Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (308 page)
(pal-ee-per′i-done)
Invega, Invega Sustenna
Func. class.:
Antipsychotic
Chem. class.:
Benzisoxazole derivative
Do not confuse:
Invega
/Iveegam
paliperidone
/risperiDONE
Mediated through both DOPamine type 2 (D
2
) and serotonin type 2 (5-HT
2
) antagonism
Schizophrenia
Breastfeeding, geriatric patients, seizure disorders, AV block, QT prolongation, torsades de pointes; hypersensitivity to this product, risperidone
Precautions:
Pregnancy (C), children, renal/hepatic disease, obesity, Parkinson’s disease
Black Box Warning:
Dementia-related psychosis (mortality)
Calculator
• Adult:
PO
6 mg/day, max 12 mg/day;
IM
234 mg on day 1 then 156 mg 1 wk later; after 2nd dose, give 117 mg each mo; range 39-234 mg, dosage change may be needed when used with CYP3A4 inducers
• Child/adolescent
≥
12 yr and
≥
51 kg:
PO
3 mg daily, may increase if needed by 3 mg/day in intervals of >5 days, up to max 12 mg/day; <51 kg max 6 mg/day
• Adult:
PO
CCr 50-79 ml/min, 3 mg/day, max 6 mg/day;
EXT REL IM
156 mg on day 1, 117 mg 1 wk later, then 78 mg each mo; CCr 10-49 ml/min, 1.5 mg/day, max 3 mg/day
Available forms:
Ext rel tabs 1.5, 3, 6, 9 mg; ext rel susp for inj 39 mg/0.25 ml, 78 mg/0.5 ml, 117 mg/0.75 ml, 156 mg/ml, 234 mg/1.5 ml
•
Avoid use with CNS depressants
•
Do not break, crush, or chew ext rel tabs
•
Without regard for food
•
Reduced dose for geriatric patients
•
Use for IM only, do not use IV or subcut; inj kits contain prefilled syringe and 2 safety needles, for single use only, shake for 10 sec;
deltoid inj:
≥90 kg, use 1.5-inch, 22G needle, <90 kg, use 1-inch, 23G needle, alternate injections between deltoid muscles;
gluteal inj:
use 1.5-inch, 22G needle; while holding syringe upright, twist rubber tip clockwise to remove, peel safety needle pouch halfway open, grasp needle sheath using plastic peel pouch, attach needle to Luer connection in clockwise motion, pull needle sheath away using straight pull, bring syringe with attached needle upright to de-aerate, de-aerate, inject; after inj, use finger, thumb, or flat surface to activate needle protection system until click heard, use deltoid × 2 doses
CNS:
EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia; drowsiness, insomnia, agitation, anxiety, headache
,
seizures, neuroleptic malignant syndrome,
dizziness
CV:
Orthostatic hypotension,
tachycardia; heart failure, QT prolongation, heart block, dysrhythmias
EENT:
Blurred vision
ENDO:
Hyperinsulinemia, weight gain, hyperglycemia, dyslipidemia
GI:
Nausea
, vomiting,
anorexia, constipation
, weight gain in adolescents, xerostomia
GU:
Priapism
HEMA:
Agranulocytosis
Peak 24 hr; elimination half-life 23 hr; excreted 80% urine, 11% feces, protein binding >47%
Increase:
sedation—other CNS depressants, alcohol, sedative/hypnotics, opiates
Increase:
EPS—other antipsychotics
Increase:
QT prolongation—class IA, III antidysrhythmics, azole antifungals, tricyclics (high doses), some phenothiazines, β-blockers, chloroquine, pimozide, droperidol, some antipsychotics, abarelix, alfuzosin, amoxapine, apomorphine, dasatinib, dolasetron, flecainide, halogenated anesthetics
Increase:
neurotoxicity—lithium
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs
Decrease:
effect of paliperidone—carBAMazepine, other CYP3A4 inducers
Decrease:
levodopa effect—levodopa
Increase:
prolactin levels
Black Box Warning:
Mental status: mood, behavior, confusion, orientation, suicidal thoughts/behaviors; dementia, especially in geriatric patients before initial administration
QT prolongation:
ECG for QT prolongation, ejection fraction; chest pain, palpitations, dyspnea
•
Swallowing of PO medication; check for hoarding, giving of medication to others
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
•
B/P (standing, lying), pulse, respirations; q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes
•
Hyperprolactinemia:
sexual dysfunction, decreased menstruation, breast pain
•
Dizziness, faintness, palpitations, tachycardia on rising
•
EPS:
akathisia, tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
Serotonin syndrome, neuroleptic malignant syndrome:
hyperthermia, increased CPK, altered mental status, muscle rigidity, fever, seizures, discontinue
•
Constipation, urinary retention daily; if these occur, increase bulk and water in diet; monitor for weight gain, especially among adolescents
•
Supervised ambulation until patient is stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for a long time
•
Increased fluids to prevent constipation
•
Sips of water, candy, gum for dry mouth
•
Storage in tight, light-resistant container
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech
•
That orthostatic hypotension may occur; to rise gradually from sitting or lying position
•
To avoid hot tubs, hot showers, tub baths because hypotension may occur
•
To avoid abrupt withdrawal of this product because EPS may result; that product should be withdrawn slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber because serious product interactions may occur; to avoid alcohol because increased drowsiness may occur
•
To avoid hazardous activities if drowsy or dizzy
•
About compliance with product regimen; that nonabsorbable tab shell is expelled in stool
•
To report impaired vision, tremors, muscle twitching
•
That heat stroke may occur in hot weather; to take extra precautions to stay cool
•
To use contraception; to inform prescriber if pregnancy is planned or suspected,
do not breastfeed
Black Box Warning:
To notify prescriber of suicidal thoughts/behaviors, other changes in behavior
Lavage if orally ingested; provide airway;
do not induce vomiting
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(pa-lone-o′se-tron)
Aloxi
Func. class.:
Antiemetic
Chem. class.:
5-HT
3
receptor antagonist
Prevents nausea, vomiting by blocking serotonin peripherally, centrally, and in the small intestine at the 5-HT
3
receptor
Prevention of nausea, vomiting associated with cancer chemotherapy, postoperative nausea/vomiting
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, hypokalemia, hypomagnesium, patients taking diuretics
Calculator
• Adult:
PO
0.5 mg as single dose 1 hr prior to chemotherapy;
IV
0.25 mg as single dose over 30 sec 1/2 hr prior to chemotherapy, max 25 mg
IV
over q7days
≤
24 hr after surgery
• Adult:
IV
0.075 mg given over 10 sec immediately before induction
Available forms:
Inj 0.25/5 ml; caps 0.5 mg
•
Give 1 hr prior to chemotherapy
•
May be taken without regard to food
•
Storage at room temp
•
Do not mix with other products; flush IV line before and after administration with 0.9% NaCl
•
Chemotherapy nausea/vomiting:
give as single dose over 30 sec
•
Postoperative nausea/vomiting:
give over 10 sec immediately prior to anesthesia induction
Syringe compatibilities:
Dexamethasone
Y-site compatibilities:
Alemtuzumab, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B liposome, ampicillin, ampicillin/sulbactam, atracurium, atropine, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium acetate/chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, dantrolene, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin hydrochloride, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gemcitabine, gentamicin, glycopyrrolate, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, inamrinone, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, line
zolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mitoXANtrone, mivacurium, morphine, nalbuphine, naloxone, neostigmine, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, PACLitaxel, pamidronate, pancuronium, pentazocine, PHENobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate/chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trimethobenzamide, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, zidovudine
CNS:
Headache, dizziness, drowsiness, fatigue, insomnia
GI:
Diarrhea, constipation
, abdominal pain
MISC:
Weakness, hyperkalemia, anxiety, rash,
bronchospasm
(rare), arthralgia
, fever, urinary retention
62% protein bound; metabolized by liver; unchanged product and metabolites excreted by kidney; terminal elimination half-life 40 hr
•
Possible QT prolongation: class 1A antidysrhythmics (disopyramide, procainamide, quiNIDine), class III antidysrhythmics (amiodarone, dofetilide, ibutilide, sotalol), chloroquine, clarithromycin, droperidol, erythromycin, haloperidol, levomethadyl, methadone, pentamidine, some phenothiazines, diuretics (except potassium sparing)
•
For agents that cause QT prolongation, even if manufacturer has removed QT prolongation from warnings
•
Absence of nausea, vomiting during chemotherapy
•
Hypersensitivity reaction:
rash, bronchospasm (rare)
•
Cardiac disease: check ECG before use
•
Hyperkalemia: monitor potassium
•
Therapeutic response: absence of nausea, vomiting during cancer chemotherapy, postoperatively
•
To report diarrhea, constipation, rash, changes in respirations, or discomfort at insertion site
•
To avoid alcohol, barbiturates
•
Use other antiemetics if nausea occurs