Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (160 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ez′moe-lole)
Brevibloc
Func. class.:
β-Adrenergic blocker (antidysrhythmic II)
Do not confuse:
esmolol
/Osmitrol
Brevibloc
/Brevital
Competitively blocks stimulation of β
1
-adrenergic receptors in the myocardium; produces negative chronotropic, inotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, decreases O
2
consumption in myocardium; also decreases renin-aldosterone-angiotensin system at high doses; inhibits β
2
-receptors in bronchial system at higher doses
Supraventricular tachycardia, noncompensatory sinus tachycardia, hypertensive crisis, intraoperative and postoperative tachycardia and hypertension
Unlabeled uses:
Acute MI, ECT, thyroid storm, pheochromocytoma
2nd- or 3rd-degree heart block; cardiogenic shock, CHF, cardiac failure, hypersensitivity, severe bradycardia
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, hypotension, peripheral vascular disease, diabetes, hypoglycemia, thyrotoxicosis, renal disease, atrial fibrillation, bronchospasms, hyperthyroidism, myasthenia gravis
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult:
IV
loading dose 500 mcg/kg/min over 1 min; maintenance 50 mcg/kg/min for 4 min; if no response after 5 min, give 2nd loading dose then increase inf to 100 mcg/kg/min for 4 min; if no response, repeat loading dose then increase maintenance inf by 50 mcg/kg/min (max of 200 mcg/kg/min); titrate to patient response
• Child:
IV
total loading dose of 600 mcg/kg over 2 min, maintenance
IV INF
200 mcg/kg/min, titrate upward by 50-100 mcg/kg/min q5-10min until B/P, heart rate reduced by >10%
Available forms:
Inj 10 mg, 20 mg/ml
•
Do not discontinue product suddenly
•
Store protected from light, moisture; in cool environment
•
Check that correct concentration being given
•
10 mg/ml inj sol needs no dilution, may be used as an IV loading dose using a handheld syringe
•
Ready-to-use bags of premixed isotonic sol of 10 mg/ml and 20 mg/ml available in 100-, 250-ml bags; use controlled inf device, central line preferred; rate is based on patient’s weight
Additive compatibilities:
Aminophylline, atracurium, heparin, potassium chloride, sodium bicarbonate
Y-site compatibilities:
Amikacin, aminophylline, amiodarone, atracurium, butorphanol, calcium chloride, ceFAZolin, cefTAZidime, ceftizoxime, chloramphenicol, cimetidine, cisatracurium, clindamycin, diltiazem, DOPamine, enalaprilat, erythromycin, famotidine, fentaNYL, gentamicin, insulin (regular), labetalol, magnesium sulfate, methyldopate, metroNIDAZOLE, midazolam, morphine, nitroglycerin, nitroprusside, norepinephrine, pancuronium, penicillin G potassium, piperacillin, polymyxin B, potassium chloride, potassium phosphate, propofol, ranitidine, remifentanil, streptomycin, tacrolimus, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vecuronium, voriconazole, zoledronic acid
CNS:
Confusion, lightheadedness, paresthesia, somnolence, fever, dizziness, fatigue, headache, depression, anxiety,
seizures
CV:
Hypotension, bradycardia, chest pain, peripheral ischemia, SOB,
CHF,
conduction disturbances; 1st-, 2nd-, 3rd-degree heart block
GI:
Nausea
, vomiting, anorexia, gastric pain, flatulence, constipation, heartburn, bloating
GU:
Urinary retention, impotence, dysuria
INTEG:
Induration, inflammation at site
, discoloration, edema, erythema, burning pallor, flushing, rash, pruritus, dry skin, alopecia
RESP:
Bronchospasm,
dyspnea, cough, wheeziness, nasal stuffiness,
pulmonary edema
Onset very rapid, duration short, half-life 9 min, metabolized by hydrolysis of ester linkage, excreted via kidneys
•
Avoid use with MAOIs
Increase:
antihypertensive effect—general anesthetics
Increase:
digoxin levels—digoxin
Increase:
α-adrenergic stimulation—ePHEDrine, EPINEPHrine, amphetamine, norepinephrine, phenylephrine, pseudoePHEDrine
Decrease:
action of thyroid hormones
Decrease:
action of esmolol—thyroid hormone
Increase:
β-blocking effect—hawthorn
Decrease:
antihypertensive effect—ephedra
Interference:
glucose/insulin tolerance test
•
CHF:
I&O ratio, weight daily, jugular venous distention, weight gain, crackles, edema
•
Dysrhythmias:
B/P, pulse q4hr; note rate, rhythm, quality; rapid changes can cause shock; if systolic <100 or diastolic <60, notify prescriber before giving product; ECG continuously during inf, hypotension common, if severe, slow or stop infusion
•
Baselines in renal/hepatic studies, blood glucose before therapy begins
•
Bronchospasm:
breath sounds, respiratory pattern
•
Therapeutic response: lower B/P immediately, lower heart rate
•
About reason for use, expected results
•
To notify prescriber if chest pain, SOB, wheezing, hypotension, bradycardia, pain, swelling at IV site occurs
Discontinue product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(es′oh-mep′rah-zohl)
NexIUM
Func. class.:
Antiulcer
Chem. class.:
Proton pump inhibitor, benzimidazole
Do not confuse:
NexIUM
/NexAVAR
Suppresses gastric secretions by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor because it blocks the final step of acid production
Gastroesophageal reflux disease (GERD), adult/child/infant; severe erosive esophagitis, adult/child; treatment of active duodenal ulcers in combination with antiinfectives for
Helicobacter pylori
infection; long-term use for hypersecretory conditions
Hypersensitivity to proton pump inhibitors (PPIs)
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients
Calculator
H. pylori
• Adult:
PO
40 mg/day × 10 days in combination with clarithromycin 500 mg bid × 10 days and amoxicillin 1000 mg bid × 10 days
• Adult:
PO/IV
max 20 mg/day (severe hepatic disease)
• Adult:
PO
20 or 40 mg/day × 4-8 wk; no adjustment needed in renal/liver failure, geriatric patients;
IV
20 or 40 mg/day up to 10 days
• Adolescent and child 12-17 yr:
PO
20 or 40 mg/day 1 hr before meals for ≤8 wk
• Child 1-11 yr and ≥20 kg:
PO
10 mg/day 1 hr before meals for ≤8 wk
• Infant ≥1 mo:
IV
0.5 mg/day over 10-30 min
• Infant 1-11 mo (>7.5-12 kg):
PO
10 mg daily × up to 6 wk
• Infant 1-11 mo (>5-7.5 kg):
PO
5 mg daily × up to 6 wk
• Infant 1-11 mo (3-5 kg):
PO
2.5 mg daily × up to 6 wk
Available forms:
Del rel caps 20, 40 mg; powder for IV inj 20, 40 mg/vial; del rel powder for oral susp 10, 20, 40 mg
•
Swallow caps whole; do not crush or chew; cap may be opened and sprinkled over Tbsp of applesauce
•
Same time daily, 1 hr before meal
•
Oral susp (del rel):
empty contents of packet into container with 1 Tbsp of water, let stand 2-3 min to thicken, restir, give within 30 min of mixing; any residual product should be flushed with more water, taken immediately
•
NG tube (del rel oral susp):
add 15 ml water to contents of packet in syringe, shake, leave 2-3 min to thicken, shake, inject through NG tube within 30 min
•
Reconstitute each vial with 5 ml 0.9% NaCl, D
5
W, LR; give over 3 min
•
Dilute reconstituted sol to 50 ml, give over 30 min, do not admix, flush line with D
5
W, 0.9% NaCl, LR after inf
Solution compatibilities:
D
5
W, LR, 0.9% NaCl
CNS:
Headache, dizziness
GI:
Diarrhea, flatulence
, abdominal pain, constipation, dry mouth,
hepatic failure, hepatitis,
microscopic colitis
INTEG:
Rash
, dry skin
MISC:
Heart failure
RESP:
Cough
,
pneumonia
SYST:
Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
Well absorbed 90%; protein binding 97%; extensively metabolized in liver (CYP2C19); terminal half-life 1-1.5 hr; eliminated in urine as metabolites and in feces; in geriatric patients, elimination rate decreased, bioavailability increased
Increase:
effect, toxicity of diazepam, digoxin, penicillins, saquinavir
Decrease:
effect—atazanavir, nelfinavir, dapsone, iron, itraconazole, ketoconazole, indinavir, calcium carbonate, vit B
12
, clopidogrel
Interference:
sodium, Hgb, WBC, platelets, magnesium
•
GI system: bowel sounds q8hr, abdomen for pain, swelling, anorexia
•
Hepatic failure, hepatitis:
AST, ALT, alk phos at baseline and periodically during treatment
•
Serious skin disorders:
Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
•
Therapeutic response: absence of epigastric pain, swelling, fullness
•
To report severe diarrhea; abdominal pain; black, tarry stools, rash; product may have to be discontinued
•
That hypoglycemia may occur if diabetic
•
To avoid hazardous activities; dizziness may occur
•
To avoid alcohol, salicylates, NSAIDs; may cause GI irritation
•
To take ≥1 hr before meal; not to crush, chew del rel product
•
If cap is unable to be swallowed, whole contents may be mixed with a Tbsp of applesauce