Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (326 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pram′lin-tide)
Symlin
Func. class.:
Antidiabetic
Chem. class.:
Synthetic human amylin analog
Modulates and slows stomach emptying, prevents postprandial rise in plasma glucagon, decreases appetite, leads to decreased caloric intake and weight loss
As an adjunct to insulin therapy for uncontrolled type 1 or type 2 diabetes
Hypersensitivity to this product or cresol; gastroparesis
Black Box Warning:
Hypoglycemia
Precautions:
Pregnancy (C), breastfeeding
Calculator
• Adult:
SUBCUT
before each meal (≥30 g carbohydrate), titrate up in 15-mcg increments to target dose of 60 mcg/dose; each dose titration should occur after no nausea for 3 days
• Adult:
SUBCUT
60 mcg prior to each meal (≥30 g CHO), titrate up to 120 mcg
SUBCUT
with each meal after no nausea for 3-7 days
Available forms:
Inj 5-ml vials (0.6 mg/ml)
•
Premeal insulin should be decreased by 50% when starting and adjusted to therapeutic dose to prevent hypoglycemia
•
Rotate injection sites, allow solution to warm to room temperature before use
•
Take immediately before mealtime or if 30 g of carbohydrates will be consumed
•
Do not use if a meal is skipped
•
Do not use if discolored; do not give in arm; absorption is variable
Syringe compatibilities:
Do not mix with insulin; give separately
CNS:
Headache
, fatigue, dizziness
GI:
Nausea, vomiting, anorexia
, abdominal pain
INTEG:
Inj site reactions
META:
Hypoglycemia
MS:
Arthralgia
RESP:
Cough
, pharyngitis
SYST:
Systemic allergy
Bioavailability 30%-40%, not extensively bound to blood cells or albumin, 40% bound in plasma, half-life 48 min, me
tabolized by kidneys, peak 20 min, duration 3 hr
• Do not use with erythromycin, metoclopramide
Increase:
effect of acetaminophen
Increase:
pramlintide action—antimuscarinics, α-glucosidase inhibitors, diphenoxylate, loperamide, octreotide, opiate agonist, tricyclics
Increase:
hypoglycemia—ACE inhibitors, disopyramide, anabolic steroids, androgens, fibric acid derivatives, alcohol, corticosteroids, insulin
Increase:
hyperglycemia—phenothiazines
Decrease:
hypoglycemia—niacin, dextrothyroxine, thiazide diuretics, triamterene, estrogens, progestins, oral contraceptives, MAOIs
•
Fasting blood glucose, 2 hr post-prandiol (80-150 mg/dl, normal fasting level; 70-130 mg/dl, normal 2 hr level); A1c may also be drawn to identify treatment effectiveness; also monitor weight, appetite
•
Hypoglycemic reaction
sweating; weakness; dizziness; chills; confusion; headache; nausea; rapid, weak pulse; fatigue; tachycardia; memory lapses; slurred speech; staggering gait; anxiety; tremors; hunger
•
Hyperglycemia:
acetone breath; polyuria; fatigue; polydipsia; flushed, dry skin; lethargy
•
Storage at room temp for ≤30 days; keep away from heat and sunlight; refrigerate all other supply
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; improving blood glucose, A1c
•
That product does not cure diabetes but rather controls symptoms
•
To carry emergency ID as diabetic
•
To recognize hypoglycemia reaction: headache, fatigue, weakness
•
About the dosage, route, mixing instructions, diet restrictions, disease process
•
To carry a glucose source (candy or lump sugar) to treat hypoglycemia
•
About the symptoms of ketoacidosis: nausea; thirst; polyuria; dry mouth; decreased B/P; dry, flushed skin; acetone breath; drowsiness; Kussmaul respirations
•
That a plan is necessary for diet, exercise; that all food on diet should be eaten; that exercise routine should not vary
•
About blood glucose testing; how to determine glucose level
•
To avoid OTC products, alcohol unless directed by prescriber
•
Not to operate machinery or drive until effect is known
•
About how to use pen
Glucose 25 g IV or 50 ml dextrose 50% sol or 1 mg glucagon SUBCUT
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(pra′soo-grel)
Effient
Func. class.:
Platelet aggregation inhibitor
Chem. class.:
ADP receptor antagonist
Inhibits ADP-induced platelet aggregation
Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients
Hypersensitivity, stroke, TIA
Black Box Warning:
Active bleeding
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, hepatic disease, increased bleeding risk, neutropenia, agranulocytosis, renal disease, surgery, trauma, thrombotic thrombocytopenic purpura, Asian patients, weight <60 kg, CABG, abrupt discontinuation
Calculator
• Adult/geriatric
<
75 yr and
≥
60 kg:
PO
60-mg loading dose then 10 mg daily with aspirin (75-325 mg/day)
• Adult/geriatric
<
75 yr and
<
60 kg:
PO
60 mg loading dose then 5 mg daily
• Geriatric
>
75 yr:
not recommended
Available forms:
Tabs 5, 10 mg
•
With food to decrease gastric symptoms
•
Do not break tablets
•
Do not discontinue therapy abruptly
CNS:
Headache, dizziness
CV:
Edema, atrial fibrillation, bradycardia, chest pain, hypo/hypertension
GI:
Nausea, vomiting, diarrhea
HEMA:
Epistaxis,
leukopenia, thrombocytopenia, neutropenia, anaphylaxis, angioedema, anemia
INTEG:
Rash, hypercholesterolemia
MISC:
Fatigue,
intracranial hemorrhage, secondary malignancy, angioedema
MS:
Back pain
Rapidly absorbed; peak 30 min; metabolized by liver (CYP3A4; CYP2B6); excreted in urine, feces; half-life 7 hr
Increase:
bleeding risk—anticoagulants, aspirin, NSAIDs, abciximab, eptifibatide, tirofiban, thrombolytics, ticlopidine, SSRIs, treprostinil, rifampin
Thrombotic/thrombocytic purpura:
fever, thrombocytopenia, neurolytic anemia
• Hepatic studies: AST, ALT, bilirubin, creatinine with long-term therapy
•
Blood studies: CBC, differential, Hct, Hgb, PT, cholesterol with long-term therapy
Black Box Warning:
Bleeding:
may be fatal, decreased B/P in those who have had CABG may be the first indication; bleeding should be controlled while continuing product; may use transfusion; do not use within 1 wk of CABG; may use lower doses in those <60 kg
•
Therapeutic response: absence of stroke, MI
•
That blood work will be necessary during treatment
•
To report any unusual bruising, bleeding to prescriber; that it may take longer to stop bleeding
•
To take with food or just after eating to minimize GI discomfort
•
To report diarrhea, skin rashes, subcutaneous bleeding, chills, fever, sore throat
•
To tell all health care providers that prasugrel is being used; that product may be held before surgery