardiac stimulation as well as increased diuresis and gastric acid secretion
Treatment or prevention of bronchospasm (reversible obstructive airway disease)
Hypersensitivity to sympathomimetics, this product, albuterol
Precautions:
Pregnancy (C), breastfeeding, hyperthyroidism, diabetes mellitus, hypertension, prostatic hypertrophy, angle-closure glaucoma, seizures, renal disease, QT prolongation, tachydysrhythmias, severe cardiac disease, hypokalemia
Calculator
• Adult/child ≥12 yr:
INH
0.63 mg tid q6-8hr by nebulization, may increase 1.25 mg q8hr
• Adult/adolescent/child >4 yr:
(HFA, metered dose) 90 mcg (2
INH
) q4-6hr
• Child 6-11 yr:
INH
0.31 mg tid by nebulization, max 0.63 mg tid
Available forms:
Sol, inh pediatric 0.31/3 ml; 0.63 mg, 1.25 mg/3 ml; 45 mcg per actuation (HFA)
•
Every 6-8hr; wait ≥1 min between inhalation of aerosols
•
Shake well before use, use a spacer device, prime with 4 test sprays in new canister or when not used for >3 days
CNS:
Tremors, anxiety
, insomnia,
headache
, dizziness, stimulation,
restlessness
, irritability, weakness
CV:
Palpitations, tachycardia, hypertension, angina, hypotension, dysrhythmias,
QT prolongation
EENT:
Dry nose, irritation of nose and throat, rhinitis
GI:
Heartburn, nausea, vomiting, diarrhea
INTEG:
Rash
META:
Hypokalemia, hyperglycemia
MS:
Muscle cramps
RESP:
Cough
SYST:
Anaphylaxis, angioedema
Metabolized in the liver and tissues; crosses placenta, breast milk, blood-brain barrier; half-life 3.3-4 hr
INH sol:
Onset 10-17 min, peak 11/2 hr, duration 5-6 hr;
INH aerosol:
onset 4.5-10.2 min, peak 76-78 min, duration ≤6 hr
Increase:
QT prolongation—Class IA, III antidysrhythmics, usually at high doses or hypokalemia
Increase:
action of aerosol bronchodilators
Increase:
levalbuterol action—tricyclics, MAOIs, other adrenergics
Decrease:
levalbuterol action—other β-blockers, severe bronchospasm may occur
Increase:
stimulation—black/green tea, coffee, cola nut, guarana, yerba maté
•
Respiratory function:
vital capacity, forced expiratory volume, ABGs, lung sounds, heart rate and rhythm (baseline); character of sputum: color, consistency, amount
•
Cardiac status: palpitations, increase/decrease in B/P, dysrhythmias
For evidence of allergic reactions, paradoxic bronchospasm, anaphylaxis, angioedema
•
Therapeutic response: absence of dyspnea, wheezing after 1 hr; improved airway exchange, ABGs
•
Not to use OTC medications because excess stimulation may occur
•
To avoid getting aerosol in eyes because blurring may result
•
To avoid smoking, smoke-filled rooms, persons with respiratory infections
That paradoxic bronchospasm may occur; to stop product immediately, contact prescriber
•
To limit caffeine products such as chocolate, coffee, tea, colas, and herbs such as cola nut, guarana, yerba maté
•
To use this product first if using other inhalers; to wait 5 min or more between products; to rinse mouth with water after each dose to prevent dry mouth
Administer a β
1
-adrenergic blocker
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(lev-eh-teer-ass′eh-tam)
Keppra, Keppra XR
Func. class.:
Anticonvulsant
Do not confuse:
Keppra
/Kaletra
Unknown; may inhibit nerve impulses by limiting influx of sodium ions across cell membrane in motor cortex
Adjunctive therapy for partial-onset seizures, primary generalized tonic-clonic seizures
Unlabeled use:
Pediatrics
Hypersensitivity, breastfeeding
Precautions:
Pregnancy (C), children, geriatric patients, renal/cardiac disease, psychosis
Calculator
• Adult/adolescent ≥16 yr:
IV
500 mg bid, may be titrated by 1000 mg/day q2wk, max 3000 mg/day in divided doses;
EXT REL
1000 mg/day, may increase q2wk, max 3000 mg/day
• Adolescent <16 yr/child/infant:
PO
10 mg/kg bid, increase daily dose q2wk by 20 mg/kg to dose of 30 mg/kg bid; if patient unable to tolerate, may reduce dose
• Adult/adolescent ≥16 yr:
PO/IV
500 mg bid, may increase by 1000 mg/day q2wk, max 3000 mg/day
• Adult:
PO
CCr 50-80 ml/min, 500-1000 mg q12hr or
EXT REL
1000-2000 q24hr, max 2000 mg/day; CCr 30-49 ml/min, 250-750 mg q12hr or
EXT REL
500-1500 mg q24hr, max 1500 mg/day; CCr <30 ml/min, 250-500 mg q12hr or
EXT REL
500-1000 q24hr, max 1000 mg/day
Available forms:
Tabs 250, 500, 750, 1000 mg; oral sol 100 mg/ml; sol for inj 100 mg/ml; ext rel tab 500, 750 mg
•
Swallow tab whole; do not break, crush, or chew
•
With food, milk to decrease GI symptoms (rare)
• Child:
<20 kg should be given oral solution; use calibrated device
•
Single-use vials: dilute in 100 ml of 0.9% NaCl, D
5
, LR; give over 15 min, discard unused vial contents, do not use product with particulates or discoloration
Additive compatibilities:
diazepam, LORazepam, valproate
CNS:
Dizziness, somnolence, asthenia, psychosis,
suicidal ideation,
nonpsychotic behavioral symptoms
HEMA:
Lowered Hct, Hgb, RBC, infection
MISC:
Infection, abdominal pain, pharyngitis
SYST:
Stevens-Johnson syndrome, toxic epidermal necrolysis
Rapidly absorbed; not protein bound; excreted via kidneys 66% unchanged; half-life 6-8 hr, longer in geriatric patients or with renal disease
•
Avoid use with alcohol
•
Possible increased carBAMazepine toxicity: carBAMazepine
Decrease:
levETIRAcetam absorption—sevelamer; separate by 1 hr before, 3 hr after sevelamer
Increase:
eosinophils
•
Seizures:
type, location, duration, character; provide seizure precautions
•
Renal studies: urinalysis, BUN, urine creatinine q3mo
•
Blood studies: RBC, Hct, Hgb
Mental status: mood, sensorium, affect, behavioral changes,
suicidal thoughts/behaviors;
if mental status changes, notify prescriber
•
Storage at room temp (PO)
•
Diluted preparation stable for 24 hr at room temp in polyvinyl bags
•
Assistance with ambulation during early part of treatment; dizziness occurs
•
Therapeutic response: decreased seizure activity; document on patient’s chart
•
To carry emergency ID stating patient’s name, products taken, condition, prescriber’s name, phone number
•
How to use oral sol; if trouble swallowing, measure oral sol in medicine cup or dropper, do not use teaspoon
•
To notify prescriber if pregnant, intending to become pregnant
•
To avoid driving, other activities that require alertness
•
Not to discontinue medication quickly after long-term use because withdrawal seizure may occur
•
Not to breastfeed, excreted in breast milk