Mosby's 2014 Nursing Drug Reference (286 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

RARELY USED
neomycin (Rx)

(nee-oh-mye′sin)

Func. class.:
Antiinfective

USES:

Severe systemic infections of CNS, respiratory, GI, urinary tract, eye, bone, skin, soft tissues caused by
Pseudomonas aeruginosa, Escherichia coli, Enterobacter, Klebsiella pneumoniae, Proteus vulgaris;
hepatic coma, preoperatively to sterilize bowel, infectious diarrhea caused by enteropathogenic
E. coli

CONTRAINDICATIONS:

Infants, children, bowel obstruction (oral use), severe renal disease, hypersensitivity, GI disease

Precautions:

 

Black Box Warning:

Dehydration, geriatric patients, hearing impairment, neuromuscular disease, renal disease, respiratory insufficiency

DOSAGE AND ROUTES
Calculator
Hepatic encephalopathy

• Adult:
PO
4-12 g/day in divided doses q6hr × 5-6 days

• Child:
PO
50-100 mg/kg/day in divided doses q6hr × 5-6 days

Preoperative intestinal antisepsis

• Adult:
PO
1 g/hr × 4 hr then 1 g q4hr for remaining 24 hr

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

neomycin topical

 

nepafenac ophthalmic

 

HIGH ALERT
nesiritide (Rx)

(neh-seer′ih-tide)

Natrecor

Func. class.:
Vasodilator

Chem. class.:
Human B-type natriuretic peptide

ACTION:

Uses DNA technology; human B-type natriuretic peptide binds to the receptor in vascular smooth muscle and endothelial cells, thereby leading to smooth muscle relaxation

USES:

Acutely decompensated CHF

CONTRAINDICATIONS:

Hypersensitivity to this product or
Escherichia coli
protein; cardiogenic shock or B/P <90 mm Hg as primary therapy

Precautions:
Pregnancy (C); breastfeeding; children; mitral stenosis; significant valvular stenosis, restriction, or obstructive cardiomyopathy, or any condition dependent on venous return; renal disease; constrictive pericarditis

DOSAGE AND ROUTES
Calculator

• Adult:
IV BOL
2 mcg/kg then
CONT IV INF
0.01 mcg/kg/min

Available forms:
Powder for inj, 1.5-mg single-use vial

Administer:
IV route

• 
Do not give through a central catheter containing other products; administer other products through separate catheter or central line heparin-coated catheter because nesiritide binds to heparin

• 
Reconstitute one 1.5-mg vial/5 ml of diluent from prefilled 250-ml plastic IV bag with diluent of choice (preservative free D
5
, 0.9% NaCl, D
5
/1/2 NaCl, D
5
/0.2% NaCl); do not shake vial, roll gently; use only clear sol

• 
Withdraw all contents of reconstituted vial and add to 250-ml plastic IV bag (6 mcg/ml), invert bag several times

• 
Use within 24 hr of reconstituting

• 
Prime IV fluid with inf of 5 ml before connecting to patient’s vascular access port and before bolus dose or IV inf

Direct IV route

• 
Prime tubing with 5 ml inf sol; calculate dose based on patient’s weight, 0.33 × patient weight (kg) = bolus vol (ml) (6 mcg/ml); withdraw prescribed bolus dose (volume) from prepared inf bag; give over 1 min through IV port

Intermittent IV INF route

• 
After bolus dose, use inf, give at 0.1 ml/kg/hr (0.01 mcg/kg/min)

Y-site compatibilities:
Acyclovir, alfen-tanil, allopurinol, amifostine, aminocaproic acid, aminophylline, amiodarone, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, buprenorphine, busulfan, butorphanol, calcium acetate/chloride/gluconate, CARBOplatin, carmustine, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, dolasetron, doxacurium, DOXOrubicin, doxycycline, droperidol, ePHEDrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, glycopyrrolate, granisetron, haloperidol, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, irinotecan, ketorolac, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meropenem, mesna, metaraminol, methohexital, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANtrone, mivacurium, moxifloxacin, mycophenolate, nalbuphine, naloxone, niCARdipine, nitroglycerin, nitroprusside, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, polymyxin B sulfate, potassium chloride/phosphates, prochlorperazine, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, tigecycline, tirofiban, tolazoline, topotecan, torsemide, trimethobenzamide, vancomycin, vasopressin, vecuronium, verap-amil, vinBLAStine, vinCRIStine, vinorelbine, zidovudine, zoledronic acid

SIDE EFFECTS

CNS:
Headache, insomnia, dizziness, anxiety, confusion, paresthesia, tremor

CV:
Hypotension
,
tachycardia,
dysrhythmias, bradycardia,
ventricular tachycardia, ventricular extrasystoles, atrial fibrillation

GI:
Vomiting, nausea

INTEG:
Rash, sweating, pruritus, inj site reaction

MISC:
Abdominal pain, back pain

RESP:
Increased cough, hemoptysis,
apnea

PHARMACOKINETICS

Half-life 18 min

INTERACTIONS

Increase:
hypotension—ACE inhibitors, antihypertensives, inotropes, IV nitrates

NURSING CONSIDERATIONS
Assess:

• 
PCWP, RAP, cardiac index, MPAP, B/P, pulse during treatment until stable

• 
Daily serum creatinine, BUN

• 
CHF:
weight gain, dyspnea, crackles, I&O ratios, peripheral edema

Evaluate:

• 
Therapeutic response: improvement in CHF with improved PCWP, RAP, MPAP

Teach patient/family:

• 
About purpose of medication, expected results, to report pain at IV site

• 
To report dizziness, blurred vision, lightheadedness, sweating

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

BOOK: Mosby's 2014 Nursing Drug Reference
2.8Mb size Format: txt, pdf, ePub
ads

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