Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (333 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(proe-jess′ter-one)
Crinone, Endometrin, First-Progesterone, Prochieve, Prometrium
Func. class.:
Progestogen
Chem. class.:
Progesterone derivative
Inhibits secretion of pituitary gonadotropins, which prevents follicular maturation, ovulation; stimulates growth of mammary tissue; antineoplastic action against endometrial cancer
Contraception, amenorrhea, premenstrual syndrome, abnormal uterine bleeding, endometrial hyperplasia prevention, assisted reproductive technology (ART) gel
Unlabeled uses:
Corpus luteum insufficiency, early pregnancy failure, PMS, preterm delivery prophylaxis
Pregnancy (B), ectopic pregnancy; hypersen
sitivity to this product, peanuts, or peanut oil; thromboembolic disorders, reproductive cancer, genital bleeding (abnormal, undiagnosed), cerebral hemorrhage, PID, STDs, thrombophlebitis
Black Box Warning:
Breast cancer
Precautions:
Breastfeeding, hypertension, asthma, blood dyscrasias, CHF, diabetes mellitus, bone disease, depression, migraine headache, seizure disorders, gallbladder/renal/hepatic disease, family history of breast/reproductive tract cancer
Black Box Warning:
Cardiac disease, dementia
Calculator
• Adult:
VAG
90 mg/day (micronized gel); 100 mg 2-3 times/day starting day after oocyte retrieval and for ≤10 wk total (insert)
• Adult:
IM
5-10 mg/day × 6-8 doses
• Adult:
PO
200 mg/day × 12 days
• Adult:
GEL
90 mg (8%) vaginally daily for supplementation; 90 mg (8%) vaginally bid for replacement; if pregnancy occurs, continue × 10-12 wk
• Adult:
VAG INSERT
90-100 mg bid-tid starting at oocyte retrieval and continuing up to 10-12 wk gestation
Available forms:
Inj 50 mg/ml; vag gel 4%, 8%; caps 100, 200 mg; vag insert 100 mg; vag supp 25, 100, 200, 500 mg; compounding kit 25, 50, 100, 200, 400 mg
•
Do not break, crush, or chew caps
•
Titrated dose; use lowest effective dose
•
In 1 dose in
AM
•
With food or milk to decrease GI symptoms
•
Start progesterone 14 days after estrogen dose if given concomitantly
•
Wait at least 6 hr after any vaginal treatment before using vaginal gel
•
Shake vial, inject deeply into large muscle, aspirate
•
Check for particulate matter and discoloration before injecting
CNS:
Dizziness, headache
, migraines, depression,
fatigue
, mood swings, dementia, drowsiness
CV:
Hypotension,
thrombophlebitis,
edema,
thromboembolism, stroke, pulmonary embolism, MI
EENT:
Diplopia, retinal thrombosis
GI:
Nausea
, vomiting, anorexia, cramps, increased weight,
cholestatic jaundice,
constipation
, abdominal pain
GU:
Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea, vaginal candidiasis, nocturia, breast changes,
gynecomastia, testicular atrophy, impotence
, endometriosis,
spontaneous abortion,
breast pain, ectopic pregnancy
INTEG:
Rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma
META:
Hyperglycemia
SYST:
Angioedema, anaphylaxis
Excreted in urine, feces; metabolized in liver
IM/RECT/VAG:
Duration 24 hr
Increase:
progesterone effect—CYP3A4 inhibitors (ketoconazole, cimetidine, clarithromycin, danazol, diltiazem, erythromycin, fluconazole, itraconazole, troleandomycin, verapamil, voriconazole)
Decrease:
progesterone effect—barbiturates, phenytoin
Increase:
alk phos, nitrogen (urine), pregnanediol, amino acids, factors VII, VIII, IX, X
Decrease:
GTT, HDL
•
Abnormal uterine bleeding:
vaginal bleeding; obtain pad count, patient menstrual history, breast exam, cervical cytology
•
Weight daily; notify prescriber of weekly weight gain of >5 lb
•
B/P at beginning of treatment and periodically
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
Hepatic studies: ALT, AST, bilirubin periodically during long-term therapy
•
Edema, hypertension, cardiac symptoms, jaundice, thromboembolism
•
Mental status: affect, mood, behavioral changes, depression
•
Hypercalcemia
•
Storage in dark area
•
Therapeutic response: decreased abnormal uterine bleeding, absence of amenorrhea
To report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, numbness or stiffness in legs, chest pain
•
To avoid gel with other vaginal products; if to be used together, to separate by ≥6 hr; for vaginal route, on proper insertion technique
•
To report suspected pregnancy
•
To monitor blood glucose if diabetic
•
To avoid activities requiring mental alertness until effects are realized, can cause dizziness
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(proe-meth′a-zeen)
Phenadoz, Phenergan, Promethagan
Func. class.:
Antihistamine, H
1
-receptor antagonist, antiemetic
Chem. class.:
Phenothiazine derivative
Do not confuse:
Phenergan
/Theragran
Acts on blood vessels, GI, respiratory system by competing with histamine for H
1
-receptor sites; decreases allergic response by blocking histamine
Motion sickness, rhinitis, allergy symptoms, sedation, nausea, preoperative and postoperative sedation
Unlabeled uses:
Allergic rhinitis, acute peripheral vestibular nystagmus, hyperemesis gravidarum
Hypersensitivity, breastfeeding, agranulocytosis, bone marrow suppression, coma, jaundice, Reye’s syndrome
Black Box Warning:
Infants, neonates, children, intraarterial/SUBCUT administration, extravasation
Precautions:
Pregnancy (C), cardiac/renal/hepatic disease, asthma, seizure disorder, prostatic hypertrophy, bladder obstruction, glaucoma, COPD, GI obstruction, ileus, CNS depression, diabetes, sleep apnea, urinary retention
Black Box Warning:
IV use
Calculator
• Adult:
PO/IM/IV/RECT
12.5-25 mg; q4-6hr prn
• Child
>
2 yr:
PO/IM/IV/RECT
0.25-0.5 mg/kg q4-6hr prn
• Adult:
PO
25 mg bid, give 1/2-1 hr before departure then q8-12hr prn
• Child
≥
2 yr:
PO/IM/RECT
12.5-25 mg bid, give 1/2-1 hr before departure then q8-12hr prn
• Adult:
PO/IM
25-50 mg at bedtime
• Child
≥
2 yr:
PO/IM/RECT
12.5-25 mg at bedtime
• Adult:
PO/IM/IV
25-50 mg
• Child
>
2 yr:
PO/IM/IV
0.5-1.1 mg/kg
• Adult:
PO
12.5 mg qid or 25 mg at bedtime
• Child
≥
2 yr:
PO
6.25-12.5 mg tid or 25 mg at bedtime
• Pregnant females:
PO/RECT/IM/IV
12.5-25 mg q4hr
• Adult:
PO
12.5-25 mg q4-6hr for ≤48 hr
Available forms:
Tabs 12.5, 25, 50 mg; supp 12.5, 25, 50 mg; inj 25, 50 mg/ml
•
Avoid use with other CNS depressants
•
With meals for GI symptoms; absorption may slightly decrease
•
When used for motion sickness, 30 min-1 hr before travel
•
IM inj deep in large muscle; rotate site
Black Box Warning:
Check for extravasation: burning, pain, swelling at IV site; can cause tissue necrosis
•
Do not use if precipitate is present
•
Rapid administration may cause transient decrease in B/P
•
After diluting each 25-50 mg/9 ml of NaCl for inj; give ≤25 mg/2 min
Syringe compatibilities:
Butorphanol, chlorproMAZINE, cimetidine, dihydroergotamine, diphenhyDRAMINE, droperidol, fentaNYL, glycopyrrolate, HYDROmorphone, hydrOXYzine, meperidine, metoclopramide, midazolam, pentazocine, perphenazine, prochlorperazine, promazine, ranitidine, scopolamine
Y-site compatibilities:
Alfentanil, amifostine, amikacin, aminocaproic acid, amsacrine, anidulafungin, ascorbic acid, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin, eptifibatide, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, gemcitabine, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, insulin (regular), irinotecan, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methoxamine, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, midazolam, milrinone, mitoXANtrone, morphine, mycophenolate, nalbuphine, naloxone, netilmicin, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, pentazocine, phenylephrine, polymyxin B, procainamide, prochlorperazine, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sargramostim, sodium acetate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, tigecycline, tirofiban, TNA, tobramycin, tolazoline, trastuzumab, trimetaphan, vancomycin, vasopressin,
vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole
CNS:
Dizziness, drowsiness
, poor coordination, fatigue, anxiety, euphoria, confusion, paresthesia, neuritis, EPS,
neuroleptic malignant syndrome
CV:
Hypo/hypertension, palpitations, tachycardia
EENT:
Blurred vision, dilated pupils, tinnitus, nasal stuffiness; dry nose, throat, mouth; photosensitivity
GI:
Constipation
, dry mouth, nausea, vomiting, anorexia, diarrhea
GU:
Urinary retention
, dysuria, frequency
HEMA:
Thrombocytopenia, agranulocytosis, hemolytic anemia
INTEG:
Rash, urticaria, photosensitivity
RESP:
Increased thick secretions, wheezing, chest tightness;
apnea in neonates, infants, young children
Metabolized in liver; excreted by kidneys, GI tract (inactive metabolites)
PO:
Onset 20 min, duration 4-12 hr
IV:
Onset 3-5 min
Increase:
CNS depression—barbiturates, opioids, hypnotics, tricyclics, alcohol
Increase:
promethazine effect—MAOIs
Decrease:
oral anticoagulants effect—heparin
False negative:
skin allergy test
False positive:
urine pregnancy test
Interference:
blood grouping (ABO), GTT
Black Box Warning:
Not to be used in children <2 yr, fatal respiratory depression may occur; use cautiously in children >2 yr, seizures, paradoxical CNS stimulation may occur
•
Antiemetic/motion sickness:
nausea, vomiting before, after dose
•
I&O ratio; be alert for urinary retention, frequency, dysuria; product should be discontinued
CBC with differential, LFTs during long-term therapy; blood dyscrasias, jaundice may occur
•
Respiratory status: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness
•
Cardiac status: palpitations, increased pulse, hypo/hypertension, B/P in those receiving IV doses
•
Neuroleptic malignant syndrome:
fever, confusion, diaphoresis, rigid muscles, elevated CPK, encephalopathy; discontinue product, notify prescriber
•
Hard candy, gum, frequent rinsing of mouth for dryness
•
Storage in tight, light-resistant container
•
Therapeutic response: absence of running, congested nose; rashes; absence of motion sickness, nausea; sedation
•
That product may cause photosensitivity; to avoid prolonged exposure to sunlight
•
To notify prescriber of confusion, sedation, hypotension, jaundice, fever
•
To avoid driving, other hazardous activity if drowsy
•
To avoid concurrent use of alcohol or other CNS depressants
•
That product may reduce sweating; that there is a risk of heat stroke
•
How to use frequent sips of water, gum to decrease dry mouth