Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (195 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(gem-ah-flox′a-sin)
Factive
Func. class.:
Antiinfective
Chem. class.:
Fluoroquinolone
Inhibits DNA gyrase, which is an enzyme involved in replication, transcription, and repair of bacterial DNA
Acute bacterial exacerbation of chronic bronchitis caused by
Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis;
community-acquired pneumonia caused by
Streptococcus pneumoniae
including multiproduct-resistant strains,
H. influenzae, M. catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae, Klebsiella pneumoniae
Unlabeled uses:
Actinetobacter iwoffii
, cystitis,
Klebsiella oxytoca, Legionella pneumophilia, Proteus vulgaris
, pyelonephritis, sinusitis,
Streptococcus pyogenes
(group A β-hemolytic streptococci), urinary tract infection
Hypersensitivity to quinolones
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, hypokalemia, hypomagnesium, renal disease, seizure disorders, excessive exposure to sunlight, psychosis, increased intracranial pressure, history of QT interval prolongation, dysrhythmias, myasthenia gravis, torsades de pointes
Black Box Warning:
Tendon pain/rupture, tendinitis, myasthenia gravis
Calculator
• Adult:
PO
320 mg/day × 5-10 days depending on type of infection
• Adult:
PO
CCr ≤40 ml/min, 160 mg q24hr
Available forms:
Tabs 320 mg
•
2 hr before or 3 hr after aluminum/magnesium antacids, iron, zinc products, multivitamins, buffered products 2 hr before sucralfate
CNS:
Dizziness, headache
, somnolence, depression, insomnia, nervousness, confusion, agitation,
seizures, pseudotumor cerebri
CV:
QT prolongation, vasodilation
EENT:
Visual disturbances
GI:
Diarrhea,
nausea
, vomiting, anorexia, flatulence, heartburn, dry mouth; increased AST, ALT; constipation, abdominal pain, oral thrush, glossitis, stomatitis,
pseudomembranous colitis
GU:
Crystalluria (rare)
HEMA:
Thrombocytopenia, neutropenia
INTEG:
Rash, pruritus, urticaria,
photosensitivity
MS:
Tendinitis,
tendon rupture
SYST:
Anaphylaxis, Stevens-Johnson syndrome
Rapidly absorbed; bioavailability 71%; peak 1-2 hr; half-life 4-12 hr; excreted in urine as active product, metabolites
Increase:
CNS stimulation—NSAIDs
Increase:
toxicity of gemifloxacin—probenecid
Increase:
QT prolongation—class IA, III antidysrhythmics, tricyclics, amoxapine, maprotiline, phenothiazines, haloperidol, pimozide, risperiDONE, sertindole, ziprasidone, β-blockers, chloroquine, cloZAPine, dasatinib, dolasetron, droperidol, dronedarone, flecainide, halogenated/local anesthetics, local anesthetics, lapatinib, methadone, erythromycin, telithromycin, troleandomycin, octreotide, ondansetron, palonosetron, pentamidine, propafenone, ranolazine, SUNItinib, tacrolimus, vardenafil, vorinostat
Decrease:
absorption antacids containing aluminum, magnesium, sucralfate, zinc, iron, give 2 hr before or 3 hr after meals
•
Renal, hepatic studies: BUN, creatinine, AST, ALT; I&O ratio
•
CNS symptoms: insomnia, vertigo, headache, agitation, confusion
Allergic reactions and anaphylaxis:
rash, flushing, urticaria, pruritus, chills, fever, joint pain; may occur a few days after therapy begins; EPINEPHrine and
resuscitation equipment should be available for anaphylactic reaction
•
Pseudomembranous colitis:
bowel pattern daily; if severe diarrhea, fever, abdominal pain occur, product should be discontinued
•
QT prolongation:
avoid use of quinolones in patients with known QT prolongation, females and those with ongoing proarrhythmic conditions (TdP) are at a greater risk; monitor ECG and/or holter monitoring if product is used
•
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
Black Box Warning:
Tendon rupture:
tendon pain, inflammation; if present, discontinue use, more common when used with corticosteroids, discontinue immediately if tendon pain, inflammation occurs
•
Toxic psychosis/pseudotumor cerebri:
headache, blurred vision, neck/shoulder pain, nausea, vomiting, dizziness, tinnitus; discontinue immediately
•
Therapeutic response: negative C&S, absence of signs, symptoms of infection
•
To take with/without food
•
That fluids must be increased to 2 L/day to avoid crystallization in kidneys
•
That if dizziness or lightheadedness occurs, to perform activities with assistance
•
To complete full course of product therapy
•
To contact prescriber if adverse reactions occur
•
To avoid iron- or mineral-containing supplements or aluminum/magnesium antacids, buffered products within 2 hr before and 3 hr after dosing, 2 hr before sucralfate
•
That photosensitivity may occur and sunscreen should be used
•
To use frequent rinsing of mouth, sugarless candy or gum for dry mouth
•
To avoid other medication unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(jen-ta-mye′sin)
Func. class.:
Antiinfective
Chem. class.:
Aminoglycoside
Do not confuse:
gentamicin
/kanamycin
Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit, thus causing misreading of genetic code; inaccurate peptide sequence forms in protein chain, thereby causing bacterial death
Severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues caused by susceptible strains of
Pseudomonas aeruginosa, Proteus, Klebsiella, Serratia, Escherichia coli, Enterobacter, Citrobacter, Staphylococcus, Shigella, Salmonella, Acinetobacter, Bacillus anthracis
, acute PID
Hypersensitivity to this product, other aminoglycosides; fungal/viral/mycobacterial infection
Black Box Warning:
Pregnancy (D), severe renal disease
Precautions:
Breastfeeding, neonates, geriatric patients
Black Box Warning:
Mild renal disease, hearing deficits, myasthenia gravis, Parkinson’s disease, infant botulism
Calculator
• Adult:
IV INF
3-5 mg/kg/day in divided doses q8hr; dilute in 50-200 ml 0.9% NaCl or D
5
W given over 30 min-1 hr;
IV
(pulse dosing, once-daily dosing) (unlabeled) 5-7 mg/kg;
IM
3 mg/kg/day in divided doses q8hr
• Child:
IM/IV
2-2.5 mg/kg q8hr;
IV
(pulse dosing, once daily dosing) (unlabeled) 5 mg/kg
• Neonate and infant:
IM/IV
2.5 mg/kg q8-12hr
• Neonate <1 wk:
IV
2.5 mg/kg q12-24hr
• Adult:
IM/IV
CCr 70-100 ml/min, reduce dose by multiplying maintenance dose by 0.85, give q8-12hr; CCr 50-69 ml/min, reduce as above, give q12hr; CCr 25-49 ml/min, reduce as above, give q24hr; CCr <25 ml/min, reduce as above, give based on serum concentrations, give doses after dialysis
Available forms:
Inj 10, 40 mg/ml; premixed inj 60, 80, 100 mg/50 ml, 120 mg/100 ml
•
IM inj in large muscle mass; rotate inj sites
•
Product in evenly spaced doses to maintain blood level
•
After diluting in 50-200 ml NS, D
5
W; decrease vol of diluent in child; maintain 0.1% sol run over 1/2-1 hr (adults) or up to 2 hr (children); flush IV line with NS, D
5
W after administration
Syringe compatibilities:
Clindamycin
Y-site compatibilities:
Amifostine, amiodarone, amsacrine, atracurium, aztreonam, cefpirome, ciprofloxacin, cyclophosphamide, cytarabine, diltiazem, enalaprilat, esmolol, famotidine, filgrastim, fluconazole, fludarabine, foscarnet, granisetron, HYDROmorphone, IL-2, insulin, labetalol, LORazepam, magnesium sulfate, melphalan, meperidine, meropenem, midazolam, morphine, multivitamins, ondansetron, PACLitaxel, pancuronium, perphenazine, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, tolazine, vecuronium, vinorelbine, vit B/C, zidovudine
CNS:
Confusion, depression, numbness, tremors,
seizures,
muscle twitching,
neurotoxicity,
dizziness, vertigo
CV:
Hypo/hypertension, palpitations, edema
EENT:
Ototoxicity,
deafness
, visual disturbances, tinnitus
GI:
Nausea, vomiting, anorexia;
increased ALT, AST, bilirubin; hepatomegaly,
hepatic necrosis,
splenomegaly
GU:
Oliguria, hematuria, renal damage, azotemia, renal failure, nephrotoxicity,
proteinuria
HEMA:
Agranulocytosis, thrombocytopenia, leukopenia,
eosinophilia, anemia
INTEG:
Rash
, burning, urticaria, dermatitis, alopecia, photosensitivity
Not metabolized, excreted unchanged in urine, crosses placental barrier
IM:
Onset rapid, peak 1-2 hr
IV:
Onset immediate; peak 1-2 hr; plasma half-life 1-2 hr, infants 6-7 hr; duration 6-8 hr
•
Do not use at the same time or physically mix with penicillins
Black Box Warning:
Increase:
ototoxicity, neurotoxicity, nephrotoxicity—other aminoglycosides, amphotericin B, polymyxin, vancomycin, ethacrynic acid, furosemide, mannitol, methoxyflurane, CISplatin, cephalosporins, penicillins, cidofovir, acyclovir
Increase:
effects—nondepolarizing neuromuscular blockers
Increase:
LDH, AST, ALT, bilirubin, BUN, creatinine, eosinophils
Decrease:
Hgb, WBC, platelet, granulocytes
Black Box Warning:
Neuromuscular disease (myasthenia gravis, Parkinson’s disease, infant botulism):
paresthesias, tetany, positive Chvostek’s/Trousseau’s signs, confusion (adults), tetany, muscle weakness (infants); correct electrolyte imbalance
•
Weight before treatment; calculation of dosage is usually based on ideal body weight but may be calculated on actual body weight
Black Box Warning:
Renal disease:
I&O ratio, urinalysis daily for proteinuria, cells, casts; report sudden change in urine output; urine pH if product is used for UTI; urine should be kept alkaline; urine for CCr testing, BUN, serum creatinine; lower dosage should be given with renal impairment (CCr <80 ml/min); toxicity is increased in patients with decreased renal function if high doses are given
•
VS during inf; watch for hypotension, change in pulse
•
IV site for thrombophlebitis, including pain, redness, swelling q30min, change site if needed; discontinue, apply warm compresses to site
•
Serum peak drawn at 30-60 min after IV inf or 60 min after IM inj and trough level drawn just before next dose; blood level should be 2-4 times bacteriostatic level; peak (5-10 mcg/ml), trough (0.5-2 mcg/ml), depending on type of infection
Black Box Warning:
Hearing deficits:
eighth cranial nerve dysfunction by audiometric testing; also ringing, roaring in ears, vertigo; assess hearing before, during, after treatment
•
Dehydration: high specific gravity, decrease in skin turgor, dry mucous membranes, dark urine
•
Overgrowth of infection:
fever, malaise, redness, pain, swelling, perineal itching, diarrhea, stomatitis, change in cough or sputum
•
C&S before starting treatment to identify infecting organism
•
Vestibular dysfunction:
nausea, vomiting, dizziness, headache; product should be discontinued if severe
•
Inj sites for redness, swelling, abscesses; use warm compresses at site
•
Adequate fluids of 2-3 L/day unless contraindicated to prevent irritation of tubules
•
Supervised ambulation, other safety measures with vestibular dysfunction
•
Therapeutic response: absence of fever, draining wounds, negative C&S after treatment
•
To report headache, dizziness, symptoms of overgrowth of infection, renal impairment
Black Box Warning:
To report loss of hearing; ringing, roaring in ears; feeling of fullness in head