Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (164 page)
(e-tham′byoo-tole)
Etibi
, Myambutol
Func. class.:
Antitubercular
Chem. class.:
Diisopropylethylene diamide derivative
Do not confuse:
ethambutol
/Ethmozine
Inhibits RNA synthesis, decreases tubercle bacilli replication
Pulmonary TB as an adjunct, other mycobacterial infections
Children <13 yr, hypersensitivity, optic neuritis
Precautions:
Pregnancy (B), breastfeeding, renal disease, diabetic retinopathy, cataracts, ocular defects, hepatic and hematopoietic disorders
Calculator
• Adult/child >13 yr:
PO
15-25 mg/kg/day as single dose, 50 mg/kg 2×/wk, or 25-30 mg/kg 3×/wk
•
CCr 10-50 ml/min, dose q24-36hr; CCr <10 ml/min, dose q48hr
• Adult:
PO
25 mg/kg/day as single dose × 2 mo with at least 1 other product then decrease to 15 mg/kg/day as single dose, max 2.5 g/day
• Child:
PO
15 mg/kg/day
Available forms:
Tabs 100, 400 mg
•
With meals to decrease GI symptoms
•
Antiemetic if vomiting occurs
•
After C&S completed; monthly to detect resistance
•
2 hr before antacids
CNS:
Headache, confusion
, fever, malaise, dizziness,
disorientation
, hallucinations, peripheral neuropathy
EENT:
Blurred vision, optic neuritis, photophobia, decreased visual acuity
GI:
Abdominal distress, anorexia, nausea, vomiting
INTEG:
Dermatitis, pruritus,
toxic epidermal necrolysis,
erythema multiforme
META:
Elevated uric acid, acute gout
, impaired hepatic function
MISC:
Thrombocytopenia,
joint pain,
anaphylaxis
Peak 2-4 hr, half-life 3 hr, metabolized in liver, excreted in urine (unchanged product/inactive metabolites, unchanged product in feces)
•
Delayed absorption of ethambutol: aluminum salts, separate by 4 hr
•
Neurotoxicity: other neurotoxics
•
Hepatic studies weekly × 2 wk then q2mo: ALT, AST, bilirubin; decreased appetite, jaundice, dark urine, fatigue
•
Signs of anemia: Hct, Hgb, fatigue
•
Mental status often: affect, mood, behavioral changes; psychosis may occur
•
C&S, including sputum, before treatment
•
Visual status: decreased activity, altered color perception
•
Serious skin reactions:
toxic epidermal necrolysis
•
Therapeutic response: decreased symptoms of TB, decrease in acid-fast bacteria
•
To avoid alcohol products
•
That compliance with dosage schedule, duration is necessary
•
That scheduled appointments must be kept or relapse may occur
•
To report to prescriber any visual changes; rash; hot, swollen, painful joints; numbness, tingling of extremities
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ee-toe′doe-lak)
Lodine, Lodine XL
Func. class.:
Nonsteroidal antiinflammatory/nonopioid analgesic
Do not confuse:
Lodine
/codeine/iodine
Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis; analgesic, antiinflammatory
Mild to moderate pain, osteoarthritis
Hypersensitivity; patients in whom aspirin, iodides, or NSAIDs have produced asthma; rhinitis, urticaria, nasal polyps, angioedema, bronchospasm
Black Box Warning:
Coronary artery bypass graft surgery (CABG)
Precautions:
Edema, renal/hepatic disease, children, GI ulcers, geriatric patients
Calculator
• Adult:
PO
800-1200 mg/day in divided doses every 6-8 hr initially, then adjust dosage to 600-1200 mg/day in divided doses; do not exceed 1200 mg/day; patients <60 kg not to exceed 20 mg/kg; ext rel 400-1200 mg q day
• Adult:
PO
200-400 mg every 6-8 hr prn for acute pain; do not exceed 1200 mg/day; patients <60 kg, not to exceed 20 mg/kg
Available forms:
Caps 200, 300 mg; tabs 400, 500 mg; ext rel 400, 500, 600 mg
•
Without regard to food
•
Store at room temperature
CNS:
Dizziness, headache, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, lightheadedness, vertigo
CV:
Tachycardia, peripheral edema, fluid retention, palpitations,
dysrhythmias, CHF
EENT:
Tinnitus, hearing loss, blurred vision, photophobia
GI:
Nausea, anorexia, vomiting, diarrhea, jaundice,
cholestatic hepatitis,
constipation, flatulence, cramps, dry mouth, peptic ulcer, dyspepsia, GI bleeding
GU:
Nephrotoxicity: dysuria, hematuria, oliguria, azotemia, cystititus, urinary tract infection
HEMA:
Blood dyscrasias
INTEG:
Erythema, urticaria, purpura, rash, pruritus, sweating,
Stevens–Johnson syndrome
SYST:
Angioedema, anaphylaxis
Peak 1½-2 hr, serum protein binding >99%, half-life 7 hr; metabolized by liver (metabolites excreted in urine)
Increase:
toxicity—cycloSPORINE, digoxin, lithium, methotrexate, phenytoin
Increase:
GI toxicity—aspirin
Decrease:
effect of—etodolac: antacids
Decrease:
effect of—beta blockers, diuretics
•
Pain:
location, frequency, characteristics; relief after medication
•
Blood, renal, liver tests: BUN, creatinine, AST, ALT, Hgb, before treatment, periodically thereafter
•
For GI bleeding: black stools, hematemesis
•
Audiometric, ophthalmic examination before, during, after treatment
•
For eye, ear problems: blurred vision, tinnitus; can indicate toxicity
•
For asthma, aspirin hypersensitivity, nasal polyps that may be hypersensitive to etodolac
•
Therapeutic response: decreased pain, stiffness, swelling in joints, ability to move more easily
•
To report blurred vision or ringing, roaring in the ears; might indicate toxicity
•
Not to break, crush, or chew ext rel tabs
•
To report change in urine pattern, weight increase, edema, pain increase in joints, fever, blood in urine; indicates nephrotoxicity
•
That therapeutic effects can take up to 1 mo
•
To avoid aspirin, NSAIDs, acetaminophen, alcoholic beverages while taking this medication
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
etomidate (Rx)
(e-tom′i-date)
Amidate
Func. class.:
General anesthetic
Induction of general anesthesia
Hypersensitivity, labor/delivery