Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (231 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(la-koe′sa-mide)
Vimpat
Func. class.:
Anticonvulsant
Chem. class.:
Functionalized amino acid
May act through action at sodium channels; exact action is unknown
Adjunctive therapy for partial seizures
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children <17 yr, geriatric patients, allergies, cardiac/renal/hepatic disease, acute MI, atrial fibrillation/flutter, AV block, bradycardia, CHD, dehydration, depression, dialysis, hazardous activity, electrolyte imbalance, heart failure, labor, PR prolongation, sick sinus syndrome, substance abuse, suicidal ideation, syncope, torsades de pointes
Calculator
• Adult and adolescent ≥17 yr:
PO
50 mg bid, may increase weekly by 100 mg bid to 200-400 mg/day;
IV
50 mg bid, infuse over 30-60 min, may be increased by 100 mg/day weekly up to 200-400 mg/day maintenance
• Adult:
PO/IV
max 300 mg/day for mild to moderate hepatic disease or CCr ≤30 ml/min
Available forms:
Film-coated tabs 50, 100, 150, 200 mg; IV 20 ml single-use vials (200 mg/20 ml); oral sol 10 mg/ml
•
Tablet:
give without regard to meals
•
Oral sol:
measure with calibrated measuring device
•
May give undiluted or mixed in 0.9%NaCl, D
5
, or LR
•
Infuse over 30-60 min
•
Do not use if discolored or if particulates are present; discard unused portions
CNS:
Dizziness, syncope, tremor, vertigo, ataxia, drowsiness, fever, hypoesthesia, paresthesias, depression, fatigue, headache, confusion, irritability, psychologic dependence,
suicidal ideation
CV:
Atrial fibrillation/flutter, AV block, bradycardia, myocarditis, orthostatic hypotension, palpitations, PR prolongation
EENT:
Diplopia, blurred vision, nystagmus, tinnitus
GI:
Nausea, constipation, vomiting,
hepatitis,
diarrhea, dyspepsia
HEMA:
Anemia, neutropenia
INTEG:
Rash, erythema, inj site reaction, pruritus, xerostomia
MS:
Asthenia, dysarthria
SYST:
Drug reaction with eosinophilia, systemic symptoms (DRESS)
Metabolized by liver; excreted by kidneys, 95%; protein binding <15%
PO:
Peak 1-4 hr
IV:
Peak 30-60 min; half-life 13 hr; elimination half-life 15-23 hr
Increase:
PR prolongation—beta-blockers, calcium channel blockers, atazanavir, dronedarone, digoxin, lopinavir, ritonavir
Increase:
lincosamide effect—CYP2C19 inhibitors (fluconazole, isoniazid, miconazole)
Increase:
LFTs
•
Seizures:
duration, type, intensity precipitating factors
•
Renal function: albumin concentration
•
CV status: orthostatic hypotension, PR prolongation; monitor cardiac status throughout treatment
•
Mental status: mood, sensorium, affect, memory (long, short term), depression, suicidal ideation, psychologic dependence
•
Rash, hypersensitivity reactions
•
Pregnancy:
Enroll in UCB Antiepileptic Drugs Registry 1-888-537-7734
•
Storage of PO products/IV vials at room temp; sol is stable for 24 hr when mixed with compatible diluents in glass or PVC bags at room temp
•
Therapeutic response: decrease in severity of seizures
•
Not to discontinue product abruptly; to taper over 1 week because seizures may occur
•
To avoid hazardous activities until stabilized on product
•
To carry emergency ID stating product use
•
To notify prescriber of suicidal thoughts/behaviors, syncope, cardiac changes
•
To notify prescriber if pregnancy is planned or suspected
•
That interactions with other medications may occur
•
To consult MedGuide for proper use, risks
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(lak′tyoo-lose)
Constulose, Enulose, Generlac, Kristalose
Func. class.:
Laxative; ammonia detoxicant (hyperosmotic)
Chem. class.:
Lactose synthetic derivative
Prevents absorption of ammonia in colon by acidifying stool; increases water, softens stool
Chronic constipation, portal-systemic encephalopathy in patients with hepatic disease
Hypersensitivity, low-galactose diet
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, debilitated patients, diabetes mellitus
Calculator
• Adult:
PO
15-30 ml/day (10-20 g), may increase to 60 ml/day prn
• Child:
PO
7.5 ml/day
• Adult:
PO
30-45 ml (20-30 g) tid or qid until stools soft;
RETENTION ENEMA
300 ml (200 g) diluted
• Child:
PO
40-90 ml/day in 3-4 divided doses
• Infant:
PO
2.5-10 ml/day in divided doses
Available forms:
Oral sol (encephalopathy) 10 g/15 ml; oral sol (constipation) 10 g/15 ml
•
With 8 oz fruit juice, water, milk to increase palatability of oral form; for rapid effect, give on empty stomach
•
Increased fluids to 2 L/day; do not give with other laxatives; if diarrhea occurs, reduce dosage
•
Kristalose:
dissolve contents of packet/4 oz water
•
Retention enema
by diluting 300 ml lactose/700 ml of water; administer by rectal balloon catheter
GI:
Nausea, vomiting, anorexia, abdominal cramps
, diarrhea, flatulence, distention, belching
META:
Hypernatremia
Metabolized in colon, excreted by kidneys, onset 1-2 days, peak unknown, duration unknown
•
Do not use with other laxatives (hepatic encephalopathy)
Increase:
GI obstruction—NIFEdipine ext-rel tabs
Decrease:
lactulose effects—neomycin, other oral antiinfectives, antacids
Increase:
laxative action—flax, senna
Increase:
blood glucose (diabetic patients)
Decrease:
blood ammonia
•
Stool:
amount, color, consistency
•
Cause of constipation;
determine whether fluids, bulk, or exercise is missing from lifestyle; use of constipating products
•
Hepatic encephalopathy:
blood ammonia level (30-70 mg/100 ml); may decrease ammonia level by 25%-50%; clearing of confusion, lethargy, restlessness, irritability if portal-systemic encephalopathy
•
Blood, urine electrolytes if product used often; may cause diarrhea, hypokalemia, hyponatremia
•
I&O ratio to identify fluid loss
•
Cramping, rectal bleeding, nausea, vomiting; if these symptoms occur, product should be discontinued
•
Therapeutic response: decreased constipation, decreased blood ammonia level, clearing of mental state
•
Not to use laxatives long term
•
To dilute with water or fruit juice to counteract sweet taste
•
To store in cool environment; not to freeze
•
To take on an empty stomach for rapid action
•
To report diarrhea; may indicate overdose