Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (359 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(rye-zah-trip′tan)
Maxalt, Maxalt-MLT
Func. class.:
Migraine agent
Chem. class.:
5-HT
1D
receptor agonist, abortive agent-triptan
Binds selectively to the vascular 5-HT
1B/1D
receptor subtype; exerts antimigraine effect; causes vasoconstriction of the cranial arteries
Acute treatment of migraine
Angina pectoris, history of MI, documented silent ischemia, Prinzmetal’s angina, ischemic heart disease, concurrent ergotamine-containing preparations, uncontrolled hypertension, hypersensitivity, basilar or hemiplegic migraine
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, postmenopausal women, men >40 yr, risk factors for CAD, hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function
Calculator
• Adult:
PO
5-10 mg single dose, redosing separated by ≥2 hr, max 30 mg/24 hr; use 5 mg for patient receiving propranolol, max 15 mg/24 hr
Available forms:
Tabs (Maxalt) 5, 10 mg; orally disintegrating tabs (Maxalt-MLT) 5, 10 mg
•
Orally disintegrating tab:
do not open blister until use; peel blister open with dry hands; place tab on patient’s tongue, where it will dissolve, and have patient swallow with saliva (contains phenylalanine)
CNS:
Dizziness, drowsiness, headache, fatigue
, warm/cold sensations, flushing
CV:
MI, ventricular fibrillation, ventricular tachycardia, coronary artery vasospasm,
palpitations, hypertension, peripheral vascular ischemia, ECG changes
ENDO:
Hot flashes, mild increase in growth hormone
GI:
Nausea
, dry mouth, diarrhea, abdominal pain, ischemic colitis
RESP:
Chest tightness, pressure, dyspnea
Onset of pain relief 10 min-2 hr; peak 1-1½ hr; duration 14-16 hr; 14% plasma protein binding; metabolized in liver (metabolite); excreted in urine (82%), feces (12%); half-life 2-3 hr
Weakness, hyperreflexia, incoordination: SSRIs
Increase:
levels of sibutramine
Increase:
rizatriptan action—cimetidine, oral contraceptives, MAOIs, nonselective MAOI (type A and B), isocarboxazide, pargyline, phenelzine, propranolol, tranylcypromine
Increase:
vasospastic effects—ergot, ergot derivatives, other 5-HT receptor agonists
Serotonin syndrome: St. John’s wort
•
Migraine symptoms:
visual disturbances, aura, intensity, nausea, vomiting, photophobia
•
Stress level, activity, recreation, coping mechanisms
•
Neurologic status: LOC, blurring vision, nausea, vomiting, tingling in extremities preceding headache
•
Ingestion of tyramine foods
(pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artificial sweeteners, chocolate, caffeine, which may precipitate these types of headaches
•
Renal status: urine output
•
Quiet, calm environment with decreased stimulation: noise, bright light, excessive talking
•
Therapeutic response: decrease in frequency, severity of headache
•
About use of orally disintegrating tab:
instruct patient not to open blister until use, to peel blister open with dry hands, to place tab on tongue, where it will dissolve, and to swallow with saliva (contains phenylalanine)
•
To report any side effects to prescriber
•
To use alternative contraception while taking product if oral contraceptives are being used
•
That product does not prevent or reduce number of migraines; if 1st dose does not relieve pain, do not use more, notify prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Daliresp
Func. class.:
Respiratory anti-inflammatory agent
Chem. class.:
Phosphodiesterase-4 (PDE4) inhibitor
Roflumilast (and the active metabolite roflumilast N-oxide) selectively inhibit phosphodiesterase-4 (PDE4); not a bronchodilator; inhibition of the PDE4 enzyme blocks the hydrolyses and inactivation of cyclic adenosine monophosphate (cAMP), resulting in intracellular cAMP accumulation; decreases inflammatory activity, PDE4 inhibition may affect migration and actions of pro-inflammatory cells (neutrophils, other leukocytes, T-lymphocytes, monocytes, macrophages, fibroblasts)
For the prevention of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations
Moderate to severe hepatic disease
(Child-Pugh B or C)
Precautions:
Pregnancy (category C), breastfeeding, neonates, infants, children, adolescents, acute bronchospasm, anxiety, insomnia, depression, suicidal ideation or behavior
Calculator
• Adult:
PO
500 mcg/day
Available forms:
Tabs 500 mcg
•
Give without regard to meals
CNS:
Insomnia, anxiety, depression, headache, dizziness, tremor,
suicidal ideation
EENT:
Rhinitis, sinusitis
GI:
Weight loss, diarrhea
,
nausea
, anorexia, abdominal pain, dyspepsia, gastritis, vomiting
GU:
Urinary tract infection
MS:
Back pain, muscle cramps/spasm
SYST:
Infections, influenza
80% absolute bioavailability; protein binding 99% (roflumilast); 97% (N-oxide metabolite); low penetration across the blood–brain barrier; extensively metabolized (liver); metabolism by CYP3A4 and CYP1A2 produces (active metabolite N-oxide); half-life parent drug 17 hr, metabolite 30; steady state 4 days (parent drug), 6 days (metabolite); 70% excreted in urine; parent drug peak 1 hr (range, 0.5-2 hr), metabolite peak 8 hr (range, 4-13 hr); contraindicated in moderate to severe hepatic impairment; use with caution in patients with mild hepatic
Increase:
roflumilast effect—CYP3A4/CYP1A2 inhibitors (enoxacin, cimetidine, delavirdine, indinavir, isoniazid, itraconazole, dalfopristin, quinupristin, tipranavir)
Increase:
roflumilast effect—oral contraceptives (gestodene and ethinyl estradiol)
Decrease:
roflumilast effect—CYP3A4 inducers (rifampin, barbiturates, carBAMazepine, phenytoin, erythromycin, ketoconazole, fluvoxaMINE, alcohol, etravirine, ritonavir, bexarotene, rifabutin, OXcarbazepine, nevirapine, modafinil, metyrapone, PHENobarbital, bosentan, dexamethasone)
Altered effect of:
fosamprenavir
Decrease:
roflumilast effect—St. John’s wort
•
Lung sounds and respiratory function baseline and periodically thereafter
Behavioral changes including mood, depression, suicidal thoughts/behaviors
•
Liver function tests baseline and periodically thereafter; if increases in liver function studies occur, product should be discontinued
•
Weight; weight loss is common
•
Storage at room temperature
•
Decreasing exacerbations in COPD
•
To take product as directed, not to skip or double doses, to take missed doses as soon as remembered unless almost time for next dose
•
Not to use OTC or other products without prescriber approval; not to discontinue other respiratory products unless approved by prescriber
•
Not to be used for acute bronchospasm but may be continued during acute asthma attacks
Suicidal thoughts/behaviors:
To notify prescriber of worsening depression or suicidal thoughts/behaviors