Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (309 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pam-i-drone′ate)
Aredia
Func. class.:
Bone-resorption inhibitor, electrolyte modifier
Chem. class.:
Bisphosphonate
Do not confuse:
Aredia
/Adriamycin
Inhibits bone resorption, apparently without inhibiting bone formation and mineralization; adsorbs calcium phosphate crystals in bone and may directly block the dissolution of hydroxyapatite crystals of bone
Moderate to severe Paget’s disease, hypercalcemia, osteolytic bone metastases in breast cancer, patients with multiple myeloma
Unlabeled uses:
Postmenopausal osteoporosis and prevention, osteoporosis prophylaxis, ankylosing spondylitis, osteogenesis imperfecta, hyperparathyroidism
Pregnancy (D), hypersensitivity to bisphosphonates
Precautions:
Children, nursing mothers, renal dysfunction, poor dentition
Calculator
• Adult:
IV INF
60-90 mg as single dose for moderate hypercalcemia, 90 mg for severe hypercalcemia over 2-24 hr; dose should be diluted in 1000 ml 0.45% NaCl, 0.9% NaCl, or D
5
W; wait 7 days before 2nd course
• Adult:
IV
90 mg/500 ml of D
5
W, 0.45% NaCl, or 0.9% NaCl given over 4 hr each mo (multiple myeloma) or over 2 hr q3-4wk (breast carcinoma)
• Adult:
IV INF
30 mg/day given over 4 hr × 3 days
• Child:
IV
1.5-3 mg/kg/cycle, cycle dose is divided in 3, administered via slow IV over 4 hr/day × 3 days
• Adult:
IV
15-60 mg as a single dose
• Adult:
IV
30 mg q3mo × 1 yr
• Adult:
IV INF
60 mg over 4 hr; 6-hr inf for 1st dose
• Adult:
IV INF
30 mg over 1 hr q3mo × 1 yr
Available forms:
Powder for inj 30, 90 mg/vial; inj 3, 6, 9 mg/ml
•
After reconstituting by adding 10 ml sterile water for inj to each vial (30 mg/10 ml or 90 mg/10 ml, depending on vial used); add to 1000 ml of sterile 0.45%, 0.9% NaCl, D
5
W, run over 2-24 hr
(hypercalcemia);
dilute reconstituted sol in 500 ml of 0.9% NaCl, 0.45% NaCl, or D
5
W, give over 4 hr
(multiple myeloma, Paget’s disease);
dilute reconstituted sol in 250 ml of 0.9% NaCl, 0.45% NaCl, or D
5
W, give over 2 hr
(osteolytic bone metastases of breast cancer)
•
Do not mix with calcium-containing inf sol such as Ringer’s sol
•
Storage of inf sol up to 24 hr at room temp
•
Reconstituted sol with sterile water may be refrigerated for ≤24 hr
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, CARBOplatin, carmustine, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DAPTOmycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron,
haloperidol, heparin, hetastarch 6%, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), isoproterenol, ketorolac, labetalol, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, mivacurium, morphine, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxytocin, PACLitaxel, palonosetron, pancuronium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, polymyxin B, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, topotecan, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine
CNS:
Fever
, fatigue
CV:
Hypertension,
atrial fibrillation
EENT:
Ocular pain, inflammation, vision impairment
GI:
Abdominal pain, anorexia, constipation, nausea, vomiting, dyspepsia
GU:
Renal failure
HEMA:
Thrombocytopenia, anemia, leukopenia
INTEG:
Redness, swelling, induration, pain on palpation at site of catheter insertion
META:
Hypokalemia, hypomagnesemia, hypophosphatemia, hypocalcemia
, hypothyroidism
MS:
Severe bone pain, myalgia, osteonecrosis of the jaw
RESP:
Coughing, dyspnea, upper respiratory tract infection
SYST:
Angioedema, anaphylaxis
Rapidly cleared from circulation and taken up mainly by bones, primarily in areas of high bone turnover; eliminated primarily by kidneys; half-life 21-35 hr, terminal half-life in bone is 300 days
Increase:
hypokalemia—loop diuretics
Increase:
nephrotoxicity—aminoglycosides, NSAIDs, vancomycin, radiopaque contrast agents, cycloSPORINE, tacrolimus
Increase:
effect of entecavir
Decrease:
pamidronate effect—calcium, vit D
Increase:
creatinine
Decrease:
potassium, magnesium, phosphate, calcium, WBC, platelets
•
Hypocalcemia:
nausea, vomiting, constipation, thirst, dysrhythmias, hypocalcemia, paresthesia, twitching, laryngospasm, Chvostek’s sign, Trousseau’s sign;
hypercalcemia:
thirst, nausea, vomiting, dysrhythmias
•
Dehydration/hypovolemia: should be corrected during treatment of hypercalcemia, before therapy, maintain adequate urine output
•
Monitor WBCs, platelets, electrolytes, creatinine, BUN, Hgb/Hct before beginning treatment
•
Dental health:
cover with antiinfectives for dental extractions
•
Temperature may be elevated during the first 3 days after a dose, risk of fever increases as dose increases
•
Renal disease: Max 90-mg single dose, longer infusions >2 hr may increase risk for renal toxicity
•
Bone pain; use analgesics
•
I&O, check for fluid overload edema, crackles, increased B/P; BUN, creatinine
•
Therapeutic response: decreased calcium levels
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (D)
•
To report hypercalcemic relapse: nausea, vomiting, bone pain, thirst; unusual muscle twitching, muscle spasms; severe diarrhea, constipation
•
To continue with dietary recommendations, including calcium and vit D
•
To obtain analgesic from provider for bone pain
•
That, if nausea, vomiting occur, small, frequent meals may help
•
To report ocular symptoms to prescriber: blurred vision, edema, inflammation
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(pan-kre-li′pase)
Creon, DMH
, Pancrease, Pancreaze, Pancrecarb MS, Pertzye, Ultrase MT, Ultresa, Viokase, Zenpep
Func. class.:
Digestant
Chem. class.:
Pancreatic enzyme—bovine/porcine
Pancreatic enzyme needed for the breakdown of substances released from the pancreas
Exocrine pancreatic secretion insufficiency, cystic fibrosis (digestive aid), steatorrhea, pancreatic enzyme deficiency
Allergy to pork
Precautions:
Pregnancy (B), ileus, pancreatitis, Crohn’s disease
Calculator
Many products listed above are not interchangeable
• Adult/adolescent/child
≥
4 yr (del rel caps: Creon Caps, Zenpap Caps, Pancreaze Caps):
PO
500 lipase units/kg/meal, titrate based on patient response, max 2500 lipase units/kg/meal
• Child 1-4 yr:
PO
1000 lipase units/kg/meal, titrate based on patient response, max 2500 lipase units/kg/meal
Available forms:
Tabs (Viokase) 10, 204; cap, del rel 4, 8, 154 (Pancrecarb MS), 12, 18, 20 (Ultrase MT), Ultrase; cap 3000, 4200, 5000, 6000, 8000, 10,500, 12,000, 15,000, 16,000, 16,800, 24,000, 25,000 units
•
After antacid or cimetidine; decreased pH inactivates product
•
Low-fat diet for GI symptoms
•
Have patient sit up during administration; give with meals
•
Do not crush, chew del rel products, caps
•
Viokase is not interchangeable with other products
GI:
Anorexia, nausea, vomiting, diarrhea, cramping, bloating
GU:
Hyperuricuria, hyperuricemia
Decrease:
absorption—cimetidine, antacids, oral iron
Decrease:
effect of acarbose, miglitol
•
Appropriate height, weight development before and periodically; may be delayed
•
I&O ratio; watch for increasing urinary output
•
Fecal fat, nitrogen, PT during treatment
•
Diabetes mellitus:
for polyuria, polydipsia, polyphagia
•
Pork sensitivity; cross-sensitivity may occur
•
Adequate hydration
•
Storage in tight container at room temp
•
Therapeutic response: improved digestion of carbohydrates, protein, fat; absence of steatorrhea
•
To notify prescriber of allergic reactions, abdominal pain, cramping, or blood in urine
•
To always take with food, not to crush, chew del rel product, caps
•
To store at room temperature, away from moisture