Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (228 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(kee-toe-koe′na-zole)
Extina, Ketoderm
, Ketodan, Nizoral, Nizoral A-D, Xolegel
Func. class.:
Topical antifungal
Chem. class.:
Imidazole derivative
Antifungal activity results from altering cell membrane permeability
Seborrheic dermatitis (immunocompromised), tinea corporis, cruris, pedis, versicolor, dandruff
Hypersensitivity, sulfite allergy
Precautions:
Pregnancy (C), breastfeeding, children
Calculator
• Adult/child
≥
12 yr:
TOP FOAM
apply to affected areas bid × 4 wk
•
GEL
apply to affected areas daily × 2 wk
• Adult:
TOP
cover areas daily × 2 wk
• Adult:
SHAMPOO
wet hair, lather, massage for 1 min, rinse, repeat 2×/wk spaced by 3 days, for up to 8 wk, then as needed
Available forms:
Topical gel, foam, cream 2%; shampoo 1%, 2%
•
For external use only; do not use skin products near the eyes, nose, or mouth, wash hands before and after use
•
Cream/lotion:
Apply to the cleansed affected area, massage gently into affected areas, do not use on skin that is broken or irritated
INTEG:
Irritation, stinging, pustules, pruritus
•
Assess for hypersensitivity, product might need to be discontinued
Assess for sulfate allergy; may be life threatening
•
Decreased itching scaling
•
Topical skin products are not for intravaginal therapy and are for external use only; do not use skin products near the eyes, nose, or mouth, wash hands before and after use
•
Cream/Ointment/Lotion:
Apply a thin film to the cleansed affected area, massage gently into affected areas
•
Foam Formulations:
Do not dispense foam directly onto hands or face; the warmth of the skin will cause the foam to melt; instead, dispense desired amount directly into the cap or onto a cool surface; make sure enough foam is dispensed to cover the affected area(s); if the can feels warm or the foam seems runny, run the can under cold water; to apply, pick up small amounts of the foam with the fingertips and gently massage into the affected areas until the foam disappears
•
To continue for prescribed time, tinea corporis/cruris ≥2 wk
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
, Rx)
(ke-toe-proe′fen)
Apo-Keto
Func. class.:
Nonsteroidal antiinflammatory product (NSAID), antirheumatic
Chem. class.:
Propionic acid derivative
Inhibits COX-1, COX-2; analgesic, antiinflammatory, antipyretic
Mild to moderate pain, osteoarthritis, rheumatoid arthritis, dysmenorrhea; OTC relief of minor aches, pains
Unlabeled uses:
Ankylosing spondylitis, bone pain, gouty arthritis
Pregnancy (D) 2nd/3rd trimester, hypersensitivity to this product, NSAIDs, salicylates; asthma, severe renal/hepatic disease, ulcer disease
Black Box Warning:
Perioperative pain with CABG
Precautions:
Pregnancy (B) 1st trimester, breastfeeding, children, geriatric patients, bleeding, GI/cardiac disorders, hypersensitivity to other antiinflammatory agents
Black Box Warning:
GI bleeding, MI, stroke
Calculator
• Adult:
PO
50 mg qid or 75 mg tid, max 300 mg/day or
EXT REL
200 mg/day
• Adult:
PO
25-50 mg q6-8hr, max 300 mg/day
Available forms:
Caps 50, 75 mg; ext rel cap 200 mg
•
Do not break, crush, or chew ext rel caps
•
Give 30 min before or 2 hr after meals, use full glass of water
CNS:
Dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, headache
CV:
Tachycardia, peripheral edema, palpitations, dysrhythmias, hypertension,
CV thrombotic events, MI, stroke
EENT:
Tinnitus, hearing loss, blurred vision
GI:
Nausea, anorexia, vomiting, diarrhea,
jaundice,
hepatitis,
constipation, flatulence, cramps, dry mouth, peptic ulcer,
GI bleeding
GU:
Nephrotoxicity: dysuria, hematuria, oliguria, azotemia
HEMA:
Blood dyscrasias
INTEG:
Purpura, rash, pruritus, sweating
SYST:
Anaphylaxis
PO:
Peak 1.2 hr; ext rel 6.8 hr, half-life 2-4 hr; 5.4 hr ext rel, metabolized in liver, urine (metabolites), breast milk; 99% plasma protein binding
Increase:
serotonin syndrome—SSRIs, SNRIs
Increase:
hypoglycemia—insulin, sulfonylureas
Increase:
toxicity—cycloSPORINE, lithium, methotrexate, phenytoin, alcohol
Increase:
bleeding risk—anticoagulants, clopidogrel, eptifibatide, plicamycin, thrombolytics, ticlopidine, tirofiban, valproic acid, SSRIs
Increase:
ketoprofen levels—aspirin, probenecid
Increase:
adverse GI reactions—aspirin, corticosteroids, NSAIDs, alcohol
Increase:
hematologic toxicity—radiation, antineoplastics
Decrease:
effect of diuretics, antihypertensives
Increase:
bleeding risk—feverfew, garlic, ginger, ginkgo
Increase:
BUN, alk phos, AST, ALT, LDH, creatinine, bleeding time
•
Pain:
type, location, intensity, ROM before and 1-2 hr after treatment
•
Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb before treatment, periodically thereafter
Aspirin sensitivity, asthma; these patients may be more likely to develop hypersensitivity to NSAIDs
•
Audiometric, ophthalmic exam before, during, after treatment
•
For eye/ear problems: blurred vision, tinnitus; may indicate toxicity
Black Box Warning:
GI bleeding: blood in sputum, emesis, stools
Black Box Warning:
CV thrombotic events: MI, stroke
•
Storage at room temp
•
Therapeutic response: decreased pain, stiffness, swelling in joints; ability to move more easily; decreased fever
•
To report blurred vision, ringing, roaring in ears; may indicate toxicity
•
To avoid driving, other hazardous activities if dizziness, drowsiness occurs, especially in geriatric patients
•
To report immediately change in urine pattern, increased weight, edema, increased pain in joints, fever, blood in urine (indicate nephrotoxicity); rash, itching, blurred vision, ringing in ears, flulike symptoms; blood in urine, vomit, or stools (bleeding)
•
That therapeutic effects may take up to 1 mo; to take with 8 oz water; to sit upright for 1/2 hr after administration to prevent GI irritation, not to crush, chew ext rel products
•
To avoid aspirin, alcohol, corticosteroids, acetaminophen, other medications, supplements unless approved by prescriber
•
To wear sunscreen, protective clothing to prevent photosensitivity
•
To report product use to all health care providers
•
To report planned or suspected pregnancy (D) (2nd/3rd trimester), (C) (1st trimester); avoid breastfeeding