Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (371 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
sulfonate (Rx)
(po-lee-stye′reen)
Kayexalate, Kionex, SPS
Func. class.:
Potassium-removing resin
Chem. class.:
Cation exchange resin
Removes potassium by exchanging sodium for potassium in body, primarily in large intestine
Hyperkalemia in conjunction with other measures
Hypersensitivity to saccharin or parabens that may be in some products, GI obstruction, neonate (reduced gut motility)
Precautions:
Pregnancy (C), geriatric patients, renal failure, CHF, severe edema, severe hypertension, sodium restriction, constipation, GI bleeding, hypocalcemia
Calculator
• Adult:
PO
15 g daily-qid;
RECT
enema 30-50 g q1-2hr initially prn then q6hr prn
• Child (unlabeled):
PO
1 g/kg q6hr prn;
RECT
1 g/kg q2-6hr prn
Available forms:
Powder for susp 453.6 g, 454 g; oral susp 15 g/60 ml
•
Powdered resin:
Each dose of the powdered resin is usually given orally as a suspension in water or in a syrup; usually, the amount of fluid ranges from 20 to 100 ml, depending on the dosage, or 3–4 ml/g of resin; suspensions should be freshly prepared and not stored for >24 hr; the suspension may be also be introduced into the stomach via a tube, or the powdered resin may be mixed with the patient’s food; the powder should not be mixed with foods or liquids that contain a large amount of potassium (bananas or orange juice)
•
Precede retention enema with a cleansing enema
•
Instruct patient to lie down on left side with lower leg extended and the upper leg flexed for support, or place the patient in the knee–chest position; gently insert a soft, large (28 Fr) rubber tube into the rectum for a distance of about 20 cm; the tip should be well into the sigmoid colon; tape the tube in place; suspend the sodium polystyrene sulfonate powdered resin in 100 ml of an aqueous vehicle (water or sorbitol) that has been warmed to body temperature and introduce through the tube by gravity; the particles should be kept suspended by stirring the suspension during administration; alternatively, 120–180 ml of a commercially available suspension may be administered as a retention enema after the suspension has been warmed to body temperature; following administration, flush the tube with 50–100 ml of fluid and clamp the tube and leave in place; the suspension should be retained in the colon for at least 30–60 min or for several hours, if possible
•
After several hours have passed, administer a cleansing enema using a non–sodium-containing solution at body temperature; up to 2 quarts of fluid may be necessary; drain fluid through a
Y
-tube connection; observe the drainage if sorbitol was used
GI:
Constipation, anorexia, nausea, vomiting, diarrhea (sorbitol), fecal impaction, gastric irritation
META:
Hypocalcemia, hypokalemia, hypomagnesemia, sodium retention
Increase:
hypokalemia—loop diuretics, cardiac glycosides
Increase:
metabolic alkalosis—magnesium/calcium antacids
Increase:
colonic necrosis—sorbitol; do not use concurrently
Decrease:
effect of—lithium, thyroid hormones
•
Hyperkalemia:
confusion, dyspnea, weakness, dysrhythmias; ECG for spiked T waves, depressed ST segments, prolonged QT and widening QRS complex
•
Bowel function daily; note consistency of stools, times/day
•
Hypotension:
confusion, irritability, muscular pain, weakness
•
Electrolytes:
serum potassium, calcium, magnesium, sodium; acid-base balance
•
I&O ratio, weight daily; crackles, dyspnea, jugular venous distension, edema
•
Digoxin toxicity
(nausea, vomiting, blurred vision, anorexia, dysrhythmias) in those receiving digoxin
•
Storage of freshly prepared sol 24 hr at room temp
•
Therapeutic response: potassium level 3.5-5 mg/dl
•
About reason for medication and expected results
•
To follow a low potassium diet, provide sample diet
•
To avoid laxatives, antacids, electrolyte-based products unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(sol-i-fen′a-sin)
VESIcare
Func. class.:
Urinary antispasmodic, anticholinergic
Chem. class.:
Anti-muscarinic
Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Overactive bladder (urinary frequency, urgency, incontinence)
Hypersensitivity, uncontrolled closed-angle glaucoma, urinary retention, gastric retention
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal/hepatic disease, controlled closed-angle glaucoma, bladder outflow obstruction, GI obstruction, decreased GI motility, history of QT prolongation
Calculator
• Adult:
PO
5 mg/day, max 10 mg/day
• Adult:
PO
(Child-Pugh B) max 5 mg/day; CCr ≤30 ml/min, 5 mg/day
Available forms:
Tabs 5, 10 mg
•
Without regard to meals
•
Swallow product whole with water, liquid
CNS:
Anxiety, paresthesia, fatigue,
dizziness
, headache, confusion
CV:
Chest pain, hypertension,
QTc prolongation,
peripheral edema
EENT:
Vision abnormalities, xerophthalmia
, nasal dryness
GI:
Nausea, vomiting, anorexia
, abdominal pain,
constipation, dry mouth
, dyspepsia
GU:
Dysuria, urinary retention, frequency, UTI
INTEG:
Rash, pruritus,
angioedema,
exfoliative dermatitis, erythema multiforme
MISC:
Hyperthermia
RESP:
Bronchitis, cough, pharyngitis, upper respiratory tract infection
90% absorbed; 98% protein bound; extensively metabolized by CYP3A4; excreted in urine 69% (metabolites), feces 22%; terminal half-life 45-68 hr
Increase:
QT prolongation—Class IA, III antidysrhythmias
Increase:
CNS depression—sedatives, hypnotics, benzodiazepines, opioids
Increase:
effects—CYP3A4 inhibitors (ketoconazole, clarithromycin, diclofenac, doxycycline, erythromycin, isoniazid, nefazodone, propofol, protease inhibitors, verapamil), max dose 5 mg
Decrease:
effects—CYP3A4 inducers (carBAMazepine, nevirapine, PHENobarbital, phenytoin)
Decrease:
effects—St. John’s wort
Increase:
effect—grapefruit juice
•
Urinary patterns:
distention, nocturia, frequency, urgency, incontinence
•
Allergic reactions:
rash
•
Angioedema:
of the face, lips, tongue, larynx
Cardiac patients: monitor ECG for QTc prolongation; avoid products that increase QT prolongation
•
Decreasing dysuria, frequency, nocturia, incontinence
•
To avoid hazardous activities because dizziness may occur
•
That constipation, blurred vision may occur, to notify prescriber if abdominal pain with constipation occurs
•
To take without regard to food
•
To swallow tab whole, do not split, crush, chew
•
To call prescriber if severe abdominal pain or constipation lasts for ≥3 days
•
That heat prostration may occur if used in hot environment, sweating is decreased
•
About
anticholinergic effects:
blurred vision, constipation, urinary retention, hyperthermia
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert