Mosby's 2014 Nursing Drug Reference (125 page)

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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

dexamethasone
(ophthalmic)

(dex-a-meth′a-sone)

Maxidex

Func. class.:
Ophthalmic antiinflammatory

Chem. class.:
Corticosteroid

Do not confuse:
dexamethasone
/desoximetasone

ACTION:

Exact mechanism of antiinflammatory action unknown; inhibits multiple inflammatory cytokines; decreases inflammation, collagen deposits, capillary dilation, edema

USES:

Treatment of corticosteroid-responsive ophthalmic disorders

CONTRAINDICATIONS:

Hypersensitivity to this product or sulfites, ocular TB, acute herpes simplex (superficial), fungal/viral infections of the eye, posterior lens capsule rupture

Precautions:
Corneal infected abrasions, glaucoma, pregnancy (C), breastfeeding, migration of intravitreal implant risk, children

DOSAGE AND ROUTES
Calculator
Treatment of corticosteroid-responsive ophthalmic disorders including allergic conjunctivitis (not controlled topically), allergic marginal corneal ulcer, anterior segment inflammation, chorioretinitis, cyclitis, Graves’ ophthalmopathy, giant papillary conjunctivitis (GPC), ophthalmic herpes zoster (herpes zoster ophthalmicus, herpes zoster keratitis), iritis, keratitis, superficial punctate keratitis, postoperative ocular inflammation, optic neuritis, diffuse choroiditis, sympathetic ophthalmia, vernal keratoconjunctivitis, corneal injury (corneal abrasion):


Adult:
Instill 1 or 2 drops of 0.1% ophthalmic sol or susp every hour during the day and every 2 hr at night; reduce application to every 4 hr after response occurs

Available forms:
Ophthalmic solution, suspension 0.1%

Administer:

• 
For ophthalmic use only

• 
Instruct patient on proper instillation of eye ointment or solution. Do not touch the tip of the dropper to the eye, fingertips, or other surface, wait ≥15 min before inserting soft contact lens

SIDE EFFECTS

EENT:
Burning, stinging, poor vision, corneal ulcerations, increased IOP, optic nerve damage

NURSING CONSIDERATIONS
Assess:

• 
Corneal effects:
ulcerations, infections can worsen with this product

Evaluate:

• 
Decreased corneal inflammation

Teach patient/family:

• 
How to use products

• 
Not to share with others or use for other conditions


 
To notify prescriber immediately if vision changes or if condition worsens

• 
To take as prescribed

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

dexamethasone topical

See
Appendix B

 

dexlansoprazole (Rx)

(dex-lan-so-prey′zole)

Dexilant

Func. class.:
Antiulcer, proton-pump inhibitor

Chem. class.:
Benzimidazole

ACTION:

Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump in
hibitor because it blocks final step of acid production

USES:

Gastroesophageal reflux disease (GERD), severe erosive esophagitis, heartburn

CONTRAINDICATIONS:

Hypersensitivity

Precautions:
Pregnancy (B), breastfeeding, children, proton-pump hypersensitivity, gastric cancer, hepatic disease, vit B
12
deficiency

DOSAGE AND ROUTES
Calculator
Erosive esophagitis


Adult: PO
60 mg daily for up to 8 wk; maintenance:
PO
30 mg daily for up to 6 mo

GERD


Adult: PO
30 mg daily × 4 wk

Hepatic disease


Adult: PO
(Child-Pugh B): max 30 mg/day

Available forms:
Del rel caps 30, 60 mg

Administer:

• 
Swallow caps whole; do not crush, chew caps; caps may be opened, contents sprinkled on food, use immediately; do not chew contents of capsule, give without regard to food

SIDE EFFECTS

CNS:
Headache, dizziness, confusion, agitation, amnesia, depression,
anxiety, seizures,
insomnia, migraine

CV:
Chest pain, angina, bradycardia, palpitations,
CVA
, hypertension,
MI

EENT:
Tinnitus

GI:
Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, colitis, dysgeusia

HEMA:
Anemia,
neutropenia, thrombocytopenia, pernicious anemia, thrombosis

INTEG:
Rash, urticaria, pruritus

META:
Gout

MS:
Arthralgia, mylagia

RESP:
Upper respiratory infections, cough, epistaxis, dyspnea,
pneumonia

SYST:
Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis

PHARMACOKINETICS

Absorption 57%-64%; plasma half-life 1-2 hr; protein binding 96.1%-98.8%; extensively metabolized in liver; excreted in urine, feces; clearance decreased in geriatric patients, renal/hepatic impairment; peak dual 1-2 hr, 4-5 hr

INTERACTIONS

Increase:
dexlansoprazole effect—CYP2C19, 3A4 inhibitors (fluvoxamine, voriconazole)

• 
Dexlansoprazole absorption: sucralfate

Decrease:
absorption of ketoconazole, itraconazole, iron, delavirdine, ampicillin, calcium carbonate

Drug/Lab Test

Increase:
LFTs, bilirubin, creatinine, glucose, lipids

Decrease:
platelets, magnesium

NURSING CONSIDERATIONS
Assess:

• 
GI system: bowel sounds q8hr, abdomen for pain, swelling, anorexia, monitor serum magnesium

• 
Hepatotoxicity (rare):
hepatitis, jaundice, monitor hepatic studies (AST, ALT, alk phos) if hepatic adverse reactions occur

• 
Hypomagnesemia:
usually 3 mo to 1 yr after beginning therapy; monitor magnesium level, assess for irregular heart beats, muscle spasms; in children, fatigue, upset stomach, dizziness; magnesium supplement may be used

• 
Anaphylaxis (rare), serious skin disorders:
require emergency intervention

Evaluate:

• 
Therapeutic response: absence of epigastric pain, swelling, fullness

Teach patient/family:

• 
To report severe diarrhea; product may have to be discontinued

• 
That diabetic patient should know that hypoglycemia may occur

• 
To avoid hazardous activities; dizziness may occur

• 
To avoid alcohol, salicylates, ibuprofen; may cause GI irritation

• 
To report allergic reactions, symptoms of low magnesium levels


 
To notify prescriber if pregnancy is planned or suspected, not to breastfeed

• 
To swallow cap whole, not to chew, crush

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

BOOK: Mosby's 2014 Nursing Drug Reference
7.1Mb size Format: txt, pdf, ePub
ads

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