Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (281 page)
HIGH ALERT(nal′byoo-feen)
Func. class.:
Opioid analgesic
Chem. class.:
Synthetic opioid agonist, antagonist
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Moderate to severe pain, supplement to anesthesia
Hypersensitivity, addiction (opiate)
Precautions:
Pregnancy (C), breastfeeding, addictive personality, increased intracranial pressure, MI (acute), severe heart disease, respiratory depression, renal/hepatic disease, bowel impaction
Calculator
• Adult:
SUBCUT/IM/IV
10 mg q3-6hr prn (based on 70-kg body weight), max 160 mg/day (IV/IM/SUBCUT); 20 mg/dose if opiate naïve (IV/IM/SUBCUT)
• Adult:
IV
0.3-3 mg/kg given over 10-15 min, may give 0.25-0.5 mg/kg as needed for maintenance
Available forms:
Inj 10, 20 mg/ml
•
With antiemetic if nausea, vomiting occur
•
When pain beginning to return; determine dosage interval by response
•
IM deep in large muscle mass, rotate inj sites, protect from light
•
Undiluted ≤10 mg over 3-5 min into free-flowing IV line of D
5
W, NS, or LR
Syringe compatibilities:
Atropine, cimetidine, diphenhydrAMINE, droperidol, glycopyrrolate, hydrOXYzine, lidocaine, midazolam, prochlorperazine, ranitidine, scopolamine, trimethobenzamide
Y-site compatibilities:
Amifostine, aztreonam, cefmetazole, cisatracurium, cladribine, filgrastim, fludarabine, granisetron, melphalan, PACLitaxel, propofol, remifentanil, teniposide, thiotepa, vinorelbine
CNS:
Drowsiness, dizziness, confusion, headache, sedation, euphoria
, dysphoria (high doses), hallucinations, dreaming, tolerance, physical, psychologic dependency
CV:
Palpitations, bradycardia, change in B/P, orthostatic hypotension,
cardiac arrest
EENT:
Tinnitus, blurred vision, miosis, diplopia
GI:
Nausea, vomiting, anorexia, constipation, cramps
, abdominal pain, dyspepsia, xerostomia, bitter taste
GU:
Increased urinary output, dysuria, urinary retention, urgency
INTEG:
Rash
, urticaria, bruising, flushing, diaphoresis, pruritus
RESP:
Respiratory depression,
pulmonary edema
SUBCUT/IM/IV:
Peak 30 min, onset 2-15 min, IV 2-3 min, duration 3-6 hr, metabolized by liver, excreted by kidneys, half-life 3-6 hr
Avoid use with MAOIs; unpredictable reactions may occur
Increase:
effects with other CNS depressants—alcohol, opiates, sedative/hypnotics, antipsychotics, skeletal muscle relaxants
•
Pain:
type, location, intensity before and 30-60 min after administration; titrate upward with 25%-50% until 50% of pain reduced; need for pain medication by pain sedation scoring, physical dependency
•
Bowel status; constipation is common, may need laxative or stool softener
Withdrawal reactions
in opiate-dependent individuals: PE, vascular occlusion; abscesses, ulcerations, nausea, vomiting, seizures; low potential for dependence
•
CNS changes:
dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
Allergic reactions: rash, urticaria
•
Respiratory dysfunction: respiratory depression,
character, rate,
rhythm; notify prescriber if respirations are <10/min
•
Storage in light-resistant area at room temp
•
Therapeutic response: decrease in pain without respiratory depression
•
To report any symptoms of CNS changes, allergic reactions
•
That physical dependency may result from long-term use; low potential for dependency
• That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia, profuse sweating, twitching; without treatment symptoms resolve in 5-14 days, chronic abstinence syndrome may last 2-6 mo
•
To avoid CNS depressants, alcohol
•
To avoid driving, operating machinery if drowsiness occurs
Naloxone (Narcan) 0.2-0.8 mg IV, O
2
, IV fluids, vasopressors
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(nal-oks′one)
Func. class.:
Opioid antagonist, antidote
Chem. class.:
Thebaine derivative
Do not confuse:
naloxone
/naltrexone
Competes with opioids at opiate receptor sites
Respiratory depression induced by opioids, pentazocine, propoxyphene
Unlabeled uses:
IBS, opiate agonist dependence, opiate agonist-induced constipation, pruritus, urinary retention, coma, nausea, vomiting
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, neonates, CV disease, opioid dependency, seizure disorder, drug dependency
Calculator
• Adult:
IV/SUBCUT/IM
0.4-2 mg, repeat q2-3min if needed, max 10 mg
• Child <5 yr or ≤20 kg:
IV/SUBCUT/IM
0.01 mg/kg slowly followed by 0.1 mg/kg if needed or as
INF
titrated to response
• Adult:
IV
0.1-0.2 mg q2-3min prn
• Child:
IV/SUBCUT/IM
0.005-0.01 mg/kg q2-3min prn
• Adult:
IV/SUBCUT/IM
0.4-2 mg (10 mcg/kg) (not opioid dependent), may repeat q2-3min; 0.1-0.2 mg q2-3min (opioid dependent)
• Adult:
IM
0.16 mg; if no withdrawal symptoms after 20-30 min, give 0.24 mg
IV
Available forms:
Inj 0.02, 0.4 mg/ml
•
Only with resuscitative equipment, O
2
nearby
•
Only sol prepared within 24 hr
•
Undiluted with sterile water for inj; give ≤0.4 mg over 15 sec
•
Dilute 2 mg/500 ml 0.9% NaCl or D
5
W (4 mcg/ml), titrate to response
Y-site compatibilities:
Acyclovir, alfen-tanil, amikacin, aminocaproic acid, aminophylline, anidulafungin, ascorbic acid, atenolol, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefo
TEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins, mycophenolate, nafcillin, nalbuphine, nesiritide, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, ritodrine, rocuronium, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zoledronic acid
CNS:
Drowsiness, nervousness,
seizures,
tremor
CV:
Rapid pulse, increased systolic B/P (high doses),
ventricular tachycardia, fibrillation, hypo/hypertension, cardiac arrest, sinus tachycardia
GI:
Nausea, vomiting,
hepatotoxicity
RESP:
Hyperpnea,
pulmonary edema
Well absorbed IM, SUBCUT; metabolized by liver, crosses placenta; excreted in urine, breast milk; half-life 30-81 min
IM/SUBCUT:
Onset 2-5 min, duration 45-60 min
IV:
Onset 1 min, duration 45 min
Increase:
seizures—traMADol overdose
Decrease:
effect of opioid analgesics
•
Withdrawal:
cramping, hypertension, anxiety, vomiting, signs of withdrawal in drug-dependent individuals may occur ≤2 hr after administration
•
VS q3-5min
•
ABGs including P
O
2
, P
CO
2
•
Cardiac status: tachycardia, hypertension; monitor ECG
•
Respiratory dysfunction:
respiratory depression, character, rate, rhythm; if respirations are <10/min, administer naloxone; probably due to opioid overdose; monitor LOC
•
Pain:
duration, intensity, location before and after administration; may be used for respiratory depression
•
Dark storage at room temp
•
Therapeutic response: reversal of respiratory depression; LOC—alert
•
When patient is lucid, about reasons for, expected results of product