Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (310 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(pan-kyoo-roe′nee-um)
Func. class.:
Neuromuscular blocker (nondepolarizing)
Chem. class.:
Synthetic curariform
Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine
Facilitation of endotracheal intubation, skeletal muscle relaxation during mechanical ventilation, surgery, or general anesthesia
Hypersensitivity to bromide ion
Precautions:
Pregnancy (C), breastfeeding, children <2 yr, neuromuscular/ cardiac/renal/hepatic disease, electrolyte imbalances, dehydration, previous anaphylactic reactions (other neuromuscular blockers)
Black Box Warning:
Respiratory insufficiency
Calculator
• Adult/child/infant
>
1 mo:
IV
0.04-0.1 mg/kg initially or 0.05 mg/kg after initial dose of succinylcholine; maintenance 0.01 mg/kg 60-100 min after initial dose then 0.01 mg/kg q25-60min as needed; for obese patients, use ideal body weight
• Neonate
<
1 mo:
IV
Test dose 0.02 mg/kg then 0.03 mg/kg/dose initially, repeat 2× as needed at 5-10 min intervals; maintenance 0.03-0.09 mg/kg/dose q30min-4 hr as needed
Available forms:
Inj 1, 2 mg/ml
•
May be given undiluted over 1-2 min (1 mg/ml [10-ml vial], 2 mg/ml [2-, 5-ml vial])
•
Add 100 mg of product to 250 ml D
5
W, NS, LR (0.4 mg/ml)
Additive compatibilities:
Verapamil, ciprofloxacin
Y-site compatibilities:
Aminophylline, ceFAZolin, cefuroxime, cimetidine, DOBUTamine, DOPamine, EPINEPHrine, esmolol, fenoldopam, fentaNYL, fluconazole, gentamicin, heparin, hydrocortisone, isoproterenol, levofloxacin, LORazepam, midazolam, morphine, nitroglycerin, ranitidine, trimethoprim-sulfamethoxazole, vancomycin
CV:
Bradycardia; tachycardia; increased, decreased B/P; ventricular extrasystoles, edema, hypertension
EENT:
Increased secretions
INTEG:
Rash, flushing, pruritus, urticaria, sweating, salivation
MS:
Weakness to prolonged skeletal muscle relaxation
RESP:
Prolonged apnea, bronchospasm, cyanosis, respiratory depression,
dyspnea
SYST:
Anaphylaxis
IV:
Onset 3-5 min, dose dependent, peak 3-5 min; metabolized (small amounts), excreted in urine (unchanged), crosses placenta
•
Dysrhythmias: theophylline
Increase:
neuromuscular blockade—aminoglycosides, clindamycin, enflurane, isoflurane, lincomycin, lithium, local anesthetics, opioid analgesics, polymyxin antiinfectives, quiNIDine, thiazides
Decrease:
cholinesterase
•
Respiratory recovery:
decreased paralysis of face, diaphragm, leg, arm, rest of body; allow to recover fully before neurologic assessment
•
Electrolyte imbalances (K, Mg); may lead to increased action of product
•
VS (B/P, pulse, respirations, airway) until fully recovered; rate, depth, pattern of respirations, strength of hand grip
•
I&O ratio; check for urinary retention, frequency, hesitancy
Allergic reactions, anaphylaxis:
rash, fever, respiratory distress, pruritus; product should be discontinued
•
Storage in refrigerator; do not store in plastic; use only fresh sol
•
Reassurance if communication is difficult during recovery from neuromuscular blockade
•
Frequent (q2hr) instillation of artificial tears, covering of eyes to prevent drying of cornea
•
Therapeutic response: paralysis of jaw, eyelid, head, neck, rest of body
Neostigmine, atropine, monitor VS; may require mechanical ventilation
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(pan-i-tue′moo-mab)
Vectibix
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Multikinase inhibitor, signal transduction inhibitor
Decreases growth and survival of cancer cells by competitive inhibition of EGF receptor
EGFR expressing metastatic colorectal cancer; not beneficial with KRAS mutations in codon 12 or 13
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, hepatic disease, acute bronchospasm, diarrhea, hamster protein allergy, hypomagnesemia, hypotension, pulmonary fibrosis, sepsis, KRAS mutations
Black Box Warning:
Exfoliative dermatitis, infusion-related reactions
Calculator
• Adult:
IV INF
6 mg/kg over 60 min every 2 wk; doses >1000 mg over 90 min
Available forms:
Sol for inj 20 mg/ml (100 mg/5 ml, 400 mg/20 ml)
•
Give in hospital or clinic setting with full resuscitation equipment
•
Only as IV inf using controlled IV inf pump; do not give IV push or bolus; use low-protein binding 0.2- or 0.22-micron in-line filter; flush line with 0.9% NaCl before and after administration
•
Give over 60 min through a peripheral line or indwelling catheter; infuse doses of >1000 mg over 90 min
•
Dilute in 100 ml of 0.9% NaCl; dilute doses >1000 mg in 150 ml of 0.9%
NaCl; mix by inverting; do not exceed 10 mg/ml; use within 6 hr if stored at room temp; can be stored between 2° C and 8° C for up to 24 hr
•
Dosage adjustment for infusion/dermatologic reaction
•
Grade 1 or 2: reduce infusion by 50%; Grade 3 or 4: terminate, permanently discontinue depending on severity/resistance
CNS:
Fatigue
CV:
Peripheral edema
EENT:
Ocular irritation,
ocular toxicity
GI:
Nausea, diarrhea, vomiting
, anorexia, mouth ulceration, abdominal pain, constipation
HEMA:
Thrombophlebitis
INTEG:
Rash
, pruritus,
exfoliative dermatitis,
skin fissure,
angioedema, severe/fatal INF reactions
META:
Hypocalcemia, hypomagnesemia, antibody formation
RESP:
Bronchospasm, cough,
dyspnea,
hypoxia, pulmonary fibrosis/embolism,
pneumonitis, wheezing, interstitial lung disease
Bioavailability 38%-49%; elimination half-life 7.5 days; peak 3 hr; high-fat meal decreases bioavailability; plasma protein binding 99.5%; metabolized in liver; oxidative metabolism by CYP3A4, glucuronidation by UGT1A9; 77% excreted in feces
•
Do not use in combination with other antineoplastics
Black Box Warning:
Serious skin disorders:
fever, sore throat, fatigue, then lesions in mouth, lips; withhold product, notify prescriber
•
Serum electrolytes periodically (calcium, magnesium)
•
Infection:
increased temp
Black Box Warning:
Inf reactions:
bronchospasm, fever, chills, hypotension; may require discontinuation, have emergency equipment available
•
Ocular toxicity:
ocular irritation, hyperemia
•
Pulmonary fibrosis:
dyspnea, cough, wheezing; may require discontinuation
•
Storage of unopened vials in refrigerator; do not shake; protect from direct sunlight; do not freeze
•
Therapeutic response: decrease in colon carcinoma progression
To report adverse reactions immediately: difficulty breathing, mouth sores, skin rash, ocular toxicity
•
About reason for treatment, expected results, adverse reactions
•
To use contraception while taking product, for 6 mo after treatment; not to breastfeed for ≥2 mo after stopping treatment
•
To avoid the sun, use sunscreen while taking product