Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (145 page)
HIGH ALERTdronedarone (Rx)
(drone′da′rone)
Multaq
Func. class.:
Antidysrhythmic (class III)
Chem. class.:
Iodinated benzofuran derivative
Prolongs duration of action potential and effective refractory period, noncompetitive α- and β-adrenergic inhibition; increases RR and QT intervals, decreases sinus rate, decreases peripheral vascular resistance
Atrial fibrillation, atrial flutter
Pregnancy (X), breastfeeding; 2nd-, 3rd-degree AV block; bradycardia, severe sinus node dysfunction, hypersensitivity, heart failure, hepatic disease, QT prolongation, aminodarone-induced lung toxicity
Black Box Warning:
NYHA Class IV heart failure or Class II-III with recent decompensation requiring hospitalization, permanent atrial fibrillation (cannot restore sinus rhythm)
Precautions:
Children, geriatric patients, Asian patients, females, electrolyte imbalances, atrial fibrillation/flutter
Calculator
•
Adult: PO
400 mg bid;
discontinue class I, III antidysrhythmics or strong CYP3A4 inhibitors before beginning treatment; max 800 mg/day
Available forms:
Tabs 400 mg
•
Give bid with morning, evening meals
•
Give MedGuide; should be dispensed with each prescription, refill
CV:
Bradycardia
,
heart failure, QT prolongation, torsades de pointes
ENDO:
Hypo/hyperthyroidism
GI:
Nausea, vomiting, diarrhea, abdominal pain,
severe hepatic injury, hepatic failure
INTEG:
Rash, photosensitivity,
anaphylaxis
Peak 3-6 hr, half-life 13-19 hr, metabolized by liver, excreted in feces (84%), via kidneys (6%), protein binding >98%
Increase:
dronedarone levels: CYP3A inhibitors/2D6 inhibitors
Decrease:
dronedarone levels: 3A/2D6 inducers
Increase:
3A/2D6 substrate levels
Increase:
bradycardia—β-blockers, calcium channel blockers
Increase:
levels of cycloSPORINE, dextromethorphan, digoxin, disopyramide, flecainide, methotrexate, phenytoin, procainamide, quiNIDine, theophylline
Increase:
anticoagulant effects—dabigatran, warfarin
Increase:
anticoagulant effect—yohimbine
Decrease:
dronedarone effect—St. John’s wort
Increase:
dronedarone effect, grapefruit; avoid use
Increase:
T
4
, creatinine
Black Box Warning:
NYHA Class IV heart failure or symptomatic heart failure with recent decomposition requiring hospitalization doubles risk of death
•
ECG
to determine product effectiveness; measure PR, QRS, QT intervals; check for PVCs, other dysrhythmias, B/P continuously for hypo/hypertension; report dysrhythmias, slowing heart rate
•
Serum creatinine, potassium, magnesium
•
I&O ratio; electrolytes (potassium, creatinine, magnesium)
•
Dehydration or hypovolemia
•
Rebound hypertension after 1-2 hr
•
Hypothyroidism:
lethargy, dizziness, constipation, enlarged thyroid gland, edema of extremities; cool, pale skin
•
Hyperthyroidism:
restlessness, tachycardia, eyelid puffiness, weight loss, frequent urination, menstrual irregularities, dyspnea; warm, moist skin
•
Cardiac rate, respiration: rate, rhythm, character, chest pain; start with patient hospitalized and monitored up to 1 wk
•
Therapeutic response: atrial fibrillation, flutter
•
To take this product as directed; to avoid missed doses; not to use with grapefruit juice, to avoid all other products without approval of provider
•
To immediately report weight gain, edema, difficulty breathing
•
To use effective contraception during treatment (pregnancy X) not to breastfeed
O
2
, artificial ventilation, ECG, administer DOPamine for circulatory depression; administer diazepam or thiopental for seizures, isoproterenol
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTdroperidol (Rx)
(droe-per′i-dole)
Func. class.:
Sedative/hypnotic
Chem. class.:
Butyrophenone
Acts on CNS at subcortical levels, produces tranquilization, sleep; antiemetic; mild α-blockade
Premedication for surgery; induction, maintenance in general anesthesia; postoperatively for nausea, vomiting
Unlabeled uses:
Anxiety, general anesthesia induction/maintenance, preanesthesia, sedation induction
Breastfeeding, children <2 yr, hypersensitivity
Black Box Warning:
QT prolongation, torsades de pointes
Precautions:
Pregnancy (C), geriatric patients, CV disease (hypotension, bradydysrhythmias), renal/hepatic disease, Parkinson’s disease, pheochromocytoma, CHF, hypokalemia, hypomagnesemia, cardiac hypertrophy
Calculator
•
Adult: IV/IM
1.25-2.5 mg, may give additional 1.25 mg with caution
• Child 2-12 yr: IV
0.05-0.1 mg/kg, titrate to response
•
Adult: IM
2.5 mg 1/2-1 hr before surgery, may give 1.25-2.5 mg additionally
• Child 2-12 yr: IM
0.05-0.1 mg/kg
Available forms:
Inj 2.5 mg/ml
•
Protect sol from light
•
Anticholinergics (benztropine, diphenhydrAMINE) for EPS
•
Only with crash cart, resuscitative equipment nearby
•
IM deep in large muscle mass
•
Undiluted; give through
Y
-tube at 10 mg or less/min; titrate to patient response
•
May be given as inf by adding dose to 250 ml LR, D
5
W, 0.9% NaCl; give slowly, titrate to patient response
Syringe compatibilities:
Atropine, bleomycin, butorphanol, chlorproMAZINE, cimetidine, CISplatin, cyclophosphamide, dimenhyDRINATE, diphenhydrAMINE, DOXOrubicin, fentaNYL, glycopyrrolate, hydrOXYzine, meperidine, metoclopramide, midazolam, mitoMYcin, morphine, nalbuphine, pentazocine, perphenazine, prochlorperazine, promazine, promethazine, scopolamine, vinBLAStine, vinCRIStine
Y-site compatibilities:
Amifostine, aztreonam, bleomycin, cisatracurium, CISplatin, cladribine, cyclophosphamide, cytarabine, DOXOrubicin, DOXOrubicin liposome, famotidine, filgrastim, fluconazole, fludarabine, granisetron, hydrocortisone, IDArubicin, melphalan, meperidine, metoclopramide, mitoMYcin, ondansetron, PACLitaxel, potassium chloride, propofol, remifentanil, sargramostim, teniposide, thiotepa, vinBLAStine, vinCRIStine, vinorelbine, vit B/C
CNS:
EPS (dystonia, akathisia, flexion of arms, fine tremors); dizziness, anxiety, drowsiness, restlessness, hallucination, depression,
seizures, neuroleptic malignant syndrome
CV:
Tachycardia, hypotension
,
prolonged QT, torsades de pointes
EENT:
Upward rotation of eyes, oculogyric crisis
INTEG:
Chills, facial sweating, shivering
RESP:
Laryngospasm, bronchospasm
IM/IV:
Onset 3-10 min, peak 1/2 hr, duration 3-6 hr, metabolized in liver, excreted in urine as metabolites, crosses placenta, half-life 2-3 hr
Increase:
CNS depression—alcohol, opiates, barbiturates, antihistamines, antipsychotics, or other CNS depressants
Increase:
hypotension—nitrates, antihypertensives
Increase:
side effects of lithium
Black Box Warning:
Increase:
QT prolongation—class IA/III antiarrhythmics, some phenothiazines, tricyclics, some quinolones, others
Increase:
action—kava, valerian, hops, chamomile
•
VS q10min during IV administration, q30min after IM dose
•
EPS: dystonia, akathisia
For increasing heart rate or decreasing B/P, notify prescriber at once; do not place patient in Trendelenburg position because sympathetic blockade may occur, thereby causing respiratory arrest
Black Box Warning:
QT prolongation, torsades de pointes:
ECG before and 2-3 hr after administration for serious arrhythmias
•
Therapeutic response: decreased anxiety, absence of vomiting during and after surgery
•
To rise slowly from sitting or standing to minimize orthostatic hypotension
•
To avoid ambulation without assistance; drowsiness, dizziness may occur