Mosby's 2014 Nursing Drug Reference (255 page)

• Adult:
PO
40-320 mg/day in divided doses

• Adult:
PO
40 mg qid or 160 mg/day

• Adult:
PO
800 mg/day (oral susp) or 625 mg/day (ES)

• Adult:
PO
20 mg bid

• Adult:
PO
40-320 mg/day in divided doses × ≥2 mo

• 
Oral susp for AIDS patients; shake well

• 
Tablets for carcinoma

• 
Without regard to food

Decrease:
megestrol effect—antidiabetics

Increase:
glucose

• 
PSA levels in men (prostate cancer); blood glucose, LFTs, serum calcium, weight

• 
Effects of alopecia on body image; feelings about body changes

• 
Frequency of stools, characteristics: cramping, acidosis, signs of dehydration (rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness)

• 
Anorexia, nausea, vomiting, constipation, weakness, loss of muscle tone

 
Thrombophlebitis:
Homans’ sign, edema; pain in calf, thigh; notify prescriber immediately

• 
Storage in tight container at room temp

• 
Therapeutic response: decreased tumor size, spread of malignancy; weight gain in AIDS patients; resolved dysfunctional uterine bleeding

• 
To report vaginal bleeding

• 
That nonhormonal contraception should be used during and for 4 mo after treatment; pregnancy (D) tabs, (X) susp

• 
That gynecomastia, alopecia can occur; reversible after discontinuing treatment

 
To recognize signs of fluid retention, thromboemboli; to report these immediately

• 
To monitor blood glucose if diabetic

Black Box Warning:

Bone marrow depression, secondary malignancy, radiation therapy; requires an experienced clinician

• Adult:
PO
6 mg daily × 2-3 wk, adjust dose based on blood counts or 10 mg daily × 7-10 day

• Adult:
IV INF
16 mg/m
²
, reduce with renal insufficiency, give over 15-20 min, give at 2-wk intervals × 4 doses then at 4-wk intervals

• Adult:
PO
200 mcg/kg/day × 5 days q4-5wk

• Adult:
PO
150 mcg/kg/day × 7 days q4wk; when leukocytes normal, give 50 mcg/kg/day maintenance

• Child:
IV
10-35 mg/m
²
q21-28days

• 
Antiemetic 30-60 min before product to prevent vomiting

Y-site compatibilities:
Acyclovir, amikacin, aminophylline, ampicillin, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, CISplatin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin, dexamethasone, diphenhy-drAMINE, DOXOrubicin, doxycycline, droperidol, enalaprilat, etoposide, famotidine, floxuridine, fluconazole, flu-darabine, fluorouracil, furosemide, gallium, ganciclovir, gentamicin, grani-setron, haloperidol, heparin, hydrocortisone, hydrocortisone sodium phosphate, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, LORazepam, mannitol, mechlorethamine, meperidine, mesna, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, miconazole, minocycline, mitoMYcin, mitoXANtrone, morphine, nalbuphine, netilmicin, ondansetron, pentostatin, piperacillin, plicamycin, potassium chloride, prochlorperazine, promethazine, ranitidine, sodium bicarbonate, streptozocin, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vinBLAStine, vinCRIStine, vinorelbine, zidovudine

Increase:
toxicity—antineoplastics, radiation

Increase:
pulmonary toxicity—carmustine

Increase:
renal failure risk—cycloSPORINE

Increase:
enterocolitis risk—nalidixic acid

Increase:
bleeding risk—NSAIDs, anticoagulants, salicylates, thrombolytics, platelet inhibitors

Decrease:
antibody response—live virus vaccines

Black Box Warning:

Bone marrow depression:
CBC, differential, platelet count weekly; withhold product if WBC is <3000/mm
³
or platelet count is <100,000/mm
³
; notify prescriber; recovery usually occurs in 6 wk

• 
Renal studies: BUN, serum uric acid before, during therapy

• 
I&O ratio; report fall in urine output to 30 ml/hr

• 
Infection:
fever, cough, temp, chills, sore throat; notify prescriber

• 
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed; jaundiced skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea

• 
Bleeding:
hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr

• 
Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia

• 
Local irritation, pain, burning, discoloration at inj site

• 
Hyperuricemia:
joint pain, edema, increased uric acid, increase fluids to >2 L unless contraindicated

 
Severe allergic reaction:
rash, pruritus, urticaria, purpuric skin lesions, itching, flushing; assess allergy to chlorambucil; cross-sensitivity may occur

• 
Increase fluid intake to 2-3 L/day to prevent urate deposits, calculi formation

• 
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss

• 
Therapeutic response: decreased tumor size, spread of malignancy

• 
That usually sterility, amenorrhea occur; reversible after discontinuing treatment

• 
To avoid foods with citric acid, hot or rough texture

• 
To report any bleeding, white spots, or ulcerations in mouth to prescriber; to examine mouth daily

• 
To report signs of infection: fever, sore throat, flulike symptoms

• 
To report suspected pregnancy; to use contraception during treatment; pregnancy (D)

• 
To report signs of anemia: fatigue, headache, faintness, SOB, irritability

• 
To avoid use of razors, commercial mouthwash

• 
To avoid use of aspirin products, NSAIDs, alcohol