Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (131 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
diflunisal
(dye-floo′ni-sal)
Dolobid
Func. class.:
Nonsteroidal antiinflammatory drug
Mild to moderate pain including osteoarthritis, rheumatoid arthritis
Hypersensitivity to this product, NSAIDs, salicylates, severe renal disease
Black Box Warning:
Perioperative pain after CABG
Calculator
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Adult: PO
500-1500 mg/day in 2 divided doses every 12 hr
• Child ≥12 yr: PO
250-1000 mg/day in 2 divided doses every 12 hr, max 1500 mg
• Adult/child ≥12 yr: PO
1000 mg, then 500 mg every 8-12 hr; a lower dose may be used
Available forms:
Tab 500 mg
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ophthalmic)
(die-flu′pred-nate)
Durezol
Func. class.:
Ophthalmic antiinflammatory
Chem. class.:
Corticosteroid
Exact mechanism of antiinflammatory action unknown; inhibits multiple inflammatory cytokines; decreases release of arachidonic acid, which increases in inflammation
For the treatment of postoperative ocular pain and postoperative ocular inflammation; for the treatment of endogenous anterior uveitis
Hypersensitivity to this product, glycerin, polysorbate, ocular TB, acute herpes simplex (superficial), fungal/viral infections of the eye
Precautions:
Pregnancy (C), breastfeeding, children, corneal infected abrasions, glaucoma
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• Adult/geriatric patients: OPHTH
Instill 1 drop into the conjunctival sac of the affected eye(s) qid beginning 24 hr after surgery; continue giving 4 ×/day for the first 2 wk of the postoperative period, then administer bid × 1 wk. At the end of the third week, taper dosage based on response
•
Adult: OPHTH
Instill 1 drop into the conjunctival sac of the affected eye(s) qid × 14 days, followed by tapering based on response
Available forms:
Ophthalmic emulsion 0.05%
•
Apply topically to the eye, shake well before use
•
Do not touch the tip of the dropper to the eye, fingertips, or other surface
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Instruct patient on proper instillation of eye sol
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When using this product, the patient should not wear contact lenses
EENT:
Burning, stinging, poor vision, corneal ulcerations, increased IOP, optic nerve damage
•
Corneal effects:
ulcerations, infections can worsen with this product, monitor IOP used IO over ten days
•
Therapeutic response:
Decreased corneal inflammation
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How to use product
•
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
HIGH ALERTdigoxin (Rx)
(di-jox′in)
APO-Digoxin
, Lanoxin
Func. class.:
Cardiac glycoside, inotropic, antidysrhythmic
Chem. class.:
Digoxin preparation
Do not confuse:
Lanoxin
/Lasix/Lonox/Lomotil/Xanax/Levoxine
Inhibits the sodium-potassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output (positive inotropic effect); increases force of contractions; decreases heart rate (negative chronotropic effect); decreases AV conduction speed
Heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiogenic shock, paroxysmal atrial tachycardia, rapid digitalization in these disorders
Unlabeled uses:
Atrial flutter, paroxysmal supraventricular tachycardia (PSVT) treatment/prophylaxis
Hypersensitivity to digoxin, ventricular fibrillation, ventricular tachycardia, carotid sinus syndrome, 2nd- or 3rd-degree heart block
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, renal disease, acute MI, AV block, severe respiratory disease, hypothyroidism, sinus nodal disease, hypokalemia
Calculator
•
Adult: IV
400–600 mcg as a single dose, effect in 5–30 min, max effect 1–4 hr, give subsequent doses of 100–300 mcg every 6–8 hr
• Adolescent/child >10 yr: IV
8–12 mcg/kg, divided into ≥3 doses, with the first dose equaling approximately one-half the total, give subsequent doses every 4–8 hr
• Child 5–10 yr: IV
15–30 mcg/kg divided into ≥3 doses, with the first dose equaling approximately one-half the total, give subsequent doses every 4–8 hr
• Child 2–4 yr: IV
25–35 mcg/kg, divided into ≥3 doses, with the first dose equaling approximately one-half the total, give subsequent doses every 4–8 hr
• Infant/child <2 yr: IV
30–50 mcg/kg, divided into ≥3 doses, with the first dose equaling approximately one-half the total, give subsequent doses every 4–8 hr
• Full-term neonate: IV
20–30 mcg/kg, divided into ≥3 doses, with the first dose equaling approximately one-half the total, give subsequent doses every 4–8 hr
• Premature neonate: IV
15–25 mcg/
kg, divided into ≥3 doses, with the first dose equaling approximately one-half the total, give subsequent doses every 4–8 hr
Loading dose, PO (tablets):
Tablets are 60%–80% bioavailable; oral elixir should be used to obtain the appropriate dose in infants, young pediatric patients, or patients with very low body weight
• Adult/adolescent/child >10 yr: PO
Total dosage of 10–15 mcg/kg in 3 divided doses, give one-half the total loading dose initially, then one-fourth the loading dose every 4–8 hr × 2 doses
• Child 5–10 yr: PO
Total dosage of 20–45 mcg/kg in 3 divided doses, give one-half the total loading dose initially, then one-fourth the loading dose every 4–8 hr × 2 doses
Loading dose, PO (elixir):
Elixir is approximately 70%–85% bioavailable
• Adult/adolescent/child >10 yr: PO
Total dosage of 10–15 mcg/kg, give one-half the total loading dose initially, then additional fractions of the planned total dose at 4–8 hr
• Child 5–10 yr: PO
Total dosage of 20–35 mcg/kg, give one-half the total loading dose initially, then additional fractions of the planned total dose at 4–8 hr
• Child 2–4 yr: PO
Total dosage of 30–45 mcg/kg, give one-half the total loading dose initially, then additional fractions of the planned total dose at 4–8 hr
• Infant/child <2 yr: PO
Total dosage of 35–60 mcg/kg, give one-half the total loading dose initially then additional fractions of the planned total dose at 4–8 hr
• Full-term neonate: PO
Total dosage of 25–35 mcg/kg, give one-half the total loading dose initially, then additional fractions of the planned total dose at 4–8 hr
• Premature neonate: PO
Total dosage of 20–30 mcg/kg, give one-half the total loading dose initially, then additional fractions of the planned total dose at 4–8 hr
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Adult: IV
125–350 mcg/day, depending on CrCl, usual daily maintenance dosage for CHF based on corrected CrCl (ml/min/70 kg) and lean body weight (LBW) are listed below
•
LBW 50–59 kg: CrCl ≥100 ml/min: 175 mcg//day; CrCl 70–99 ml/min: 150 mcg/day; CrCl 60–69 ml/min: 125 mcg/day
•
LBW 60–69 kg: CrCl ≥90 ml/min: 200 mcg/day; CrCl 70–89 ml/min: 175 mcg/day; CrCl 60–69 ml/min: 150 mcg/day
•
LBW 70–79 kg: CrCl ≥100 ml/min: 250 mcg/day; CrCl 90–99 ml/min: 225 mcg/day; CrCl 70–89 ml/min: 200 mcg/day; CrCl 60–69 ml/min: 175 mcg/day
•
LBW 80–89 kg: CrCl ≥100 ml/min: 275 mcg/day; CrCl 80–99 ml/min: 250 mcg/day; CrCl 70–79 ml/min: 225 mcg/day; CrCl 60–69 ml/min: 200 mcg/day
•
LBW 90–99 kg: CrCl ≥90 ml/min: 300 mcg/day; CrCl 80–89 ml/min: 275 mcg/day; CrCl 70–79 ml/min: 250 mcg/day; CrCl 60–69 ml/min: 225 mcg/day
•
LBW ≥100 kg: CrCl ≥100 ml/min: 350 mcg/day; CrCl 90–99 ml/min: 325 mcg IV/day; CrCl 80–89 ml/min: 300 mcg/day; CrCl 70–79 ml/min: 275 mcg IV/day; CrCl 60–69 ml/min: 250 mcg/day
• Child >10 yr:
25%–35% of the IV digitalizing dose/day
• Child 5–10 yr:
25%–35% of the IV digitalizing dose bid
• Children 2–4 yr:
25%–35% of the IV digitalizing dose bid
• Infant, child <2 yr:
25%–35% of the IV digitalizing dose bid
• Full term neonate:
25%–35% of the IV digitalizing dose bid
• Preterm neonate:
20%–30% of the IV digitalizing dose bid
• Adult/adolescent/child >10 yr: PO
3.4–5.1 mcg/kg/day
•
LBW 40–49 kg: CrCl ≥70 ml/min: 187.5 mcg/day; CrCl ≥60–69 ml/min: 125 mcg/day
•
LBW 50–59 kg: CrCl ≥90 ml/min: 250 mcg/day; CrCl 60–89 ml/min: 187.5 mcg/day
•
LBW 60–69 kg: CrCl ≥100 ml/min: 312.5 mcg/day; CrCl 60–99 ml/min: 250 mcg/day
•
LBW 70–79 kg: CrCl ≥80 ml/min:
312.5 mcg/day; CrCl 60–79 ml/min: 250 mcg/day
•
LBW 80–89 kg: CrCl ≥90 ml/min: 375 mcg/day; CrCl 60–89 ml/min: 312.5 mcg/day
•
LBW 90–99 kg: CrCl ≥90 ml/min: 437.5 mcg/day; CrCl 70–89 ml/min: 375 mcg/day; CrCl 60–69 ml/min: 312.5 mcg/day
•
LBW ≥100 kg: CrCl ≥100 ml/min: 500 mcg/day; CrCl 80–99 ml/min: 437.5 mcg/day; CrCl 60–79 ml/min: 375 mcg/day
• Child 5–10 yr: PO
6.4–12.9 mcg/kg/day in 2 divided doses is recommended starting maintenance dose
• Adult/adolescent/child >10 yr: PO
3–4.5 mcg/kg/day
•
LBW 40–49 kg: CrCl ≥100 ml/min: 170 mcg/day; CrCl 90–99 ml/min: 160 mcg/day; CrCl 80–89 ml/min: 150 mcg/day; CrCl 70–79 ml/min: 140 mcg/day; CrCl 60–69 ml/min: 130 mcg/day
•
LBW 50–59 kg: CrCl ≥100 ml/min: 213 mcg/day; CrCl 90–99 ml/min: 200 mcg/day; CrCl 80–89 ml/min: 188 mcg/day; CrCl 70–79 ml/min: 175 mcg/day; CrCl 60–69 ml/min: 163 mcg/day
•
LBW 60–69 kg: CrCl ≥100 ml/min: 255 mcg/day; CrCl 90–99 ml/min: 240 mcg/day; CrCl 80–89 ml/min: 225 mcg/day; CrCl 70–79 ml/min: 210 mcg/day; CrCl 60–69 ml/min: 195 mcg/day
•
LBW 70–79 kg: CrCl ≥100 ml/min: 298 mcg/day; CrCl 90–99 ml/min: 280 mcg/day; CrCl 80–89 ml/min: 263 mcg/day; CrCl 70–79 ml/min: 245 mcg/day; CrCl 60–69 ml/min: 228 mcg/day
•
LBW 80–89 kg: CrCl ≥100 ml/min: 340 mcg/day; CrCl 90–99 ml/min: 320 mcg/day; CrCl 80–89 ml/min: 300 mcg/day; CrCl 70–79 ml/min: 280 mcg/day; CrCl 60–69 ml/min: 260 mcg/day
•
LBW 90–99 kg: CrCl ≥100 ml/min: 383 mcg/day; CrCl 90–99 ml/min: 360 mcg/day; CrCl 80–89 ml/min: 338 mcg/day; CrCl 70–79 ml/min: 315 mcg/day; CrCl 60–69 ml/min: 293 mcg/day
•
LBW ≥100 kg: CrCl ≥100 ml/min: 425 mcg/day; CrCl 90–99 ml/min: 400 mcg/day; CrCl 80–89 ml/min: 375 mcg/day; CrCl 70–79 ml/min: 350 mcg/day; CrCl 60–69 ml/min: 325 mcg/day
• Child 5–10 yr: PO
5.6–11.3 mcg/kg/day in 2 divided doses
• Child 2–4 yr: PO
9.4–13.1 mcg/kg/day in 2 divided doses
• Infant/child <2 yr:
PO
11.3–18.8 mcg/kg/day in 2 divided doses
• Full-term neonate: PO
7.5–11.3 mcg/kg/day in 2 divided doses
• Preterm neonate: PO
4.7–7.8 mcg/kg/day in 2 divided doses
•
Crcl 50–59 ml/min:
LBW 50–59 kg: 125 mcg 1× daily; LBW 60–69 kg: 150 mcg 1× daily; LBW 70–79 kg: 175 mcg 1× daily; LBW 80–89 kg: 200 mcg 1× daily; LBW 90–99 kg: 225 mcg 1× daily; LBW ≥100 kg: 250 mcg 1× daily
•
Crcl 40–49 ml/min:
LBW 50–59 kg: 100 mcg 1× daily; LBW 60–69 kg: 125 mcg 1× daily; LBW 70–79 kg: 150 mcg 1× daily; LBW 80–89 kg: 175 mcg 1× daily; LBW 90–99 kg: 200 mcg 1× daily; LBW ≥100 kg: 225 mcg 1× daily
•
Crcl 30–39 ml/min:
LBW 50–59 kg: 100 mcg 1× daily; LBW 60–69 kg: 125 mcg 1× daily; LBW 70–89 kg: 150 mcg 1× daily; LBW 90–99 kg: 175 mcg 1× daily; LBW ≥100 kg: 200 mcg 1× daily
•
Crcl 20–29 ml/min:
LBW 50–69 kg: 100 mcg 1× daily; LBW 70–79 kg: 125 mcg 1× daily; LBW 80–99 kg: 150 mcg 1× daily; LBW ≥100 kg: 175 mcg 1× daily
•
Crcl 10–19 ml/min:
LBW 50–59 kg: 75 mcg 1× daily; LBW 60–79 kg: 100 mcg 1× daily; LBW 80–89 kg: 125 mcg 1× daily; LBW ≥90 kg: 150 mcg 1× daily
•
Crcl <10 ml/min LBW 50–69 kg:
75 mcg 1× daily; LBW 70–89 kg: 100 mcg 1× daily; LBW 90–99 kg: 125 mcg 1× daily; LBW ≥100 kg: 150 mcg 1× daily
•
Crcl 40–59 ml/min:
LBW 50–69 kg: 187.5 mcg 1× daily
•
Crcl 50–59 ml/min:
LBW 70–89 kg: 250 mcg 1× daily; LBW ≥90 kg: 312.5 mcg 1× daily
•
Crcl 30–39 ml/min:
LBW 50–59 kg: 125 mcg 1× daily; LBW 60–79 kg: 187.5 mcg 1× daily; LBW 80–99 kg: 250 mcg 1× daily; LBW ≥100 kg: 312.5 mcg 1× daily
•
Crcl 20–29 ml/min:
LBW 50–69 kg: 125 mcg 1× daily; LBW 70–89 kg: 187.5 mcg 1× daily; LBW ≥90 kg: 250 mcg 1× daily
•
Crcl <20 ml/min:
LBW 50–69 kg: 125 mcg 1× daily; LBW 70–99 kg: 187.5 mcg 1× daily; LBW ≥100 kg: 250 mcg 1× daily
•
Crcl 50–59 ml/min:
LBW 50–59 kg: 150 mcg 1× daily; LBW 60–69 kg: 180 mcg 1× daily; LBW 70–79 kg: 210 mcg 1× daily; LBW 80–89 kg: 240 mcg 1× daily; LBW 90–99 kg: 270 mcg 1× daily; LBW ≥100 kg: 300 mcg 1× daily
•
Crcl 40–49 ml/min:
LBW 50–59 kg: 138 mcg 1× daily; LBW 60–69 kg: 165 mcg 1× daily; LBW 70–79 kg: 193 mcg 1× daily; LBW 80–89 kg: 220 mcg 1× daily; LBW 90–99 kg: 248 mcg 1× daily; LBW ≥100 kg: 275 mcg 1× daily
•
Crcl 30–39 ml/min:
LBW 50–59 kg: 125 mcg 1× daily; LBW 60–69 kg: 150 mcg 1× daily; LBW 70–79 kg: 175 mcg PO 1× daily; LBW 80–89 kg: 200 mcg PO 1× daily; LBW 90–99 kg: 225 mcg 1× daily; LBW ≥100 kg: 250 mcg PO 1× daily
•
Crcl 20–29 ml/min:
LBW 50–59 kg: 113 mcg 1× daily; LBW 60–69 kg: 135 mcg 1× daily; LBW 70–79 kg: 158 mcg 1× daily; LBW 80–89 kg: 180 mcg PO 1× daily; LBW 90–99 kg: 203 mcg 1× daily; LBW ≥100 kg: 225 mcg PO 1× daily
•
Crcl <20 ml/min:
LBW 50–59 kg: 100 mcg 1× daily; LBW 60–69 kg: 120 mcg 1× daily; LBW 70–79 kg: 140 mcg 1× daily; LBW 80–89 kg: 160 mcg 1× daily; LBW 90–99 kg: 180 mcg 1× daily; LBW ≥100 kg: 200 mcg 1× daily
The daily maintenance dose can also be estimated using patient CrCl and loading dose (LD) according to the method of Jelliffe and Brooker: Daily % loss = 14 + CrCl/5
Available forms:
Caps 0.05, 0.1, 0.2 mg; elix 0.05 mg/ml; tabs 0.125, 0.25, 0.5 mg; inj 0.5, 0.25 mg/ml; pediatric inj 0.1 mg/ml
Bioavailability varies among different oral dosage forms of digoxin and among different brands of the same dosage form. Changing from one preparation to another might require dosage adjustments.
•
All dosage forms:
May be administered without regard to meals
•
Tab:
May be crushed and administered with food or fluids
•
Pediatric elixir:
Administer using a calibrated measuring device
•
IV is preferred over IM because it is less painful
•
PO should replace parenteral therapy as soon as possible
•
Visually inspect parenteral products for particulate matter and discoloration before use
•
Do not administer >2 ml at any one IM injection site.
•
Inject deeply into gluteal muscle, then massage area
•
May be given undiluted or each 1 ml may be diluted in 4 ml of sterile water for injection, NS, D
5
W, or LR. Diluent volumes <4 ml will cause precipitation. Use diluted solutions immediately
•
Inject over ≥5 min via
Y
-site or 3-way stopcock. In patients with pulmonary edema, administer over 10–15 min. To avoid inadvertent overdosage, do not flush the syringe following administration
Additive compatibilities:
Cimetidine, floxacillin, furosemide, lidocaine, potassium chloride, ranitidine, verapamil
Syringe compatibilities:
Heparin, milrinone
Y-site compatibilities:
Acyclovir, alfentanil, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, anidulafungin, ascorbic acid
injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cilastatin, indomethacin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, meperidine, meropenem, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, morphine, moxalactam, multiple vitamins injection, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, nesiritide, metilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex, voriconazole, zoledronic acid