Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (121 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(den-oh′sue-mab)
Prolia, Xgeva
Func. class.:
Bone resorption inhibitor
Chem. class.:
Monoclonal antibody, bone resorption
Neutralizes activity of receptor activator nuclear factor kappa-B ligand (RANKL) by binding to it and blocking its interaction with cell-surface receptors; use of a RANKL inhibitor may reduce bone turnover and decrease tumor burden
Osteoporosis in postmenopausal women or men at high risk for fractures; increase bone mass in men who are receiving androgen deprivation therapy for prostate cancer and women receiving aromastase inhibitor therapy for breast cancer at high risk for fractures; prevention of skeletal-related events in bone metastases from solid tumors (Xgeva)
Hypersensitivity, hypocalcemia
Precautions:
Pregnancy (C), breastfeeding, child/infant/neonate, anemia, coagulopathy, diabetes mellitus, dialysis, eczema, hypoparathyroidism, immunosuppression, latex hypersensitivity, malabsorption syndrome, neoplastic disease, pancreatitis, parathyroid disease, dental/renal/thyroid disease, TB, vit D deficiency
Calculator
• Adult female: SUBCUT
60 mg q6mo with 1000 mg calcium and 400 international units vitamin D, max 60 mg q6mo
•
Adult: SUBCUT
120 mg q4wk, max 120 mg q4wk; administer with calcium and vitamin D as necessary to prevent hypocalcemia
•
Adult: SUBCUT
(Xgeva): 120 mg q4wk
Available forms:
Sol for inj 60 mg/ml (Prolia); 120 mg/1.7 ml (Xgeva)
•
Give acetaminophen before and for 72 hr after to decrease pain
•
Do not use if particulate matter or discoloration is present; sol is clear and colorless to slightly yellow with small white/opalescent particles; remove from refrigerator and allow to warm to room temp (15-30 min)
•
Use of prefilled syringe with needle safety guard:
leave green guard in original position until after administration, remove and discard needle cap immediately before inj, give by subcut inj in upper arm/thigh or abdomen; after inj, point needle away from people and slide green guard over needle
•
Use of single-use vials:
use 27G needle, give in upper arm/thigh or abdomen, do not reinsert needle in vial, discard supplies as appropriate
•
Store and use out of direct sunlight/heat; do not freeze, use within 14 days after removal from refrigerator, store unopened containers in refrigerator
CNS:
Chills, fever, flushing, headache, vertigo, neuropathic pain
CV:
Angina,
atrial fibrillation
GI:
Abdominal pain, constipation,
diarrhea
, flatulence, GERD,
vomiting, nausea
GU:
Cystitis, lactation suppression
HEMA:
Anemia, neutropenia
INTEG:
Atopic dermatitis, pruritus
META:
Hypercholesterolemia, hypocalcemia, hypophosphatemia
MS:
Back, bone pain; MS pain, myalgia,
osteonecrosis of the jaw,
atypical low trauma femoral fractures
RESP:
Cough,
dyspnea
SYST:
Infection, secondary malignancy
Terminal half-life 25.4 days, bioavailability 62%, max serum concentration 3-21 days, steady state 6 mo
Increase:
infection, possible—immunosupressives, corticosteroids
Increase:
osteonecrosis of the jaw, possible—antineoplastics, corticosteroids
•
Acute acute-phase reaction:
fever, myalgia, headache, flulike symptoms for 72 hr after inj, usually resolves after 72 hr
•
Blood tests:
serum calcium, creatitine, BUN, magnesium, phosphate
•
Hypocalcemia:
paresthesia, twitching, laryngospasm, Chvostek’s and Trouseau’s signs; preexisting hypocalcemia should be corrected before treatment; patient with vit D deficiency may require higher doses of vit D
•
Hypercalcemia:
nausea, vomiting, anorexia, weakness, thirst, constipation, dysrhythmias
•
Dental status:
correct dental complications before product use; good oral hygiene should be maintained; if dental work is to be performed, antiinfectives should be given to prevent osteonecrosis of the jaw
•
Infection:
do not start treatment in patients with active infections; infections should be resolved first
•
Therapeutic response: increased/maintained bone density, decreased calcium levels
•
To report hypercalcemic relapse: nausea, vomiting, bone pain, thirst
•
To continue with dietary recommendations, including additional calcium and vit D
•
To avoid use during pregnancy and breastfeeding; to notify prescriber if pregnancy is planned, suspected
•
To use acetaminophen before and for 72 hr after inj to lessen bone pain
•
About the purpose of this product and its expected results
•
To avoid OTC, Rx medications and herbs and supplements unless approved by prescriber
•
To exercise regularly, stop smoking, and avoid alcohol to maintain bone health
•
To inform all health care providers of product use; to avoid dental procedures/surgery if possible; to practice good oral hygiene
•
That lab tests and follow-up exams will be required
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(dess-ip′ra-meen)
Norpramin
Func. class.:
Antidepressant, tricyclic
Chem. class.:
Dibenzazepine, secondary amine
Blocks reuptake of norepinephrine, serotonin into nerve endings, thereby increasing action of norepinephrine, serotonin in nerve cells
Depression
Unlabeled uses:
Chronic pain, postherpetic neuralgia, ADHD, bulimia, diabetic neuropathy, panic disorder, social phobia
Hypersensitivity to tricyclics, closed-angle glaucoma, acute MI
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, severe depression, increased intraocular pressure, seizure disorder, CV disease, urinary retention, cardiac dysrhythmias, cardiac conduction disturbances, family history of sudden death, prostatic hypertrophy, thyroid disease
Black Box Warning:
Children <18 yr, suicidal patients
Calculator
•
Adult: PO
50-75 mg/day in 1-4 divided doses, titrate by 25-50 mg weekly up to 300 mg/day in single or divided doses
• Geriatric: PO
25 mg/day at bedtime, titrate weekly, may increase to 150 mg/day
•
Adolescent: PO
25-50 mg/day in divided doses, max 150 mg/day
•
Child 6-12 yr: PO
1-3 mg/kg/day in divided doses; give >3 mg/kg/day with close medical monitoring; max 5 mg/kg/day
•
Adult: PO
25 mg tid, may titrate to 200 mg/day by 25-50 mg/day at weekly intervals
•
Child ≥5 yr: PO
up to 3.5 mg/kg/day divided BID
•
Adult: PO
10-25 mg at bedtime, titrate to relief
•
Adult: PO
75-150 mg
Available forms:
Tabs 10, 25, 50, 75, 100, 150 mg
•
Increased fluids, bulk in diet for constipation, especially in geriatric patients; with food or milk for GI symptoms; crushed if patient is unable to swallow medication whole
•
Dosage at bedtime if oversedation occurs during day; may take entire dose at bedtime; geriatric patients may not tolerate once-daily dosing
CNS:
Dizziness, drowsiness
, confusion, headache, anxiety, tremors, stimulation, weakness, insomnia, nightmares, EPS (geriatric patients), increased psychiatric symptoms, paresthenia,
suicidal ideation
CV:
Orthostatic hypotension, ECG changes, tachycardia, hypertension
, palpitations
EENT:
Blurred vision
, tinnitus, mydriasis, ophthalmoplegia
GI:
Diarrhea
,
dry mouth
, nausea, vomiting,
paralytic ileus,
increased appetite, cramps, epigastric distress, jaundice,
hepatitis,
stomatitis, constipation, weight gain
GU:
Retention
,
acute renal failure
HEMA:
Agranulocytosis, thrombocytopenia, eosinophilia, leukopenia
INTEG:
Rash, urticaria, sweating, pruritus, photosensitivity
Well absorbed, widely distributed, protein binding 92%, extensively metabolized in the liver to active metabolite of imipramine, half-life 7-60 hr
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists, other tricyclic antidepressants
Increase:
CNS depression—alcohol, barbiturates, opioids, CNS depressants
Increase:
desipramine level—cimetidine, diltiazem, fluvoxaMINE, FLUoxetine, PARoxetine, sertraline, verapamil
Increase:
life-threatening B/P elevations, do not use concurrently—cloNIDine
Increase:
hypertension—EPINEPHrine, norepinephrine
Increase:
hyperpyrexia, seizures, excitation; do not use within 14 days of MAOIs
Increase:
QT interval—tricyclics, SUNItinib, vorinostat, ziprasidone, gatifloxacin, levofloxacin, moxifloxacin, sparfloxacin, class IA/III antidysrhythmics
Increase:
serotonin syndrome, avoid concurrent use—St. John’s wort
Increase:
CNS depression—kava, valerian
Increase:
serum bilirubin, blood glucose, alk phos
•
B/P (lying, standing), pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; take VS q4hr in patients with cardiovascular disease
•
Hepatic studies: AST, ALT, bilirubin; thyroid function studies
•
Weight weekly; appetite may increase with product
•
ECG
for flattening T wave, bundle branch block, AV block, dysrhythmias in cardiac patients
•
EPS
primarily in geriatric patients: rigidity, dystonia, akathisia
•
Seizure activity
in those with a history of seizures
Black Box Warning:
Mental status: mood, sensorium, affect,
suicidal tendencies
, increase in psychiatric symptoms (depression, panic); this product is not indicated for children
•
Urinary retention, constipation; constipation most likely in children
•
Withdrawal symptoms:
headache, nausea, vomiting, muscle pain, weakness; not usual unless product discontinued abruptly
•
Alcohol consumption; if consumed, hold dose until morning
•
Check to confirm that PO medication is swallowed
•
Therapeutic response: decreased depression
•
That therapeutic effects may take 2-3 wk
Black Box Warning:
That suicidal thoughts/behaviors may occur; to notify prescriber immediately
•
To use caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
•
To avoid alcohol, other CNS depressants
•
Not to discontinue medication abruptly after long-term use because this may cause nausea, headache, malaise
•
To wear sunscreen or large hat because photosensitivity occurs
ECG monitoring; lavage, activated charcoal; administer anticonvulsant