Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (106 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(kol′chih-seen)
Colcrys
Func. class.:
Antigout agent
Chem. class.: Colchicum autumnale
alkaloid
Inhibits microtubule formation of lactic acid in leukocytes, which decreases phagocytosis and inflammation in joints
Gout, gouty arthritis (prevention, treatment); to arrest the progression of neurologic disability in those with MS, Mediterranean fever
Unlabeled uses:
Hepatic cirrhosis, pericarditis, amyloidosis, Behçet’s syndrome, biliary cirrhosis, dermatitis herpetiformis, idiopathic thrombocytopenic
purpura, Paget’s disease, pseudogout, pulmonary fibrosis
Pregnancy (D) (injectable), serious GI, severe cardiac/renal/hepatic disorders, hypersensitivity
Precautions:
Pregnancy (C) (PO), breastfeeding, children, geriatric patients, blood dyscrasias, hepatic disease
Calculator
• Adult:
PO
0.6-1.2 mg/day, depending on severity
• Adult:
PO
1.2 mg initially, then 0.6 mg 1 hr later (1.8 mg); for those on strong CYP3A4 inhibitor (during past 14 days), 0.6 mg initially, then 0.3 mg 1 hr later
• Adult:
PO
CCr <30 ml/min, for acute gout, do not repeat course for 2 wk; for familial Mediterranean fever, 0.3 mg daily, increase cautiously
• Adult on no interacting products:
PO
1.2-2.4 mg/day in 1-2 divided doses; strong CYP3A4 inhibitor; P-glycoprotein inhibitors within 14 day: max 0.6 mg/day in 1-2 divided doses; moderate CYP3A4 inhibitors with 14 day: max 1.2 mg/day in 1-2 divided doses
• Adolescent:
PO
1.2-2.4 mg/day in 1-2 divided doses, titrate by 0.3 mg/day
• Child > 6-12 yr:
PO
0.9-1.8 mg/day in 1-2 divided doses
• Child 4-6 yr:
PO
0.3-1.8 mg/day in 1-2 divided doses
• Adult:
PO
0.5-0.6 mg bid-tid
Available forms:
Tabs 0.5, 0.6, 1 mg
•
Without regard to food
•
Cumulative doses ≤4 mg, renal patients ≤2 mg; when reached, administer only for 3 wk
GI:
Nausea, vomiting, anorexia, malaise
, metallic taste, cramps, peptic ulcer, diarrhea
GU:
Hematuria,
oliguria, renal damage
HEMA:
Agranulocytosis, thrombocytopenia, aplastic anemia, pancytopenia
INTEG:
Chills, dermatitis, pruritus, purpura, erythema
MISC:
Myopathy, alopecia, reversible azoospermia, peripheral neuritis
PO:
Peak 1/2-2 hr, half-life 4.4 hr, deacetylates in liver, excreted in feces (metabolites/active product)
Increase:
colchicine level/toxicity—moderate/strong CYP3A4 inhibitors, reduce dose
Increase:
GI effects—NSAIDs, ethanol
Increase:
bone marrow depression—radiation, bone marrow depressants, cycloSPORINE
Decrease:
action of vit B
12
; may cause reversible malabsorption
Increase:
colchicine level—grapefruit juice
Increase:
alk phos, AST
Decrease:
platelets, WBC, granulocytes
False positive:
urine Hgb
Interference:
urinary 17-hydroxycorticosteroids
•
Relief of pain, uric acid levels returning to normal
•
I&O ratio; observe for decrease in urinary output
CBC, platelets, reticulocytes before, during therapy (q3mo); may cause aplastic anemia, agranulocytosis, decreased platelets
•
Toxicity:
weakness, abdominal pain, nausea, vomiting, diarrhea; product should be discontinued, report symptoms immediately
•
Therapeutic response: decreased stone formation, decreased pain in kidney region, absence of hematuria, decreased pain in joints
•
To avoid alcohol, OTC preparations that contain alcohol
•
To report any pain, redness, hard areas, usually in legs; rash, sore throat, fever, bleeding, bruising, weakness, numbness, tingling, nausea, vomiting, abdominal pain
•
About the importance of complying with medical regimen (diet, weight loss, product therapy); about the possibility of bone marrow depression occurring
•
Advise all providers of product use; surgery may increase possibility of acute gout symptoms
D/C medication; may need opioids to treat diarrhea
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(koe-leh-seve′eh-lam)
WelChol
Func. class.:
Antilipemic
Chem. class.:
Bile acid sequestrant
Adsorbs, combines with bile acids to form insoluble complex excreted through feces; loss of bile acids lowers cholesterol levels
Elevated LDL cholesterol, alone or in combination with HMG-COA reductase inhibitor; type 2 diabetes (adjunct)
Hypersensitivity, biliary obstruction, dysphagia, bowel disease, primary biliary cirrhosis, triglycerides >300 mg/dl, fat-soluble vitamin deficiency, bowel obstruction pancreatitis
Precautions:
Pregnancy (B), breastfeeding, children
Calculator
• Adult:
PO
3 625-mg tabs bid with meals or 6 tabs daily with meal; may increase to 7 tabs if needed
• Adult:
PO
3 tabs bid with meals or 6 tabs daily with meal given with an HMG-CoA reductase inhibitor
• Adult and geriatric:
PO
Approx 3.8 g (6 tabs)/day or approx 1.9 g (3 tabs) bid
• Females (postmenarchal and >10 yr) and males ≥10 yr:
PO
1.875-g packet bid or 3.75-g packet daily dissolved in 4-8 oz of water with meal
Available forms:
Tabs 625 mg; powder for oral susp 3.75 g/packet
•
Swallow tabs whole; do not break, crush, or chew
•
Drug daily or bid with meals; give all other medications 1 hr before or 4 hr after colesevelam; with liquid to avoid poor absorption
CNS:
Headache, dizziness, drowsiness, vertigo, tinnitus
GI:
Constipation, abdominal pain, nausea
, fecal impaction, hemorrhoids, flatulence, vomiting, GI obstruction
INTEG:
Rash, irritation of perianal area, tongue, skin
MISC:
Hypertriglycerides, hypoglycemia
MS:
Muscle, joint pain
Excreted in feces, peak response 2 wk
Decrease:
absorption of diltiazem, gemfibrozil, mycophenolate, phenytoin, propranolol, warfarin, thiazides, digoxin, penicillin G, tetracyclines, corticosteroids, iron, thyroid, fat-soluble vitamins, glyburide
Decrease:
action of—oral contraceptives
Increase:
LFTs
•
Cardiac glycoside level, if both products administered
•
Fasting LDL, HDL, total cholesterol, triglyceride levels, electrolytes if on extended therapy
•
Bowel pattern daily; increase bulk, water in diet for constipation
•
Therapeutic response: decreased total cholesterol level, LDL cholesterol, apolipoproteins
•
About the importance of compliance; toxicity may result if doses missed
•
That risk factors should be decreased: high-fat diet, smoking, alcohol consumption, absence of exercise