Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (249 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(lox′a-peen)
Loxapac
, Loxitane
Func. class.:
Antipsychotic, neuroleptic
Chem. class.:
Dibenzoxazepine
Do not confuse:
Loxitane
/Soriatane
Depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmission produced by DOPamine at synapse; exhibits strong α-adrenergic, anticholinergic blocking action; mechanism for antipsychotic effects is unclear
Psychotic disorders, nonpsychotic symptoms associated with dementia
Unlabeled uses:
Depression, anxiety
Hypersensitivity, blood dyscrasias, coma, brain damage, bone marrow depression, alcohol and barbiturate withdrawal states, severe CNS depression, closed-angle glaucoma
Precautions:
Pregnancy (C), breastfeeding, children <16 yr, geriatric patients, seizure disorders, cardiac/renal/hepatic disease, prostatic hypertrophy, cardiac conditions
Black Box Warning:
Increased mortality in elderly patients with dementia-related psychosis
Calculator
• Adult:
PO
10 mg bid-qid initially, may be rapidly increased depending on severity of condition, maintenance 60-100 mg/day
• Geriatric:
PO
5-10 mg daily-bid, increase q4-7days by 5-10 mg, max 250 mg/day
Available forms:
Caps 5, 10, 25, 50 mg; tabs 5, 10, 25, 50 mg; conc 25 mg/ml
•
Reduced dose to geriatric patients
•
Anticholinergic agent if EPS symptoms occur
•
Concentrate mixed in orange or grapefruit juice
CNS:
EPS: pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, headache
,
seizures,
confusion,
neuroleptic malignant syndrome
CV:
Orthostatic hypotension
,
cardiac arrest,
ECG changes, tachycardia
EENT:
Blurred vision, glaucoma
GI:
Dry mouth, nausea, vomiting, anorexia, constipation
, diarrhea, jaundice, weight gain
GU:
Urinary retention, urinary frequency, enuresis, impotence, amenorrhea, gynecomastia
HEMA:
Anemia, leukopenia, leukocytosis, agranulocytosis
INTEG:
Rash
, photosensitivity, dermatitis
RESP:
Laryngospasm,
dyspnea,
respiratory depression
Metabolized by liver, excreted in urine, crosses placenta, enters breast milk, initial half-life 5 hr, terminal half-life 19 hr
PO:
Onset 20-30 min, peak 2-4 hr, duration 12 hr
Increase:
toxicity—EPINEPHrine
Increase:
EPS—other antipsychotics
Increase:
CNS depression—MAOIs, antidepressants, alcohol
Increase:
anticholinergic effects—anticholinergics
Decrease:
effects—guanadrel, guanethidine, levodopa
Increase:
CNS depression—chamomile, cola tree, hops, kava, nettle, nutmeg, skullcap, valerian
Increase:
EPS—betel palm, kava
•
Mental status before initial administration
•
Swallowing of PO product; check for hoarding, giving of product to other patients
•
I&O ratio; palpate bladder if low urinary output occurs, urinary retention may be present
•
Bilirubin, CBC, LFTs q mo
•
Urinalysis recommended before and during prolonged therapy
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep-pattern disturbances
•
B/P standing and lying; pulse, respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg
•
Dizziness, faintness, palpitations, tachycardia on rising
•
EPS
including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
Neuroleptic malignant syndrome:
muscle rigidity, increased CPK, altered mental status, hyperthermia
•
Constipation, urinary retention daily; if these occur, increase bulk, water in diet
•
Supervised ambulation until stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for long periods
•
Increased fluids to prevent constipation
•
Sips of water, candy, gum for dry mouth
•
Storage in airtight, light-resistant container
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech
•
That orthostatic hypotension may occur; to rise from sitting or lying position gradually
•
To avoid hot tubs, hot showers, tub baths because hypotension may occur; that, in hot weather, heat stroke may occur; to take extra precautions to stay cool
•
To avoid abrupt withdrawal of product because EPS may result; that product should be withdrawn slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber; that serious product interactions may occur; to avoid use with alcohol, CNS depressants; that increased drowsiness may occur
•
To avoid hazardous activities until stabilized on medication
•
To use sunscreen during sun exposure to prevent burns
•
About necessity for meticulous oral hygiene because oral candidiasis may occur
•
To report impaired vision, jaundice, tremors, muscle twitching
Lavage; provide an airway, do not use EPINEPHrine
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(loo-bee-pros′tone)
Amitiza
Func. class.:
Gastrointestinal agent —miscellaneous
Locally acting chloride channel activator; enhances a chloride-rich intestinal fluid secretion without altering other electrolytes; increases motility in the intestine, thereby increasing softening and passage of stool
Chronic idiopathic constipation, constipation-predominant irritable bowel syndrome in women >18 yr
Hypersensitivity, GI obstruction
Precautions:
Pregnancy (C), breastfeeding, children, diarrhea, inflammatory bowel disease, abdominal pain, cholelithiasis, fecal impaction, GI/hepatic disease
Calculator
• Adult:
PO
24 mcg bid with food, water
• Adult and adolescent ≥18 yr:
PO
8 mcg bid with food, water
• Adult:
PO For chronic constipation:
16 mcg bid (Child-Pugh B); 8 mcg bid (Child-Pugh C);
for irritable bowel:
8 mcg daily (Child-Pugh C), may be increased if tolerated
Available forms:
Caps 8, 24 mcg
•
With food bid
CNS:
Headache
, dizziness, depression, fatigue, insomnia
CV:
Hypertension, chest pain
GI:
Nausea, abdominal pain, eructation
, abdominal distention, constipation, diarrhea, dry mouth, dyspepsia, flatulence, gastroenteritis viral, gastroesophageal reflux disease, vomiting, fecal incontinence, fecal urgency
GU:
UTI
MISC:
Chest pain, peripheral edema, influenza, pyrexia, viral infection
MS:
Back pain, arthralgia, muscle cramps, pain in extremities
RESP:
Bronchitis, cough, dyspnea, nasopharyngitis, sinusitis, upper respiratory tract infection
Peak 1.14 hr; 94% protein binding; half-life 0.9-1.4 hr; metabolism rapid, extensively in stomach, jejunum
Decrease:
effect by antidiarrheals and anticholinergics
•
Do not use with sodium phosphate monobasic monohydrate, sodium phosphate dibasic anhydrous or with other laxative, purgatives when evacuating bowel prior to radiologic exam or surgery
•
Possible GI obstruction: NIFEdipine ext rel tab
•
GI symptoms:
nausea, abdominal pain, diarrhea
•
Need for continued treatment periodically
•
Storage at room temp
•
Therapeutic response: decreased constipation
•
To notify prescriber of GI symptoms, diarrhea, hypersensitivity reactions