Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (139 page)
HIGH ALERTDOPamine (Rx)
(doe′pa-meen)
Func. class.:
Adrenergic
Chem. class.:
Catecholamine
Do not confuse:
DOPamine
/DOBUTamine
Causes increased cardiac output; acts on β
1
- and α-receptors, causing vasoconstriction in blood vessels; low dose causes renal and mesenteric vasodilation; β
1
stimulation produces inotropic effects with increased cardiac output
Shock, increased perfusion, hypotension, cardiogenic/septic shock
Unlabeled uses:
Bradycardia, cardiac arrest, CPR, acute renal failure, cirrhosis, barbiturate intoxication
Hypersensitivity, ventricular fibrillation, tachydysrhythmias, pheochromocytoma, hypovolemia
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, arterial embolism, peripheral vascular disease, sulfite hypersensitivity, acute MI
Black Box Warning:
Extravasation
Calculator
•
Adult: IV INF
2-5 mcg/kg/min, titrate upward in 5-10 mcg/kg/min increments, max 50 mcg/kg/min; titrate to patient’s response
• Child: IV
1-5 mcg/kg/min initially; usual dosage range, 2-20 mcg/kg/min
•
Adult: IV
4 mcg/kg/min
•
Adult: IV
3-10 mcg/kg/min
•
Adult: IV
2-10 mcg/kg/min, titrate as needed
Available forms:
Inj 40 mg, 80 mg, 160 mg/ml; conc for IV inf 0.8, 1.6, 3.2 mg/ml in 250, 500 ml D
5
W
•
IV after diluting 200-400 mg/250-500 ml of D
5
W, D
5
0.45% NaCl, D
5
0.9% NaCl, D
5
LR, LR; use large vein
•
After reconstituting, use inf pump; give at rate of 0.5-5 mcg/kg/min, increase by 1-4 mcg/kg/min at 10-30 min intervals until desired response
Black Box Warning:
Extravasation:
if extravasation occurs, stop infusion, may inject area with phentolamine 10 mg/15 ml of NS
Y-site compatibilities:
Alfentanil, alprostadil, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, anidulafungin, argatroban, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, cefmetazole, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefpirome, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clarithromycin, clindamycin, cloNIDine, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, micanfungin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins injection, mycophenolate, nafcillin, nalbuphine, naloxone, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pen
tazocine, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sargramostim, sodium acetate, succinylcholine, SUFentanil, tacrolimus, temocillin, 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, warfarin, zidovudine, zoledronic acid
CNS:
Headache
, anxiety
CV:
Palpitations
,
tachycardia,
hypertension, ectopic beats, angina
,
wide QRS complex,
peripheral vasoconstriction, hypotension
GI:
Nausea, vomiting, diarrhea
INTEG:
Necrosis, tissue sloughing with extravasation, gangrene
RESP:
Dyspnea
IV:
Onset 5 min; duration <10 min; metabolized in liver, kidney, plasma; excreted in urine (metabolites); half-life 2 min
•
Do not use within 2 wk of MAOIs; hypertensive crisis may result
Increase:
bradycardia, hypotension—phenytoin
Increase:
dysrhythmias—general anesthetics
Increase:
severe hypertension—ergots
Increase:
B/P—oxytocics
Increase:
pressor effect—tricyclics, MAOIs
Decrease:
DOPamine action—β-/α-blockers
Increase:
urinary catecholamine, serum glucose
•
Hypovolemia; if present, correct first
•
Oxygenation/perfusion deficit:
check B/P, chest pain, dizziness, loss of consciousness
•
Heart failure:
S
3
gallop, dyspnea, neck venous distention, bibasilar crackles in patients with CHF, cardiomyopathy, palpate peripheral pulses
•
I&O ratio: if urine output decreases without decrease in B/P, product may need to be reduced
•
ECG
during administration continuously; if B/P increases, product should be decreased; PCWP, CVP during inf
•
B/P, pulse q5min
•
Paresthesias and coldness of extremities; peripheral blood flow may decrease
•
Inj site: tissue sloughing; if this occurs, administer phentolamine mixed with NS
•
Storage of reconstituted sol for up to 24 hr if refrigerated
•
Do not use discolored sol; protect from light
•
Therapeutic response: increased B/P with stabilization; increased urine output
•
About the reason for product administration
Discontinue IV, may give a short-acting α-adrenergic blocker
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(dore-i-pen′em)
Doribax
Func. class.:
Antiinfective—miscellaneous
Chem. class.:
Carbapenem
Bactericidal; interferes with cell-wall replication of susceptible organisms; osmotically unstable cell wall swells, bursts from osmotic pressure
Serious infections caused by
Acinetobacter baumannii, Bacteroides caccae, Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Escherichia coli, Klebsiella pneumoniae, Peptostreptococcus micros, Proteus mirabilis, Pseudomonas aeruginosa, Streptococcus constellatus, Streptococcus intermedius
; complicated urinary tract infections, pyelonephritis, complicated intraabdominal infections
Hypersensitivity to carbapenems (meropenem, doripenem, imipenem), penicillin, β-lactam; viral infection
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, renal disease, seizure disorder, pseudomembranous colitis, nebulizer or inhalation use
Calculator
•
Adult: IV
500 mg q8hr × 5-14 days; if improvement occurs after 3 days, switch to appropriate oral product
•
Adult: IV
CCr 30-50 ml/min, 250 mg over 1 hr, q8hr; CCr >10 to <30 ml/min, 250 mg over 1 hr q12hr; CCr ≤10 ml/min, no data
Available forms:
Powder for inj 250, 500 mg
•
Visually inspect parenteral products for particulate matter and discoloration before use, diluted range in color from clear, colorless solutions to solutions that are clear and slightly yellow
•
Reconstitution:
No bacteriostatic preservative is present; observe aseptic technique while preparing the infusion
•
500-mg dose using the 500-mg vial
: Constitute the vial with 10 ml of sterile water for injection or sodium chloride 0.9% (normal saline). Gently shake (50 mg/ml);
the constituted suspension is not for direct injection; further dilution is required.
Using a syringe with a 21-G needle, withdraw the suspension and add it to an infusion bag containing 100 ml of NS or D
5
W; gently shake until clear: final concentration: 4.5 mg/ml
•
250-mg dose using the 500 mg vial
: Constitute the vial with 10 ml of sterile water for injection or sodium chloride 0.9% (normal saline). Gently shake (50 mg/ml);
the constituted suspension is not for direct injection; further dilution is required.
Using a syringe with a 21-G needle, withdraw the suspension and add it to an infusion bag containing 100 ml of normal saline or D
5
W; gently shake until clear; remove 55 ml of this solution and discard. The remaining inf sol contains 250 mg (4.5 mg/ml)
•
250-mg dose using the 250 mg vial
: Constitute the vial with 10 ml of sterile water for injection or sodium chloride 0.9% (normal saline). Gently shake (25 mg/ml);
the constituted suspension is not for direct injection; further dilution is required.
Using a syringe with a 21-G needle, withdraw the suspension and add it to an infusion bag containing 50 or 100 ml of normal saline or D
5
W; gently shake until clear; final concentration 4.2 mg/ml (50 ml infusion bag) or 2.3 mg/ml (100 ml infusion bag)
•
Storage:
Constituted suspensions may be held in vial for up to 1 hr before
transfer and dilution in the infusion bag. Including storage and infusion time, diluted infusion sols are stable for up to 12 hr (NS) or 4 hr (D
5
W) at controlled room temperature; diluted infusion sols are stable for up to 72 hr (NS) or 24 hr (D
5
W) refrigerated, do not freeze constituted solutions.
•
If Baxter Minibag Plus inf bags are to be used, consult the instructions provided by the inf bag manufacturer
•
After C&S is taken
•
Do not mix with or physically add to solutions containing other drugs, infuse over 1 hr
Y-site compatibilities:
Acyclovir, amikacin, aminophylline, amiodarone, anidulafungin, atropine, azithromycin, bumetanide, calcium gluconate, CARBOplatin, caspofungin, ceftobiprole, cimetidine, ciprofloxacin, CISplatin, cyclophosphamide, cycloSPORINE, DAPTOmycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin, enalaprilat, esmolol, esomeprazole, etoposide, famotidine, fentaNYL, fluconazole, fluorouracil, foscarnet, furosemide, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, insulin (regular), labetalol, levofloxacin, linezolid, LORazepam, magnesium sulfate, mannitol, meperidine, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, micafungin, midazolam, milrinone, morphine, moxifloxacin, norepinephrine, ondansetron, PACLitaxel, pantoprazole, PHENobarbital, phenylephrine, potassium chloride, ranitidine, sodium bicarbonate/phosphates, tacrolimus, tigecycline, tobramycin, vancomycin, voriconazole, zidovudine
Solution compatibilities:
D
5
W, 0.9% NaCl, sterile water for inj
CNS:
Seizures,
headache
GI:
Diarrhea, nausea, vomiting,
pseudomembranous colitis, hepatitis
HEMA:
Neutropenia, leukopenia, anemia
INTEG:
Rash
, urticaria, phlebitis, erythema at inj site,
Stevens-Johnson syndrome, toxic epidermal necrolysis,
pruritus
SYST:
Anaphylaxis
IV:
Distributed to most body fluids/tissue, excreted mainly unchanged in urine, 70% recovered in 48 hr, half-life 1 hr, half-life extended in renal disease
Increase:
doripenem plasma levels—probenecid
Decrease:
effect of valproic acid, divalproex sodium
Increase:
AST, ALT, LDH, BUN, alk phos, bilirubin, creatinine
False positive:
direct Coombs’ test
•
Sensitivity to carbapenem antibiotics, penicillins
•
Renal disease: lower dose may be required
•
Bowel pattern daily; if severe diarrhea occurs, product should be discontinued; may indicate pseudomembranous colitis
•
For infection: temp; sputum; characteristics of wound before, during, and after treatment
Allergic reactions, anaphylaxis:
rash, urticaria, pruritus; may occur few days after therapy begins
•
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
•
Therapeutic response: negative C&S; absence of symptoms and signs of infection
•
To report severe diarrhea; may indicate pseudomembranous colitis
•
To report sore throat, bruising, bleeding, joint pain; may indicate blood dyscrasias (rare)
•
To report overgrowth of infection: black, furry tongue; vaginal itching; foul-smelling stools
•
To avoid breastfeeding; product is excreted in breast milk
EPINEPHrine, antihistamines; resuscitate if needed (anaphylaxis)