Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (375 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTsuccinylcholine (Rx)
(suk-sin-ill-koe′leen)
Anectine, Quelicin
Func. class.:
Neuromuscular blocker (depolarizing, ultra short)
Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, thus antagonizing action of acetylcholine; causes release of histamine
Facilitation of endotracheal intubation, skeletal muscle relaxation during orthopedic manipulations
Hypersensitivity, malignant hyperthermia, trauma
Precautions:
Pregnancy (C), breastfeeding, geriatric or debilitated patients, cardiac disease, severe burns, fractures (fasciculations may increase damage) electrolyte imbalances, dehydration, neuromuscular/respiratory/cardiac/renal/hepatic disease, collagen diseases, glaucoma, eye surgery
Black Box Warning:
Children <2 yr, hyperkalemia, myopathy, rhabdomyolysis
Calculator
• Adult:
IV
0.3-1.1 mg/kg, max 150 mg, maintenance 0.04-0.07 mg/kg q5-10min as needed;
CONT IV INF
dilute to conc of 1-2 mg/ml in D
5
W or NS 10-100 mcg/kg/min
• Child:
IV
initially 1-2 mg/kg;
CONT IV INF
not recommended
Available forms:
Inj 20, 50, 100 mg/ml; powder for inj 100, 500 mg/vial, 1 g/vial
•
Give IV or IM; only experienced clinicians familiar with the use of neuromuscular blocking drugs should administer or supervise the use of this product
•
Visually inspect parenteral products for particulate matter and discoloration before use
•
Monitor heart rate and mechanical ventilator status during use
•
Recommended for infants and other patients in whom a suitable vein is not accessible
•
Inject into a large muscle, preferably high into the deltoid muscle; aspirate before injection
•
Owing to tachyphylaxis and prolonged apnea, this method is not recommended for prolonged procedures; rapid IV injection of succinylcholine can result in profound bradycardia or asystole in pediatric patients; as with adults, the risk increases with repeated doses; pretreatment with atropine may be needed
•
No dilution of injection solution is necessary
•
Inject rapidly IV over 10–30 sec
•
Not recommended for infants and children owing to risk of malignant hyperthermia
•
This route is preferred for long surgical procedures owing to possible tachyphylaxis and prolonged apnea associated with administration of repeated fractional doses
•
Dilute succinylcholine to a concentration of 1–2 mg/ml with D
5
W, D
5
NS, NS, or 1/6 M sodium lactate injection; one gram of the powder for injection or 20 ml of a 50-mg/ml solution may be added to 1 L or 500 ml of diluent to give solutions containing 1 or 2 mg/ml, respectively; alternatively, 500 mg of the powder for injection or 10 ml of a 50 mg/ml solution may be added to 500 ml or 250 ml of diluent to give solutions containing 1 or 2 mg/ml, respectively
•
Infuse IV at a rate of 2.5 mg/minute (range = 0.5–10 mg/min); adjust rate based on patient’s response and requirements
Additive compatibilities:
Amikacin, cephapirin, isoproterenol, meperidine, methyldopate, morphine, norepinephrine, scopolamine
Syringe compatibilities:
Heparin
Y-site compatibilities:
Etomidate, heparin, potassium chloride, propofol, vit B/C
CV:
Bradycardia, tachycardia; increased, decreased B/P;
sinus arrest, dysrhythmias,
edema
EENT:
Increased secretions, intraocular pressure
HEMA:
Myoglobulinemia
INTEG:
Rash, flushing, pruritus, urticaria
MS:
Weakness, muscle pain, fasciculations, prolonged relaxation, myalgia,
rhabdomyolysis
RESP:
Prolonged apnea, bronchospasm, cyanosis, respiratory depression,
wheezing, dyspnea
SYST:
Anaphylaxis, angioedema
Hydrolyzed in blood, excreted in urine (active/inactive metabolites)
IM:
Onset 2-3 min, duration 10-30 min
IV:
Onset 1 min, peak 2-3 min, duration 6-10 min
•
Dysrhythmias: theophylline
Increase:
neuromuscular blockade—aminoglycosides, β-blockers, cardiac glycosides, clindamycin, lincomycin, procainamide, quiNIDine, local anesthetics, polymyxin antibiotics, lithium, opioids, thiazides, enflurane, isoflurane, magnesium salts, oxytocin
•
Blocks succinylcholine: melatonin
•
Electrolyte imbalances (K, Mg); may lead to increased action of product
•
VS (B/P, pulse, respirations, airway) until fully recovered; rate, depth, pattern of respirations, strength of hand grip
•
I&O ratio; check for urinary retention, frequency, hesitancy
•
Recovery:
decreased paralysis of face, diaphragm, leg, arm, rest of body
•
Allergic reactions:
rash, fever, respiratory distress, pruritus; product should be discontinued
•
Myopathy, rhabdomyolysis:
in pediatric patients (rare)
•
Storage in refrigerator, powder at room temp; close tightly
•
Reassurance if communication is difficult during recovery from neuromuscular blockade; postoperative stiffness is normal, soon subsides
•
Therapeutic response: paralysis of jaw, eyelid, head, neck, rest of body
Neostigmine, atropine, monitor VS; may require mechanical ventilation
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(soo-kral′fate)
Carafate, Sulcrate
Func. class.:
Protectant, antiulcer
Chem. class.:
Aluminum hydroxide, sulfated sucrose
Do not confuse:
Carafate
/Cafergot
Forms a complex that adheres to ulcer site, adsorbs pepsin
Duodenal ulcer, oral mucositis, stomatitis after radiation of head and neck
Unlabeled uses:
Gastric/aphthous ulcers, gastroesophageal reflux, NSAID-induced ulcer prophylaxis, proctitis, stomatitis, stress gastritis prophylaxis,
C. difficile
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, renal failure; hypoglycemia (diabetics)
Calculator
• Adult:
PO
1 g qid 1 hr before meals, at bedtime
• Child:
PO
40-80 mg/kg/day divided
• Adult:
PO
5-10 ml (500 mg-1 g) swished in mouth for several min; spit or swallow qid
• Adult:
PO
1 g qid, 1 hr before meals and at bedtime
Available forms:
Tabs 1 g; oral susp 1 g/10 ml
•
Do not crush or chew tabs; tabs may be broken or dissolved in water
•
Do not take antacids 30 min before or after sucralfate
•
On an empty stomach 1 hr before meals or other medications and at bedtime
CNS:
Drowsiness, dizziness
GI:
Dry mouth, constipation
, nausea, gastric pain, vomiting, bezoar (for critically ill patients)
INTEG:
Urticaria, rash, pruritus
PO:
Duration up to 6 hr
Decrease:
action of tetracyclines, phenytoin, fat-soluble vitamins, digoxin, ketoconazole, theophylline
Decrease:
absorption of fluoroquinolones
Decrease:
absorption of sucralfate—antacids, cimetidine, ranitidine
•
GI symptoms:
abdominal pain, blood in stools
•
Hypoglycemia:
may occur in patients with diabetes mellitus
•
Storage at room temp
•
Therapeutic response: absence of pain, GI complaints
•
To take on empty stomach
•
To take full course of therapy; not to use for >8 wk; to avoid smoking
•
To avoid antacids within 1/2 hr of product
•
To increase fluids, bulk, exercise to lessen constipation