Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (155 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ep-roh-sar′tan)
Teveten
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin II–receptor antagonist (Subtype AT
1
)
Blocks the vasoconstrictive and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT
1
receptor found in tissues
Hypertension, alone or with other antihypertensives
Hypersensitivity
Black Box Warning:
Pregnancy (D) 2nd/3rd trimesters
Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children, geriatric patients, hypersensitivity to ACE inhibitors; renal/hepatic disease, angioedema
Calculator
• Adult:
PO
600 mg/day; dose may be divided, given bid, with total daily doses from 400-800 mg, max 900 mg/day
Available forms:
Tabs 400, 600 mg
•
Without regard to meals
CNS:
Dizziness
, depression, fatigue, headache
CV:
Chest pain, hypotension
EENT:
Sinusitis
GI:
Diarrhea, dyspepsia
, abdominal pain
GU:
UTI
INTEG:
Pruritus,
angioedema
META:
Hypertriglyceridemia
MS:
Myalgia, arthralgia,
rhabdomyolysis
RESP:
Cough, upper respiratory infection
, rhinitis, pharyngitis, viral infection
SYST:
Anaphylaxis
Peak 1-2 hr, food delays absorption; protein binding 98%; moderate renal impairment increases product levels by 30%, hepatic impairment increases levels by 40%; excreted in urine and feces; half-life 5-9 hr
Decrease:
antihypertensive effect—NSAIDs, salicylates
Increase:
ALT, AST, alk phos
Decrease:
Hgb
•
B/P with position changes, pulse q4hr; note rate, rhythm, quality
Hypersensitivity reactions, including anaphylaxis
Myalgia, arthralgia; may cause rhabdomyolysis
•
Baselines of renal, hepatic studies before therapy begins
•
Edema in feet, legs daily
•
Skin turgor, dryness of mucous membranes for hydration status
•
Therapeutic response: decreased B/P
•
To comply with dosage schedule, even if feeling better
•
To notify prescriber of fever; chest pain; swelling of hands, feet, face, lip, or tongue
•
That excessive perspiration, dehydration, diarrhea may lead to fall in B/P; consult prescriber if these occur
•
That product may cause dizziness; to avoid hazardous activities until effect is known
Black Box Warning:
Not to take this product if pregnant or breastfeeding, or if have had an allergic reaction to product
•
To take missed dose as soon as possible unless within 1 hr before next dose
•
That therapeutic effect may take 2-3 wk
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTeptifibatide (Rx)
(ep-tih-fib′ah-tide)
Integrilin
Func. class.:
Antiplatelet agent
Chem. class.:
Glycoprotein IIb/IIIa inhibitor
Platelet glycoprotein antagonist; this agent reversibly prevents fibrinogen, von Willebrand’s factor from binding to the glycoprotein IIb/IIIa receptor, thus inhibiting platelet aggregation
Acute coronary syndrome including those undergoing percutaneous coronary intervention (PCI)
Hypersensitivity, active internal bleeding; history of bleeding, stroke within 2 yr; major surgery with severe trauma, severe hypertension, history of intracranial bleeding, current or planned use of another parenteral GP IIb/IIIa inhibitor, dependence on renal dialysis, coagulopathy, AV malformation, aneurysm
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, bleeding, impaired renal function
Calculator
• Adult:
IV BOL
180 mcg/kg as soon as diagnosed, max 22.6 mg, then
IV CONT
2 mcg/kg/min until discharge or CABG up to 72 hr, max 15 mg/hr
• Adult:
IV BOL
180 mcg/kg given immediately before PCI then 2 mcg/kg/min × 18 hr CONT IV INF and a second 180-mcg/kg bolus by 10 min after 1st bolus; continue inf for up to 18-24 hr at rate of 1 mcg/kg/min
• Adult:
IV
maintenance CCr <50 ml/min, 1 micro mcg/kg/min, max rate 7.5 mg/hr; CCr <10 ml/min, contraindicated
Available forms:
Sol for inj 2 mg/ml (10 ml), 0.75 mg/ml (100 ml)
•
Aspirin and heparin may be given with this product; check for bleeding
•
D/C heparin before removing femoral artery sheath, after PCI
•
After withdrawing bolus dose from 10-ml vial, give IV push over 1-2 min
•
Follow bolus dose with continuous inf using pump; give product undiluted directly from 100-ml vial, spike 100-ml vial with vented inf set, use caution when centering spike on circle of stopper top
Y-site compatibilities:
Alfentanil, alteplase, amikacin, aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, argatroban, atenolol, atracurium, atropine, azithromycin, aztreonam, bivalirudin, bumetanide, buprenorphine, butorpha
nol, calcium chloride/gluconate, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, ciprofloxacin, cisatracurium, clindamycin, cycloSPORINE, DAPTOmycin, dexamethasone, D
5
/NaCl 0.9%, diazepam, diltiazem, diphenhydrAMINE, DOBUTamine, dolasetron, DOPamine, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, ertapenem, erythromycin, esmolol, famotidine, fentaNYL, fluconazole, fosphenytoin, ganciclovir, gatifloxacin, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, imipenem-cilastatin, inamrinone, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, meperidine, meropenem, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, minocycline, mivacurium, morphine, nalbuphine, naloxone, niCARdipine, nitroglycerin, nitroprusside, NS, octreotide, ofloxacin, ondansetron, oxytocin, palonosetron, pancuronium, PEMEtrexed, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, ranitidine, remifentanil, rocuronium, sodium bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, teniposide, theophylline, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, trimethobenzamide, vancomycin, vecuronium, verapamil, zidovudine, zoledronic acid
Solution compatibilities:
0.9% NaCl, D
5
/0.9% NaCl
CV:
Stroke,
hypotension
GU:
Hematuria
HEMA:
Thrombocytopenia
SYST:
Bleeding, anaphylaxis
Onset within 1 hr, protein binding 25%, half-life 1.5-2 hr, steady state 4-6 hr, metabolism limited, excretion via kidneys
•
Do not give with glycoprotein inhibitors IIb, IIIa
Increase:
bleeding—aspirin, heparin, NSAIDs, anticoagulants, ticlopidine, clopidogrel, dipyridamole, thrombolytics, valproate, abciximab
Increase:
Bleeding risk—arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng
Thrombocytopenia:
platelets, Hgb, Hct, creatinine, PT/APTT baseline INR within 6 hr of loading dose, daily therafter, patients undergoing PCI should have ACT monitored; maintain APTT 50-70 sec unless PCI to be performed; during PCI, ACT should be 200-300 sec; if platelets drop <100,000/mm
3
, obtain additional platelet counts; if thrombocytopenia is confirmed, discontinue product; draw Hct, Hgb, serum creatinine
Bleeding:
gums, bruising, ecchymosis, petechiae; from GI, GU tract, cardiac cath sites, IM inj sites
•
Do not give discolored solutions, those with particulates; discard unused amount
•
Discontinue product prior to CABG
•
All medications PO if possible; avoid IM inj, all catheters
•
About reason for medication and expected results
•
To report bruising, bleeding, chest pain immediately