Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (32 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(a-mill′oh-ride)
Midamor
Func. class.:
Potassium-sparing diuretic
Chem. class.:
Pyrazine
Do not confuse:
aMILoride
/amLODIPine/amiodarone
Inhibits sodium, potassium ATPase in the distal tubule, cortical collecting duct resulting in inhibition of sodium reabsorption and decreasing potassium secretion
Edema in CHF in combination with other diuretics, for hypertension, adjunct with other diuretics to maintain potassium, polyuria due to lithium administration
Unlabeled uses:
Ascites
Anuria, hypersensitivity, impaired renal function, diabetic nephropathy
Black Box Warning:
Hyperkalemia
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, dehydration, diabetes, respiratory acidosis, hyponatremia
Calculator
• Adult: PO
5-10 mg/day in 1-2 divided doses; may be increased to 10-20 mg/day if needed
• Infant/child (6-20 kg):
PO
0.625 mg/kg/day
• Adult: PO
CCr 10-50 ml/min reduce dose by 50%; however, avoid if possible; CCr <10 ml/min contraindicated
• Adult: PO
10 mg/day, max 40 mg
Available forms:
Tabs 5 mg
•
In
AM
to avoid interference with sleep if using as diuretic; if 2nd daily dose is needed, give in late afternoon
•
With food; if nausea occurs, absorption may be decreased slightly
CNS:
Headache
, dizziness, fatigue, weakness, paresthesias, tremor, depression, anxiety,
encephalopathy
CV:
Orthostatic hypotension
, dysrhythmias, chest pain
EENT:
Blurred vision, increased intraocular pressure
ELECT:
Hyperkalemia,
dehydration, hyponatremia, hypochloremia
GI:
Nausea, diarrhea
, dry mouth,
vomiting, anorexia
, cramps, constipation, abdominal pain, jaundice
GU:
Polyuria
, dysuria, urinary frequency, impotence
HEMA:
Aplastic anemia, neutropenia
INTEG:
Rash, pruritus
, alopecia, urticaria
MS:
Cramps
RESP:
Cough, dyspnea, shortness of breath
15%-25% absorbed from GI tract; widely distributed; onset 2 hr; peak 3-4 hr; duration 24 hr; excreted in urine, feces; half-life 6-9 hr
Black Box Warning:
Hyperkalemia: other potassium-sparing diuretics, potassium products, ACE inhibitors, salt substitutes, cycloSPORINE, tacrolimus; avoid concurrent use, if using together monitor potassium level
Increase:
lithium toxicity: lithium, monitor lithium levels
Increase:
action of antihypertensives
Decrease:
effect of amiloride—NSAIDs, avoid concurrent use
Increase:
effect—hawthorn, horse chestnut
•
Possible hyperkalemia: foods high in potassium, potassium-based salt substitutes
Increase:
LFTs, BUN, potassium, sodium
Interference:
GTT
•
Heart rate, B/P lying, standing; postural hypotension may occur
•
Electrolytes: potassium, sodium, chloride; glucose (serum), BUN, CBC, serum creatinine, blood pH, ABGs, periodic ECG
•
Discontinue potassium-sparing diuretics 3 days before GTT, hyperkalemia may occur
•
Hypokalemia:
weakness, polyuria, polydipsia, fatigue, ECG U wave
Black Box Warning:
Hyperkalemia: fatigue, weakness, paresthesia, confusion, dyspnea, dysrhythmias, ECG changes
•
Therapeutic response: improvement in edema of feet, legs, sacral area daily if medication is being used for CHF; decreased B/P; prevention of hypokalemia (diuretics)
•
To take as prescribed; if dose is missed, to take when remembered within 1 hr of next dose; to take with food or milk for GI symptoms; to take early in day to prevent nocturia
•
About adverse reactions: muscle cramps, weakness, nausea, dizziness, blurred vision
•
To avoid potassium-rich foods: oranges, bananas, salt substitutes, dried fruits
•
To rise slowly from sitting to standing to avoid orthostatic hypotension
•
To avoid hazardous activities if dizziness occurs
Lavage if taken orally, monitor electrolytes, administer sodium bicarbonate for potassium >6.5 mEq/L, IV glucose, kayoxalate as needed; monitor hydration, CV, renal status
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-mee′noe)
Aminosyn, Amynosyn II, Aminosyn-PF, Clinisol, FreAmine III, Premasol, Travasol, TrophAmine
Aminosyn II with dextrose, Clinimix, Amino Acid Infusions/electrolytes
Aminosyn II with electrolytes, FreAmine III with electrolytes, ProcalAmine with electrolytes, Travasol with electrolytes
Aminosyn II with electrolytes in dextrose
HepatAmine, Hepatasol
Aminosyn-HBC, FreAmine HBC
Aminosyn-RF, NephrAmine
Func. class.:
Nutritional supplement/protein
Chem. class.:
n/a
Needed for anabolism to maintain structure, decrease catabolism, promote healing
Black Box Warning:
Central infusions: Administration by central venous catheter should be used only by those familiar with this technique and its complications
Hepatic encephalopathy, cirrhosis, hepatitis, nutritional support in cancer; burn or solid organ transplant patients; to prevent nitrogen loss when adequate nutrition by mouth, gastric, or duodenal tube cannot be obtained
Hypersensitivity, severe electrolyte imbalances, anuria, severe liver damage, maple syrup urine disease, PKU, azotemia, genetic disease of amino acid metabolism
Precautions:
Pregnancy (C), breastfeeding, children, renal disease, diabetes mellitus, CHF, sulfite sensitivity
Calculator
•Adult: IV
80-120 g/day amino acids/12-18 g nitrogen of hepatic failure formula
•Adult: IV
1-1.5 g/kg/day
•Adult: IV
1.5 g/kg, use formula for high metabolic stress
•Adult: IV
Minosyn-RF 300-600 ml/70% dextrose/day; NephrAmine 250-500 ml/70% dextrose/day; the total daily dosage is calculated based on the daily protein requirements, as well as the patient’s metabolic and clinical response. Check product instructions for specific directions
• Child ≥10 kg (22 lb):
IV
20-25 g/day × first 10 kg, then 1-1.25 g/kg/day for each kg >10 kg
• Child <10 kg (22 lb):
IV
2-4 kg/day
• Child:
IV
1 g/kg/day max
•
The dosage and constant infusion rate of IV dextrose must be selected with caution in children, particularly neonates and low birth weight infants, because of
the increased risk of hyperglycemia/hypoglycemia. Owing to their concentration, these solutions are not recommended for use in children younger than 1 year
•
The total daily dosage is calculated based on the daily protein requirements, as well as the patient’s metabolic and clinical response. Check each product’s instructions for specific directions
Injection:
250, 500, 1000, 2000 ml, containing amino acids in various concentrations; amino acid infusions, crystalline: Aminosyn: 3.5%, 5%, 7%, 8.5%, 10%; AminosynII: 3.5%, 5%, 7%, 8.5%, 10%, 15%; Aminosyn-PF: 7%, 10%; Clinisol: 15%; FreAmine III: 8.5%, 10%; Premasol: 6%, 10%; Travasol: 10%; TrophAmine: 6%, 10%
Amino acid infusion/dextrose:
Aminosyn II: 3.5% in 5% dextrose, 4.25% in 20% dextrose, 4.25% in 10% dextrose 4.25% in 25% dextrose; Clinimix: 2.75% in 5% dextrose, 4.25% in 5% dextrose, 4.25% in 10% dextrose 4.25% in 20% dextrose, 4.25% in 25% dextrose, 5% in 10% dextrose, 5% in 15% dextrose, 5% in 20% dextrose, 5% in 25% dextrose, 5 Amino acid infusions/electrolytes: Aminosyn: 3.5%, 7%, 8.5%; Aminosyn II: 3.5%, 7%, 8.5%; FreAmine III: 3%, 8.5%; ProcalAmine: 3%; Travasol: 3.5%, 5.5%, 8.5%
Amino acid infusions/electrolytes/dextrose:
Aminosyn II: 3.5% with electrolytes in 5% dextrose, 3.5% with electrolytes in 25% dextrose, 4.25% with electrolytes in 10% dextrose, 4.25% with electrolytes in 20% dextrose, 4.25% with electrolytes in 25% dextrose; Amino acid infusions (hepatic failure): HepatAmine: 8%; Hepatasol: 8%
Amino acid infusions (high metabolic stress):
Aminosyn-HBC 7%; Freamine HBC: 6.9%; Amino acid (renal failure): Aminosyn-RF:5.2%; NephrAmine: 5.4%
•
Up to 40% protein and dextrose (up to 12.5%) via peripheral vein; stronger sol requires central IV administration
•
TPN only mixed with dextrose to promote protein synthesis
•
Immediately after mixing under strict aseptic technique, use inf pump, in-line filter (0.22 μm) unless mixed with fat emulsion and dextrose (3 in 1). Using careful monitoring technique; do not speed up inf; pulmonary edema, glucose overload will result
CNS:
Dizziness, headache, confusion, loss of concentration, fever
CV:
Hypertension,
CHF/pulmonary edema,
flushing,
thrombosis
ENDO:
Hyperglycemia, rebound hypoglycemia, electrolyte imbalances, hyperosmolar hyperglycemic nonketotic syndrome, alkalosis, hypophosphatemia, hyperammonemia, dehydration, hypocalcemia
GI:
Nausea, abdominal pain
GU:
Glycosuria osmotic dieresis
INTEG:
Extravasation necrosis, phlebitis at inj site
Decrease:
Protein-sparing effects—tetracycline
Increase:
LFTs, ammonia glucose
Decrease:
Potassium, phosphate, glucose
•
Electrolytes (potassium, sodium, phosphate, chloride, magnesium, bicarbonate, blood glucose, ammonia, ketones)
•
Renal/hepatic studies: BUN, creatinine, ALT, AST, bilirubin
•
Weight changes, triglycerides before and after inf; vit A level with renal disease
•
Inj site for extravasation: redness along vein, edema at site, necrosis, pain, hard tender area; site should be changed immediately
•
Discontinue inf, culture tubing and sol
•
Sepsis:
chills, fever, increased temperature, if sepsis is suspected
•
For impending hepatic coma: asterixis, confusion, uremic fetor, lethargy
•
Hyperammonemia: nausea, vomiting, malaise, tremors, anorexia, seizures
•
Change of dressing and IV tubing to prevent infection every 24-48 hr if chills, fever, other signs of infection occur
•
Therapeutic response: weight gain, decrease in jaundice with liver disorders, increased LOC
•
Reason for use of TPN
•
If chills, sweating are experienced to report at once
•
About infusion pump and blood glucose