Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (246 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
OTC
, Rx)
(loe-per′a-mide)
Anti-Diarrheal, Equaline Anti-Diarrheal, Good Sense Anti-Diarrheal, Imodium
, Imodium A-D, Select Brand Anti-Diarrheal, Top Care Anti-Diarrheal, Walgreens Anti-Diarrheal
Func. class.:
Antidiarrheal
Chem. class.:
Piperidine derivative
Do not confuse:
Imodium
/Indocin
Loperamide
/furosemide
Direct action on intestinal muscles to decrease GI peristalsis; reduces volume, increases bulk; electrolytes not lost
Diarrhea (cause undetermined), travelers’ diarrhea, chronic diarrhea, to decrease amount of ileostomy discharge
Unlabeled uses:
Irinotecan-induced diarrhea, irritable bowel syndrome
Hyper-sensitivity, pseudomembranous colitis, constipation, dysentery, GI bleeding/obstruction/perforation, ileus, vomiting
Precautions:
Pregnancy (C), breastfeeding, children <2 yr, hepatic disease, dehydration, gastroenteritis, toxic megacolon, geriatric patients, severe ulcerative colitis
Calculator
• Adult:
PO
4 mg then 2 mg after each loose stool, max 16 mg/day
• Child 9-11 yr:
PO
2 mg then 1 mg after each loose stool, max 6 mg/24 hr
• Child 6-8 yr:
PO
2 mg then 0.1 mg/kg after each loose stool, max 4 mg/day
• Child 2-5 yr:
PO
1 mg then 0.1 mg/kg after each loose stool, max 4 mg/24 hr
• Adult:
PO
4 mg at first sign of late diarrhea (≥24 hr after irinotecan) then 2 mg q2hr × ≥12 hr; at night, 4 mg q4hr
Available forms:
Caps 2 mg; liq 1 mg/5 ml; tabs 2 mg, chew tabs 2 mg
•
Do not break, crush, or chew caps
•
For 48 hr only
•
Do not mix oral sol with other sol
CNS:
Dizziness, drowsiness, fatigue
GI:
Nausea, dry mouth, vomiting, constipation
, abdominal pain, anorexia,
toxic megacolon,
bacterial enterocolitis, flatulence
INTEG:
Rash
MISC:
Hyperglycemia
SYST:
Anaphylaxis, angioedema, toxic epidermal necrolysis
PO:
Onset 1-3 hr, duration 4-5 hr, half-life 9-14 hr, metabolized in liver, excreted in feces as unchanged product, small amount in urine
Increase:
CNS depression—alcohol, antihistamines, analgesics, opioids, sedative/hypnotics
Increase:
CNS depression—chamomile, hops, kava, valerian
•
Stools:
volume, color, characteristics, frequency; bowel pattern before product; rebound constipation
•
Electrolytes (potassium, sodium, chlorine) if receiving long-term therapy
•
Skin turgor q8hr if dehydration is suspected; fluid replacement
•
Response after 48 hr; if no response, product should be discontinued
•
Dehydration, CNS problems in children, those with hepatic disease
•
Abdominal distention, toxic megacolon; may occur with ulcerative colitis
•
Storage in tight container
•
Therapeutic response: decreased diarrhea (48 hr); decreased chronic diarrhea (10 days)
•
To avoid OTC products unless directed by prescriber
•
That ileostomy patient may take product for extended time
•
If drowsiness occurs, not to operate machinery
•
To use hard candy, sips of water for dry mouth
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(low-pin′ah-ver/ri-toe′na-veer)
Kaletra
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
Inhibits human immunodeficiency virus (HIV-1) protease and prevents maturation of the infectious virus
HIV-1 in combination with or without other antiretrovirals
Hypersensitivity to this product or polyoxyethylated castor oil (oral solution), CYP3A4 metabolized products
Precautions:
Pregnancy (C), breastfeeding, hepatic disease, pancreatitis, diabetes, hemophilia, AV block, hypercholesterolemia, immune reconstitution syndrome, neonates, cardiomyopathy, congenital long-QT prolongation, hypokalemia, elderly patients, Grave’s disease, polymyositis, Guillain-Barré syndrome, children, HBV/HCVCO-infection
Calculator
• Adult:
PO
400 mg lopinavir/100 mg ritonavir bid or 800 mg lopinavir/200 mg ritonavir per day may be administered to patients with <3 lopinavir resistance–associated substitutions (L10F/I/R/V, K20M/N/R, L24I, L33F, M36I, I47V, G48V, 154L/T/V, V82A/C/F/S/T, and I84V); do not give once-daily dosing with concomitant carBAMazepine, PHENobarbital, or phenytoin; do not give as once daily dosing with efavirenz, nevirapine, (fos)amprenavir, nelfinavir
• Pregnant adults:
PO
400 mg lopinavir/100 mg ritonavir bid, may need 600 mg lopinavir/150 mg ritonavir bid in the 2nd/3rd trimesters; once-daily dosing is not recommended; a preferred PI-based regimen for pregnant patients combines twice-daily lopinavir; ritonavir with zidovudine and either lamiVUDine or emtricitabine
• Adult receiving concomitant efavirenz, nelfinavir, or nevirapine:
PO TABS,
500 mg lopinavir/125 mg ritonavir bid;
CAPS/SOL
, 533 mg lopinavir/133 mg ritonavir bid
• Adolescent/child/infant >6 mo:
The once-daily regimen is not recommended in pediatric patients; capsules are not recommended for use in patients ≤40 kg; a preferred PI-based regimen for all children combines lopinavir/ritonavir with a dual NRTI; a lopinavir/ritonavir plus dual NRTI regimen is an alternative option in adolescents
Available forms:
Oral solution 400 mg lopinavir/100 mg ritonavir/5 ml; tablets 100 mg lopinavir/25 mg ritonavir, 200 mg lopinavir/50 mg ritonavir, cup 133.3/33.3 mg
•
TAB:
take without regard to food; swallow whole, do not crush, break, chew
•
CAP:
must take with food
•
ORAL SOL:
shake well, use calibrated measuring device
•
Drug resistance testing should be done before beginning therapy in antiretroviral-naive patients and before changing therapy for treatment failure
•
For adults and adolescents, therapy is recommended in those with a CD4 ≤500/mm
3
, who is pregnant, who has HIV-associated nephropathy, or who is being treated for hepatitis B (HBV) infection; therapy should be offered to patients at risk of transmitting HIV to sexual partners; treatment in those with a CD4 count >500/mm
3
may be considered
•
For children, use is recommended in any symptomatic patient; for asymptomatic or mildly symptomatic children ≥5 years, therapy is recommended for those with HIV RNA ≥100,000 copies/ml or CD4 <500/mm
3
; for asymptomatic or mildly symptomatic children 1–4 yr, therapy is recommended for patients with HIV RNA ≥100,000 copies/ml or CD4 <25%
•
For infants <12 mo, therapy is recommended regardless of clinical status, CD4 percentage, or viral load
CNS:
Paresthesia, headache,
seizures,
fever, dizziness, insomnia, asthenia,
intracranial bleeding, encephalopathy
CV:
QT, PR interval prolongation, deep vein thrombosis
EENT:
Blurred vision, otitis media, tinnitus
GI:
Diarrhea, buccal mucosa ulceration, abdominal pain, nausea, taste perversion, dry mouth, vomiting, anorexia
INTEG:
Rash
MISC:
Asthenia,
angioedema, anaphylaxis, Stevens–Johnson syndrome,
increase lipids, lipodystrophy
MS:
Pain,
rhabdomyolysis,
myalgias
Well absorbed, 98% protein binding, hepatic metabolism, peak 2-4 hr, terminal half-life 6 hr
Increase:
Toxicity—amiodarone, astemizole, azole antifungals, benzodiazepines, buPROPion, CISapride, cloZAPine, desipramine, dihydroergotamine, encainide, ergotamine, flecainide, HMG-CoA reductase inhibitors, interleukins, meperidine, midazolam, pimozide, piroxicam, propafenone, propoxyphene, quiNIDine, ranolazine, saquinavir, terfenadine, triazolam, zolpidem
Increase:
QT prolongation—class 1A/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine, CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl, CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
Increase:
Ritonavir levels—fluconazole
Increase:
Level of both products—clarithromycin, ddI
Increase:
Levels of bosentan
Decrease:
Ritonavir levels—rifamycins, nevirapine, barbiturates, phenytoin
Decrease:
Levels of anticoagulants, atovaquone, divalproex, ethinyl estradiol, lamoTRIgine, phenytoin, sulfamethoxazole, theophylline, voriconazole, zidovudine
Increase:
AST, ALT, CPK, cholesterol, GGT, triglycerides, uric acid
Decrease:
Hct, Hgb, RBC, neutrophils, WBC
Decrease:
Ritonavir levels—St. John’s wort; avoid concurrent use
Avoid use with red yeast rice, evening primrose oil
•
HIV: viral load, CD4 at baseline, throughout therapy; blood glucose, plasma HIV RNA, serum cholesterol/lipid profile; resistance testing before starting therapy and after treatment failure
•
Signs of infection, anemia
•
Hepatic studies: ALT, AST
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, discontinue product; monitor hydration
•
Skin eruptions; rash
Rhabdomyolysis:
Muscle pain, increased CPK, weakness, swelling of affected muscles; if these occur and if confirmed by CPK, product should be discontinued
QT prolongation:
ECG for QT prolongation, ejection fraction; assess for chest pain, palpitations, dyspnea
Serious skin disorders:
Stevens–Johnson syndrome, angioedema, anaphylaxis
•
Therapeutic response: improvement in HIV symptoms; improving viral load, CD4+ T cells
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
That product is not a cure for HIV; that opportunistic infections can continue to be acquired
•
That redistribution of body fat or accumulation of body fat may occur
•
That others can continue to contract HIV from patient
•
To avoid OTC, prescription medications, herbs, supplements unless approved by prescriber; not to use St. John’s wort because it decreases product’s effect
•
That regular follow-up exams and blood work will be required