Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (269 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mi-kon′a-zole)
Oravig
Desenex, Femizol-M, Fungoid, Tincture, Lotrimin AF, Micatin, Micozole, Monistat-1, Monistat-3, Monistat-7, M-Zole 3, M-Zole 7, Tetterine, Ting, Vagistat-1, Zeasorb-AF
Func. class.:
Antifungal
Chem. class.:
Imidazole
Do not confuse:
miconazole
/clotrimazole/metroNIDAZOLE
Antifungal activity results from disruption of cell membrane permeability
Treatment of topical fungal infection, vulvovaginal candidiasis; athlete’s foot (tinea pedis), jock itch (tinea cruris), and ringworm (tinea corporis)
Hypersensitivity to this product or imidazoles; pregnancy first trimester(vaginal)
Precautions:
Breastfeeding, children
Calculator
• Adult/child >2 yr:
TOP
apply bid × 2-4 wk
• Adult/child >2 yr:
TOP
use × 2 wk, apply sparingly every day
• Adult/child ≥12 yr:
VAG
1 applicatorful of Monistat-7 (100 mg) or 1 supp (100 mg) at bedtime × 7 days, repeat if needed, or Monistat-3 (200 mg) × 3 days or a 1200 mg supp × 1 day
Available forms:
Topical cream, ointment, solution, lotion, powder, aerosol, powder 2%; aerosol spray 2%; vag cream 2, 4%; vag supp 100, 200, 1200 mg
•
Topical skin products are not for intravaginal therapy and are for external use only; do not use skin products near the eyes, nose, or mouth
•
Wash hands before and after use; wash affected area and gently pat dry
•
Cream/Ointment/Lotion/Solution:
Apply a thin film to the cleansed affected area; massage gently into affected areas
•
Solution Formulations:
Apply a thin film to the cleansed affected area; massage gently into affected areas; if using a solution-soaked pledget, patient may use more than 1 pledget per application as needed to treat affected areas, but each pledget should be used only once and then discarded
•
Intravaginal Route:
Only use dosage formulations specified for intravaginal use; intravaginal dosage forms are not for topical therapy; do not ingest
•
Suppository:
Unwrap vaginal ovule (suppository) before insertion; use applicator(s) supplied by the manufacturer
•
Cream:
Use applicator(s) supplied by the manufacturer
CNS:
Headache
GU:
Pruritus, irritation, vaginal burning
INTEG:
Burning, dermatitis, rash
•
Assess for hypersensitivity, product may need to be discontinued
•
Assess for severity of infection
•
Decreasing severity of infection
•
That topical skin products are not for intravaginal therapy and are for external use only; not to use skin products near the eyes, nose, or mouth
•
To wash hands before and after use; wash affected area and gently pat dry
•
Cream/Ointment/Lotion/Solution:
To apply a thin film to the cleansed affected area and massage gently into affected areas
•
Solution Formulations:
To shake well before use, apply a thin film to the cleansed affected area, and massage gently into affected areas
•
To only use dosage formulations specified for intravaginal use; not to ingest intravaginal dosage forms
•
Suppository:
To unwrap vaginal ovule (suppository) before inserting; to use applicator(s) supplied by the manufacturer
•
Cream:
To use applicator(s) supplied by the manufacturer
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(mid′ay-zoe-lam)
Func. class.:
Sedative, hypnotic, antianxiety
Chem. class.:
Benzodiazepine, short-acting
Depresses subcortical levels in CNS; may act on limbic system, reticular formation; may potentiate γ-aminobutyric acid (GABA) by binding to specific benzodiazepine receptors
Preoperative sedation, general anesthesia induction, sedation for diagnostic endoscopic procedures, intubation, anxiety
Unlabeled uses:
Refractory status epilepticus, alcohol withdrawal
Pregnancy (D), hypersensitivity to benzodiazepines, acute closed-angle glaucoma, status asthmaticus
Precautions:
Breastfeeding, children, geriatric patients, COPD, CHF, chronic renal failure, chills, debilitated, hepatic disease, shock, coma, alcohol intoxication
Black Box Warning:
Neonates (contains benzyl alcohol), IV administration, respiratory depression/insufficiency
Calculator
• Adult and child ≥12 yr:
IM
0.07-0.08 mg/kg 1/2-1 hr before general anesthesia
• Child 6 yr-11 yr:
IV
0.025-0.05 mg/kg; total dose of 0.4 mg/kg may be necessary
• Child 6 mo-5 yr:
IV
0.05-0.1 mg/kg; total dose of 0.6 mg/kg may be necessary
• Child 1-6 mo:
IM
0.1-0.15 mg/kg; may give up to 0.5 mg/kg if needed, max 10 mg
• Adult >55 yr:
(ASA I/II)
IV
150-300 mcg/kg over 30 sec; (ASA III/IV) limit dose to 250 mcg/kg (nonpremedicated) or 150 mcg/kg (premedicated)
• Adult <55 yr:
IV
200-350 mcg/kg over 20-30 sec; if patient has not received premedication, may repeat by giving 20% of original dose; if patient has received premedication, reduce dose by 50 mcg/kg
• Child:
No safe and effective dose established; however, doses of 50-200 mcg/kg
IV
have been used
• Adult:
IV
0.01-0.05 mg/kg over several min; repeat at 10- to 15-min intervals until adequate sedation then 0.02-0.10 mg/kg/hr maintenance; adjust as needed
• Child:
IV
0.05-0.2 mg/kg over 2-3 min then 0.06-0.12 mg/kg/hr by cont inf; adjust as needed
• Neonate:
IV
0.03-0.06 mg/kg/hr, titrate using lowest dose
• Child and infant >2 mo:
IV
0.15 mg/kg then
CONT IV
1 mcg/kg/min, titrate upward q5min until seizures controlled
• Adult:
IV
1-5 mg q1-2hr (mild-moderate symptoms);
CONT IV INF
1-20 mg q1-2hr (delirium tremens)
Available forms:
Inj 1, 5 mg/ml, syr 2 mg/ml
•
Remove cap of press-in bottle adaptor, push adaptor into neck of bottle; close with cap; remove cap, insert tip of dispenser, insert into adaptor; turn upside-down, withdraw correct dose; place in mouth
•
IM deep into large muscle mass
•
May be given diluted or undiluted
•
After diluting with D
5
W or 0.9% NaCl to 0.25 mg/ml; give over 2 min (conscious sedation) or over 30 sec (anesthesia induction)
Y-site compatibilities:
Abciximab, alfentamil, amikacin, amiodarone, argatroban, atracurium, atropine, aztreonam, benzotropine, calcium gluconate, ceFAZolin, cefotaxime, cefOXitine, cefTRIAXone, cimetidine, ciprofloxacin, CISplatin, clindamycin, cloNIDine, cyanocobalamin, cycloSPORINE, DACTINomycin, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxal, DOPamine, doxycyclin, enalaprilat, EPINEPHrine, erythromycin, esmolol, etomidate, etoposide, famotidine, fentaNYL, fluconazole, folic acid, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, HYDROmorphone, hydrOXYzine, inamrinone, isoproterenol, labetalol, lactated Ringer’s, levofloxacin, lidocaine, linezolid, LORazepam, magnesium, mannitol, meperdine, methadone, methyldopa, methylPREDNISolone, metoclopromide, metomolol, metroNIDAZOLE, milrinone, morphine, nalbuphine, naloxone, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, oxacillin, oxytocin, PACLitaxel, palonasetron, pancuronium, papaverin, phytonadione, piperacillin, potassium chloride, propanolol, protamine, pyridoxine, ranitidine, remifentanil, sodium nitroprusside, succinylcholine, SUFentanil, teniposide, theophylline, thiotepa, ticarcillin, tobramycin, vancomycin, vasopressin, vecuronium, verap-amil, voriconazole
CNS:
Retrograde amnesia, euphoria, confusion, headache, anxiety, insomnia, slurred speech, paresthesia, tremors, weakness, chills, agitation, paradoxic reactions
CV:
Hypotension, PVCs, tachycardia, bigeminy, nodal rhythm,
cardiac arrest
EENT:
Blurred vision, nystagmus, diplopia, loss of balance
GI:
Nausea, vomiting
, increased salivation, hiccups
INTEG:
Urticaria; pain, swelling, pruritus at inj site; rash
RESP:
Coughing,
apnea, bronchospasm, laryngospasm,
dyspnea,
respiratory depression
Protein binding 97%; half-life 1.8-6.4 hr, metabolized in liver; metabolites excreted in urine; crosses placenta, blood-brain barrier
PO:
Onset 20-30 min
IM:
Onset 15 min, peak 1/2-1 hr, duration 2-3 hr
IV:
Onset 3-5 min, onset of anesthesia 1½-2½ min, duration 2 hr
Increase:
hypotension—antihypertensives, opiates, alcohol, nitrates
Increase:
extended half-life—CYP3A4 inhibitors (cimetidine, erythromycin, ranitidine)
Increase:
respiratory depression—other CNS depressants, alcohol, barbiturates, opiate analgesics, verapamil, ritonavir, indinavir, fluvoxaMINE
Decrease:
midazolam metabolism—CYP3A4 inducers (azole antifungals, theophylline)
Increase:
sedation—kava, valerian
Decrease:
midazolam effect—St. John’s wort
Increase:
(PO) midazolam effect—grapefruit juice
•
B/P, pulse, respirations during IV; emergency equipment should be nearby
•
Inj site for redness, pain, swelling
•
Degree of amnesia in geriatric patients; may be increased
•
Anterograde amnesia
•
Vital signs for recovery period in obese patients; half-life may be extended
Black Box Warning:
Respiratory depression insufficiency:
apnea, respiratory depression that may be increased in geriatric patients
•
Assistance with ambulation until drowsy period ends
•
Storage at room temp; protect from light
•
Immediate availability of resuscitation equipment, O
2
to support airway; do not give by rapid bolus
•
Therapeutic response: induction of sedation, general anesthesia
•
That amnesia occurs; that events may not be remembered
Flumazenil, O
2