Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (192 page)
Enhances cholinergic functioning by increasing acetylcholine in cerebral cortex
Mild to moderate dementia of Alzheimer’s disease
Unlabeled uses:
Vascular dementia, dementia with Lewy bodies, Pick’s disease
Hypersensitivity to this product, GI bleeding, jaundice, renal failure, breastfeeding, children
Precautions:
Pregnancy (B), geriatric patients, respiratory/renal/hepatic/cardiac disease, seizure disorder, peptic ulcer, asthma, bradycardia, heart block, surgery, urinary tract obstruction
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• Adult:
PO
4 mg bid with morning and evening meals; after 4 wk or more, may increase to 8 mg bid; may increase to 12 mg bid after another 4 wk, usual dose 16-24 mg/day in 2 divided doses;
EXT REL
8 mg/day in
AM
; may increase to 16 mg/day after 4 wk and 24 mg/day after another 4 wk
• Adult:
PO
Child-Pugh 7-9, max 16 mg/day; Child-Pugh 10-15, avoid use
• Adult:
PO
CCr 10-70 ml/min, max 16 mg/day; CCr <9 ml/min, avoid use
Available forms:
Tabs 4, 8, 12 mg; ext rel tabs 8, 16, 24 mg; oral sol 4 mg/ml
•
With meals; take with morning and evening meal (immediate rel); morning (ext rel)
•
Dose increase after minimum of 4 wk at prior dose; if dose is interrupted for ≥3 days, restart at lower dose, titrate to current dose
•
Ext rel in
AM
with food; do not crush, open, or chew
•
Oral sol:
use pipette provided, put in liquid and have patient consume
CNS:
Tremors, insomnia
, depression, dizziness, headache, somnolence, fatigue
CV:
Bradycardia,
chest pain,
AV block
GI:
Nausea, vomiting, anorexia, abdominal distress, flatulence
, diarrhea
GU:
Urinary incontinence, bladder outflow obstruction, hematuria
HEMA:
Anemia
META:
Weight decrease
MS:
Asthenia
RESP:
Upper respiratory tract infection, rhinitis
Rapidly and completely absorbed; metabolized by CYP2D6, 3A4; excreted via kidneys; clearance is lower in geriatric patients, hepatic disease; clearance is 20% lower in females; elimination half-life 7 hr; 18% protein binding
Increase:
Synergistic effect: cholinomimetics, other cholinesterase inhibitors
Increase:
galantamine effect—CYP3A4, CYP2D6 inhibitors (antiretroviral protease inhibitors, ketoconazole, erythromy
cin, conivaptan, delaviridine, diltiazem, efavirenz, fluconazole, fluvoxaMINE, imatinib, itraconazole, clarithromycin, troleandomycin, nefazodone, niCARdipine, verapamil, voriconazole, zafirlukast)
Increase:
GI effects—NSAIDs
Decrease:
galantamine effect—CYP3A4, CYP2D6 inducers (bosentan, carBAMazepine, nevirapine, OXcarbazepine, phenytoin, fosphenytoin/rifabutin, rifampin, rifapentine, troglitazone)
Decrease:
galantamine effect—St. John’s wort
Alzheimer’s disease:
mental status: affect, mood, behavioral changes, depression, attention, confusion; neurologic status: long- and short-term memory, cognitive functioning
•
Hepatic/renal studies: AST, ALT, alk phos, LDH, bilirubin, CBC; BUN, creatinine
•
For severe GI effects: nausea, vomiting, anorexia, weight loss
•
B/P, heart rate, respiration during initial treatment: bradycardia/AV block may occur
•
Fluid status: ensure adequate hydration
•
Assistance with ambulation during beginning therapy
•
Therapeutic response: decreased confusion
•
To notify all prescribers of use
•
About correct procedure for giving oral sol using instruction sheet provided
•
To notify prescriber of severe GI effects; hypo/hypertension, slow heart rate
•
That product is not a cure but relieves symptoms
•
That results may take several weeks or months to occur
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(gan-sye′kloe-vir)
Cytovene, Vitrasert, Zirgan
Func. class.:
Antiviral
Chem. class.:
Synthetic nucleoside analog
Do not confuse:
Cytovene
/Cytosar
Inhibits replication of herpesviruses; competitively inhibits human CMV DNA polymerase and is incorporated, resulting in termination of DNA elongation
Cytomegalovirus (CMV) retinitis in immunocompromised persons, including those with AIDS, after indirect ophthalmoscopy confirms diagnosis; prophylaxis for CMV in transplantation; ophthalmic: acute herpes keratitis
Unlabeled uses:
CMV pneumonia in organ transplant patients; CMV gastroenteritis, esophagitis, colitis; CMV pneumonitis, congenital CMV disease; Epstein-Barr virus; herpes simplex types 1, 2; varicella-zoster, hepatitis B
Hypersensitivity to acyclovir, ganciclovir
Black Box Warning:
Absolute neutrophil count <500, platelet count <25,000 (intravitreal)
Precautions:
Pregnancy (C), breastfeeding, children <6 mo, geriatric patients, preexisting cytopenias, renal function impairment, radiation therapy, hypersensitivity to famciclovir, penciclovir, valacyclovir, valganciclovir
Black Box Warning:
Secondary malignancy, bone marrow suppression, anemia, infertility, neutropenia
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• Adult/adolescent (unlabeled):
IV
5 mg/kg/dose over 1 hr q12hr × 1-2 wk,
then 5 mg/kg/day 7 day/wk, then 6 mg/kg/day × 5 days/wk;
PO
1000 mg tid starting 10 days posttransplant × 14 wk
• Adult:
IV
5 mg/kg/dose given over 1 hr, q12hr × 2-3 wk
• Adult:
IV INF
5 mg/kg given over 1 hr, daily × 7 days/wk or 6 mg/kg/day × 5 days/wk;
PO
1000 mg tid with food or 500 mg q3hr while awake for 6 doses;
INTRAVITREAL
4.5 mg implant
• Adult/adolescent/child ≥2 yr:
OPHTH
1 drop in affected eye 5 times daily
• Adult:
IV
CCr 50-69 ml/min, reduce to 2.5 mg/kg q12hr (induction), 2.5 mg/kg q24hr (maintenance);
PO
1500 mg/day or 500 mg tid;
IV
CCr 25-49 ml/min, reduce to 2.5 mg q24hr (induction); 1.25 mg/kg q24hr (maintenance);
PO
1000 mg/day or 500 mg bid;
IV
CCr 10-24 ml/min, reduce to 1.25 mg/kg q24hr (induction); 0.625 mg/kg q24hr (maintenance);
PO
500 mg/day;
IV
CCr <10 ml/min, reduce to 1.25 mg/kg 3×/wk after hemodialysis (induction); 0.625 mg/kg 3×/wk after hemodialysis (maintenance);
PO
500 mg 3×/wk after hemodialysis
Available forms:
Powder for inj 500 mg/vial; caps 250, 500 mg; implant, intraviteral 4.5 mg; ophth gel 0.15% (Zirgan)
•
With food and a full glass of water
•
Do not open, crush capsules
•
Implanted by surgeon only
•
Handle carefully to prevent damage to coating
•
Reconstitute and dilute IV powder to 2 mg/0.1 ml or 5 mg/0.1 ml, depending on dose; injected using TB syringe
•
Mixed in biologic cabinet using gown, gloves, mask; use cytotoxic handling procedures
•
IV after reconstituting 500 mg/10 ml sterile water for inj (50 mg/ml); shake; further dilute in 50-250 ml D
5
W, 0.9% NaCl, LR, Ringer’s and run over 1 hr; use inf pump, in-line filter
•
Do not give by bolus IV, IM, SUBCUT inj
•
Use reconstituted sol within 24 hr; do not refrigerate or freeze
Y-site compatibilities:
Allopurinol, amphotericin B cholesteryl, CISplatin, cyclophosphamide, DOXOrubicin liposome, enalaprilat, etoposide, filgrastim, fluconazole, gatifloxacin, granisetron, linezolid, melphalan, methotrexate, PACLitaxel, propofol, remifentanil, tacrolimus, teniposide, thiotepa
CNS:
Fever
, chills,
coma,
confusion
, abnormal thoughts, dizziness, bizarre dreams,
headache
, psychosis, tremors, somnolence,
paresthesia
,
weakness
,
seizures,
peripheral neuropathy
CV:
Dysrhythmia, hypo/hypertension
EENT:
Retinal detachment in CMV retinitis, ocular hypertension, ocular pain, conjunctival scarring, cataracts
GI:
Abnormal LFTs, nausea, vomiting, anorexia, diarrhea, abdominal pain
,
hemorrhage, perforation, pancreatitis
GU:
Hematuria,
increased creatinine
, BUN, infertility, decreased sperm count
HEMA:
Granulocytopenia, thrombocytopenia, irreversible neutropenia, anemia, eosinophilia, pancytopenia
INTEG:
Rash
, alopecia,
pruritus
, urticaria, pain at site, phlebitis
RESP:
Dyspnea
Half-life 3-4½ hr; excreted by kidneys (unchanged); crosses blood-brain barrier, CSF, increased bioavailability with fatty foods
Increase:
severe granulocytopenia—zidovudine, antineoplastics, radiation; do not give together
Increase:
ganciclovir toxicity—adriamycin, amphotericin B, cycloSPORINE, dapsone, DOXOrubicin, flucytosine, pentamidine, probenecid, trimethoprim-sulfamethoxazole combinations, vinBLAStine, vinCRIStine, other nucleoside analogs, mycophenolate, tenofovir, tacrolimus, aminoglycosides, NSAIDs
Increase:
seizures—imipenem/cilastatin
Increase:
didanosine effect—didanosine
Increase:
LFTs, creatinine
Decrease:
Hgb, WBC, platelets, neutrophils, granulocytes
•
CMV retinitis:
culture should be completed before starting treatment (urine, blood, throat), ophthalmic exam
•
Infection:
increased temp, sore throat, chills, fever; report to prescriber
Black Box Warning:
Leukopenia/neutropenia/thrombocytopenia:
CBC, WBCs, platelets q2days during 2×/day dosing and then q1wk for leukopenia with daily WBC count in patients with prior leukopenia with other nucleoside analogs or for whom leukopenia counts are <1000 cells/mm
3
at start of treatment
•
Serum creatinine or CCr ≥q2wk, BUN; LFTs; ophthalmic exam
•
For seizures, dysrhythmias
Black Box Warning:
Secondary malignancy: avoid direct contact with powder in caps/solution, if skin contact occurs, wash thoroughly with soap and water; do not get in the eyes
•
Therapeutic response: decreased symptoms or prevention of CMV
•
Do not wear contact lenses while using gel
•
That product does not cure condition; that regular blood tests, ophthalmologic exams are necessary
•
That major toxicities may necessitate discontinuing product
Black Box Warning:
To use contraception during treatment and that infertility may occur; to use barrier contraception for 90 days after treatment; may cause reversible infertility at lower doses, irreversible infertility at higher doses
•
To take PO with food
To report infection:
fever, chills, sore throat; blood dyscrasias: bruising, bleeding, petechiae; to avoid crowds, persons with respiratory infections