Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (322 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pit′a-va-stat′-in)
Livalo
Func. class.:
Antilipidemic
Chem. class.:
HMG-CoA reductase inhibitor
Do not confuse:
pitavastatin
/pravastatin
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis; high doses lead to plaque regression
As an adjunct for primary hypercholesterolemia (types Ia, Ib), dysbetalipoproteinemia, elevated triglyceride levels, prevention of CV disease by reduction of heart risk in those with mildly elevated cholesterol
Unlabeled uses:
Atherosclerosis
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease, cholestasis
Precautions:
Past hepatic disease, alcoholism, severe acute infections, trauma,
severe metabolic disorders, electrolyte imbalance, seizures, surgery, organ transplant, endocrine disease, females, hypotension, renal disease
Calculator
• Adult:
PO
2 mg/day, usual range 1-4, max 4 mg/day
• Adult:
PO
CCr 30-<60 ml/min, 1 mg daily, max 2 mg daily; CCr <30 ml/min on hemodialysis, 1 mg daily, max 2 mg daily; CCr <30 ml/min, not recommended
• Adult:
PO
4 mg/day
Available forms:
Tabs 1, 2, 4 mg
•
Total daily dose any time of day without regard to meals
•
Storage in cool environment in tight container protected from light
CNS:
Headache
GI:
Constipation, diarrhea
INTEG:
Rash, pruritus, alopecia
MS:
Arthralgia, myalgia,
rhabdomyolysis
RESP:
Pharyngitis
Peak 1 hr; metabolized in liver, excreted in urine, feces; half-life 12 hr; protein binding 99%; concentrations lower in healthy African Americans
Increase:
risk for possible rhabdomyolysis—azole antifungals, cycloSPORINE, erythromycin, niacin, gemfibrozil, clofibrate
Increase:
levels of pitavastatin—erythromycin
Increase:
pitavastatin—red yeast rice
Increase:
bilirubin, alk phos, ALT, AST
Interference:
thyroid function tests
•
Diet;
obtain diet history including fat, cholesterol in diet
•
Cholesterol, triglyceride levels periodically during treatment; check lipid panel 6 wk after changing dose
•
Hepatic studies at 12 wk after starting treatment, then q6mo; if AST >3× normal, reduce or discontinue; AST, ALT, LFTs may be increased
•
Renal studies in patients with compromised renal system: BUN, I&O ratio, creatinine
Rhabdomyolysis:
muscle pain, tenderness; obtain CPK baseline; if markedly increased, product may need to be discontinued
•
Therapeutic response: decrease in cholesterol to desired level after 6 wk
•
That blood work will be necessary during treatment
•
To report blurred vision, severe GI symptoms, headache, muscle pain, weakness, tenderness
•
That previously prescribed regimen will continue: low-cholesterol diet, exercise program, smoking cessation
• Not to take product if pregnant (X) or if pregnancy is planned or suspected (notify prescriber); to avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Plasmanate
Func. class.:
Hematological agent
Chem. class.:
Plasma volume expander
Exerts similar oncotic pressure as human plasma, expands blood volume
Hypovolemic shock, hypoproteinemia, ARDS, preoperative cardiopulmonary bypass, acute hepatic failure, nephrotic syndrome, cardiogenic shock
Hypersensitivity to this product or albumin; CHF, severe anemia, renal insufficiency, hyponatremia, cardiopulmonary bypass
Precautions:
Pregnancy (C), decreased salt intake, decreased cardiac reserve, lack of albumin deficiency, hepatic disease
Calculator
• Adult:
IV INF
250-500 ml (12.5-25 g protein), max 10 ml/min
• Child:
IV INF
10-30 ml/kg at max 5-10 ml/min
• Adult:
IV INF
1000-1500 ml/day, max 8 ml/min
Available forms:
Inj 5%
•
IV access at distant site from infection or trauma; no dilution required; use inf pump, use large-gauge needle (≥20 G); discard unused portion; infuse slowly to prevent hypotension
•
Within 4 hr of opening, discard partially used vials
•
Do not use sol that has been frozen
•
Adjust rate to changes in B/P
Additive compatibilities:
Carbohydrate and electrolyte sol, whole blood, packed RBCs, chloramphenicol, tetracycline
CNS:
Fever, chills, headache, paresthesias, flushing
CV:
Fluid overload,
hypotension, erratic pulse
GI:
Nausea, vomiting, increased salivation
INTEG:
Rash, urticaria, cyanosis
RESP:
Altered respirations, dyspnea,
PE
Metabolized as a protein/energy source
False increase:
alk phos
•
Blood studies: Hct, Hgb, electrolytes, serum protein; if serum protein declines, dyspnea, hypoxemia can result
•
B/P (decreased), pulse (erratic), respiration during inf
•
I&O ratio; urinary output may decrease
• Allergy: fever, rash, itching, chills, flushing, urticaria, nausea, vomiting, hypotension requires discontinuation of inf; use new lot if therapy reinstituted; premedicate with diphenhydrAMINE
Increased CVP reading: distended neck veins indicate circulatory overload; SOB, anxiety, insomnia, expiratory crackles, frothy blood-tinged cough, cyanosis indicate pulmonary overload
•
Adequate hydration before administration
•
Storage at room temp, max 86° F
•
Therapeutic response: increased B/P, decreased edema, increased serum albumin