Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (282 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(nal-trex′one)
ReVia, Vivitrol
Func. class.:
Opioid antagonist
Chem. class.:
Thebaine derivative
Do not confuse:
naloxone
/naltrexone
Competes with opioids at opioid-receptor sites
Blockage of opioid analgesics; used for treatment of opiate addiction, alcoholism
Unlabeled uses:
Nicotine withdrawal, opiate-agonist withdrawal, pruritus
Hypersensitivity, opioid dependence
Black Box Warning:
Hepatic failure, hepatitis
Precautions:
Pregnancy (C), breastfeeding, children, renal disease, depression, suicidal ideation
Black Box Warning:
Hepatic disease
Calculator
• Adult:
PO
25 mg; if no withdrawal symptoms in 1 hr, then 25 mg additionally; if no withdrawal symptoms, then 50-150 mg/day or in divided doses
• Adult:
PO
50 mg/day with food × 12 wk;
IM
(Vivitrol) 380 mg q4wk
• Adult:
PO
50 mg/day × 7 days to 4 wk
• Adult:
PO
50 mg/day
• Adult:
PO
50 mg prior to sedation with midazolam
Available forms:
Tabs 50 mg; powder for inj 380 mg
•
Give with food, antacid to prevent nausea, vomiting
•
Do not give until opioid-free for 7-10 days to prevent opioid withdrawal
•
IM deep in gluteal, alternate inj sites; use supplied needle to prevent inj site reaction; aspirate before inj
•
Only if resuscitative equipment is nearby
•
Not to use IV or SUBCUT
CNS:
Stimulation, drowsiness
, dizziness, confusion,
seizures,
headache, flushing, hallucinations, nervousness, irritability,
suicidal ideation,
syncope, anxiety
CV:
Rapid pulse,
pulmonary edema,
hypertension,
DVT
EENT:
Tinnitus, hearing loss, blurred vision
GI:
Nausea, vomiting, diarrhea, heartburn
, anorexia,
hepatitis,
constipation, abdominal pain
GU:
Delayed ejaculation, decreased potency
INTEG:
Rash
, urticaria, bruising, oily skin, acne, pruritus, inj site reactions
MISC:
Increased thirst, chills, fever
MS:
Joint and muscle pain
RESP:
Wheezing, hyperpnea, nasal congestion, rhinorrhea, sneezing, sore throat, pneumonia
Metabolized by liver, excreted by kidneys; crosses placenta, excreted in breast milk; half-life 4 hr; extensive first-pass metabolism; protein binding 21%-28%
PO:
Onset 15-30 min, peak 1-2 hr, duration is dose dependent
IM:
Peak 2 hr
Increase:
lethargy—phenothiazines
Increase:
hepatotoxicity—disulfiram
Increase:
bleeding risk—anticoagulants
Decrease:
effect of analgesics, antidiarrheals, cough preparations
Black Box Warning:
Hepatic status: LFTs, jaundice, hepatitis, hepatic failure
•
ABGs including P
O
2
, P
CO
2
, LFTs, VS q3-5min
•
Signs of withdrawal in drug-dependent individuals, use naltrexone challenge to test opioid dependence; must be free of opioids for 7-10 days before using this product, or withdrawal symptoms can occur
•
Cardiac status: tachycardia, hypertension
•
Respiratory dysfunction: respiratory depression,
character, rate, rhythm; if respirations <10/min, respiratory stimulant should be administered
•
Mental status: depression,
suicidal ideation
•
Storage in tight container
•
Therapeutic response: blocking opiate ingestion; successful nicotine, alcohol withdrawal
•
That patient must be drug-free to start treatment
That using opioid while taking this product could prove fatal because high dose is needed to overcome this antagonist; not to self-dose with OTC products unless approved by prescriber
•
To carry emergency ID stating product used
•
That, if surgery is needed, all involved should be aware of this product
•
To use caution while driving or performing other hazardous tasks until effect is known
That suicidal thoughts/behaviors may occur; to report these immediately
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(ophthalmic)
(na-faz′oh-leen)
Advanced Eye Relief, Redness Maximum Relief, Ak-Con, All Clear, Clear Eyes, Naphcon Forte
, Vasoclear
Func. class.:
Ophthalmic vasoconstrictor
Chem. class.:
Sympathomimetic
Acts on the blood vessels in the eye to produce vasoconstriction
Ocular congestion, irritation, itching of the eye
Hypersensitivity, acute angle-closure glaucoma, 0.1% solution in children/infants
Precautions:
Hyperthyroidism, diabetes mellitus, hypertension, cardiac conditions
Calculator
• Adult:
OPHTH
Instill 1-2 drops in affected eye in the conjunctival sac every 3-4 hr, up to qid
Available forms:
Ophthalmic solution 0.012%, 0.1%, 0.02%
•
Store at room temperature, keep tightly closed
CNS:
Headache
EENT:
Blurred vision, irritation, photophobia, dilation, stinging, elevated IOP, keratitis
Onset 10 min, duration up to 6 hr
Increase:
Systemic effects—β-blockers
•
Do not use within 14 days of MAOIs
•
Ocular itching, congestion, irritation: should show improvement quickly, avoid using more than 3 days, long-term use or exceeding dosage can lead to rebound congestion; report eye pain, blurred vision
•
Decreasing ocular itching, congestion, irritation
•
Method for instilling drops
•
To notify prescriber of eye pain, blurred vision
•
That ocular itching, congestion, irritation should show improvement quickly
•
To avoid using longer than 3 days; that long-term use or exceeding dosage can lead to rebound congestion
•
To wait for at least 15 min before wearing contact lenses