Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (283 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
)
Aleve, Anaprox, Anaprox DS, Apo-Napro-Na
, EC-Naprosyn, Equaline All Day Relief, Good Sense All Day Pain Relief, Midol Extended Relief, Naprelan, Novo-Naprox, Novo-Naprox Sodium, Nu-Naprox, Top Care All Day Pain Relief, Wal-Proxen
Func. class.:
Nonsteroidal antiinflammatory, nonopioid analgesic
Chem. class.:
Propionic acid derivative
Do not confuse:
Naprosyn
/Natacyn/Naprelan
Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflammatory, antipyretic
Osteoarthritis; rheumatoid, gouty arthritis; primary dysmenorrhea; ankylosing spondylitis, bursitis, tendinitis, myalgia, dental pain
Unlabeled uses:
Juvenile rheumatoid arthritis, bone pain, migraine/migraine prophylaxis, heterotropic ossification
Pregnancy (D) 3rd trimester, hypersensitivity to NSAIDs, salicylates; asthma, severe renal/hepatic disease, ulcer disease
Black Box Warning:
Perioperative pain in CABG surgery
Precautions:
Pregnancy (C) breastfeeding, children <2 yr, geriatric patients, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents, CCr <30 ml/min
Black Box Warning:
MI, GI bleeding, stroke
Calculator
200 mg base
=
220 mg naproxen sodium
• Adult:
PO
250-500 mg bid, max 1500 mg/day;
DEL REL
375-500 mg bid
• Child ≥2 yr:
PO
5-7 mg/kg q8-12hr
• Adult:
PO
750 mg, then 250 mg q8hr
• Adult:
PO
220 mg q8-12hr or 440 mg then 220 mg q12hr; max 660 mg/24hr taken ≤10 days
• Geriatric >65 yr:
PO
Max 220 mg q12hr
Available forms:
Naproxen:
tabs 250, 375, 500 mg; del rel tabs (EC-Naprosyn, Naprosyn-E) 250, 375, 500 mg; oral susp 125 mg/5 ml; ext rel tabs (CR) 375, 500, 750 mg;
naproxen sodium:
tabs 220, 275, 550 mg tab, ext rel 220 mg
•
With food to decrease GI symptoms; take on empty stomach to facilitate absorption, give with full glass of liquid
•
Do not crush, break, or chew ext rel tabs
•
OTC for ≤10 days unless approved by prescriber
•
Oral susp:
shake well, use measuring cup provided or other calibrated device
CNS:
Dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression
CV:
Tachycardia, peripheral edema, palpitations, dysrhythmias,
MI, stroke
EENT:
Tinnitus, hearing loss, blurred vision
GI:
Nausea, anorexia, vomiting, diarrhea, jaundice,
hepatitis,
constipation, flatulence, cramps, peptic ulcer,
GI ulceration, bleeding, perforation
GU:
Nephrotoxicity: dysuria, hematuria, oliguria, azotemia
HEMA:
Blood dyscrasias
INTEG:
Purpura, rash, pruritus, sweating
SYST:
Anaphylaxis
PO:
Peak 2-4 hr, half-life 12-17 hr; metabolized in liver; excreted in urine (metabolites), breast milk; 99% protein binding
Increase:
renal impairment—ACE inhibitors
Increase:
toxicity risk—methotrexate, lithium, antineoplastics, probenecid, radiation treatment
Increase:
bleeding risk—oral anticoagulants, thrombolytic agents, eptifibatide, tirofiban, cefamandole, cefotetan, cefoperazone, clopidogrel, ticlopidine, plicamycin, SSRIs, SNRIs, tricyclics, valproic acid
Increase:
GI side effects risk—aspirin, corticosteroids, alcohol, NSAIDs
Decrease:
effect of antihypertensives, diuretics
Decreased:
absorption of naproxen—antacids, sucralfate, cholestyramine
•
Bleeding risk: feverfew, garlic, ginger, ginkgo, ginseng
(Panax)
Increase:
BUN, alk phos, LFTs, potassium, glucose, cholesterol
Decrease:
potassium, sodium
False increase:
5-HIAA, 17KS
Black Box Warning:
Cardiac status: CV thrombotic events, MI, stroke; may be fatal; not to be used with CABG
Black Box Warning:
GI status: ulceration, bleeding, perforation; may be fatal; obtain stool guaiac
•
Pain:
frequency, characteristics, intensity; relief before and 1-2 hr after product
•
Arthritis:
range of motion, pain, swelling before and 1-2 hr after use
•
Fever:
before, 1 hr after use
Asthma, aspirin hypersensitivity or nasal polyps, increased risk of hypersensitivity
•
Renal, hepatic, blood studies:
BUN, creatinine, AST, ALT, Hgb, LDH, blood glucose, Hct, WBC, platelets, CCr before treatment, periodically thereafter during long-term therapy
•
Audiometric, ophthalmic exam before, during, after treatment; if taking long term, eye, ear problems: blurred vision, tinnitus (may indicate toxicity)
•
Storage at room temp
•
Therapeutic response: decreased pain, stiffness, swelling in joints; ability to move more easily
•
To report blurred vision, ringing, roaring in ears (may indicate toxicity)
•
To avoid driving, other hazardous activities if dizziness or drowsiness occurs
To report change in urine pattern, weight increase, edema (face, lower extremities), pain increase in joints, fever, blood in urine (indicates nephrotoxicity); black stools, flulike symptoms
•
That therapeutic effects may take up to 1 mo in arthritis
•
To avoid ASA, alcohol, steroids or other OTC medications without prescriber approval
•
To report use to all health care providers
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (C), avoid breastfeeding