Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (159 page)
•
Infection:
temp, characteristics of wounds, urine, stools, sputum, WBCs at baseline and periodically
•
I&O ratio; report hematuria, oliguria in renal disease
•
Hepatic studies: AST, ALT if patient is receiving long-term therapy
•
Hearing at baseline and after treatment
•
Renal studies: urinalysis, protein, blood
•
C&S before product therapy; product may be given as soon as culture is taken; C&S may be repeated after treatment
•
Pseudomembranous colitis:
diarrhea with blood, mucus; abdominal pain, fever; product should be discontinued immediately, notify prescriber
•
Anaphylaxis:
generalized hives, itching, flushing, swelling of lips, tongue, throat, wheezing; have emergency equipment nearby
•
QT prolongation:
may occur (IV >15 mg/min); those with electrolyte imbalances, congenital QT prolongation, elderly at greater risk; correct electrolyte imbalances before treatment, ECG
•
Storage at room temp; store susp in refrigerator
•
Adequate intake of fluids (2 L) during diarrhea episodes
•
Therapeutic response: decreased symptoms of infection
•
To report sore throat, fever, fatigue (could indicate superinfection), rhythm changes in the heart, hearing loss
•
To notify nurse of diarrhea stools, dark urine, pale stools, jaundice of eyes or skin, severe abdominal pain
•
To take at evenly spaced intervals; to complete dosage regimen; to take without food
Withdraw product; maintain airway; administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(e-rith-roe-mye′sin)
Akne-mycin, Ery-sol
Func. class.:
Topical anti-infective, anti-acne
Chem. class.:
Macrolide
Antibacterial activity results from inhibition of protein synthesis; bacteriostatic
Treatment of acne vulgaris
Hypersensitivity, children
Calculator
• Adult/adolescent:
TOP
Apply to affected areas bid,
AM
,
PM
Available forms:
Topical gel, ointment, pledget, solution 2%
•
For external use only; do not use skin products near the eyes, nose, or mouth
•
Wash hands before and after use. Wash affected area and gently pat dry before using
•
Gel/ointment/pledget/solution:
Apply to the cleansed affected area. Massage gently into affected areas
•
Each pledget should be used once and discarded
INTEG:
Burning, rash, pruritus, peeling, irritation
•
Allergic reaction:
Assess for hypersensitivity, product might need to be discontinued
•
Infection
: Assess for number of lesions, severity in acne
•
Decreased lesions in acne
•
That product is for external use only; do not use skin products near the eyes, nose, or mouth
•
To wash hands before and after use, wash affected area and gently pat dry before using
•
Gel/pledget/solution/ointment/lotion:
To apply to the cleansed affected area; massage gently into affected areas
•
That each pledget should be used once and discarded
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(es-sit-tal′oh-pram)
Lexapro
Func. class.:
Antidepressant, SSRI (selective serotonin reuptake inhibitor)
Inhibits CNS neuron uptake of serotonin but not of norepinephrine
General anxiety disorder; major depressive disorder in adults/adolescents
Unlabeled uses:
Panic disorder, social phobia
Hypersensitivity to this product, citalopram
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, renal/hepatic disease, history of seizures
Black Box Warning:
Children/adolescents ≤12 yr, suicidal ideation
Calculator
• Adult:
PO
10 mg/day in
AM
or
PM
; after 1 wk, if no clinical improvement is noted, dose may be increased to 20 mg/day
PM
; maintenance 10-20 mg/day; reassess to determine need for treatment
• Adult:
PO
10 mg/day
Available forms:
Tabs 5, 10, 20 mg; oral sol 5 mg (as base)/5 ml (contains sorbitol)
•
With food or milk for GI symptoms, give with full glass of water
•
Crushed if patient is unable to swallow medication whole
•
Dosage at bedtime if oversedation occurs during the day
•
Gum, hard candy, frequent sips of water for dry mouth
•
Oral sol:
measure with calibrated device
•
Storage at room temp; do not freeze
CNS:
Headache, nervousness, insomnia
,
suicidal ideation,
drowsiness, anxiety, tremor, dizziness, fatigue, sedation, poor concentration, abnormal dreams, agitation
,
seizures,
apathy, euphoria, hallucinations, delusions, psychosis,
neuroleptic malignant-like syndrome
CV:
Hot flashes, palpitations
, angina pectoris,
hemorrhage,
hypertension,
tachycardia,
1st-degree AV block,
bradycardia, MI, thrombophlebitis,
postural hypotension
EENT:
Visual changes, ear/eye pain, photophobia, tinnitus
GI:
Nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, cramps, vomiting, taste changes, flatulence, decreased appetite
GU:
Dysmenorrhea, decreased libido, urinary frequency, UTI
, amenorrhea, cystitis, impotence, urine retention, ejaculation disorder
INTEG:
Sweating, rash, pruritus
, acne, alopecia, urticaria, photosensitivity
MS:
Pain
, arthritis, twitching
RESP:
Infection, pharyngitis, nasal congestion, sinus headache, sinusitis, cough, dyspnea, bronchitis
, asthma, hyperventilation, pneumonia
SYST:
Asthenia, viral infection, fever, allergy, chills
,
serotonin syndrome
PO:
Metabolized in liver; excreted in urine; 56% protein binding; metabolized by CYP2C19, 3A4, half-life 27-32 hr; half-life increased by 50% in geriatric patients
•
Paradoxical worsening of OCD: busPIRone
Increase:
serotonin syndrome—tryptophan, amphetamines, busPIRone, lithium, amantadine, bromocriptine, SSRI, SNRIs, serotonin-receptor agonists, tramadol
Do not use pimozide, MAOIs, with or 14 days before escitalopram
Increase:
CNS depression—alcohol, antidepressants, opioids, sedatives
Increase:
side effects of escitalopram—highly protein-bound products
Increase:
levels or toxicity of carBAMazepine, lithium, warfarin, phenytoin, antipsychotics, antidysrhythmics
Increase:
levels of tricyclics, phenothiazines, haloperidol, diazepam
Increase:
bleeding risk—NSAIDs, salicylates, anticoagulants, SSRIs, platelet inhibitors
Decrease:
escitalopram effect—cyproheptadine
•
St. John’s wort: do not use together, serotonin syndrome may occur
Increase:
CNS effect—kava, valerian
•
Grapefruit juice—increased escitalopram effect
Increase:
serum bilirubin, blood glucose, alk phos
Decrease:
VMA, 5-HIAA
False increase:
urinary catecholamines
Black Box Warning:
Mental status: mood, sensorium, affect,
suicidal tendencies,
increase in psychiatric symptoms, depression, panic, not approved for use in children
•
Appetite with bulimia nervosa, weight daily; increase nutritious foods in diet, watch for binging and vomiting
•
Allergic reactions:
itching, rash, urticaria; product should be discontinued, may need to give antihistamine
•
B/P (lying/standing), pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber
•
Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient receiving long-term therapy; check platelets; bleeding can occur
•
Serotonin syndrome:
nausea, vomiting, sedation, dizziness, sweating, facial flushing, mental changes, shivering, increased B/P; discontinue product, notify prescriber
•
Hepatic studies: AST, ALT, bilirubin, creatinine; thyroid function studies
•
Weight weekly; appetite may decrease with product
•
ECG
for flattening of T wave, bundle branch, AV block, dysrhythmias in cardiac patients
•
Alcohol consumption; if alcohol is consumed, hold dose until
AM
•
Sexual dysfunction:
ejaculation dysfunction, erectile dysfunction, decreased libido, orgasm dysfunction, priapism
•
Assistance with ambulation during therapy, since drowsiness, dizziness occur; safety measures primarily for geriatric patients
•
Therapeutic response: decreased depression
•
That therapeutic effect may take 1-4 wk, may have increased anxiety for first 5-7 days
•
To use caution when driving, performing other activities requiring alertness
because drowsiness, dizziness, blurred vision may occur
•
To avoid alcohol, other CNS depressants; to avoid all OTC products unless approved by prescriber
•
To notify prescriber if pregnant or planning to become pregnant or breastfeeding
•
To change positions slowly, orthostatic hypotension may occur
•
To report signs of urinary retention immediately
Black Box Warning:
That clinical worsening and suicide risk may occur
•
To use MedGuide provided
Activated charcoal, supportive care, serotonin antagonist