Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (31 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(a-mi-foss′teen)
Ethyol
Func. class.:
Cytoprotective agent for cisplatin/radiation
Binds and detoxifies damaging metabolites of cisplatin, alkylating agents, DNA-reactive agents, ionizing radiation by converting this product by alk
phos in tissue to an active free thiol compound
To reduce renal toxicity when cisplatin is given repeatedly for ovarian cancer; to reduce xerostomia (dry mouth) after radiation therapy for head, neck cancer
Unlabeled uses:
To prevent or reduce cisplatin-induced neurotoxicity, cyclophosphamide-induced granulocytopenia; to prevent or reduce toxicity of radiation therapy; to reduce toxicity of paclitaxel, myelodysplastic syndrome (MDS)
Breastfeeding, hypersensitivity to mannitol, aminothiol; hypotension, dehydration
Precautions:
Pregnancy (C), children, geriatric patients, CV disease, hypocalcemia, MI, radiation therapy, stroke, dehydration, hypotension, chemotherapy, exfoliative dermatitis
Calculator
•Adult: IV
910 mg/m
2
/day within 1/2 hr before chemotherapy, give over 15 min; may reduce dose to 740 mg/m
2
if higher dose is poorly tolerated
•Adult: IV
200 mg/m
2
/day over 3 min as inf 15-30 min before radiation therapy
•Adult: IV
100-340 mg/m
2
/day over 15 min before each dose of chemotherapy/radiation
•Adult: IV
100 mg/m
2
3×/wk, max 300 mg/m
2
3×/wk
Available forms:
Powder for inj, lyophilized 500 mg/vial
•
Intermittent inf after reconstituting 500 mg/9.7 ml of sterile 0.9% NaCl, further dilute with 0.9% NaCl to concentration of 5-40 mg/ml, give over 15 min within 1/2 hr of chemotherapy, place patient in supine position during inf
•
Xerostomia:
Give over 3 min 15-30 min before radiation
Y-site compatibilities:
Amikacin, aminophylline, amphotericin B liposome, ampicillin, ampicillin/sulbactam, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, caspofungin, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, ciprofloxacin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin, doxycycline, droperidol, enalaprilat, epirubicin, ertapenem, etoposide, famotidine, fenoldopam, floxuridine, fluconazole, fludarabine, fluorouracil, furosemide, gallium, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem-cilastatin, leucovorin, levofloxacin, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, mezlocillin, milrinone, mitoMYcin, morphine, nalbuphine, nesiritide, netilmicin, octreotide, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pantoprazole, pemetrexed, piperacillin, plicamycin, potassium chloride, promethazine, ranitidine, sodium bicarbonate, streptozocin, tacrolimus, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, trastuzumab, trimethoprim-sulfamethoxazole, trimetrexate,
vancomycin, vinBLAStine, vinCRIStine, voriconazole, zidovudine
Solution compatibility:
0.9% NaCl
Additive incompatibilities:
Do not mix with other products
CNS:
Dizziness, somnolence, loss of consciousness,
seizures
CV:
Hypotension
EENT:
Sneezing
GI:
Nausea, vomiting
, hiccups,
diarrhea
INTEG:
Flushing, feeling of warmth
MISC:
Hypocalcemia
, rash, chills,
anaphylaxis, toxic epidermal necrolysis, toxicoderma, Stevens-Johnson syndrome, exfoliative dermatitis, erythema multiforme
Metabolized to free thiol compound, half-life 8 min, onset 5-8 min
Increase:
hypotension—antihypertensives
Decrease:
calcium
•
B/P before and q5min during inf; antihypertensives should be discontinued 24 hr before inf if severe hypotension occurs, give IV 0.9% NaCl to expand fluid volume, place patient in modified Trendelenburg position
•
Fluid status before administration; administer antiemetic before administration to prevent severe nausea and vomiting; may also give dexamethasone 20 mg IV and a serotonin antagonist such as ondansetron, dolasetron, granisetron
•
Calcium levels before and during treatment; may cause hypocalcemia, calcium supplements may be needed
•
Xerostomia:
mouth lesions, dry mouth during therapy
•
Anaphylaxis:
Rash, pruritus, wheezing, laryngeal edema, discontinue; give antihistamines, EPINEPHrine depending on severity; reactions may be delayed, if severe product should be permanently discontinued; other serious skin disorders (Stevens-Johnson syndrome, toxic epidermal necrolysis, toxicoderma, erythema multiforme, exfoliative dermatitis)
•
Therapeutic response: prevention of renal toxicity associated with cisplatin therapy; decreased xerostomia associated with radiation therapy of head, neck cancer
•
To stay supine during inf, B/P will be monitored often
•
To drink fluids
•
To report signs, symptoms, severe reactions
•
The reason for the medication and expected results
•
That side effects may include severe nausea, vomiting, decreased B/P, chills, dizziness, somnolence, hiccups, sneezing, skin reactions
•
Not to breastfeed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(am-i-kay′sin)
Amikin
Func. class.:
Antiinfective
Chem. class.:
Aminoglycoside
Do not confuse:
Amikin
/Amicar
Amikacin
/anakinra
Interferes with protein synthesis in bacterial cells by binding to ribosomal subunits, which causes misreading of genetic code; inaccurate peptide sequence forms in protein chain, thereby causing bacterial death
Severe systemic infections of CNS, respiratory tract, GI tract, urinary tract, bone, skin, soft tissues caused by
Staphylococcus aureus (MSSA), Pseudomonas aeruginosa, Escherichia coli, Enterobacter, Acinetobacter, Providencia, Citrobacter, Serratia, Proteus, Klebsiella pneumoniae
Unlabeled uses:
Mycobacterium avium
complex (MAC) (intrathecal or intraventricular) in combination; aerosolization, actinomycotic mycetoma, febrile neutropenia
Pregnancy (D), mild to moderate infections, hypersensitivity to aminoglycosides, sulfites
Precautions:
Breastfeeding, neonates, geriatric patients, myasthenia gravis, Parkinson’s disease
Black Box Warning:
Hearing impairment, renal/neuromuscular disease
Calculator
• Adult and child:
IV INF
10-15 mg/kg/day in 2-3 divided doses q8-12hr in 100-200 ml D
5
W over 30-60 min, max 1.5 g; use for 7-10 days; decreased doses are needed with poor renal function as determined by blood levels, renal studies;
pulse dosing
(once-daily dosing) may be used with some infections;
IM
10-15 mg/kg/day in divided doses q8-12hr; daily or extended-interval dosing as an alternative dosing regimen
• Infant: IV/IM
10 mg/kg initially then 7.5 mg/kg q12hr
• Neonate:
IV/IM
10 mg/kg initially then 7.5 mg/kg q12hr
• Premature neonate:
10 mg/kg initially then 7.5 mg/kg q8-12hr
• Adult:IM
10-15 mg/kg/day divided q8-12hr
• Adult:IM/IV
7.5 mg/kg followed by 5 mg/kg 3×/wk after each dialysis session (for TIW dialysis)
•Adult: IV
CCr 40-59 ml/min 15 mg/kg q36hr; CCr 20-39 ml/min 15 mg/kg q48hr; <20 ml/min adjust based on serum concentrations and MIC
• Adult and adolescent:
IV
7.5-15 mg/kg divided q12-24hr as part of multiple-drug regimen
• Child:
IV
15-30 mg/kg/day divided q12-24hr as part of multiple-drug regimen, max 1.5 g/day
• Adult:IM/IV
15 mg/kg/day in 2 divided doses × 3 wk with co-trimoxazole for 5 wk; repeat cycle once, may be repeated 2×
Available forms:
Inj 50, 250 mg/ml
•
Inj in large muscle mass; rotate inj sites
•
Obtain C&S before administration, begin treatment before results
•
Obtain peak 1 hr after IM, trough before next dose
•
Dilute 500 mg of product/100-200 ml of D
5
W, 0.9% NaCl and give over 1/2-1 hr; dilute in sufficient volume to allow for inf over 1-2 hr (infants); flush after administration with D
5
W or 0.9% NaCl; sol clear or pale yellow; discard if precipitate or dark color develops
•
In children, amount of fluid will depend on ordered dose; in infants, infuse over 1-2 hr
•
In evenly spaced doses to maintain blood level, separate from penicillins by at least 1 hr
Y-site compatibilities:
Acyclovir, aldesleukin, alfentanil, amifostine, aminophylline, amiodarone, amsacrine, anidulafungin, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefepime, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, codeine, cyanoco
balamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, doxycycline, eftifibatide, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, ertapenem, erythromycin, esmolol, etoposide, famotidine, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, IL-2, imipenem/cilastin, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pantoprazole, papaverine, PEMEtrexed, penicillin G, pentazocine, perphenazine, PHENobarbital, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, rantidine, remifentanil, riTUXimab, rocuromium, sargramostim, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimethaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, warfarin, zidovudine
CNS:
Confusion, depression, numbness, tremors,
seizures,
muscle twitching,
neurotoxicity,
dizziness, vertigo, tinnitus,
neuromuscular blockade with respiratory paralysis
CV:
Hypo/hypertension, palpitations
EENT:
Ototoxicity
, deafness, visual disturbances
GI:
Nausea, vomiting, anorexia;
increased ALT, AST, bilirubin; hepatomegaly,
hepatic necrosis,
splenomegaly
GU:
Oliguria, hematuria, renal damage, azotemia, renal failure, nephrotoxicity
HEMA:
Agranulocytosis, thrombocytopenia, leukopenia, eosinophilia, anemia
INTEG:
Rash
, burning, urticaria, dermatitis, alopecia
IM:
Onset rapid, peak 1-2 hr, leads to unpredictable concentrations, IV preferred
IV:
Onset immediate, peak 15-30 min; half-life 2-3 hr, prolonged up to 7 hr in infants; not metabolized; excreted unchanged in urine; crosses placenta; removed by hemodialysis
•
Mask ototoxicity: dimenhyDRINATE, ethacrynic acid
Increase:
serum trough and peak—NSAIDs
Increase:
nephrotoxicity—cephalosporins, acyclovir, vancomycin, amphotericin B, cycloSPORINE, loop diuretics, cidofovir
Increase:
neuromuscular blockade, respiratory depression—anesthetics, nondepolarizing neuromuscular blockers
Increase:
BUN, creatinine
•
Weight before treatment; calculation of dosage is usually based on ideal body weight but may be calculated on actual body weight
•
I&O ratio; urinalysis daily for proteinuria, cells, casts; report sudden change in urine output
•
VS during infusion; watch for hypotension, change in pulse
•
IV site for thrombophlebitis including pain, redness, swelling q30min; change site if needed; apply warm compresses to discontinued site
Black Box Warning:
Renal impairment by securing urine for CCr, BUN, serum creatinine; lower dosage should be given with renal impairment; nephrotoxicity may be reversible if product stopped at 1st sign
Black Box Warning:
Deafness: audiometric testing, ringing, roaring in ears, vertigo; assess hearing before, during, after treatment
•
Dehydration: high specific gravity, decrease in skin turgor, dry mucous membranes, dark urine
•
Overgrowth of infection: increased temp, malaise, redness, pain, swelling, perineal itching, diarrhea, stomatitis, change in cough, sputum
•
Vestibular dysfunction: nausea, vomiting, dizziness, headache; product should be discontinued if severe
Black Box Warning:
Neuromuscular blockade; respiratory paralysis may occur
•
Adequate fluids of 2-3 L/day, unless contraindicated, to prevent irritation of tubules
•
Therapeutic response: absence of fever, draining wounds, negative C&S after treatment
•
To report headache, dizziness, symptoms of overgrowth of infection, renal impairment; symptoms of neurotoxicity, hepatotoxicity
To report loss of hearing; ringing, roaring in ears; feeling of fullness in head
•
To report hypersensitivity: rash, itching, trouble breathing, facial edema; notify health care provider
Hemodialysis, exchange transfusion in the newborn, monitor serum levels of product, may give ticarcillin or carbenicillin