Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (186 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(for-moh′ter-ahl)
Foradil Aerolizer, Oxeze
, Perforomist
Func. class.:
Bronchodilator
Chem. class.:
β-Adrenergic agonist
Do not confuse:
Foradil
/Toradol
Has β
1
and β
2
action; relaxes bronchial smooth muscle and dilates the trachea and main bronchi by increasing levels of cAMP, which relaxes smooth muscles; causes increased contractility and heart rate by acting on β-receptors in heart
Maintenance, treatment of asthma, COPD; prevention of exercise-induced bronchospasm
Hypersensitivity to sympathomimetics, monotherapy for asthma, COPD, status asthmaticus
Precautions:
Pregnancy (C), geriatric patients, cardiac disorders, hyperthyroidism, diabetes mellitus, prostatic hypertrophy, hypertension, African descendants, aneurysm
Black Box Warning:
Asthma-related death
Calculator
• Adult and child ≥5 yr:
INH
AM
and
PM
long-term 1 cap (12 mcg) q12hr using aerolizer inhaler
• Adult:
INH
12 mcg q12hr
• Adult and child ≥12 yr:
INH
prn occasionally 1 cap (12 mcg) ≥15 min before exercise, do not use additional doses for ≥12 hr
Available form:
INH powder in cap 12 mcg; nebulizer sol for INH 20 mcg/2 ml
•
Place cap in aerolizer inhaler; cap is punctured; do not wash aerolizer inhaler
•
Pull off cover, twist mouthpiece to open, push buttons in; make sure the 4 pins are visible; remove cap from blister pack, place cap in chamber; twist to close, press (a click will be heard), release; patient should exhale, place inhaler in mouth, inhale rapidly
CNS:
Tremors
,
anxiety
, insomnia, headache, dizziness, stimulation
CV:
Palpitations, tachycardia, hypertension, chest pain
GI:
Nausea, vomiting, xerostomia
RESP:
Bronchial irritation, dryness of oropharynx,
bronchospasms
(overuse), infection, inflammatory reaction (child)
Onset 15 min; peak 1-3 hr; duration 12 hr; metabolized in liver, lungs, GI tract; half-life 10 hr
Increase:
serious dysrhythmias—MAOIs, tricyclics
Increase:
hypokalemia—loop/thiazide diuretics
Increase:
effects of both products—other sympathomimetics, thyroid hormones
Increase:
QT prolongation—class IA/III antiarrhythmics, phenothiazines, pimozide, haloperidol, risperiDONE, sertindole, ziprasidone, amoxapine, arsenic trioxide, chloroquine, clarithromycin, dasatinib, dolasetron, droperidol, erythromycin, halofantrine, halogenated anesthetics, levomethadyl, maprotiline, methadone, some quinolones, ondansetron, paliperidone, palonosetron, pentamidine, probucol, ranolazine, SUNItinib, tricyclics, vorinostat
Decrease:
action when used with β-blockers
•
Respiratory function: B/P, pulse, lung sounds; note sputum color, character; respiratory function tests before, during treatment
•
Cardiac status: hypertension, palpitations, tachycardia
•
For paresthesias, coldness of extremities; peripheral blood flow may decrease
•
Storage at room temp; protection from heat, moisture
•
Therapeutic response: ease of breathing
Black Box Warning:
Asthma-related death, severe asthma exacerbations; if wheezing worsens and cannot be relieved during an acute asthma attack, immediate medical attention should be sought
•
To rinse mouth after use
•
About correct use of inhaler/nebulizer (review package insert with patient); to avoid getting aerosol in eyes
•
About all aspects of product; to avoid smoking, smoke-filled rooms, persons with respiratory infections; not to swallow caps
Administration of β-blocker
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(fos-am-pren′a-veer)
Lexiva, Telzir
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
A prodrug of amprenavir; inhibits human immunodeficiency virus (HIV) protease, which prevents maturation of the infectious virus
HIV-1 infection in combination with antiretrovirals
Hypersensitivity to protease inhibitors
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, hepatic disease, hemolytic anemia, diabetes, sulfa sensitivity, autoimmune disease with immune reconstitution
Calculator
• Adult:
PO
1400 mg bid without ritonavir or fosamprenavir 1400 mg/day and with ritonavir 200 mg/day or fosamprenavir 700 mg bid and ritonavir 100 mg bid
• Infant/child ≥4 wk, adolescents:
PO
30 mg/kg bid max 1400 mg/dose, without ritonavir
• Adult:
PO
700 mg bid and ritonavir 100 mg bid
• Child/adolescent ≥20 kg:
PO
18 mg/kg bid with ritonavir 3 mg/kg bid
• Child/adolescent 15 kg to <20 kg:
PO
23 mg/kg bid with ritonavir 3 mg/kg bid
• Child/adolescent 11 kg to <15 kg:
PO
30 mg/kg bid with ritonavir 3 mg/kg bid
• Child/adolescent <11 kg:
PO
45 mg bid with ritonavir 7 mg bid
• Infant ≥6 mo: 15 kg to <20 kg:
PO
susp 23 mg/kg bid with ritonavir 3 mg/kg bid
• Infant ≥6 mo: 11 kg to <15 kg:
PO
susp 30 mg/kg bid with ritonavir 3 mg/kg bid
• Infant ≥6 mo: <11 kg:
PO
susp 45 mg/kg bid with ritonavir 7 mg/kg bid
• Adult:
PO
add another 100 mg/day of ritonavir for a total of 300 mg/day when all 3 products given
• Adult:
PO
(Child-Pugh 5-6) 700 mg bid without ritonavir (treatment-naive patients) or 700 mg bid with ritonavir 100 mg daily (treatment-naive or experienced patients); (Child-Pugh 7-9) 700 mg bid without ritonavir (treatment-naive patients) or 450 mg bid with ritonavir 100 mg daily (treatment-naive or experienced patients); (Child-Pugh 10-15) 350 mg bid without ritonavir (treatment-naive patients) or 300 mg bid with ritonavir 100 mg daily (treatment-naive or experienced patients)
Available forms:
Tabs 700 mg (equivalent to 600 mg amprenavir); oral susp 50 mg/ml
•
Tab:
without regard to food
•
Oral susp:
give without food (adult), with food (pediatric); if vomiting occurs within 30 min of dose, readminister; shake vigorously before dose, use calibrated device
CNS:
Headache, fatigue, depression, oral paresthesia
GI:
Nausea, diarrhea, vomiting, abdominal pain
INTEG:
Rash, pruritus
MISC:
Redistribution or accumulation of body fat, hyperglycemia,
Stevens-Johnson syndrome
Prodrug of amprenavir, peak 1½-4 hr; 90% protein binding; metabolized in liver by cytochrome P4503AY (CYP3A4); excretion of unchanged product minimal; half-life 7.7 hr
Increase:
effect of—warfarin
Serious life-threatening reactions:
amiodarone, calcium channel blockers, lidocaine, pimozide, ergots, midazolam, triazolam, flecainide, lovastatin, simvastatin, propafenone
Increase:
effect of—ARIPiprazole, rifbutin, ketoconazole, itraconazole, sildenafil, vardenafil
Increase:
toxicity—HMG-CoA reductase inhibitors
Decrease:
effect of oral contraceptives, methadone
Decrease:
fosamprenavir levels—nevirapine, antacids, efavirenz, saquinavir, ranitidine, carBAMazepine, phenytoin, lopinavir/ritonavir, barbiturates, proton-pump inhibitors, H
2
-receptor antagonists, dexamethasone; avoid concurrent use
•
Avoid use with St. John’s wort
Increase:
serum glucose, AST, ALT, triglycerides
•
HIV:
monitor CD4 + T cell count, plasma HIV RNA, serum cholesterol, serum lipid profile
•
Bowel pattern before, during treatment; monitor hydration
•
Skin eruptions, rash, urticaria, itching; allergy to sulfonamides; cross-sensitivity may occur
Stevens-Johnson syndrome; skin reactions, report immediately
•
Immune reconstitution syndrome:
may occur with combination antiretroviral therapy, autoimmune disease may also develop, up to months after treatment starts
•
To avoid taking with other medications unless directed by provider
•
That product does not cure but does manage symptoms; that product does not prevent transmission of HIV to others
•
To use a nonhormonal form of birth control while taking this product
•
That if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
Not to alter dose or stop therapy without talking to physician
•
To advise physician if patient has sulfa allergy
•
To report all medications, including herbal supplements, to physician
•
That patients receiving phosphodiesterase type 5 inhibitors may be at increased risk for PDE5 inhibitor adverse effects