Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (114 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(da-bye-gat′ran)
Pradaxa
Func. class.:
Anticoagulant-thrombin inhibitor
Direct thrombin inhibitor that inhibits both free and clot-bound thrombin, prevents thrombin-induced platelet aggregation and thrombus formation by preventing conversion of fibrinogen to fibrin
Stroke/systemic embolism prophylaxis with nonvalvular atrial fibrillation
Unlabeled uses:
Deep venous thrombus (DVT), pulmonary embolism prophylaxis
Hypersensitivity, bleeding, prosthetic heart valves
Precautions:
Pregnancy (C), labor, obstetric delivery, breastfeeding, children, geriatric patients, abrupt discontinuation, anticoagulant therapy, renal disease, surgery
Calculator
• Adult: PO
150 mg bid
•
When converting from warfarin to dabigatran, discontinue warfarin and initiate dabigatran therapy when the INR is <2.0; when converting from a parenteral anticoagulant to dabigatran, initiate dabigatran 0-2 hr before the time of the next scheduled anticoagulant dose or at the time of discontinuation of a continuously administered anticoagulant (e.g., intravenous unfractionated heparin)
•
Adult:
CCr >50 ml/min, start warfarin 3 days before discontinuing dabigatran; CCr 31-50 ml/min, start warfarin 2 days before discontinuing dabigatran; CCr 15-30 ml/min, start warfarin 1 day before discontinuing dabigatran
•
Adult: PO
discontinue dabigatran, start parenteral anticoagulant 12 hr (CCr ≥30 ml/min) or 24 hr (CCr <30 ml/min) after the last dabigatran dose
•
Adult: PO
CCr 15-30 ml/min, 75 mg bid
•
Adult: PO
220 mg or 150 mg/day × 28-35 days, starting with 1/2 dose 1-4 hr after surgery
Available forms:
Caps 75, 100 mg
•
Do not crush, break, chew, or empty contents of capsule
•
If dose is missed, take as soon as remembered if on the same day; do not administer if <6 hr before next dose
•
Without regard to food
•
Store in original package at room temp until time of use; discard after 30 days, protect from moisture
CNS:
Intracranial bleeding
CV:
Myocardial infarction
GI:
Abdominal pain, dyspepsia, peptic ulcer, esophagitis, GERD, gastritis,
GI bleeding
HEMA:
Bleeding, hemorrhagic erosive gastritis
INTEG:
Rash, pruritus
SYST:
Anaphylaxis (rare)
Protein binding 35%, half-life 12-17 hr (extended in renal disease), peak 1 hr, high-fat meal delays peak
Increase:
bleeding risk—amiodarone, other anticoagulants, clopidogrel, ketoconazole, quiNIDine, thrombolytics, verapamil
Decrease:
dabigatran effect—rifampin
Decrease:
dabigatran effect—P-glycoprotein inducers (carBAMazepine, rifampin, tipranovir
Increase:
thrombin time, aPTT
•
Bleeding:
blood in urine or emesis, dark tarry stools, lower back pain; caution with arterial/venous punctures, catheters, NG tubes; monitor vital signs frequently; elderly patients more prone to serious bleeding, monitor aPTT, ecarin clotting time baseline and during treatment
•
Thrombosis/MI/emboli:
swelling, pain, redness, difficulty breathing, chest pain, tachypnea, cough, coughing up blood, cyanosis
•
Postthrombotic syndrome:
pain, heaviness, itching/tingling, swelling, varicose veins, brownish/reddish skin discoloration, ulcers; use of ambulation, compression stockings, adequate anticoagulation can prevent this syndrome
•
Surgery:
discontinue 24-48 hr before surgery in those with CCr ≥50 ml/min, 72-96 hr in those with CCr <50 ml/min; longer times may be needed in major surgery
•
Therapeutic response: decreased thrombus formation/extension, absence of emboli, post-thrombotic effects
•
About the purpose and expected results of this product, to take at same time of day, not to skip or double doses
•
To take without regard to food, swallow cap whole
•
To avoid all other products unless approved by prescriber
•
To notify all providers that this product is being used
•
To report any bleeding including blood in stool, emesis, urine; nosebleeds
HIGH ALERTdacarbazine (Rx)
(da-kar′ba-zeen)
DTIC
, DTIC-Dome
Func. class.:
Antineoplastic alkylating agent
Chem. class.:
Cytotoxic triazine
Alkylates DNA, RNA; inhibits DNA, RNA synthesis; also responsible for breakage, cross-linking of DNA strands; activity is not cell-cycle–phase specific
Hodgkin’s disease, malignant melanoma
Unlabeled uses:
Malignant pheochromocytoma in combination with cyclophosphamide and vinCRIStine, metastatic soft-tissue sarcoma in combination with other agents, carcinoma meningitis, neuroblastoma
Breastfeeding, hypersensitivity
Precautions:
Renal disease
Black Box Warning:
Pregnancy (C) 1st trimester, radiation therapy, hepatic disease, bone marrow suppression, secondary malignancy
Calculator
•
Adult: IV
2-4.5 mg/kg/day × 10 days or 100-250 mg/m
2
/day × 5 days; repeat q3-4wk depending on response
•
Adult: IV
150 mg/m
2
/day × 5 days with other agents, repeat q4wk; or 375 mg/m
2
on days 1 and 15 when given in combination, repeat q28days
• Adult and child: IV
250 mg/m
2
/day as continuous inf × 4 days q28days
• Adult and child: IV
250-300 mg/m
2
/day as continuous inf × 3 days q21-28days
•
Adult: INTRATHECAL
5-30 mg in a fixed dose 2-3 ×/wk until disease controlled
Available forms:
Powder for inj 10, 100, 200 mg
•
Antiemetic 30-60 min before giving product to prevent vomiting, nausea; vomiting may subside after several doses
•
Antibiotics for prophylaxis of infection
•
Use cytotoxic handling precautions
•
After diluting 100 mg/9.9 or 200 mg/19.7 ml of sterile water for inj (10 mg/ml), give by direct IV over 1 min through
Y
-tube or 3-way stopcock
•
May be further diluted in 50-250 ml D
5
W or NS for inj, given as an inf over 1/2 hr
•
Watch for extravasation; stop infusion, apply ice to area
Y-site compatibilities:
Amifostine, anidulafungin, atenolol, aztreonam, bivalirudin, bleomycin, caspofungin, DAPTOmycin, dexmedetomidine, DOCEtaxel, DOXOrubicin, ertapenem, etoposide, fenoldopam, filgrastim, fludarabine, gemtuzumab, granisetron, levofloxacin, mechlorethamine, melphalan, nesiritide, octreotide, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pamidronate, quinupristin-dalfopristin, sargramostim, teniposide, thiotepa, tigecycline, tirofiban, vinorelbine, voriconazole, zoledronic acid
CNS:
Facial paresthesia, flushing, fever, malaise; confusion, headache,
seizures, cerebral hemorrhage,
blurred vision (high doses)
GI:
Nausea, anorexia, vomiting
,
hepatotoxicity
(rare)
HEMA:
Thrombocytopenia, leukopenia,
anemia
INTEG:
Alopecia
, dermatitis, pain at inj site, photosensitivity; severe sun reactions (high doses)
MISC:
Flulike symptoms, malaise, fever, myalgia, hypotension
SYST:
Anaphylaxis