Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (258 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mez-al′a-meen)
Apriso, Asacol, Asacol HD, Canasa, Lialda, Pentasa, Rowasa Salofalk
, sf Rowasa
Func. class.:
GI antiinflammatory
Chem. class.:
5-Aminosalicylic acid
Do not confuse:
Asacol
/Ansaid/Os-Cal
May diminish inflammation by blocking cyclooxygenase, inhibiting prostaglandin production in colon; local action only
Mild to moderate active distal ulcerative colitis, proctosigmoiditis, proctitis
Unlabeled uses:
Crohn’s disease
Hypersensitivity to this product or salicylates, 5-aminosalicylates
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, renal disease, sulfite sensitivity, pyloric stenosis
Calculator
• Adult:
RECT
60 ml (4 g) at bedtime, retained for 8 hr × 3-6 wk;
DEL REL TAB (Lialda)
2.4-4.8 g/day × 8 wk;
DEL REL TAB (Asacol)
800 mg tid × 6 wk;
CONTROLLED REL CAP (Pentasa)
1 g qid up to 8 wk;
EXT REL
cap
(Apriso)
1500 mg (4 caps) q
AM
daily up to 6 mo,
RECT SUPP
500 mg bid retained for 1-3 hr × 3-6 wk until remission, may increase tid if needed
• Adult:
PO
(del rel tab: Asacol) 800 mg bid or 400 mg qid;
PO
(del rel cap: Apriso) 1500 mg (4 caps) each
AM
;
PO
(del rel tab: Lialda) 2.4 g (2 tabs) daily with meal
Available forms:
Enema 4 g/60 ml (Rowasa, sf Rowasa); ext rel tab 500 mg; ext rel cap 250, 500 mg (Pentasa); 0.375 g (Apriso); del rel tab 400 mg (Asacol), 800 mg (Asacol HD); del rel tab (Lialda) 1.2 g; rectal supp 1000 mg (Canasa)
•
Swallow tabs whole; do not break, crush, or chew tabs
•
Lialda:
take with meal
•
Apriso caps:
take without regard to meals in
AM
•
Product should be given at bedtime, retained until morning (8 hr); empty bowel before insertion, shake well
•
Moisten before insertion; suppository should be retained for 1-3 hr
CNS:
Headache, fever, dizziness
, insomnia, asthenia, weakness, fatigue
CV:
Pericarditis, myocarditis, chest pain, palpitations
EENT:
Sore throat, cough, pharyngitis, rhinitis
GI:
Cramps, gas, nausea, diarrhea
, rectal pain, constipation
GU:
Nephrotoxicity, interstitial nephritis
INTEG:
Rash, itching
, acne
SYST:
Flulike symptoms, malaise
, back pain, peripheral edema, leg and joint pain, arthralgia, dysmenorrhea,
anaphylaxis,
acute intolerance syndrome
RECT:
Primarily excreted in feces but some in urine as metabolite; half-life 1 hr, metabolite half-life 5-10 hr
•
Do not give H
2
blockers with Apriso
Increase:
nephrotoxicity—NSAIDs
Increase:
action, adverse reactions of azaTHIOprine, mercaptopurine
Decrease:
mesalamine absorption—lactulose, antacids
Decrease:
effect of—warfarin
Increase:
AST, ALT, alk phos, LDH, GGTP, amylase, lipase
•
Allergy to salicylates, sulfonamides;
if allergic reactions occur, discontinue product
•
Renal studies: BUN, creatinine before, periodically during treatment; renal toxicity may occur
•
Bowel disorders:
cramps, gas, nausea, diarrhea, rectal pain; if severe, product should be discontinued
•
Therapeutic response: absence of pain, bleeding from GI tract, decrease in number of diarrhea stools
•
That usual course of therapy is 3-6 wk
•
To shake bottle well (rectal susp)
•
About method of rectal administration
•
To inform prescriber of GI symptoms
•
To report abdominal cramping, pain, diarrhea with blood, headache, fever, rash, chest pain; product should be discontinued
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(met-for′min)
Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet
Func. class.:
Antidiabetic, oral
Chem. class.:
Biguanide
Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin
Type 2 diabetes mellitus
Unlabeled uses:
Precocious puberty or early-normal onset of puberty to delay menarche; polycystic ovary syndrome, infertility
Hypersensitivity; hepatic disease; creatinine ≥1.5 mg/ml (males), ≥1.4 (females); alcoholism; cardiopulmonary disease; acidemia; acute MI; cardiogenic shock; diabetic ketoacidosis; metabolic acidosis
Black Box Warning:
History of lactic acidosis
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, previous hypersensitivity, thyroid disease, CHF, type 1 diabetes mellitus
Calculator
• Adult:
PO
500 mg bid or 850 mg/day initially then 500 mg weekly or 850 mg q2wk up to 2000 mg/day in divided doses with morning meal, with dosage increased every other wk, max 2550 mg/day,
EXT REL
(Glucophage XR) 500 mg daily with evening meal, may increase by 500 mg per wk, max 2000 mg/day; (Glumetza) 1000 mg daily with food, preferably with
PM
meal, may increase by 500 mg per wk, max 2000 mg daily; (Fortamet) 500-1000 mg daily with
PM
meal, may increase by 500 mg per wk, max 2550 mg daily; regular rel or oral sol 2000-2500 mg/day for ext rel tab, depending on formulation
• Geriatric:
PO
Use lowest effective dose
• Child 8-9 yr:
PO
825 mg/day with
PM
meal
• Child >6 yr:
PO
425 mg/day with
PM
meal
• Adult (female):
PO
500 mg tid
Available forms:
Tabs 500, 850, 1000 mg; ext rel tab 500, 850, 1000 mg; oral sol 500 mg/5 ml
•
Immediate rel product:
twice a day given with meals to decrease GI upset, and provide the best absorption; immediate rel tabs crushed, mixed with meal, fluids for patients with difficulty swallowing
•
Ext rel product
may also be taken as single dose; titrate slowly to therapeutic response, side effect tolerance
•
Ext rel tabs: do not chew, break, crush
CNS:
Headache, weakness, dizziness, drowsiness
, tinnitus, fatigue, vertigo,
agitation
CV:
Heart failure
ENDO:
Lactic acidosis,
hypoglycemia
GI:
Nausea, vomiting, diarrhea
, heartburn, anorexia, metallic taste
HEMA:
Thrombocytopenia,
decreased vit B
12
levels
INTEG:
Rash
Excreted by kidneys unchanged 35%-50%, half-life 1½-5 hr, terminal 6-20 hr, peak 1-3 hr
•
Do not give with radiologic contrast media; may cause renal failure
•
Do not use with dofetilide; may cause lactic acidosis
Increase:
metformin level—cimetidine, digoxin, morphine, procainamide, quiNIDine, ranitidine, triamterene, vancomycin
Increase:
hyperglycemia—calcium channel blockers, corticosteroids, estrogens, oral contraceptives, phenothiazines, sympathomimetics, diuretics, phenytoin, β-blockers
Increase:
hyperglycemia—glucosamine
Increase:
hypoglycemia—garlic, green tea, horse chestnut
Decrease:
vit B12
•
Hypoglycemic reactions
(sweating, weakness, dizziness, anxiety, tremors, hunger); hyperglycemic reactions soon after meals; these occur rarely with product, may occur when product combined with sulfonylureas
•
CBC (baseline, q3mo) during treatment; check LFTs periodically, AST, LDH, renal studies: BUN, creatinine during treatment; glucose, A1c; folic acid, vit B
12
q1-2yr
•
Surgery:
product should be discontinued temporarily for surgical procedures when patient is NPO or if contrast media is used, resume when patient is eating
Black Box Warning:
Lactic acidosis:
malaise, myalgia, abdominal distress; risk increases with age, poor renal function; monitor electrolytes, lactate, pyruvate, blood pH, ketones, glucose; suspect in any diabetic patient with metabolic acidosis, with ketoacidosis; immediately stop product if hypoxemia or significant renal dysfunction occurs
•
Conversion from other oral hypoglycemic agents; change may be made without gradual dosage change; monitor serum glucose, urine ketones tid during conversion
•
Storage in tight container in cool environment
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; blood glucose, A1c at normal level
Black Box Warning:
Lactic acidosis:
hyperventilation, fatigue, malaise, chills, myalgia, somnolence; to notify prescriber immediately; stop product
•
To regularly self-monitor blood glucose with blood-glucose meter
•
About symptoms of hypo/hyperglycemia, what to do about each (rare)
•
That product must be continued on daily basis; about consequences of discontinuing product abruptly
•
To avoid OTC medications, alcohol unless approved by prescriber
•
That diabetes is a lifelong illness; that product is not a cure, only controls symptoms
•
To carry emergency ID and glucagon emergency kit
•
That Glucophage XR tab may appear in stool
•
To take with meals, not to break, crush, chew ext rel product
•
About signs, symptoms of hypo/hyperglycemic reactions