Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (134 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
, Rx)
(dye-fen-hye′dra-meen)
Allerdryl
, AllerMax, Altaryl, Banophen, Benadryl, Benadryl Allergy, Benadryl Allergy Dye Free, Benadryl Children’s Allergy, Buckley’s Bedtime, Diphedryl, Diphenhist, Dytan, ElixSure Allergy, Equaline Allergy, Equaline Children’s Allergy, Equate Allergy, Equate Children’s Allergy, Genahist, Good Sense Children’s Allergy Relief, Good Sense Diphedryl, Leader Complete Allergy, Nytol, PediaCare Children’s Allergy, PediaCare Nighttime Cough, Q-Dryl Allergy, Select Brand Allergy, Siladryl, Silphen, Simply Sleep, Sleepinal, Sleep Tabs, Sominex, Top Care Allergy, Top Care Children’s Allergy, Unisom, Valu-Dryl, Wal-dryl Allergy, Wal-dryl Allergy Dye Free, Wal-dryl Children’s Allergy, Walgreen’s Sleep Aid, Walgreen’s Sleep II, Wal-Som
Func. class.:
Antihistamine (1st generation, nonselective)
Chem. class.:
Ethanolamine derivative, H
1
-receptor antagonist
Do not confuse:
diphenhydrAMINE
/dicyclomine
diphenhydrAMINE
/dimenhyDRINATE
Acts on blood vessels, GI, respiratory system by competing with histamine for H
1
-receptor site; decreases allergic response by blocking histamine
Allergy symptoms, rhinitis, motion sickness, antiparkinsonism, nighttime sedation, infant colic, nonproductive cough, insomnia in children
Unlabeled uses:
Nystagmus
Hypersensitivity to H
1
-receptor antagonist, acute asthma attack, lower respiratory tract disease, neonates
Precautions:
Pregnancy (B), breastfeeding, children <2 yr, increased intraocular pressure, cardiac/renal disease, hypertension, bronchial asthma, seizure disorder, stenosed peptic ulcers, hyperthyroidism, prostatic hypertrophy, bladder neck obstruction
Calculator
• Adult and child >12 yr: PO
25-50 mg q4-6hr, max 300 mg/day;
IM/IV
10-50 mg, max 300 mg/day
• Child 6-12 yr: PO/IM/IV
5 mg/kg/day in 4 divided doses, max 300 mg/day
• Adult and child ≥12 yr: PO
25-50 mg at bedtime
• Adult and child ≥12 yr: PO
25 mg q4hr, max 150 mg/24 hr
• Child 6-12 yr: PO
12.5 mg q4hr, max 75 mg/24 hr
•
CCr >50 ml/min, dose q6hr; CCr 10-50 ml/min, dose q6-12hr; CCr <10 ml/min, dose q12-18hr
•
Adult: PO
25-50 mg q4-6hr up to 48 hr
Available forms:
Caps 25, 50 mg; tabs 25, 50 mg; chew tabs 12.5 mg; elix 12.5 mg/5 ml; syr 12.5 mg/5 ml; inj 10, 50 mg/ml; orally disintegrating tabs 12.5, 25 mg
Avoid use in children <2 yr; death has occurred; overdose has occurred with topical gel taken orally (adult/child)
•
With meals for GI symptoms; absorption rate may slightly decrease
•
At bedtime only if using for sleep aid
•
Deep IM in large muscle; rotate site
•
Undiluted; give 25 mg/min or less
•
Dilute with 0.9% NaCl, 0.45% NaCl, D
5
W, 0.9% NaCl, D
10
W, LR, Ringer’s
Syringe compatibilities:
Atropine, butorphanol, chlorproMAZINE, cimetidine, dimenhyDRINATE, droperidol, fentaNYL, fluPHENAZine, glycopyrrolate, HYDROmorphone, hydrOXYzine, meperidine, metoclopramide, midazolam, morphine, nalbuphine, pentazocine, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, scopolamine, SUFentanil
Y-site compatibilities:
Abciximab, aldesleukin, alfentanil hydrochloride, amifostine, amikacin sulfate, aminocaproic acid, amphotericin B lipid complex (Abelcet), amphotericin B liposome (AmBisome), amsacrine, anidulafungin, argatroban, ascorbic acid injection, atenolol, atracurium besylate, atropine sulfate, azithromycin, benztropine mesylate, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefTAZidime, ceftizoxime, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, digoxin, diltiazem, DOBUTamine, docetaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, folic acid, gallium, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, irinotecan, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, metaraminol, methadone, methicillin, methotrexate, methoxamine, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, midazolam, minocycline, mitoXANtrone, morphine, multiple vitamins injection, mycophenolate, nalbuphine, naloxone, nesiritide, netilmicin, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sargramostim, sodium acetate, 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/C, voriconazole, zoledronic acid
CNS:
Dizziness, drowsiness
, poor coordination, fatigue, anxiety, euphoria, confusion, paresthesia, neuritis,
seizures
CV:
Hypotension, palpitations
EENT:
Blurred vision, dilated pupils, tinnitus, nasal stuffiness, dry nose, throat, mouth
GI:
Nausea, anorexia, diarrhea
GU:
Retention
, dysuria, frequency
HEMA:
Thrombocytopenia, agranulocytosis, hemolytic anemia
INTEG:
Photosensitivity
MISC:
Anaphylaxis
RESP:
Increased thick secretions, wheezing, chest tightness
Metabolized in liver, excreted by kidneys, crosses placenta, excreted in breast milk, half-life 2-7 hr
PO:
Peak 1-3 hr, duration 4-7 hr
IM:
Onset 1/2 hr, peak 1-4 hr, duration 4-7 hr
IV:
Onset immediate, duration 4-7 hr
Increase:
CNS depression—barbiturates, opiates, hypnotics, tricyclics, alcohol
Increase:
diphenhydrAMINE effect—MAOIs
False negative:
skin allergy tests
•
Urinary retention, frequency, dysuria; product should be discontinued
•
CBC during long-term therapy; blood dyscrasias may occur
•
Respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness
•
Product should be discontinued 4 days before skin allergy tests
•
Storage in tight container at room temp
•
Therapeutic response: absence of running or congested nose or rashes, improved sleep
•
About all aspects of product use; to notify prescriber of confusion, sedation, hypotension
•
To avoid driving, other hazardous activity if drowsiness occurs
•
That photosensitivity may occur
•
To avoid concurrent use of alcohol, other CNS depressants
•
To avoid breastfeeding;
not to breastfeed (injectable)
•
To use hard candy, gum, frequent rinsing of mouth for dryness
Administer diazepam, vasopressors, phenytoin IV