Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (370 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sit-a-glip′tin)
Januvia
Func. class.:
Antidiabetic, oral
Chem. class.:
Dipeptidyl-peptidase-4 inhibitor (DPP-4 inhibitor)
Slows the inactivation of incretin hormones; improves glucose homeostasis, improves glucose-dependent insulin secretion, lowers glucagon secretions, and slows gastric emptying time
Type 2 diabetes mellitus as monotherapy or in combination with other antidiabetic agents
Hypersensitivity, diabetic ketoacidosis (DKA)
Precautions:
Pregnancy (B), geriatric patients, GI obstruction, surgery, thyroid/renal/hepatic disease, trauma, breastfeeding, pancreatitis, hypercortisolism, hyperglycemia, hyperthyroidism, hypogylcemia, ileus, pituitary insufficiency, surgery, type 1 diabetes mellitus, diabetic ketoacidosis
Calculator
• Adult:
PO
100 mg/day; may use with antidiabetic agents other than insulin
• Adult:
PO
CCr 30-50 ml/min, 50 mg daily; CCr <30 ml/min, 25 mg daily
Available forms:
Tabs 25, 50, 100 mg
•
May be taken with/without food
•
Do not split, crush, chew; swallow whole
CNS:
Headache
ENDO:
Hypoglycemia
GI:
Nausea, vomiting
, abdominal pain, diarrhea,
pancreatitis,
constipation
MISC:
Peripheral edema
SYST:
Anaphylaxis, Stevens-Johnson syndrome, angioedema
Rapidly absorbed, excreted by the kidneys (unchanged 79%), terminal half-life 12.4 hr, peak 1-4 hr
Increase:
sitaGLIPtin level—cimetidine, disopyramide
Increase:
levels of digoxin
Increase:
hypoglycemia—androgens, insulins, β-blockers, cimetidine, corticosteroids, salicylates, MAOIs, fibric acid derivatives, FLUoxetine, sulfonylureas
Decrease:
antidiabetic effect—thiazide diuretics, ACE inhibitors, protease inhibitors, sympathomimetics, ARIPiprazole, cloZAPine, OLANZapine, QUEtiapine, risperiDONE, ziprasidone, phenytoin, fosphenytoin, phenothiazines, estrogens, progestins, oral contraceptives
Increase:
antidiabetic effect—garlic, green tea, horse chestnut
Increase:
creatinine, LFTs
•
Hypoglycemic reactions:
sweating, weakness, dizziness, anxiety, tremors, hunger; hyperglycemic reactions soon after meals
Serious skin reactions:
swelling of face, mouth, lips, dyspnea, wheezing
Pancreatitis:
severe abdominal pain, nausea, vomiting; discontinue product
•
Renal studies:
BUN, creatinine during treatment, especially in geriatric patients or those with renal disease
•
Glycosylated hemoglobin A1c; monitor blood glucose (BG) as needed
•
Conversion from other antidiabetic agents; change may be made with gradual dosage change
•
Storage in tight container at room temp
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait, blood glucose, A1c improvement
•
To perform regular self-monitoring of blood glucose using blood-glucose meter
•
About the symptoms of hypo/hyperglycemia, what to do about each; to carry emergency ID
•
To notify prescriber if pregnancy is planned, suspected
•
That product must be continued on daily basis; about consequences of discontinuing product abruptly; to continue health regimen (diet, exercise)
•
To avoid OTC medications, alcohol, digoxin, exenatide, insulins, nateglinide, repaglinide, and other products that lower blood glucose unless approved by prescriber
•
That diabetes is a lifelong illness; that product is not a cure, only controls symptoms
•
That all food included in diet plan must be eaten to prevent hypo/hyperglycemia
•
To immediately notify prescriber of hypersensitivity reactions (rash, swelling of face, trouble breathing)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
)
Baking soda, Neut, Sellymin
Func. class.:
Alkalinizer
Chem. class.:
NaHCO
3
Orally neutralizes gastric acid, which forms water, NaCl, CO
2
; increases plasma bicarbonate, which buf
fers H
+
ion concentration; reverses acidosis IV
Acidosis (metabolic), cardiac arrest, alkalinization (systemic/urinary) antacid, salicylate poisoning
Unlabeled uses:
Contrast media nephrotoxicity prevention
Metabolic/respiratory alkalosis, hypochloremia, hypocalcemia
Precautions:
Pregnancy (C), children, CHF, cirrhosis, toxemia, renal disease, hypertension, hypokalemia, breastfeeding, hypernatremia, Bartter’s syndrome, Cushing’s syndrome, hyperaldosteronism
Calculator
• Adult and child:
IV INF
2-5 mEq/kg over 4-8 hr depending on CO
2
, pH, ABGs
• Adult and child:
IV BOL
1 mEq/kg of 7.5% or 8.4% sol, then 0.5 mEq/kg q10min, then doses based on ABGs
• Infant:
IV
1 mEq/kg over several min (use only the 0.5 mEq/ml [4.2%] sol for inj)
• Adult:
PO
325 mg to 2 g qid or 48 mEq (4 g) then 12-24 mEq q4hr
• Child:
PO
84-840 mg/kg/day (1-10 mEq/kg) in divided doses q4-6hr
• Adult:
PO
300 mg to 2 g chewed, taken with water daily-qid
Available forms:
Tabs 300, 325, 600, 650 mg; inj 4.2%, 5%, 7.5%, 8.4%
•
Chew antacid tablets and drink 8 oz water
•
Do not take antacid with milk because milk-alkali syndrome may result
•
Use for cardiac emergencies, not used often in cardiac arrest
•
Use ampules or prefilled syringes only; give by rapid bolus dose; flush with NS before, after use
•
Diluted in an equal amount of compatible sol given 2-5 mEq/kg over 4-8 hr, max 50 mEq/hr; slower rate in children
•
Extravasation with IV administration (tissue sloughing, ulceration, necrosis)
Y-site compatibilities:
Acyclovir, amifostine, asparaginase, aztreonam, bivalirudin, bumetanide, ceFAZolin, cefepime, cefTAZidime, ceftizoxime, cefTRIAXone, chloramphenicol, cimetidine, cladribine, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DAPTOmycin, DAUNOrubicin, dexamethasone sodium phosphated exmedetomidine, digoxin, DOCEtaxel, DOXOrubicin, enalaprilat, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fentaNYL, filgrastim, fluconazole, fludarabine, furosemide, gallium nitrate, gemcitabine, gentamicin, granisetron, heparin, hydrocortisone sodium succinate, ifosfamide, indomethacin, insulin, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, melphalan, mesna, meperidine, methylPREDNISolone sodium succinate, metoclopramide, metoprolol, metroNIDAZOLE, milrinone, morphine, nafcillin, nitroglycerin, nitroprusside, PACLitaxel, palonosetron, pantoprazole, PEMEtrexed, penicillin G potassium, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, propranolol, propofol, protamine, ranitidine, remifentanil, tacrolimus, teniposide, thiotepa, ticarcillin/clavulanate, tirofiban, tobramycin, tolazoline, vasopressin, vit B complex with C, voriconazole
CNS:
Irritability, headache, confusion, stimulation, tremors,
twitching, hyperreflexia
,
tetany,
weakness,
seizures
of alkalosis
CV:
Irregular pulse,
cardiac arrest,
water retention, edema, weight gain
GI:
Flatulence,
belching, distention
META:
Metabolic alkalosis
MS:
Muscular twitching, tetany, irritability
PO:
Onset rapid, duration 10 min
IV:
Onset 15 min, duration 1-2 hr, excreted in urine
Increase:
effects—amphetamines, mecamylamine, quiNINE, quiNIDine, pseudoephedrine, flecainide, anorexiants, sympathomimetics
Increase:
sodium and decrease potassium—corticosteroids
Decrease:
effects—lithium, chlorproPAMIDE, barbiturates, salicylates, benzodiazepines, ketoconazole, corticosteroids
Increase:
sodium, lactate
Decrease:
potassium
•
Respiratory and pulse rate, rhythm, depth, lung sounds; notify prescriber of abnormalities
•
Fluid balance
(I&O, weight daily, edema); notify prescriber of fluid overload; assess for edema, crackles, shortness of breath
•
Electrolytes, blood pH, PO
2
, HCO
3
−
, during treatment; ABGs frequently during emergencies
•
Weight daily with initial therapy
•
Alkalosis:
irritability, confusion, twitching, hyperreflexia stimulation, slow respirations, cyanosis, irregular pulse
•
Milk-alkali syndrome:
confusion, headache, nausea, vomiting, anorexia, urinary stones, hypercalcemia
•
For GI perforation secondary to carbon dioxide in GI tract; may lead to perforation if ulcer is severe enough
•
Therapeutic response: ABGs, electrolytes, blood pH, HCO
3
−
WNL
•
Not to take antacid with milk because milk-alkali syndrome may result; not to use antacid for >2 wk
To notify prescriber if indigestion accompanied by chest pain; trouble breathing; diarrhea; dark, tarry stools; vomit that looks like coffee grounds; swelling of feet/ankles
•
About sodium-restricted diet; to avoid use of baking soda for indigestion