Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (180 page)
See
Appendix B
See
Appendix B
HIGH ALERTfluorouracil (Rx)
(flure-oh-yoor′a-sil)
Adrucil, Carac, Efudex, 5-FU
Func. class.:
Antineoplastic, antimetabolite
Chem. class.:
Pyrimidine analog
Do not confuse:
fluorouracil
/flucytosine
Inhibits DNA, RNA synthesis; interferes with cell replication by competitively inhibiting thymidylate production, specific for S phase of cell cycle
Systemic:
cancer of breast, colon, rectum, stomach, pancreas;
topical:
multiple actinic keratoses, superficial basal cell carcinomas
Unlabeled uses:
Anal, biliary tract, cervical, head and neck, hepatocellular, ovarian cancer
Pregnancy (X), breastfeeding, hypersensitivity, poor nutritional status, serious infections
Black Box Warning:
Bone marrow suppression
Precautions:
Children, renal/hepatic disease, angina
Black Box Warning:
GI bleeding
Calculator
Doses vary widely, based on actual body weight unless obese, then based on lean body weight
• Adult:
IV bolus
300-500 mg/m
2
/day × 4-5 days q28days or 600-1500 mg/m
2
weekly or every other wk; continuous IV infusion: 300-1000 mg/m
2
/day × 4-5 days q4wk or 300 mg/m
2
/day indefinitely, high dose 3000-3400 mg/m
2
over 24-72 hr
• Adult:
IV bolus
400-600 mg/m
2
on days 1 and 8 of every cycle with cyclophosphamide and methotrexate or 600 mg/m
2
day 1 with cyclophosphamide and methotrexate q21-28days
• Adult:
IV bolus
600 mg/m
2
on days 1, 8, 29, 36 with DOXOrubicin and mitoMYcin q8wk
• Adult:
TOP
1% cream/sol 1-2×/day or 2-5% sol for hands
• Adult:
TOP
5% sol or cream 2×/day × 3-12 wk
Available forms:
Inj 50 mg/ml; cream 0.5%, 1%, 5%; sol 1%, 2%, 5%
•
Antiemetic 30-60 min before product to prevent vomiting, for several days thereafter
•
The 1% strength is used on face; higher strengths are used on other parts of the body
•
Wear gloves when applying; may use with a loose dressing; use plastic or wooden applicator
•
Prepared in biologic cabinet using gloves, gown, mask; use cytotoxic handling procedures
•
Undiluted; may inject through
Y
-tube or 3-way stopcock; give over 1-3 min; may be diluted in NS, D
5
W; given as a continuous infusion in plastic containers, do not refrigerate/freeze, protect from light, discard unused portion
Y-site compatibilities:
Acyclovir, alatrofloxacin, alfentanil, allopurinol, amifostine, amikacin, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, argatroban, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, butorphanol, calcium gluconate, CARBOplatin, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZi
dime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, cisatracurium, CISplatin, clindamycin, codeine, cyclophosphamide, cycloSPORINE, DAPTOmycin, dexamethasone, digoxin, DOCEtaxel, DOPamine, doripenem, DOXOrubicin liposomal, enalaprilat, ePHEDrine, ertapenem, erythromycin, esmolol, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem-cilastatin, inamrinone, isoproterenol, ketorolac, labetalol, leucovorin, levorphanol, lidocaine, linezolid, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methylPREDNISolone, metoprolol, metroNIDAZOLE, milrinone, mitoMYcin, mitoXANtrone, morphine sulfate, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, octreotide, ofloxacin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride/phosphates, procainamide, propofol, propranolol, ranitidine, remifentanil, riTUXimab, sargramostim, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, trastuzumab, vasopressin, vecuronium, vinBLAStine, vinCRIStine, vitamin B complex/C, voriconazole, zidovudine, zoledronic acid
CNS:
Lethargy, malaise, weakness, acute cerebellar dysfunction
CV:
Myocardial ischemia,
angina
EENT:
Light intolerance, lacrimation
GI:
Anorexia, stomatitis
, diarrhea, nausea, vomiting,
hemorrhage,
enteritis, glossitis
HEMA:
Thrombocytopenia, leukopenia, myelosuppression, anemia, agranulocytosis
INTEG:
Rash
, fever, photosensitivity,
anaphylaxis
Half-life 20 hr terminal; metabolized in liver; excreted in urine; crosses blood-brain barrier
Increase:
bleeding—anticoagulants, NSAIDs, platelet inhibitors, thrombolytics
Increase:
toxicity—metroNIDAZOLE
Increase:
toxicity, bone marrow depression—radiation or other antineoplastics, leucovorin
Decrease:
antibody response—live virus vaccines
Decrease:
effect of phenytoin
Increase:
AST, ALT, LDH, serum bilirubin, Hct, Hgb, WBC, platelets, 5-HIAA
Decrease:
albumin
Black Box Warning:
Bone marrow suppression:
CBC, differential, platelet count daily (IV); withhold product if WBC is <3500/mm
3
or platelet count is <100,000/mm
3
; notify prescriber of results; product should be discontinued; nadir of leukopenia within 2 wk, recovery 1 mo, if pretreatment of WBC <2,000/mm
3
or platelets <100,000/mm
3
, delay until recovery of counts above this level
•
Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy
•
Hepatic studies before, during therapy: bilirubin, alk phos, AST, ALT, LDH before, during therapy
•
Bleeding:
hematuria, guaiac, bruising, petechiae, mucosa or orifices q8hr
•
Inflammation of mucosa, breaks in skin; buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia
•
GI symptoms: frequency of stools, cramping, intractable vomiting, stomatitis
•
Infection:
those with current infections should be treated before receiving 5-FU, the dose reduced or discontinued if infection occurs
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To avoid crowds, persons with known infection
•
To avoid foods with citric acid, hot or rough texture if stomatitis is present; to drink adequate fluids
•
To report stomatitis: any bleeding, white spots, ulcerations in mouth; that patient should examine mouth daily, report symptoms; viscous lidocaine may be used; rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss, give ice chips for mucositis
•
To report signs of
infection:
fever, sore throat, flulike symptoms
•
To report signs of
anemia:
fatigue, headache, faintness, shortness of breath, irritability
•
To report
bleeding:
to avoid razors, commercial mouthwash, IM inj if counts are low
•
Not to use aspirin products or NSAIDs
•
To use contraception during therapy (men and women), pregnancy (X); to avoid breastfeeding (topical use)
•
Not to receive vaccinations during therapy
•
To use sunscreen or stay out of the sun to prevent photosensitivity
•
About hair loss; to explore use of wigs or other products until hair regrowth occurs
•
To apply topically only to affected areas, being careful around mouth, nose, eyes
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(floo-ox′eh-teen)
PROzac, PROzac Weekly, Sarafem
Func. class.:
Antidepressant, SSRI (selective serotonin reuptake inhibitor)
Do not confuse:
PROzac
/Proscar/ProSom/PriLOSEC
Sarafem
/Serophene
Inhibits CNS neuron uptake of serotonin but not of norepinephrine
Major depressive disorder, obsessive-compulsive disorder (OCD), bulimia nervosa;
Sarafem:
premenstrual dysphoric disorder (PMDD), panic disorder
Unlabeled uses:
Alcoholism, anorexia nervosa, borderline personality disorder, obesity, posttraumatic stress disorder, autism, fibromyalgia, orthostatic hypotension, premature ejaculation
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, diabetes mellitus, narrow-angle glaucoma, cardiac malformations in infants (exposed to FLUoxetine in utero)
Black Box Warning:
Children, suicidal ideation
Calculator
• Adult:
PO
20 mg/day in
AM
; after 4 wk, if no clinical improvement is noted, dose may be increased to 20 mg bid in
AM
,
PM
, max 80 mg/day;
PO
90 mg/wk
• Geriatric:
PO
5-10 mg/day, increase as needed
• Child 8-18 yr:
PO
10-20 mg/day, max 20 mg/day
• Adult:
PO
20 mg/day, may be taken daily 14 days before menses
• Adult:
PO
20-80 mg/day
• Adult:
PO
10 mg q day, max 60 mg/day
• Adult:
PO
20 mg/day, max 80 mg/day
• Adult:
PO
60 mg/day after titration
• Adult:
PO
10-80 mg/day
Available forms:
Caps 10, 20, 40 mg; tabs 10, 20 mg; oral sol 20 mg/5 ml; del rel caps (PROzac Weekly) 90 mg; tab 10, 15, 20 mg (Sarafem)
•
Without regard to meals
•
Crushed if patient is unable to swallow medication whole (tab only)
•
Gum, hard candy, frequent sips of water for dry mouth
•
PROzac Weekly
on the same day each week, swallow whole; do not crush, cut, chew
•
Oral sol:
use oral syringe or calibrated measuring device
CNS:
Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, poor concentration, abnormal dreams, agitation
,
seizures,
apathy, euphoria, hallucinations, delusions, psychosis,
suicidal ideation, neuroleptic malignant syndrome–like reactions,
serotonin syndrome
CV:
Hot flashes, palpitations
, angina pectoris, hypertension,
tachycardia, 1st-degree AV block, bradycardia, MI, thrombophlebitis
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
HEMA:
Hemorrhage
INTEG:
Sweating, rash, pruritus
, acne, alopecia, urticaria,
angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis
META:
Hyponatremia
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
PO:
Peak 6-8 hr, metabolized in liver, excreted in urine, terminal half-life 2-3 days, norfluoxetine active metabolite half-life 4-16 days, steady state 28-35 days, protein binding 94%
Increase:
serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists, selegiline, busPIRone, tryptophan, phenothiazines, haloperidol, loxapine, thiothixene, tricyclics; do not use concurrently
Increase:
bleeding risk—platelet inhibitors, thrombolytics, NSAIDs, salicylates, anticoagulants
Do not use MAOIs with or 14 days prior to FLUoxetine
Increase:
levels or toxicity of carBAMazepine, lithium, digoxin, warfarin, phenytoin, diazepam, vinBLAStine, donepezil, antidiabetics, dorifenacin, paricalcitrol, budesonide, bosentan, thioridazine
Increase:
CNS depression—alcohol, antidepressants, opioids, sedatives
Decrease:
FLUoxetine effect—cyproheptadine
Do not use together; increased risk of serotonin syndrome: St. John’s wort, SAM-e
Increase:
CNS effect—hops, kava, lavender, valerian
Increase:
serum bilirubin, blood glucose, alk phos, BUN, CK
Black Box Warning:
Mental status: mood, sensorium, affect, suicidal tendencies (child/young adult), increase in psychiatric symptoms, depression, panic; monitor for seizures, seizure potential increased, sarafem is not approved for children
•
Bulimia nervosa:
appetite, weight daily, increase nutritious foods in diet, watch for bingeing and vomiting
Allergic reactions/serious skin reactions:
angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, 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; ECG for flattening of T wave, bundle branch, AV block, dysrhythmias in cardiac patients
•
Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient is receiving long-term therapy; check platelets; bleeding can occur, thyroid function, growth rate, weight
•
Hepatic studies: AST, ALT, bilirubin, creatinine, weight weekly; appetite may decrease with product
•
Alcohol consumption; if alcohol is consumed, hold dose until
AM
•
Storage at room temp; do not freeze
•
Safety measures, primarily for geriatric patients
•
Therapeutic response: decreased depression, symptoms of OCD
•
That therapeutic effect may take 1-4 wk
•
To use caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision
•
To avoid alcohol, other CNS depressants
•
To notify prescriber if pregnant, planning to become pregnant, or breastfeeding
•
To change positions slowly because orthostatic hypotension may occur
•
To avoid all OTC products unless approved by prescriber
Black Box Warning:
That suicidal thoughts/behaviors may occur in young adults, children
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
decanoate (Rx)
(floo-fen′a-zeen)
Modecate
hydrochloride (Rx)
Func. class.:
Antipsychotic
Chem. class.:
Phenothiazine, piperazine