Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (306 page)
Do not confuse:
oxymorphones
/oxyCODONE
Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception
Moderate to severe pain
Hypersensitivity, addiction (opiate), asthma, hepatic disease, ileus, intrathecal use, surgery
Black Box Warning:
Respiratory depression
Precautions:
Pregnancy (B) (short-term), breastfeeding, children <18 yr, addictive personality, increased intracranial pressure, MI (acute), severe heart disease, respiratory depression, renal/hepatic disease, bowel impaction
Black Box Warning:
Alcoholism, opioid-naive patients, substance abuse
Calculator
• Adult:
IM/SUBCUT
1-1.5 mg q4-6hr prn;
IV
0.5 mg q4-6hr prn;
opiate naive
PO
(immediate release only) 5-20 mg q4-6hr prn;
opiate naive
PO-ER
5 mg q12hr in those requiring around-the-clock dosing
• Adult:
IM
0.5-1 mg
Available forms:
Inj 1, 1.5 mg/ml; ER tab 5, 10, 20, 40 mg; ER tab, crush resistant 5, 10, 20, 30, 40 mg; tabs 5, 10 mg
•
1 hr before or 2 hr after food (PO)
•
With antiemetic for nausea, vomiting
•
Do not break, crush, chew ER product
•
When pain is beginning to return; determine interval by response
•
Opiate naive:
start with lowest dose, titrate upward 5-10 mg q12hr q3-7days to therapeutic response
•
When converting from immediate rel to ext rel, give 1/2 daily dose of ext rel product q12hr
•
Rotate inj sites
•
Do not use if respirations are <12/min
•
Give undiluted over 2-3 min
Syringe compatibilities:
Glycopyrrolate, hydrOXYzine, ranitidine
CNS:
Drowsiness, dizziness, confusion, headache
, hallucinations,
increased intracranial pressure,
sedation
,
seizures,
euphoria (geriatric patients)
CV:
Palpitations,
bradycardia,
change in B/P, hypotension
EENT:
Tinnitus, blurred vision, miosis, diplopia
GI:
Nausea, vomiting, anorexia, constipation, cramps
GU:
Dysuria, urinary retention
INTEG:
Rash
, urticaria, bruising, flushing, diaphoresis, pruritus
RESP:
Respiratory depression
Metabolized by liver, excreted in urine, crosses placenta, half life: PO: 7-9 hr, ext rel: 9-11 hr
PO:
Peak 1 hr (fasting)
SUBCUT/IM:
Onset 10-15 min, peak 1½ hr, duration 3-6 hr
IV:
Onset 5-10 min, peak 15-30 min, duration 3-6 hr
Increase:
effects with other CNS depressants—alcohol, opiates, sedative/hypnotics, antipsychotics, skeletal muscle relaxants
Increase:
unpredictable effects/reactions—MAOIs
Increase:
sedative effect—kava, St. John’s wort, valerian
Increase:
amylase
•
Pain:
location, intensity, type, other characteristics before and 1 hr after (IM) IV 30 min; need for pain medication, physical dependence, give 25%-50% until pain reduction of 50% on pain rating scale, repeat dose may be given at time of peak if previous dose does not control pain and respiratory depression has not occurred; give short-acting opioids for breakthrough pain if patient receiving controlled rel product
•
I&O ratio for decreasing output; may indicate urinary retention
•
Bowel status:
constipation; may need stimulative laxative, increased fluids, fiber
•
CNS changes:
dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
Allergic reactions:
rash, urticaria
Black Box Warning:
Respiratory dysfunction:
respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min
Black Box Warning:
Accidental exposure:
dispose of properly, away from children/pets
Black Box Warning:
Overdose/poisoning:
avoid alcohol ingestion, do not crush, chew, snort, or inject tabs, high abuse potential
Black Box Warning:
Opioid-naive patients:
ext rel tabs are not to be used immediately postop (12-24 hr after surgery) in these patients
•
Storage in light-resistant area at room temp
•
Therapeutic response: decrease in pain
•
To report any symptoms of CNS changes, allergic reactions
•
That physical dependency may result from extended use
•
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
•
Not to drive or operate machinery if drowsiness occurs
Not to use other CNS depressants, alcohol
•
To make position changes slowly to prevent orthostatic hypotension
Naloxone (Narcan) 0.2-0.8 mg IV, (caution with patients physically dependent on opioids) O
2
, IV fluids, vasopressors
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERToxytocin (Rx)
(ox-i-toe′sin)
Pitocin
Func. class.:
Hormone
Chem. class.:
Oxytocic, uterine-active agent
Acts directly on myofibrils, thereby producing uterine contraction; stimulates milk ejection by the breast; vasoactive antidiuretic effect
Stimulation, induction of labor; missed or incomplete abortion; postpartum bleeding
Hypersensitivity, serum toxemia, cephalopelvic disproportion, fetal distress, hypertonic uterus, prolapsed umbilical cord, active genital herpes
Precautions:
Cervical/uterine surgery, uterine sepsis, primipara >35 yr, 1st/2nd stage of labor
Black Box Warning:
Elective induction of labor
Calculator
• Adult:
IV
10-40 units in 1000 ml nonhydrating diluent infused at 20-40 mU/min
• Adult:
IM
3-10 units after delivery of placenta
• Adult:
IV
0.5 mU/min, increase q20min until 3 contractions within 10 min
• Adult:
IV
1-2 mU/min, increase by 1-2 mU q15-60min until contractions occur then decrease dose
• Adult:
IV INF
10 units/500 ml D
5
W or 0.9% NaCl at 10-20 mU/min, max 30 units/12 hr
Available forms:
Inj 10 units/ml
•
Use infusion pump
•
After diluting 10 units/1000 ml of 0.9% NS or D
5
NS run at 1-2 mU/min at 15- to 30-min intervals to begin normal labor; dilute 10-40 mU/min; titrate to control postpartum bleeding; dilute 10 units/500 ml sol; run 10 units-20 mU/ml; administer by only 1 route at a time; use inf pump; rotate inf to provide mixing; do not shake
•
Dilute 10-40 units/1000 ml of sol; run at 10-20 mU/min; adjust rate as needed
•
With crash cart available on unit (magnesium sulfate at bedside)
•
Dilute 10 units/500 ml compatible IV sol
Y-site compatibilities:
Heparin, hydrocortisone, insulin (regular), meperidine, morphine, potassium chloride, vit B/C, warfarin
CNS:
Seizures, tetanic contractions
CV:
Hypo/hypertension, dysrhythmias, increased pulse, bradycardia, tachycardia, PVC
FETUS:
Dysrhythmias, jaundice, hypoxia,
intracranial hemorrhage
GI:
Anorexia, nausea, vomiting, constipation
GU:
Abruptio placentae, decreased uterine blood flow
HEMA:
Increased hyperbilirubinemia
INTEG:
Rash
RESP:
Asphyxia
SYST:
Water intoxication of mother
IM:
Onset 3-7 min, duration 1 hr, half-life 12-17 min
IV:
Onset 1 min, duration 30 min, half-life 12-17 min
•
Hypertension: vasopressors
•
Hypertension: ephedra
•
I&O ratio
•
B/P, pulse; watch for changes that may indicate hemorrhage
•
Respiratory rate, rhythm, depth; notify prescriber of abnormalities
•
Length, intensity, duration of contraction; notify prescriber of contractions lasting >1 min or absence of contractions; turn patient on her side; discontinue oxytocin
•
FHTs, fetal distress; watch for acceleration, deceleration; notify prescriber if problems occur; fetal presentation, pelvic dimensions; turn patient on left side if FHT change in rate, give O
2
Water intoxication;
confusion, anuria, drowsiness, headache
•
Therapeutic response: stimulation of labor, control of postpartum bleeding
•
To report increased blood loss, abdominal cramps, fever, foul-smelling lochia
•
That contractions will be similar to menstrual cramps, gradually increasing in intensity
Black Box Warning:
Elective induction of labor: use only for induction when medically necessary
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert