Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (368 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
, Rx)
(si-meth′i-kone)
Barriere
, Equaline Extra Strength Gas Relief, Gas Relief, Gas-Relief, Gas-X, Good Sense Ultra Strength Gas Relief, Mylanta Gas Relief, Mylanta Gas, Mylicon, Ovol, Phazyme, Top Care Gas Relief Extra Strength, Walgreens Gas Relief
Func. class.:
Antiflatulent
Do not confuse:
Mylicon
/Mylanta Gas
Disperses/prevents mucus gas pockets in GI system, lowers surface tension of gas bubbles
Flatulence
Unlabeled uses:
Dyspepsia
Hypersensitivity, GI obstruction/perforation
Precautions:
Pregnancy (C), abdominal pain, fistula, hiatal hernia
Calculator
• Adult and child >12 yr:
PO
40-125 mg after meals and at bedtime prn, max 500 mg/day
• Child 2-12 yr:
PO
40-50 mg after meals and at bedtime prn, max 240 mg/day
• Child <2 yr:
PO
20 mg qid prn
Available forms:
Chew tabs 40, 150, 166 mg; tabs 60, 80, 95, 125 mg; drops 20 mg/0.3 ml, 95 mg/1.425 ml; caps 95, 180 mg; soft gel caps 125, 180 mg; oral dissolving film 62.5 mg
•
After meals, at bedtime; shake susp well before giving; chew tabs should be chewed
GI:
Belching, rectal flatus, diarrhea
•
Reason for excess gas production, decreased bowel sounds, recent surgery, other GI conditions
•
Therapeutic response: reduction of abdominal gas, discomfort
•
That tablets must be chewed
•
To shake susp well before pouring
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(sim-va-sta′tin)
Zocor
Func. class.:
Antilipemic
Chem. class.:
HMG-CoA reductase inhibitor
Do not confuse:
Zocor
/Cozaar/Zoloft
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
As an adjunct for primary hypercholesterolemia (types IIa, IIb), isolated hypertriglyceridemia (Frederickson type IV) and type III hyperlipoproteinemia, CAD, heterozygous familial hypercholesterolemia
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Precautions:
Past hepatic disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances, Chinese patients
Calculator
• Adult:
PO
20-40 mg/day in
PM
initially; usual range 5-40 mg/day in
PM
, max 40 mg/day for most patients, max 80 mg/day for patients taking 80 mg/day chronically without myopathy; dosage adjustments may be made in ≥4-wk intervals; those taking verapamil and amiodarone max 20 mg/day; max <80 mg for Chinese patients taking lipid-modifying niacin doses
• Child/adolescent ≥10 yr including girls ≥1 yr postmenarche:
PO
10 mg in
PM
, range 10-40 mg/day
• Adult:
PO
5-10 mg in
PM
, max 10 mg/day
• Adult:
PO
5-20 mg daily in evening, max 20 mg/day
• Adolescent 10-17 yr:
PO
10 mg/day, max 40 mg/day
Available forms:
Tabs 5, 10, 20, 40, 80 mg
•
Total daily dose in evening
CNS:
Headache, cognitive impairment
GI:
Nausea, constipation, diarrhea, dyspepsia, flatus, abdominal pain,
liver dysfunction, pancreatitis,
hyperglycemia
INTEG:
Rash, pruritus
MS:
Muscle cramps, myalgia,
myositis, rhabdomyolysis,
myopathy
RESP:
Upper respiratory tract infection
Metabolized in liver (active metabolites); >98% protein bound; excreted primarily in bile, feces (60%), kidneys (15%); peak 1-2 hr; half-life 3 hr
Do not use with cycloSPORINE, gemfibrozil
Increase:
effects of warfarin
Increase:
rhabdomyolysis, myalgia; do not use concurrently—niacin, erythromycin, clofibrate, clarithromycin, ketoconazole, itraconazole, protease inhibitors, macrolide antibiotics, danazol, delavirdine, nefazodone, verapamil, diltiazem, amiodarone, azole antifungals, telithromycin, voriconazole
Increase:
serum level of digoxin
Increase:
effect—red yeast, rice
Decrease:
effect—St. John’s wort
Increase:
CK, LFTs
•
Diet history: fat consumption; baseline and lipid profile: LDL, HDL, TG, cholesterol
•
Hepatic studies at baseline, after 4-6 wk, periodically thereafter; AST, ALT, may increase
Rhabdomyolysis:
muscle tenderness, increased CPK levels (10× above upper normal limit); therapy should be discontinued, more likely in those receiving >80 mg/day, first year of treatment, those ≥65 yr, females
•
Renal studies in patients with compromised renal systems: BUN, I&O ratio, creatinine
•
Storage in cool environment in tight container protected from light
•
Therapeutic response: decrease in LDL, total cholesterol, triglycerides; increase in HDL; slowing CAD
•
That blood work will be necessary during treatment
•
To report severe GI symptoms, headache
•
That previously prescribed regimen will continue: low-cholesterol diet, exercise program
•
To notify prescriber if pregnancy is suspected or planned; pregnancy (X); not to breastfeed