Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (210 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(eye-byoo′tih-lide)
Corvert
Func. class.:
Antidysrhythmic (class III)
Chem. class.:
Methane sulfonamide
Prolongs duration of action potential and effective refractory period
For rapid conversion of atrial fibrillation/flutter, including within 1 wk of coronary artery bypass or valve surgery
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, sinus node dysfunction, 2nd- or 3rd-degree AV block, electrolyte imbalances, bradycardia, renal/hepatic disease, CHF
Black Box Warning:
QT prolongation, torsades de pointes, ventricular arrhythmias, ventricular tachycardia, cardiac dysrhythmias
Calculator
• Adult ≥60 kg: IV INF
1 vial (1 mg) given over 10 min, may repeat same dose after 10 min
• Adult <60 kg: IV INF
0.01 mg/kg given over 10 min, may repeat same dose after 10 min
Available forms:
Inj 0.1 mg/ml
•
Ice compress after stopping inf for extravasation, tubing should be removed and attempt to aspirate product, elevate affected areas
•
Undiluted or diluted in 50 ml 0.9% NaCl, or D
5
W (0.017 mg/ml); give over 10 min
•
Solution is stable for 48 hr refrigerated or 24 hr at room temp
•
Do not admix with other sol, products
•
Reduce dosage slowly with ECG monitoring
•
Stop infusion as soon as arrhythmia is controlled
•
Do not use if discolored or particulate is present
CNS:
Headache
CV:
Hypotension, bradycardia
,
sinus arrest, CHF, dysrhythmias, torsades de pointes,
hypertension, extrasystoles, ventricular tachycardia, bundle branch block, AV block, palpitations, supraventricular extrasystoles, syncope,
prolonged QT interval
GI:
Nausea
Elimination half-life 6 hr, metabolized by liver, excreted by kidneys
Increase:
prodysrhythmia—phenothiazines, tricyclics, tetracyclics, antidepressants, H
1
-receptor antagonists, antihistamines
Increase:
masking of cardiotoxicity—digoxin
•
Do not use within 5 hr of ibutilide: class Ia antidysrhythmics (disopyramide, quiNIDine, procainamide), class III agents (amiodarone, sotalol)
Black Box Warning:
ECG continuously for ≥4 hr to determine product effectiveness; measure PR, QRS, QT intervals, check for PVCs, other dysrhythmias; discontinue if atrial fibrillation/flutter ceases; continue until QT interval corrected for heart rate (QTc) returned to baseline; if used ≥2 days, anticoagulation must be adequate
•
I&O ratio; electrolytes: K, Na, Cl
•
Hepatic studies: AST, ALT, bilirubin, alk phos
•
Dehydration or hypovolemia
•
Rebound hypertension after 1-2 hr
•
Cardiac rate, respiration: rate, rhythm, character, chest pain
•
Therapeutic response: decrease in atrial fibrillation/flutter
•
To report side effects immediately
•
About reason for medication
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERT(eye-dah-roob′ih-sin)
Idamycin PFS
Func. class.:
Antineoplastic, antibiotic
Chem. class.:
Anthracycline glycoside
Do not confuse:
IDArubicin
/DOXOrubicin/DAUNOrubicin/epirubicin
Idamycin
/Adriamycin
Non–cell-cycle specific; topoisomerase II inhibitor; vesicant; intercalcalating between DNA base pairs, causing shape change, low free radicals
Used in combination with other antineoplastics for acute myelocytic leukemia in adults
Unlabeled uses:
Breast cancer, liquid tumors, non-Hodgkin’s lymphoma, ALL, CLL, AML
Pregnancy (D), breastfeeding, hypersensitivity
Black Box Warning:
Myelosuppression, bilirubin >5 mg/dl
Precautions:
Children, gout, bone marrow depression, preexisting CV disease
Black Box Warning:
Renal/hepatic disease, heart failure
Calculator
• Adult: IV
8-12 mg/m
2
/day × 3 days in combination with cytarabine (induction)
• Adolescent/child (unlabeled): IV
10-12 mg/m
2
/day × 3 days
• Adult: IV
CCr >2.5 mg/dl, reduce dose; bilirubin 2.5-5 mg/dl, reduce dose by 50%; bilirubin >5 mg/dl, do not use
Available forms:
Inj 1 mg/ml
•
Ice compress after stopping inf for extravasation
•
Do not give IM/SUBCUT
•
Use cytotoxic handling procedures after preparing in biologic cabinet wearing gown, gloves, mask
•
Antiemetic 30-60 min before product and 6-10 hr after treatment to prevent vomiting
•
After reconstituting 5-mg vial with 5 ml 0.9% NaCl (1 mg/1 ml); give over 10-15 min through
Y
-tube or 3-way stopcock of inf of D
5
or NS; discard unused portion; use caution when needle inserted into vial (negative pressure)
Y-site compatibilities:
Amifostine, amikacin, aztreonam, cimetidine, cladribine, cyclophosphamide, cytarabine, diphenhydrAMINE, droperidol, erythromycin, filgrastim, granisetron, imipenem/CISplatin, magnesium sulfate, mannitol, melphalan, metoclopramide, potassium chloride, ranitidine, sargramostim, thiotepa, vinorelbine
CNS:
Fever, chills,
headache
,
seizures
CV:
Dysrhythmias, CHF, pericarditis, myocarditis,
peripheral edema, angina,
MI, myocardial toxicity
GI:
Nausea, vomiting, abdominal pain, mucositis, diarrhea
,
hepatotoxicity
GU:
Nephrotoxicity,
red urine
HEMA:
Thrombocytopenia, leukopenia, anemia
INTEG:
Rash,
extravasation,
dermatitis,
reversible alopecia
, urticaria; thrombophlebitis and tissue necrosis at inj site; radiation recall
SYST:
Infection,
tumor lysis syndrome
Half-life 22 hr; metabolized by liver; crosses placenta; excreted in bile, urine (primarily as metabolites); 97% protein binding
Increase:
bleeding risk—anticoagulants, salicylates, NSAIDs, thrombolytics; avoid concurrent use
Decrease:
IDArubicin effect—corticosteroids
Increase:
CHF, ventricular dysfunction—trastuzumab
Increase:
ECG changes (QT prolongation, changes in QRS voltage)—class IA/III antidysrhythmias, some phenothiazines, and other products that increase QT prolongation
Increase:
cardiotoxicity—cyclophosphamide
Increase:
toxicity—other antineoplastics or radiation
Decrease:
antibody response—live virus vaccines
Decrease:
calcium, platelets, neutrofils
Increase:
uric acid, phosphate, potassium
Black Box Warning:
CBC, differential, platelet count weekly; notify prescriber of results, severe myelosuppression can occur
•
Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy
Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia
•
I&O ratio; report fall in urine output to <30 ml/hr
•
Monitor temp; fever may indicate beginning infection
Black Box Warning:
Hepatic studies before, during therapy: bilirubin, AST, ALT, alk phos prn or monthly; check for jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
Black Box Warning:
Cardiac toxicity: CHF, dysrythmias, cardiomyopathy; cardiac studies before and periodically during treatment: ECG, chest x-ray, MUGA; ECG: watch for ST-T wave changes, low QRS and T, possible dysrhythmias (sinus tachycardia, heart block, PVCs)
•
Bleeding:
hematuria, guaiac stools, bruising or petechiae, mucosa or orifices
•
Effects of alopecia on body image; discuss feelings about body changes
•
Inflammation of mucosa, breaks in skin
•
Buccal cavity for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
Black Box Warning:
Local irritation, pain, burning at inj site; extravasation (vesicant)
•
GI symptoms: frequency of stools, cramping
•
Strict handwashing technique, gloves, protective clothing
•
Increase fluid intake to 2-3 L/day to prevent urate and calculi formation
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth tid-qid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
•
Storage at room temp for 3 days after reconstituting or 7 days refrigerated
•
Therapeutic response: decreased liquid tumor, spread of malignancy
•
To report signs of CHF, cardiac toxicity, beginning infection
•
That hair may be lost during treatment; that wig or hairpiece may make patient feel better; that new hair may be different in color, texture
•
To avoid foods with citric acid, hot or rough texture
•
To avoid crowds, persons with upper respiratory illness
•
To report any bleeding, white spots, ulcerations in mouth; to examine mouth daily
•
That urine may be red-orange for 48 hr
•
To report if pregnancy is planned or suspected, pregnancy (D)
•
To use contraception during treatment, for ≥4 mo after treatment
•
That all body fluids will change color