Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (318 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(fee-noe-bar′bi-tal)
Func. class.:
Anticonvulsant
Chem. class.:
Barbiturate
Do not confuse:
PHENobarbital
/PENTobarbital
Decreases impulse transmission; increases seizure threshold at cerebral cortex level
All forms of epilepsy, status epilepticus, febrile seizures in children, sedation, insomnia
Unlabeled uses:
Neonatal hyperbilirubinemia, chronic cholestasis, neonatal abstinence syndrome, febrile seizures in children
Pregnancy (D), breastfeeding, geriatric patients, hypersensitivity to barbiturates, porphyria, hepatic/respiratory disease, nephritis, hyperthyroidism, diabetes mellitus
Precautions:
Anemia, renal disease
Calculator
• Adult:
PO
1-3 mg/kg/day in divided doses bid-tid or total dose at bedtime
• Child 5-12 yr:
PO
3-6 mg/kg/day in 1-2 divided doses
• Child 1-5 yr:
PO
6-8 mg/kg/day in 1-2 divided doses
• Infant:
PO
5-6 mg/kg/day in 1-2 divided doses
• Neonate:
PO
3-4 mg/kg/day as single dose
• Adult:
IV INF
10 mg/kg; run no faster than 50 mg/min; may give up to 30 mg/kg
• Child:
IV INF
5-10 mg/kg; may repeat q10-15min up to 20 mg/kg; run no faster than 50 mg/min
• Adult:
PO/IM/SUBCUT
100-200 mg
• Child (unlabeled):
PO/IM/SUBCUT
3-5 mg/kg
• Adult:
PO/IM
30-120 mg/day in 2-3 divided doses
• Child:
PO
6 mg/kg/day in 3 divided doses
• Adult:
IM
100-200 mg 1-11/2 hr before surgery
• Child:
PO/IM/IV
1-3 mg/kg 1-11/2 hr before surgery
Available forms:
Caps 15 mg; elix 20 mg/5 ml; tabs 15, 30, 32, 60, 65, 100 mg; inj 30, 60, 65, 130 mg/ml
•
Tabs may be crushed and mixed with food or fluids
•
Oral sol:
use undiluted or mixed with water or other fluids; use calibrated measuring device
•
IM inj deep in large muscle mass to prevent tissue sloughing; use <5 ml at each site
•
Reconstitute powder for IV with ≥3 ml sterile water for inj; slow IV after dilution with ≥10 ml sterile water for inj regardless of dose; give ≤50 mg/min; titrate to patient response
Y-site compatibilities:
Doxapram, enalaprilat, fentaNYL, fosphenytoin, levofloxacin, linezolid, meropenem, methadone, morphine, propofol, SUFentanil
CNS:
Paradoxic excitement (geriatric patients), drowsiness, lethargy, hangover headache, flushing, hallucinations,
coma
GI:
Nausea, vomiting, diarrhea, constipation
HEMA:
Agranulocytosis, megaloblastic anemia, thrombocytopenia, thrombophlebitis
INTEG:
Rash, urticaria,
Stevens-Johnson syndrome, angioedema,
local pain, swelling, necrosis, scaling eczema
Metabolized by liver; crosses placenta; excreted in urine, breast milk; half-life 53-118 hr
PO:
Onset 20-60 min, duration 6-10 hr
IM/SUBCUT:
Onset 10-30 min, duration 4-6 hr
IV:
Onset 5 min, peak 30 min, duration 4-6 hr
Increase:
effects—CNS depressants, alcohol, chloramphenicol, valproic acid, disulfiram, nondepolarizing skeletal muscle relaxants, sulfonamides, MAOIs
Increase:
orthostatic hypotension—furosemide
Decrease:
effects—theophylline, oral anticoagulants, corticosteroids, metroNIDAZOLE, doxycycline, quiNIDine, estrogens, hormonal contraceptives
Increase:
CNS depression—chamomile, eucalyptus, hops, kava, valerian
Decrease:
barbiturate effect—St. John’s wort
•
Mental status: mood, sensorium, affect, memory (long, short)
•
Blood dyscrasias:
fever, sore throat, bruising, rash, jaundice
•
Seizures:
type, duration, precipitating factors
•
Blood studies, LFTs during long-term treatment
•
Therapeutic blood level periodically: 15-40 mcg/ml
•
Respiratory status: rate, rhythm, depth, respiratory depression; have emergency equipment nearby
•
Dependence:
physical or psychological, monitor amount given to patient; if patient suicidal, may save medication for attempt
•
Pain:
use pain scale if product used for pain; product may increase pain level
•
Supervision of ambulation because dizziness, drowsiness may occur
•
Therapeutic response: decreased seizures, increased sedation, adequate sleep
•
To use exactly as ordered
•
To avoid alcohol, other CNS depressants
•
To avoid hazardous activities until patient stabilized on product because drowsiness may occur
•
Never to withdraw product abruptly because withdrawal symptoms may occur
•
That therapeutic effects (PO) may not be seen for 2-3 wk
•
To use additional nonhormonal contraception during treatment; to notify prescriber if pregnancy (D) is planned or suspected
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(fen-tole′a-meen)
Func. class.:
Antihypertensive
Chem. class.:
α-Adrenergic blocker
Do not confuse:
phentolamine
/phentermine
α-Adrenergic blocker, binds to α-adrenergic receptors, dilating peripheral blood vessels, lowering peripheral resistances, lowering blood pressure
Hypertension; pheochromocytoma; prevention/treatment of dermal necrosis following extravasation of norepinephrine, DOPamine, EPINEPHrine
Unlabeled uses:
Impotence, hypertensive crisis due to MAOIs, sympathomimetic amines, heart failure
Hypersensitivity, MI, coronary insufficiency, angina
Precautions:
Pregnancy (C), breast-feeding, dysrhythmia
Calculator
• Adult:
IM/IV
5 mg, repeat if necessary
• Child:
IV
0.05-0.1 mg/kg/dose, repeat if necessary; max 5 mg
• Adult:
IV
2.5 mg; if negative, repeat with 5 mg IV
• Child:
IV
0.05 mg/kg; if negative, repeat with 0.1 mg/kg IV
• Adult:
5-10 mg/10 ml
NS
injected into area of norepinephrine extravasation within 12 hr
• Child:
0.1-0.2 mg/kg, max 5 mg
• Adult:
10 mg/L of norepinephrine-containing sol
• Child:
IV
0.1-0.2 mg/kg, max 5 mg
• Adult:
IV
0.17-0.4 mg/min
• Adult:
PO
40-80 mg
• Adult:
IV BOL
5-15 mg
Available forms:
Inj 5 mg/ml
•
Gum, frequent rinsing of mouth, or hard candy for dry mouth
•
With vasopressor available
•
After discontinuing all medication for 24 hr
•
Treatment during required bed rest, 1 hr after
•
After diluting 5 mg/1 ml sterile H
2
O for inj; give 5 mg or less/min; patient to remain recumbent during administration
•
Dilute 5-10 mg/500 ml D
5
W, titrate to patient response
•
10 mg/L may be added to norepinephrine in IV sol for prevention of dermal necrosis
Additive compatibilities:
DOBUTamine, verapamil
Syringe compatibilities:
Papaverine
Y-site compatibilities:
Amiodarone
CNS:
Dizziness
, flushing, weakness,
cerebrovascular spasm
CV:
Hypotension, tachycardia, angina, dysrhythmias
,
MI
EENT:
Nasal congestion
GI:
Dry mouth, nausea, vomiting, diarrhea, abdominal pain
Metabolized in liver, excreted in urine
IM:
Peak 15-20 min, duration 3-4 hr
IV:
Peak 2 min, duration 10-15 min
Increase:
effects of EPINEPHrine, antihypertensives
Increase:
toxicity, death—aconite
Increase:
antihypertensive effect—barberry, betony, black catechu, black cohosh, bloodroot, broom, burdock, cat’s claw, dandelion, goldenseal, hawthorn, Irish moss, Jamaican dogwood, kelp, khella, mistletoe, parsley
Increase or decrease:
antihypertensive effect—astragalus, cola tree
Decrease:
antihypertensive effect—coltsfoot, guarana, khat, licorice, yohimbe
•
Weight daily, I&O
•
B/P lying, standing before starting treatment, q4hr after
•
Nausea, vomiting, diarrhea, edema in feet, legs daily; skin turgor, dryness of mucous membranes for hydration status, postural hypotension, cardiac system: pulse, ECG
•
Therapeutic response: decreased B/P
•
That bed rest is required during treatment, 1 hr after
Administer norepinephrine; discontinue product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(fen-ill-ef′rin)
Neo-Synephrine
Func. class.:
Adrenergic, directacting
Chem. class.:
Substituted phenylethylamine
Powerful and selective (α
1
) receptor agonist that causes the contraction of blood vessels
Hypotension, paroxysmal supraventricular tachycardia, shock; maintain B/P for spinal anesthesia
Hypersensitivity, ventricular fibrillation, tachydysrhythmias, pheochromocytoma, closed-angle glaucoma, severe hypertension
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, arterial embolism, peripheral vascular disease, hyperthyroidism, bradycardia, myocardial disease, severe arteriosclerosis, partial heart block
Black Box Warning:
Cardiac disease, extravasation
Calculator
• Adult:
SUBCUT/IM
2-5 mg; may repeat q10-15min if needed; do not exceed initial dose;
IV
0.1-0.5 mg; may repeat q10-15min if needed; do not exceed initial dose
• Child:
IM/SUBCUT
0.1 mg/kg/dose q1-2hr prn
• Adult:
IV BOL
max 0.5 mg; max single dose 1 mg
• Adult:
IV INF
10 mg/500 ml D
5
W given 100-180 mcg/min (if 20 gtt/ml inf device) then maintenance of 40-60 mcg/min; use inf device
• Child:
IV BOL
5-20 mcg/kg/dose q10-15min;
IV INF
0.1-0.5 mcg/kg/min
Available forms:
Inj 1% (10 mg/ml)
•
Plasma expanders for hypovolemia
•
IV after diluting 1 mg/9 ml sterile water for inj; give dose over 1/2-1 min; may be diluted 10 mg/500 ml of D
5
W or NS; titrate to response (normal B/P); check for extravasation, check site for infiltration, use inf pump
Additive compatibilities:
Chloramphenicol, DOBUTamine, lidocaine, potassium chloride, sodium bicarbonate
Y-site compatibilities:
Amiodarone, amrinone, cisatracurium, famotidine, haloperidol, remifentanil, zidovudine
CNS:
Headache, anxiety, tremor, insomnia, dizziness
CV:
Palpitations, tachycardia, hypertension, ectopic beats, angina
, reflex bradycardia,
dysrhythmias
GI:
Nausea, vomiting
INTEG:
Necrosis, tissue sloughing with extravasation,
gangrene
SYST:
Anaphylaxis
IM/SUBCUT:
Onset 10-15 min, duration 45-60 min
IV:
Onset immediate, duration 20-30 min
•
Dysrhythmias: general anesthetics, digoxin
Do not use within 2 wk of MAOIs because hypertensive crisis may result
Increase:
in B/P—oxytocics
Increase:
pressor effect—tricyclics, β-blockers, H
1
antihistamines
Decrease:
phenylephrine action—α-blockers
•
I&O ratio; notify prescriber if output <30 ml/hr
•
ECG during administration continuously; if B/P increases, product is decreased
•
B/P and pulse q5min after parenteral route
•
CVP or PWP during inf if possible
•
Paresthesias and coldness of extremities; peripheral blood flow may decrease
•
Storage of reconstituted sol if refrigerated for ≤24 hr
•
Discard discolored sol
•
Therapeutic response: increased B/P with stabilization
•
About the reason for administration
•
To report pain at inf site or other adverse reactions immediately
Administer α-blocker
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert