Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (285 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(ne-biv′oh-lol)
Bystolic
Func. class.:
Antihypertensive
Chem. class.:
β
1
-blocker
Competitively blocks stimulation of β-adrenergic receptors within vascular smooth muscle; decreases rate of SA node discharge, increases recovery time, slows conduction of AV node, thereby resulting in decreased heart rate (negative chronotropic effect), which decreases O
2
consumption in myocardium due to β
1
-receptor antagonism; decreases renin-aldosterone-angiotensin system at high doses, inhibits β
2
-receptors in bronchial system at high doses
Hypertension alone or in combination
Unlabeled uses:
Heart failure
Cardiogenic shock, heart failure, severe hepatic disease, severe bradycardia, sick sinus syndrome, AV heart block; hypersensitivity to product, β-blockers
Precautions:
Pregnancy (C), breastfeeding, children, major surgery, peripheral vascular disease, diabetes mellitus, thyrotoxicosis disease, COPD, asthma, well-compensated heart failure, renal/hepatic disease, abrupt discontinuation, acute bronchospasm
Calculator
• Adult:
PO
5 mg/day, may be increased to desired response q2wk; max 40 mg/day
• Geriatric:
PO
max 40 mg/day
• Adult:
PO
CCr <30 ml/min, 2.5 mg/day; may increase cautiously; (Child-Pugh class B) 2.5 mg daily, use dose escalation cautiously
• Adult:
PO
1.25 mg titrated to max 10 mg/day
Available forms:
Tabs 2.5, 5, 10, 20 mg
•
Without regard to meals; tab may be crushed or swallowed whole; give with food to prevent GI upset
CNS:
Insomnia, fatigue, dizziness, mental changes
, drowsiness, headache
CV:
Bradycardia, MI,
AV heart block, edema
GI:
Nausea, diarrhea
, vomiting, abdominal pain
GU:
Impotence
HEMA:
Thrombocytopenia
INTEG:
Rash, pruritus, vasculitis, urticaria, psoriasis,
angioedema
MISC:
Renal failure, pulmonary edema,
hyperuricemia, hypercholesterolemia
RESP:
Bronchospasm,
dyspnea
Peak 1.5-4 hr; half-life 12 hr; metabolized in liver by CYP2D6; 38% excreted in urine, 44% in feces
Do not give with other β-blockers, mefloquine
Increase:
nebivolol action—CYP2D6 inhibitors (amiodarone, buPROPion, chloroquine, chlorpheniramine, chlorproMAZINE, cinacalcet, diphenhydrAMINE, DULoxetine, FLUoxetine, haloperidol, imatinib, PARoxetine, promethazine,
propoxyphene, quiNIDine, quiNINE, ritonavir, terbinafine, thioridazine), cimetidine, calcium channel blockers (nondihydropyridine)
Decrease:
nebivolol action—CYP2D6 inducers (rifampin), sildenafil
•
May increase nebivolol effect—hawthorn
•
May decrease nebivolol effect—ephedra
Increase:
serum lipoprotein levels, BUN, potassium, triglycerides, uric acid, LDH, AST, ALT, alk phos
Decrease:
platelets
•
Hypertension:
B/P during beginning treatment, periodically thereafter; apical/radial pulse before administration; notify prescriber of any significant changes (pulse <50 bpm);
signs of CHF
(dyspnea, crackles, weight gain, jugular venous distention)
•
Baselines of renal, hepatic function tests before therapy begins and periodically,
do not use in Child-Pugh class >B
•
Edema in feet, legs daily: monitor I&O
•
Storage protected from light, moisture; place in cool environment
•
Therapeutic response: decreased B/P after 1-2 wk; decreased dysrhythmias
Not to discontinue product abruptly because severe cardiac reactions may occur, to taper over 2 wk; not to double dose; if dose is missed, to take as soon as remembered up to 4 hr before next dose
•
That product may mask signs of hypoglycemia or alter blood glucose levels
•
Not to use OTC products containing α-adrenergic stimulants (nasal decongestants, OTC cold preparations) unless directed by prescriber
•
To report low pulse, dizziness, confusion, depression, fever
•
To take pulse, B/P at home; advise patient when to notify prescriber
•
To comply with weight control, dietary adjustments, modified exercise program
•
To carry emergency ID to identify product, allergies
•
To avoid hazardous activities if dizziness, drowsiness present
•
To report symptoms of CHF:
difficulty breathing, especially on exertion or when lying down, night cough, swelling of extremities
•
To continue with required lifestyle changes (exercise, diet, weight loss, stress reduction)
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O
2
, diuretic for cardiac failure, IV glucose for hypoglycemia, IV diazepam (or phenytoin) for seizures, IV fluids, IV pressors
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(nell-fin′a-ver)
Viracept
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
Inhibits human immunodeficiency virus (HIV-1) protease, which prevents maturation of the infectious virus
Uses:
HIV-1 in combination with other antiretrovirals
Hypersensitivity to protease inhibitors
Precautions:
Pregnancy (B), breastfeeding, renal/hepatic disease, hemophilia, PKU, pancreatitis, diabetes, infection, immune reconstitution syndrome
Calculator
• Adult and child >13 yr:
PO
750 mg tid or 1250 mg bid
• Child 2-13 yr:
PO
25-35 mg/kg tid, max 2500 mg/day
• Adult:
PO
1250 mg bid with 2 other antiretroviral agents × 4 wk
Available forms:
Tabs 250, 625 mg; powder, oral 50 mg/g/scoop
•
Do not mix with juice or acidic fluids
•
Oral powder:
mixed with fluids if desired; stable mixed for 6 hr, may use in child unable to take tabs, do not mix with water in original bottle
•
Tabs
may be crushed and dispersed in water or mixed with food; consume immediately
CNS:
Headache, asthenia, poor concentration,
seizures, suicidal ideation
CV:
Bleeding
ENDO:
Hyperglycemia, hyperlipidemia
GI:
Diarrhea
, anorexia, dyspepsia,
nausea, flatulence
,
hepatitis, pancreatitis
HEMA:
Anemia, leukopenia, thrombocytopenia,
Hgb abnormalities
INTEG:
Rash
, dermatitis,
anaphylaxis
MS:
Pain, arthralgia, myalgia, myopathy
OTHER:
Hypoglycemia,
redistribution/accumulation of body fat,
immune reconstitution syndrome
Half-life 3½-5 hr, excreted in feces (87%), peak 2-4 hr, 98% protein binding; metabolized by CYP3A4 enzyme system; potent inhibitor of CYP3A4
Increase:
serious dysrhythmias: amiodarone, ergots, lovastatin, midazolam, pimozide, quiNIDine, simvastatin, triazolam, salmeterol
Increase:
effect of—atorvastatin, azithromycin, rifabutin, indinavir, saquinavir, cycloSPORINE, tacrolimus, sirolimus, sildenafil, alfentanil, alosetron, buprenorphine, busPIRone, bortezomib, calcium channel blockers, cilostazol, disopyramide, dofetilide, DOCEtaxel, donepezil, ethosuximide, fentaNYL, galantamine, gefitinib, levomethadyl, systemic lidocaine, PACLitaxel, sibutramine, SUFentanil, vinca alkaloids, ziprasidone, zonisamide, traZODone, tricyclic antidepressants, sildenafil
Increase:
nelfinavir levels—ketoconazole, indinavir, ritonavir; delavirdine, other HIV protease inhibitors
Decrease:
nelfinavir levels—rifamycins, nevirapine, PHENobarbital, phenytoin, carBAMazepine
Decrease:
effect of—didanosine, methadone, oral contraceptives, phenytoin
Decrease:
antiretroviral effect—St. John’s wort; do not use concurrently
Increase:
absorption with food
Increase:
AST, ALT, alk phos, total bilirubin, CPK, LDH, lipids, uric acid
Decrease:
WBC, platelets
•
Resistance testing at initiation, with failure of treatment
•
Signs of infection, anemia
•
Hepatic studies: ALT, AST
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
Immune reconstitution syndrome:
occurs with combination therapy, including MAC, CMV, PCP TB requiring treatment
Anaphylaxis, hypersensitivity reaction:
wheezing, flushing; swelling of lips, tongue, throat, skin eruptions, rash, urticaria, itching
•
HIV:
serum lipid profile, plasma HIV RNA, blood glucose, viral load, CD4 cell counts at baseline and throughout treatment
•
To avoid taking with other medications unless directed by prescriber
•
Diarrhea
is most common side effect, may use loperamide to control
•
That product does not cure but does manage symptoms; that product does not prevent transmission of HIV to others
•
To use a nonhormonal form of birth control while taking this product if using contraceptives
•
If dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
To take with food
•
To report symptoms of hyperglycemia, bleeding, abdominal pain; yellowing of skin, eyes
•
Phenylketonuria:
powder contains phenylalanine