Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (302 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(oss-el-tam′ih-veer)
Tamiflu
Func. class.:
Antiviral
Chem. class.:
Neuramidase inhibitor
Inhibits influenza virus neuraminidase with possible alteration of virus particle aggregation and release
Prevention and treatment of influenza type A or B
Unlabeled uses:
Avian flu (H5N1), avian influenzae A (H5N1), swine flu (H1N1), encephalitis
Hypersensitivity
Precautions:
Pregnancy (C), neonates, breastfeeding, infants, children, geriatric patients, renal/hepatic/pulmonary/cardiac disease, psychosis, viral infection
Calculator
• Adult/child >40 kg:
PO
75 mg bid × 5 days, begin treatment within 2 days of onset of symptoms
• Child 23-40 kg and ≥1 yr:
PO
60 mg bid
• Child 15-23 kg and ≥1 yr:
PO
45 mg bid
• Child ≤15 kg and ≥1 yr:
PO
30 mg bid
• Neonates ≥14 days, infants:
PO
3 mg/kg/dose BID × 5 days
• Adult/child ≥13 yr:
PO
75 mg/day × ≥10 days; begin treatment within 2 days of contact, max use 6 wk
• Adult:
PO
CCr 10-30 ml/min, 75 mg/day × 5 days (treatment); 75 mg every other day or 30 mg/day (prophylaxis)
• Adult/adolescent/child >40 kg:
PO
75 mg bid × 5 days
• Adolescent/child 24-40 kg:
PO
60 mg bid × 5 days
• Child >1 yr and 15-23 kg:
PO
45 mg bid × 5 days
• Child >1 yr and ≤15 kg:
PO
30 mg bid × 5 days
Available forms:
Caps 30, 45, 75 mg; powder for oral susp 6 mg/ml
•
Within 2 days of symptoms of influenza; continue for 5 days
•
At least 4 hr before bedtime to prevent insomnia
•
Without regard to food; give with food for GI upset
•
Take with full glass of water
•
Oral susp:
6 mg/ml conc, take care to administer correct dose; loosen powder from side of bottle, add 55 ml, shake well (6 mg/ml), remove child-resistant cap, push bottle adapter into neck of bottle, close tightly with child-resistant cap to ensure sealing, use within 17 days of preparation when refrigerated or within 10 days at room temp, write expiration date on bottle, shake well prior to use, use oral syringe provided but only with markings for 30, 45, 60 mg, confirm that dosing instructions are in same units as syringe provided
CNS:
Headache, dizziness
, fatigue,
insomnia
,
seizures,
delirium,
self-injury (children)
ENDO:
Hyperglycemia
GI:
Nausea, vomiting
, diarrhea, abdominal pain
INTEG:
Toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme
RESP:
Cough
Rapidly absorbed, protein binding 40%-45%, converted to oseltamivir carboxylate (active form), active forms half-life 1-3 hr, metabolite 6-10 hr, excreted in urine (99%), protein binding 3%
•
Avoid use with H1N1 virus vaccine, intranasal influenzae vaccine
•
Bowel pattern before, during treatment
•
Influenza:
fever, fatigue, sore throat, headache, muscle soreness, aches
•
Storage in tight, dry container
•
Therapeutic response: absence of fever, malaise, cough, dyspnea in infection
•
About aspects of product therapy
•
To avoid hazardous activities if dizziness occurs
•
To take as soon as symptoms appear; to take full course even if feeling better
•
To take missed dose as soon as remembered if within 2 hr of next dose
To stop immediately; to report to prescriber skin rash, delirium, psychosis, hallucinations (child)
•
That this product should not be substituted for flu shot
•
Will not treat the common cold
•
To avoid other products unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERToxaliplatin (Rx)
(ox-al-i′plat-in)
Eloxatin
Func. class.:
Antineoplastic
Chem. class.:
3rd-generation platinum analog
Forms crosslinks, thereby inhibiting DNA replication and transcription; not specific to cell cycle
Metastatic carcinoma of the colon or rectum in combination with 5-FU/leucovorin
Unlabeled uses:
Relapsed or refractory non-Hodgkin’s lymphoma; advanced ovarian cancer; breast, head/neck, testicular, pancreatic, gastric cancer; mesothelioma
Pregnancy (D), breastfeeding, radiation therapy or chemotherapy within 1 mo, thrombocytopenia, smallpox vaccination
Black Box Warning:
Hypersensitivity to this product or other platinum products
Precautions:
Children, geriatric patients, pneumococcus vaccination, renal disease
Calculator
Dosage protocols may vary
• Adult:
IV INF
Day 1:
oxaliplatin 85 mg/m
2
in 250-500 ml D
5
W and leucovorin 200 mg/m
2
in D
5
W, give both over 2 hr at the same time in separate bags using a
Y
-line, followed by 5-FU 400 mg/m
2
IV BOL
over 2-4 min then 5-FU 600 mg/m
2
IV INF
in 500 ml D
5
W as a 22-hr
CONT INF;
day 2:
leucovorin 200 mg/m
2
IV INF
over 2 hr, then 5-FU 400 mg/m
2
IV BOL
over 2-4 min, then 5-FU 600 mg/m
2
IV INF
in 500 ml D
5
W as a 22-hr
CONT INF;
repeat cycle q2wk
• Adult:
IV
CCr <30 ml/min, reduce starting dose to 65 mg/m
2
• Adult:
IV
130 mg/m
2
q3wk as a single agent in those previously treated
• Adult:
IV
130 mg/m
2
on day 1 plus 5-fluorouracil (1000 mg/m
2
CONT IV INF
days 1-4) q3wk
• Adult:
IV
100 mg/m
2
on day 2, with gemcitabine 1000 mg/m
2
on day 1, repeat q2wk; 625 mg/m
2
bid throughout treatment or fluorouracil 200 mg/m
2
/day throughout treatment
• Adult:
IV
130 mg/m
2
over 2 hr on day 1 with epirubic 50 mg/m
2
and capecitabine
Available forms:
Powder for inj 50, 100-mg single-use vials (5 mg/ml); solution for inj 50 mg/10 ml, 100 mg/20 ml, 200 mg/40 ml
•
Premedicate with antiemetics including 5HT
3
blockers, with or without dexamethasone; prehydration not needed
•
Do not reconstitute or dilute with sodium chloride or any chloride-containing sol, do not use aluminum equipment during any preparation or administration, will degrade platinum; do not refrigerate unopened powder or sol; do not freeze; protect from light
•
Use cytotoxic handling procedures; prepare in biologic cabinet using gown, gloves, mask; do not allow product to come in contact with skin; use soap and water if contact occurs
•
EPINEPHrine, antihistamines, corticosteroids for hypersensitivity reaction
•
Lyophilized powder:
reconstitute vial 50 mg/10 ml or 100 mg/20 ml sterile water for inj or D
5
W; after reconstitution, sol may be stored for ≤24 hr in refrigerator; after dilution in 250-500 ml D
5
W,
may store ≤24 hr in refrigerator or 6 hr at room temp, infuse over 2 hr
•
Aqueous solution:
dilute in 250-500 ml of D
5
W; after dilution, may store ≤24 hr refrigerator, 6 hr at room temp, infuse over 2 hr
Y-site compatibilities:
Alfentanil, amifostine, amikacin, aminocaproic acid, amiodarone, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, foscarnet, fosphenytoin, furosemide, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, meperidine, meropenem, mesna, metaraminol, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANtrone, mivacurium, morphine, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, PACLitaxel, palonosetron, pancuronium, PEMEtrexed, pentamidine, pentazocine, phenylephrine, piperacillin, polymyxin B, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, rocuronium, sodium acetate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, topotecan, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Peripheral neuropathy, fatigue, headache, dizziness, insomnia
CV:
Cardiac abnormalities,
thromboembolism
EENT:
Decreased visual acuity, tinnitus, hearing loss
GI:
Severe nausea, vomiting, diarrhea, weight loss
, stomatitis, anorexia, gastroesophageal reflux, constipation, dyspepsia, mucositis, flatulence
GU:
Hematuria, dysuria, creatinine
HEMA:
Thrombocytopenia, leukopenia, pancytopenia, neutropenia, anemia, hemolytic uremic syndrome
INTEG:
Alopecia
, rash, flushing, extravasation, redness, swelling, pain at inj site
META:
Hypokalemia
RESP:
Fibrosis,
dyspnea, cough, rhinitis, URI, pharyngitis
SYST:
Anaphylaxis, angioedema
Metabolized in liver, excreted in urine; after administration, 15% of platinum in systemic circulation, 85% either in tissues or being eliminated in urine; half-life 390 hr; protein binding >90%
Increase:
bleeding risk—NSAIDs, alcohol, anticoagulants, platelet inhibitors, thrombolytics, salicylates
Increase:
oxaliplatin toxicity—tannins
Increase:
myelosuppression—myelosuppressive agents, radiation
Increase:
nephrotoxicity—aminoglycosides, loop diuretics
Decrease:
antibody response—live virus vaccines
Increase:
ALT, AST, bilirubin, creatinine
Decrease:
potassium, neutrophils, WBC, platelets
Bone marrow depression:
CBC, differential, platelet count each cycle; withhold product if WBC is <4000 or platelet count is <100,000; notify prescriber of results
•
Renal/hepatic studies: BUN, creatinine, serum uric acid, urine CCr before, electrolytes during therapy; dose should not be given if BUN >19 mg/dl; creatinine <1.5 mg/dl; I&O ratio; report fall in urine output of <30 ml/hr; LFTs
Black Box Warning:
Anaphylaxis:
wheezing, tachycardia, facial swelling, fainting; discontinue product, report to prescriber; resuscitation equipment should be nearby
Pulmonary fibrosis:
cough, crackles, dyspnea, pulmonary infiltrate; discontinue immediately, death may occur
•
Monitor temp; may indicate beginning infection
•
Hepatic studies before each cycle (bilirubin, AST, ALT, LDH) as needed or monthly
•
Bleeding:
hematuria, guaiac, bruising or petechiae, mucosa or orifices; obtain prescription for viscous lidocaine (Xylocaine)
•
Effects of alopecia on body image; discuss feelings about body changes
•
Edema in feet, joint pain, stomach pain, shaking
•
Comprehensive oral hygiene
•
All medications PO if possible; avoid IM inj when platelets <100,000/mm
3
•
Increase fluid intake to 2-3 L/day to prevent urate deposits, calculi formation; elimination of product
•
Blankets, hat, gloves for cold prevention
•
Therapeutic response: decreased tumor size, spread of malignancy
To report signs of
infection:
increased temp, sore throat, flulike symptoms
•
To report signs of
anemia:
fatigue, headache, faintness, SOB, irritability
•
To report
bleeding;
to avoid use of razors, commercial mouthwash
•
To avoid aspirin, ibuprofen, NSAIDs, alcohol; may cause GI bleeding
To report any changes in breathing, coughing
•
That hair may be lost during treatment; that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture
•
To report numbness, tingling in face or extremities, poor hearing or joint pain or swelling
•
Not to receive vaccines during treatment
To use contraception during treatment and for 4 mo after; that product may cause infertility, pregnancy (D)
•
Dysesthesias:
to avoid contact with cold (air, ice, liquid)