Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (311 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pan-toe-pray′zole)
Panto
, Pantoloc, Protonix, Prontonix IV
Func. class.:
Proton pump inhibitor
Chem. class.:
Benzimidazole
Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor because it blocks the final step of acid production
Gastroesophageal reflux disease (GERD), severe erosive esophagitis;
maintenance of long-term pathologic hypersecretory conditions, including Zollinger-Ellison syndrome
Unlabeled uses:
Duodenal/gastric ulcer, NSAID ulcer prophylaxis,
Helicobacterpylori–
associated ulcer, dyspepsia
Hypersensitivity to this product or benzimidazole
Precautions:
Pregnancy (C), breastfeeding, children, proton pump hypersensitivity
Calculator
• Adult:
PO
40 mg/day × 8 wk, may repeat course
• Adult:
IV
40 mg/day × 7-10 day;
PO
40 mg/day × 8 wk; may repeat
PO
course
• Adult:
PO
40 mg bid;
IV
80 mg q12hr, max 240 mg/day
• Adult:
PO
40 mg/day
associated ulcers (unlabeled)
• Adult:
PO
40 mg bid; may be used with other products
Available forms:
Del rel tabs 20, 40 mg; powder for inj 40 mg/vial; del rel granules for susp 40 mg
•
Swallow del rel tabs whole; do not break, crush, or chew; take del rel tabs at same time of day
•
May take with/without food
•
Suspension:
give in apple juice 30 min before a meal or sprinkled on 1 Tbsp of applesauce
•
NG tube:
Empty contents of packet of granules into barrel of a 60 ml catheter tip syringe (plunger removed) connected to ≥16F NG tube, add 10 ml apple juice and tap or shake barrel of syringe to empty into the tube; add another 10 ml of apple juice, rinse with additional apple juice until syringe is clear
•
Use of Protonix IV vials with spiked IV system adaptors is not recommended
•
Visually inspect for particulate matter and discoloration before use
•
Give as an IV infusion over 15 min either through a dedicated line or a
Y
-site; a 2-min slow-injection regimen is also approved, do not give fast IV push
•
When using a
Y
-site, immediately stop use if a precipitation or discoloration occurs
•
Reconstitution of vial
: Use 40 mg vial/10 ml NS, do not freeze
•
Two-minute slow IV infusion injection:
Dilute one or two 40-mg vials with 10 ml NS per vial to 4 mg/ml, store ≤24 hr at room temperature before use; infuse slowly over ≥2 min; do not give with other IV fluids or medications; flush line with D
5
W, NS, or LR before and after each dose
•
Fifteen-minute IV infusion:
Dilute each 40-mg dose with 10 ml NS; the reconstituted vial should be further admixed with 100 ml (for one vial) or 80 ml (for 2 vials) of D
5
W, NS, or LR (to 0.4 mg/ml or 0.8 mg/ml, respectively); store ≤6 at room temperature before further dilution; the admixed solution (0.4 mg/ml or 0.8 mg/ml) may be stored at room temperature and must be used within 24 hr from the time of initial reconstitution; infuse over 15 min at 7 ml/min; do not administer with other IV fluids or medications; flush IV line with D
5
W, NS, or LR before and after each dose
Y-site compatibilities:
Acyclovir, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amoxicillin-clavulanate, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, azithromycin, bleomycin, bumetanide, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefOXitin,
cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dextrose 3.3% in sodium chloride 0.3%, digoxin, dimenhyDRINATE, DOCEtaxel, DOPamine, doripenem, doxycycline, enalaprilat, EPINEPHrine, ertapenem, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gentamicin, granisetron, heparin, hydrocortisone HYDROmorphone, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, magnesium, mannitol, mesna, methohexital, methyldopate, metoclopramide, nafcillin, nitroglycerin, nitroprusside, ofloxacin, oxytocin, PACLitaxel, pentazocine, PENTobarbital, phenylephrine, piperacillin-tazobactam, potassium chloride, procainamide, rifampin, sodium bicarbonate, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, teniposide, theophylline, thiopental, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, traMADol, vasopressin, zidovudine
CNS:
Headache
, insomnia, asthenia, fatigue, malaise, insomnia, somnolence
GI:
Diarrhea, abdominal pain
, flatulence,
pancreatitis,
weight changes
INTEG:
Rash
META:
Hyperglycemia, weight gain/loss, hyponatremia, hypomagnesemia
MS:
Rhabdomyolysis, myalgia
RESP:
Pneumonia
SYST:
Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, angioedema
Peak 2.4 hr, duration >24 hr, half-life 1.5 hr, protein binding 97%, eliminated in urine as metabolites and in feces; in geriatric patients, elimination rate decreased; some Asian patients (15%-20%) may be poor metabolizers
Increase:
pantoprazole serum levels—diazepam, phenytoin, flurazepam, triazolam, clarithromycin
Increase:
bleeding—warfarin
Decrease:
absorption of these products—sucralfate, calcium carbonate, vit B
12
, ketoconazole, itraconazole, atazanavir, ampicillin, iron salts
Decrease:
clopidogrel effect
Decrease:
effect of pantoprazole—St. John’s wort
• GI system:
bowel sounds q8hr; abdomen for pain, swelling; anorexia
•
Hepatic studies:
AST, ALT, alk phos during treatment
•
For vit B
12
deficiency in patients receiving long-term therapy
Serious skin reactions:
toxic epidermal necrolysis, Stevens-Johnson syndrome, exfoliative dermatitis: fever, sore throat, fatigue, thin ulcers; lesions in the mouth, lips
•
Electrolyte imbalances:
hyponatremia; hypomagnesemia in patients using product 3 mo to 1 year; if hypomagnesemia occurs, use of magnesium supplements may be sufficient; if severe, discontinuation of product may be required
Rhabdomyolysis, myalgia:
muscle pain, increased CPK; weakness, swelling of affected muscles
•
Therapeutic response: absence of epigastric pain, swelling, fullness
•
To report severe diarrhea; black, tarry stools; abdominal pain; product may have to be discontinued
•
That hyperglycemia may occur in diabetic patients
•
To avoid alcohol, salicylates, NSAIDs; may cause GI irritation
•
To notify prescriber if pregnant or planning to become pregnant;
not to breastfeed
•
To continue taking even if feeling better