Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (251 page)
See
Appendix B
Mag-64
OTC
)
magnesium gluconate (
OTC
)
Mag-G, Magtrate
OTC
)
Mag-Ox 400, Uro-Mag
OTC
)
Freelax, MOM, Phillips’ Milk of Magnesia
OTC
, Rx)
epsom salts; magnesium sulfate (IV)—HIGH ALERT
Func. class.:
Electrolyte; anticonvulsant; saline laxative, antacid
Increases osmotic pressure, draws fluid into colon, neutralizes HCl
Constipation; bowel preparation before surgery or exam; anticonvulsant for preeclampsia, eclampsia (magnesium sulfate); electrolyte
Unlabeled uses:
Magnesium sulfate:
persistent pulmonary hypertension of the
newborn (PPHN), cardiac arrest, CPR, digitoxin/digoxin toxicity, premature labor, seizure prophylaxis, status asthmaticus, torsades de pointes, ventricular fibrillation/tachycardia
Hypersensitivity, abdominal pain, nausea/vomiting, obstruction, acute surgical abdomen, rectal bleeding, heart block, myocardial damage
Precautions:
Pregnancy (A); (B) (magnesium sulfate), renal/cardiac disease
Calculator
• Adult:
PO
(Milk of Magnesia) 15-60 ml at bedtime
• Adult and child >12 yr:
PO
(magnesium sulfate) 15 g in 8 oz water;
PO
(Concentrated Milk of Magnesia) 5-30 ml;
PO
(magnesium citrate) 5-10 oz at bedtime
• Child 2-6 yr:
PO
(Milk of Magnesia) 5-15 ml/day
• Adult and child ≥10 yr:
PO
(male) 350-400 mg/day; (female) 280-300 mg/day; (breastfeeding) 335-350 mg/day; (pregnancy) 320 mg/day
• Child 8-10 yr:
PO
170 mg/day
• Child 4-7 yr:
PO
120 mg/day
• Adult:
PO
200-400 mg in divided doses tid-qid;
IM
1 g q6hr × 4 doses;
IV
5 g (severe)
• Child 6-12 yr:
PO
3-6 mg/kg/day in divided doses tid-qid
• Adult:
IM/IV
4-5 g IV inf; with 5 g
IM
in each gluteus, then 5 g q4hr or 4 g
IV INF,
then 1-2 g/hr
CONT INF,
max 40 g/day or 20 g/48 hr in severe renal disease
• Premature infants >33 wk and term neonates:
IV
(magnesium sulfate) 200 mg/kg over 20-30 min then
CONT IV INF
20-150 mg/kg/hr to maintain blood magnesium levels at 3.5-5.5 mmol/L
• Adult:
IV
(magnesium sulfate) 2 g
• Child:
IV INF
(PALS) (magnesium sulfate) 25-50 mg/kg diluted in D
5
W, given over 10-20 min, max 2 g/dose
• Adult:
IV INF
(magnesium sulfate) 4-6 g given as a loading dose over 20-30 min then 2-4 g/hr
CONT INF;
use infusion pump until contractions cease; continue inf at lowest dose over 12-24 hr;
PO
(magnesium chloride/gluconate/oxide) 648-1200 mg/day elemental magnesium in divided doses
• Adult:
IV
(magnesium sulfate) use ACLS guidelines or 1-2 g in 50-100 ml D
5
W given over 5-20 min in emergent cases or over 5-60 min
Available forms:
Chloride:
sus rel tabs 535 mg (64 mg Mg); enteric tabs 833 mg (100 mg Mg);
citrate:
oral sol 240-, 296-, 300-ml bottles (77 mEq/100 ml);
oxide:
tabs 400 mg; caps 140 mg;
hydroxide:
liq 400 mg/5 ml; conc liq 800 mg/5 ml; chew tabs 300, 600 mg;
sulfate:
powder for oral, bulk packages; epsom salts, bulk packages; inj 10%, 12.5%, 25%, 50%
•
With 8 oz water
•
Refrigerate magnesium citrate before giving
•
Shake susp before using as antacid at least 2 hr after meals
•
Tablets should be chewed thoroughly before patient swallows; give 4 oz of water afterwards
•
Laxative:
give on empty stomach
•
Give deeply in gluteal site
•
Only when calcium gluconate available for magnesium toxicity
•
Dilute 50% sol to ≤20%, give at ≤150 mg/min
•
May dilute to 20% sol, infuse over 3 hr
•
IV at less than 125 mg/kg/hr; circulatory collapse may occur; use inf pump
Y-site compatibilities:
Acyclovir, aldesleukin, amifostine, amikacin, ampicillin, aztreonam, ceFAZolin, cefoperazone, cefotaxime, cefOXitin, cephalothin, cepha-pirin, chloramphenicol, cisatracurium, DOBUTamine, doxycycline, DOXOrubicin liposome, enalaprilat, erythromycin, esmolol, famotidine, fludarabine, gallium, gentamicin, granisetron, heparin, HYDROmorphone, IDArubicin, insulin, kanamycin, labetalol, meperidine, metroNIDAZOLE, minocycline, morphine, moxalactam, nafcillin, ondansetron, oxacillin, PACLitaxel, penicillin G potassium, piperacillin, piperacillin/tazobactam, potassium chloride, propofol, remifentanil, sargramostim, thiotepa, ticarcillin, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vit B complex/C
CNS:
Muscle weakness, flushing, sweating, confusion, sedation, depressed reflexes,
flaccid paralysis,
hypothermia
CV:
Hypotension, heart block,
circulatory collapse,
vasodilation
GI:
Nausea, vomiting, anorexia, cramps
, diarrhea
HEMA:
Prolonged bleeding time
META:
Electrolyte, fluid imbalances
RESP:
Respiratory depression/paralysis
PO:
Onset 1-2 hr
IM:
Onset 1 hr, duration 4 hr
IV:
Duration 1/2 hr
Excreted by kidney, effective anticonvulsant serum levels 2.5-7.5 mEq/L
Increase:
effect of neuromuscular blockers
Increase:
hypotension—antihypertensives
Decrease:
absorption of tetracyclines, fluoroquinolones, nitrofurantoin
Decrease:
effect of digoxin
•
Laxative:
cause of constipation; lack of fluids, bulk, exercise; cramping, rectal bleeding, nausea, vomiting; product should be discontinued
Eclampsia:
seizure precautions, B/P, ECG (magnesium sulfate);
magnesium toxicity:
thirst, confusion, decrease in reflexes; I&O ratio; check for decrease in urinary output
•
Therapeutic response: decreased constipation; absence of seizures (eclampsia), normal serum calcium levels
•
Not to use laxatives for long-term therapy because bowel tone will be lost
•
That chilling improves taste of magnesium citrate
•
To shake suspension well
•
Not to give at bedtime as a laxative; may interfere with sleep; MOM is usually given at bedtime
•
To give citrus fruit after administering to counteract unpleasant taste
•
About reason for product, expected results
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(man′i-tole)
Osmitrol, Resectisol
Func. class.:
Diuretic, osmotic
Chem. class.:
Hexahydric alcohol
Acts by increasing osmolarity of glomerular filtrate, which inhibits reabsorption of water and electrolytes and increases urinary output
Edema; promotion of systemic diuresis in cerebral edema; decrease in intraocular/intracranial pressure; im
proved renal function in acute renal failure, chemical poisoning
Active intracranial bleeding, hypersensitivity, anuria, severe pulmonary congestion, edema, severe dehydration, progressive heart, renal failure
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, dehydration, severe renal disease, CHF, electrolyte imbalances
Black Box Warning:
Acute bronchospasm asthma
Calculator
• Adult:
IV
after initial test dose; if urine output is 30-50 ml/hr × 2 hr, give 20-100 g over a 24-hr period of 15% or 20% sol
• Adult:
IV
after initial test dose; give balance of 50 g of a 20% sol over 1 hr then 5% via
CONT IV INF
to maintain output at 50 ml/hr
• Child (unlabeled):
IV
0.5-2 g/kg as 15%-20% sol, run over 30-60 min; maintenance 0.25-0.5 g/kg q4-6hr
• Adult:
IV
1.5-2 g/kg of 15%-25% sol over 30-60 min
• Adult:
IV
1-2 g/kg then 0.25-1 g/kg q4hr
• Adult and child >12 yr:
5%-10% sol continuously up to 200 g
IV
while maintaining 100-500 ml urine output/hr
Available forms:
Inj 5%, 10%, 15%, 20%, 25%; GU irrigation: 5%
•
Change IV q24hr
•
In 15%-25% sol with filter; rapid inf may worsen CHF; warm in hot water, shake to dissolve if crystals are present, use in-line filter, do not give as direct injection
•
Test dose
with severe oliguria, 0.2 g/kg over 3-5 min; if continued oliguria, give 2nd test dose; if no response, reassess patient
Y-site compatibilities:
Acyclovir, aldesleukin, alemtuzumab, amifostine, amikacin, ampicillin, atropine, aztreonam, bivalirudin, bumetanide, calcium gluconate, caspofungin, ceFAZolin, cefotaxime, cefOXitin, cefTAZidime, ceftizoxime, chloramphenicol, cimetidine, cisatracurium, clindamycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin liposome, doxycycline, enalaprilat, EPINEPHrine, ertapenem, esmolol, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, gentamicin, granisetron, heparin, HYDROmorphone, hydrOXYzine, IDArubicin, imipenem/cilastatin, insulin, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, meperidine, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, morphine, nafcillin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pantoprazole, penicillin G potassium, phenylephrine, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, quinupristin/dalfopristin, ranitidine, remifentanil, sargramostim, sodium bicarbonate, tacrolimus, thiotepa, ticarcillin/clavulanate, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, verapamil, vit B complex with C, voriconazole
CNS:
Dizziness, headache,
seizures, rebound increased ICP,
confusion
CV:
Edema, thrombophlebitis, hypo/hypertension,
tachycardia,
angina-like chest pains, fever, chills,
CHF, circulatory overload
EENT:
Loss of hearing, blurred vision, nasal congestion, decreased intraocular pressure
ELECT:
Fluid, electrolyte imbalances,
acidosis
, electrolyte loss, dehydration, hypo/hyperkalemia
GI:
Nausea, vomiting
, dry mouth, diarrhea
GU:
Marked diuresis, urinary retention, thirst
RESP:
Pulmonary congestion
IV:
Onset 1-3 hr for diuresis, 1/2-1 hr for intraocular pressure, 15 min for cerebrospinal fluid; duration 4-6 hr for intraocular pressure, 3-8 hr for cerebrospinal fluid; excreted in urine; half-life 100 min
Increase:
elimination of mannitol—lithium
Increase:
excretion of salicylates, barbiturates, imipramine, bromides
Increase:
hypokalemia—arsenic trioxide, cardiac glycosides, levomethadyl
Interference:
inorganic phosphorus, ethylene glycol
•
Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily; output every hr prn
•
B/P lying, standing; postural hypotension may occur
•
Electrolytes: potassium, sodium, chloride; include BUN, CBC, serum creatinine, blood pH, ABGs, CVP, PAP
•
Metabolic acidosis:
drowsiness, restlessness
•
Hypokalemia:
postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness, or hyperkalemia
•
Rashes, temp daily
•
Confusion, especially in geriatric patients; take safety precautions if needed
•
Hydration including skin turgor, thirst, dry mucous membranes, provide adequate fluids
•
Blurred vision, pain in eyes before, during treatment
(increased intraocular pressure);
neurologic checks, intracranial pressure during treatment
(increased intracranial pressure)
•
Therapeutic response: improvement in edema of feet, legs, sacral area daily if medication being used with CHF; decreased intraocular pressure, prevention of hypokalemia, increased excretion of toxic substances; decreased ICP
•
To rise slowly from lying or sitting position
•
About the reason for, method of treatment
•
To report signs of electrolyte imbalance, confusion
Discontinue inf; correct fluid, electrolyte imbalances; hemodialysis; monitor hydration, CV status, renal function