Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (123 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(dess-ox′ee-met′ah-sone)
Topicort
Func. class.:
Corticosteroid, topical
Crosses cell membrane to attach to receptors to decrease inflammation, itching; inhibits multiple inflammatory cytokines
Inflammation/itching of corticosteroid-responsive dermatoses on the skin
Hypersensitivity, use of some preparations on face, axilla, groin, intertriginous areas; monotherapy in primary bacterial infection
Precautions:
Pregnancy (C), breastfeeding, children, skin infections
Calculator
Adult/child >10 yr:
•
Apply to affected areas 2 times/day
Available forms:
Cream 0.05%, 0.25%; ointment 0.05%, 0.25%; gel 0.05%
Do not use with occlusive dressings
•
Cream/ointment/lotion:
apply sparingly in a thin film and rub gently into the cleansed, affected area
•
Gel:
apply sparingly in a thin film and rub gently into the cleansed, affected area
INTEG:
Burning, folliculitis, pruritus, dermatitis, maceration
MISC:
Hyperglycemia, glycosuria, systemic absorption, HPA axis suppression,
Cushing syndrome
•
Skin reactions: burning pruritus, folliculitis, dermatitis
•
Decreasing itching, inflammation on the skin
Not to use with occlusive dressings
•
Cream/ointment/lotion:
apply sparingly in a thin film and rub gently into the cleansed, affected area
•
Gel:
apply sparingly in a thin film and rub gently into the cleansed, affected area
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Pristiq
Func. class.:
Antidepressant, serotonin-receptor norepinephrine reuptake inhibitor (SNRI)
May work by blocking the central presynaptic reuptake of 5-HT and NE, resulting in an increased sustained level of these neurotransmitters.
Major depressive disorder
Unlabeled uses:
Vasomotor symptoms (hot flashes) associated with menopause
Hypersensitivity
to this product or
venlafaxine, MAOI therapy
Precautions:
CNS depression, abrupt discontinuation, hypertension, hepatic/renal disease, hyponatremia, geriatric patients, pregnancy (C), labor and delivery, breastfeeding, angina, bleeding, cardiac dysrhythmias, MI, stroke, mania, hypovolemia, dehydration
Black Box Warning:
Children, suicidal ideation
Calculator
•
Adult: PO
Initially, 50 mg/day; max 400 mg/day with adjustments as needed
•
Adult: PO
CCr 30-50 ml/min 50 mg q day; CCr < 30 ml/min or end stage renal disease 50 mg q other day
•
Adult: PO
100-150 mg/day
Available forms:
Extended release tabs 50, 100 mg
•
Without regard to food, food may minimize GI symptoms
•
Extended release tab: do not crush, break, or chew
•
Store at room temperature
CNS:
Dizziness
, drowsiness,
headache
, tremor, paresthesias, asthenia, worsening of depression,
suicidal thoughts/behaviors, seizures,
fatigue, chills, yawning, hot flashes, flushing,
irritability
,
insomnia
,
anxiety, abnormal dreams, fatigue
CV:
Palpitations, sinus tachycardia, increased blood pressure, orthostatic hypotension
EENT:
Blurred vision, mydriasis, tinnitus, bruxism
GI:
Nausea
, xerostomia,
diarrhea
, constipation, vomiting, anorexia, weight loss, dysgeusia, hypercholesterolemia, hypertriglyceridemia
GU:
Urinary retention/hesitancy, orgasm dysfunction, decreased libido, impotence, proteinuria
HEMA:
Impaired platelet aggregation
INTEG:
Photosensitivity, hyperhidrosis, diaphoresis, rash
SYST:
Serotonin syndrome, neuroleptic malignant syndrome–like symptoms, toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, angioedema; neonatal abstinence syndrome (fetal exposure)
Protein binding 30%, elimination half-life 11 hrs; elimination half-life is increased (hepatic/renal disease)
Increase:
serotonin syndrome, neuroleptic malignant syndrome–like reactions—SSRIs, other SNRIs, serotonin receptor agonists (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan), TCAs, traZADone, sibutramine, SUMAtriptan, ergots, dexfenfluramine, fenfluramine, lithium, nefazodone, meperidine, phentermine, MAOIs, dextromethorphan, linezolid, promethazine, methylphenidate, dexmethylphenidate, mirtazapine, pentazocine, tryptophan; do not administer concurrently
Increase:
bleeding risk—salicylates, thrombolytics, NSAIDs, platelet inhibitors, anticoagulants
Increase:
CNS depression—alcohol, opioids, antihistamines, sedatives/hypnotics
Increase:
hallucinations, delusions, disorientation—zolpidem
Increase:
desvenlafaxine action—kava, valerian
Increase:
sodium, cholesterol, triglycerides
Black Box Warning:
Suicidal thoughts/behaviors: mental status and mood, identify suicidal ideation
•
Serotonin syndrome, neuroleptic malignant syndrome–like symptoms:
assess for nausea/vomiting, sedation, dizziness, diaphoresis (sweating), facial flush, hallucinations, mental status changes, myoclonia, restlessness, shivering, elevated blood pressure, hyperthermia, muscle rigidity, autonomic instability, mental status changes; if serotonin syndrome occurs discontinue desvenlafaxine, and any other serotonergic agents
•
Monitor B/P baseline and periodically during treatment
•
Appetite and nutritional intake, weight loss is common, change diet as need to support weight
•
Decreased depression; increased sense of well-being, renewed interest in activities
•
To take as directed, not to double or skip doses; if a dose is missed, take as soon as remembered unless close to next dose; do not discontinue abruptly, decreased gradually
Black Box Warning:
To report immediately suicidal thoughts/behaviors, have family members look for symptoms of suicidal ideation
•
Not to operate machinery or engage in hazardous activities until reaction is known, may cause dizziness, drowsiness
•
To avoid all other products unless approval by prescriber
•
To report if pregnancy is planned or suspected (pregnancy category C) or if breastfeeding
•
To report immediately allergic reactions, including rash, hives, difficulty breathing, or swelling of face, lips
•
That continuing follow-up exams will be needed