Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (144 page)
(dox-i-sye′kleen)
Oracea
Vibramycin
Adoxa, Apo-Doxy
, Doryx, Doxy, Doxycaps, Doxycin, Periostat, Vibramycin, Vibra-Tabs
Adoxa, Monodox, Vibramycin
Func. class.:
Antiinfective
Chem. class.:
Tetracycline
Do not confuse:
doxycycline
/doxepin/dicyclomine
Inhibits protein synthesis, phosphorylation in microorganisms by binding to 30S ribosomal subunits, re
versibly binding to 50S ribosomal subunits; bacteriostatic
Syphilis,
Chlamydia trachomatis
, gonorrhea,
Rickettsia
, lymphogranuloma venereum, uncommon gram-negative/gram-positive organisms, malaria prophylaxis, chronic periodontitis, acne, anthrax, Lyme disease
Unlabeled uses:
Traveler’s diarrhea, prevention of chronic bronchitis, leptospirosis, pleural effusion, malaria (chloroquine-resistant
Plasmodium falciparum
)
Pregnancy (D), children <8 yr, hypersensitivity to tetracyclines, esophageal ulceration
Precautions:
Breastfeeding, hepatic disease, pseudomembranous colitis, ulcerative colitis
Calculator
•
Adult: PO/IV
100 mg q12hr on day 1 then 100 mg/day;
IV
200 mg in 1-2 inf on day 1 then 100-200 mg/day
• Child >8 yr, ≥45 kg: PO
100 mg q12hr on day 1 then 100 mg daily; severe infections 100 mg q12hr;
IV
200 mg on day 1 then 100-200 mg daily, give 200 mg dose as 1 or 2 inf
• Child ≥8 yr, <45 kg: PO
2.2 mg/kg q12hr on day 1 then 2.2 mg/kg daily, severe infections 2.2 mg/kg q12hr;
IV
4.4 mg/kg on day 1 then 2.2-4.4 mg/kg daily in 1 to 2 divided doses
•
Adult: PO
100 mg q12hr × 7 days or 300 mg followed 1 hr later by another 300 mg
•
Adult: PO
100 mg/day 1-2 days before travel, daily during travel, and for 4 wk after return
• Adolescent/child ≥8 yr, <45 kg: PO
2 mg/kg/day (up to 100 mg/day) begin 1-2 days before travel, continue for 4 wk after return
•
Adult: PO
100 mg bid × 7 days
•
Adult: PO
100 mg bid × 14 days
• Adult and child >8 yr and ≥45 kg: IV
100 mg q12hr; change to
PO
when able × 60 days
• Adolescent/child ≥8 yr and <45 kg: PO
2.2 mg/kg q12hr × 60 days;
IV
100 mg q12hr, change to
PO
when able × 60 days
• Adult/adolescent/child ≥8 yr: PO
100 mg bid × 10-21 days
• Adult: 20 mg bid after scaling and root planing for ≤9 mo; give close to meal time
AM
or
PM
•
Adult: INTRACAVITARY
500 mg diluted with 250 ml 0.9% NaCl given by chest tube lavage and drainage
Available forms:
Doxycycline: cap 40 mg; doxycycline calcium: syrup 50 mg/5 ml; doxycycline hyclate: cap 50, 100 mg; pellet caps 75, 100 mg; inj 42.5, 100, 200 mg; tabs 20, 100 mg; doxycycline monohydrate: caps 50, 100 mg; tabs 50, 75, 100 mg; oral susp 25 mg/5 ml
•
Do not break, crush, or chew caps; may crush tabs and mix with food
•
On empty stomach or with full glass of water 2 hr before or after meals; avoid dairy products, antacids, laxatives, iron-containing products; if these must be taken, give 2 hr before or after product; avoid giving oral products within 1 hr of bedtime, esophageal uleration may occur
•
After diluting 100 mg or less/10 ml of sterile water or NS for inj, further dilute with 100-1000 ml of NaCl, D
5
, Ringer’s, LR D
5
LR, Normosol-M, Normosol-R in D
5
W; run 100 mg or less over 1-4 hr; inf must be completed in 6 hr when diluted in LR sol or 12 hr with other sol; protect from light, heat
Y-site compatibilities:
Acyclovir, alemtuzumab, alfentanil, amifostine, amikacin,
aminophylline, amiodarone, anidulafungin, ascorbic acid, atracurium, atropine, aztreonam, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefonicid, cefotaxime, cefTRIAXone, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, IDArubicin, ifosfamide, imipenem/cilastatin, insulin, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methoxamine, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nalbuphine, naloxone, nesiritide, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, pancuronium, pantoprazole, papaverine, pentamidine, pentazocine, perphenazine, phentolamine, phenylephrine, phytonadione, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, ritodrine, riTUXimab, rocuronium, sargramostim, sodium acetate, succinylcholine, SUFentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, tirofiban, tobramycin, tolazoline, TPN (2 in 1), trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zoledronic acid
CNS:
Fever
CV:
Pericarditis
EENT:
Dysphagia, glossitis, decreased calcification of deciduous teeth, oral candidiasis, tooth discoloration
GI:
Nausea, abdominal pain, vomiting, diarrhea
, anorexia, enterocolitis,
hepatotoxicity,
flatulence, abdominal cramps, gastric burning, stomatitis
GU:
Increased BUN
HEMA:
Eosinophilia, neutropenia, thrombocytopenia, hemolytic anemia
INTEG:
Rash, urticaria, photosensitivity, increased pigmentation
,
exfoliative dermatitis,
pruritus
MS:
Bone growth retardation (<8 yr old)
SYST:
Stevens-Johnson syndrome, angioedema, anaphylaxis
PO:
Well absorbed; widely distributed; peak 1½-4 hr; half-life 14-17 hr; excreted in urine, feces, bile; 90% protein bound; crosses placenta; enters breast milk
Increase:
effect of—anticoagulants, digoxin
Decrease:
doxycycline effect—antacids, NaHCO
3
, dairy products, alkali products, iron, kaolin/pectin, barbiturates, carBAMazepine, phenytoin, cimetidine sucralfate, cholestyramine, colestipol, rifampin, bismuth; iron, magnesium, zinc, calcium, aluminum salts
Decrease:
effects—penicillins, oral contraceptives, digoxin
Increase:
BUN, alk phos, bilirubin, amylase, ALT, AST, eosinophils, WBC
Decrease:
Hgb
False increase:
urinary catecholamines
•
I&O ratio
•
Blood studies: PT, CBC, AST, ALT, BUN, creatinine
•
Signs of infection
•
Allergic reactions:
rash, itching, pruritus, angioedema
•
Nausea, vomiting, diarrhea; administer antiemetic, antacids as ordered
•
Overgrowth of infection:
fever, malaise, redness, pain, swelling, drainage, perineal itching, diarrhea, changes in cough or sputum
•
IV site for phlebitis/thrombosis; product is highly irritating
•
After C&S is obtained, do not wait for results
•
Storage in tight, light-resistant container at room temp; IV stable for 12 hr at room temp, 72 hr refrigerated; discard if precipitate forms
•
Therapeutic response: decreased temp, absence of lesions, negative C&S
•
To avoid sun because burns may occur; that sunscreen does not seem to decrease photosensitivity
•
That all prescribed medication must be taken to prevent superinfection; not to use outdated products because Fanconi syndrome may occur (reversible nephrotoxicity)
•
That if children ≤8 yr old are undergoing tooth development, teeth will be permanently discolored
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert