Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (335 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(proe-pran′oh-lole)
Inderal, Inderal LA, InnoPran XL
Func. class.:
Antihypertensive, antianginal, antidysrhythmic (class II)
Chem. class.:
β-Adrenergic blocker
Do not confuse:
propranolol
/Pravachol
Inderal
/Toradol/Inderide/Adderall/Imuran
Nonselective β-blocker with negative inotropic, chronotropic, dromotropic properties
Chronic stable angina pectoris, hypertension, supraventricular dysrhythmias, migraine prophylaxis, pheochromocytoma, cyanotic spells related to hypertrophic subaortic stenosis
Unlabeled uses:
Anxiety, Parkinson’s tremor, prevention of variceal bleeding caused by portal hypertension, akathisia induced by antipsychotics, acute MI, portal hypertension, sclerodermal renal crisis, unstable angina, infantile capillary hemangioma, lithium-induced tremor
Hypersensitivity to this product; cardiogenic shock, AV heart block; bronchospastic disease; sinus bradycardia; bronchospasm; asthma
Precautions:
Pregnancy (C), breastfeeding, children, diabetes mellitus, hyperthyroidism, COPD, renal/hepatic disease, myasthenia gravis, peripheral vascular disease, hypotension, cardiac failure, Raynaud’s disease, sick sinus syndrome, vasospastic angina, smoking, Wolff-Parkinson-White syndrome, thyrotoxicosis
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult:
PO
10-30 mg tid-qid;
IV BOL
1-3 mg give 1 mg/min; may repeat after 2 min, may repeat q4hr thereafter
• Child:
PO
1 mg/kg/day in 2 divided doses;
IV
0.01-0.1 mg/kg over 5 min
• Adult:
PO
40 mg bid or 80 mg/day (ext rel) initially; usual dose 120-240 mg/day bid-tid or 120-160 mg/day (ext rel)
• Child:
PO
0.5-1 mg/kg/day divided q6-12hr
• Adult:
PO
10-20 mg bid-qid, increase at 3-7 day intervals up to 160-320 mg/day or 80 mg daily
• Adult:
PO
180-240 mg/day tid-qid starting 5 days to 2 wk after MI
• Adult:
PO
60 mg/day × 3 days preoperatively in divided doses or 30 mg/day in divided doses (inoperable tumor)
• Adult:
PO
80 mg/day (ext rel) or in divided doses; may increase to 160-240 mg/day in divided doses
• Child >35 kg (unlabeled):
PO
20-40 mg tid
• Child ≤35 kg (unlabeled):
PO
10-20 mg tid
• Adult:
PO
40 mg bid; usual dose 120 mg/day
• Adult:
PO
180-320 mg/day in 3-4 divided doses
• Adult:
PO
10-80 mg given 1 hr prior to anxiety-producing event
• Adult:
PO
40 mg bid, may increase q3-7days, max 160-480 mg/day
• Adult:
PO
40 mg bid, titrate to heart rate reduction of 25%
• Infant:
PO
2-3 mg/kg/day
Available forms:
Ext rel caps 60, 80, 120, 160 mg; tabs 10, 20, 40, 60, 80, 90 mg; inj 1 mg/ml; oral sol 4 mg/ml, 8 mg/ml
•
Do not break, crush, chew, or open ext rel cap
•
Do not use ext rel cap for essential tremor, MI, cardiac dysrhythmias; do not use InnoPran XL in hypertropic subaortic stenosis, migraine, angina pectoris
•
Ext rel caps should be taken daily; InnoPran XL should be taken at bedtime
•
May mix oral sol with liquid or semisolid food; rinse container to get entire dose
•
With 8 oz water with food; food enhances bioavailability
•
Do not give with aluminum-containing antacid; may decrease GI absorption
•
IV undiluted or diluted 10 ml D
5
W for inj; give ≤1 mg/min
•
May be diluted in 50 ml NaCl and run 1 mg over 10-15 min
Y-site compatibilities:
Acyclovir, alfentanil, alteplase, amikacin, aminocaproic acid, aminophylline, anidulafungin, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, ritodrine, rocuronium, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex/C, voriconazole, zoledronic acid
CNS:
Depression, hallucinations, dizziness,
fatigue
, lethargy, paresthesias, bizarre dreams, disorientation
CV:
Bradycardia,
hypotension,
CHF,
palpitations, AV block, peripheral vascular insufficiency, vasodilation, cold extremities,
pulmonary edema, dysrhythmias
EENT:
Sore throat,
laryngospasm,
blurred vision, dry eyes
GI:
Nausea, vomiting, diarrhea, colitis, constipation, cramps, dry mouth, hepatomegaly, gastric pain, acute pancreatitis
GU:
Impotence, decreased libido, UTIs
HEMA:
Agranulocytosis, thrombocytopenia
INTEG:
Rash, pruritus, fever
META:
Hyperglycemia, hypoglycemia
MISC:
Facial swelling, weight change, Raynaud’s phenomenon
MS:
Joint pain, arthralgia, muscle cramps, pain
RESP:
Dyspnea, respiratory dysfunction,
bronchospasm
, cough
Metabolized by liver; crosses placenta, blood-brain barrier; excreted in breast milk; protein binding 90%
PO:
Onset 30 min, peak 1-1½ hr, duration 12 hr, half-life 3-8 hr
PO-ER:
Peak 6 hr, duration 24 hr, half-life 8-11 hr
IV:
Onset 2 min, peak 1 min, duration 5 min
Increase:
toxicity—phenothiazines
Increase:
propranolol level—propafenone
Increase:
effect of calcium channel blockers, neuromuscular blocker
Increase:
negative inotropic effects—disopyramide
Increase:
β-blocking effect—cimetidine
Increase:
hypotension—quiNIDine, haloperidol, prazosin
Decrease:
β-blocking effects—barbiturates
Decrease:
propranolol levels—smoking
•
Avoid use with feverfew
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ma huang
Increase:
serum potassium, serum uric acid, ALT, AST, alk phos, LDH
Decrease:
blood glucose
Interference:
glaucoma testing
Black Box Warning:
Abrupt withdrawal:
taper over a few weeks, do not discontinue abruptly; dysrhythmias, angina, myocardial ischemia, or MI may occur, taper over at least a few weeks
•
B/P, pulse, respirations during beginning therapy; notify prescriber if pulse <50 bpm or systolic B/P <90 mm Hg
ECG
continuously if using as antidysrhythmic IV, PCWP (pulmonary capillary wedge pressure), CVP (central venous pressure)
•
Hepatic enzymes: AST, ALT, bilirubin
•
Angina pain: duration, time started, activity being performed, character
•
Tolerance with long-term use
•
Headache, lightheadedness, decreased B/P; may indicate need for decreased dosage; may aggrevate symptoms of arterial insufficiency
•
Fluid overload:
weight daily; report gain of >5 lb
I&O ratio, CCr if kidney damage is diagnosed; fatigue, weight gain, jugular distention, dyspnea, peripheral edema, crackles
•
Protection from light
•
Therapeutic response: decreased B/P, dysrhythmias
Not to discontinue abruptly; may precipitate life-threatening dysrhythmias, exacerbation of angina, MI; to take product at same time each day, either with or without food consistently; to decrease dosage over 2 wk
•
To avoid OTC products unless approved by prescriber; to avoid alcohol
•
To avoid hazardous activities if dizzy
•
About the importance of compliance with complete medical regimen; to monitor blood glucose, may mask symptoms of hypoglycemia
•
To make position changes slowly to prevent fainting
•
That sensitivity to cold may occur
•
How to take pulse, B/P; to withhold product if <50 bpm or systolic B/P <90 mm Hg