Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (394 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(tye-cloe′pi-deen)
Func. class.:
Platelet aggregation inhibitor
Chem. class.:
Thienopyridine compound
Irreversible inhibition of platelet aggregation through antagonism of ADP
Reducing the risk for stroke in high-risk patients
Unlabeled uses:
Intermittent claudication, chronic arterial occlusion, subarachnoid hemorrhage, uremic patients with AV shunts/fistulas, open heart surgery, coronary artery bypass grafts, primary glomerulonephritis, sickle cell disease, diabetic retinopathy
Hypersensitivity, severe hepatic disease, active bleeding, coagulopathy
Black Box Warning:
Agranulocytosis, neutropenia, thrombocytopenia, thrombotic thrombocytopenic purpura (TTP)
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, past hepatic disease, renal disease, increased bleeding risk, peptic ulcer disease, surgery
Black Box Warning:
Anemia, hematologic disease
Calculator
• Adult:
PO
250 mg bid with food
Available forms:
Tabs 250 mg
•
With food to decrease gastric symptoms
•
Discontinue when absolute neutrophil count falls during treatment to <1200/
mm
3
or platelets <80,000/mm
3
; may use methylPREDNISolone IV 20 mg to provide normal bleeding time in 2 hr
CNS:
Dizziness, headache, weakness
EENT:
Tinnitus, epistaxis
GI:
Nausea, vomiting,
diarrhea
, GI discomfort,
cholestatic jaundice, hepatitis,
increased cholesterol, LDL, VLDL, triglycerides
GU:
Hematuria
HEMA:
Bleeding (epistaxis, hematuria, conjunctival hemorrhage, GI bleeding), agranulocytosis, neutropenia, thrombocytopenia, thrombotic thombocytopenic purpura
INTEG:
Rash
, pruritus
META:
Hypercholesterolemia, hypertriglyceridemia
Peak 1-3 hr; metabolized by liver; excreted in urine, feces; half-life increases with repeated dosing, initially 12-36 hr; antiplatelet effect 2-5 days; 98% protein binding
Increase:
levels of CYP2C19, CYP2DC substrates, phenytoin, fosphenytoin, ambrisentan, theophylline
Increase:
bleeding tendencies—anticoagulants, salicylates, thrombolytics, NSAIDs, abciximab, eptifibatide, tirofiban, thrombin inhibitors, SSRIs, aspirin
Increase:
effects of ticlopidine—cimetidine
Decrease:
plasma levels of ticlopidine—antacids
Decrease:
plasma levels of digoxin, cycloSPORINE
Increase:
bleeding risk—ginger, ginkgo, garlic, feverfew, horse chestnut, green tea
•
Hepatic studies: AST, ALT, bilirubin, creatinine with long-term therapy
Black Box Warning:
Blood dyscrasias, bone marrow depression, do not use in those with a history of these conditions; blood studies: CBC; CBC q2wk × 3 mo, Hct, Hgb, PT with long-term therapy
Bleeding time at baseline and throughout treatment; levels may be 2-5× normal limit
•
Therapeutic response: absence of stroke
•
That blood work will be necessary during treatment
•
To report any unusual bleeding to prescriber
•
To report side effects such as diarrhea, skin rashes, subcut bleeding, signs of cholestasis (jaundiced skin and sclera, dark urine, light-colored stools)
•
That product should be discontinued 10-14 days before surgery; not to double a missed dose
•
That there are many product and herbal interactions to avoid all OTC products unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tye-ge-sye′kleen)
Tygacil
Func. class.:
Broad-spectrum antiinfective
Chem. class.:
Glycylcyclines
Inhibits protein synthesis and phosphorylation in microorganisms; bacteriostatic structurally similar to the tetracyclines
Complicated skin/skin-structure infections
(Escherichia coli, Enterococcus faecalis
[vancomycin-susceptible only]
Staphylococcus aureus
,
Streptococcus agalactiae
,
S. anginosus
group,
S. pyogenes
,
Bacteroides fragilis;
complicated intraabdominal infections
[Citrobacter freundii] Enterobacter cloacae, E. coli, Klebsiella oxytoca, K. pneumoniae, E. faecalis
[vancomycin-susceptible o
nly],
S. aureus
[methicillin-susceptible only],
S. anginosus
group,
B. fragilis, Bacteroides thetaiotaomicron, B. uniformis, B. vulgatus, Clostridium perfringens, Peptostreptococcus micros);
community-acquired pneumonia
Pregnancy (D), breastfeeding, children <18 yr, hypersensitivity to tigecycline
Precautions:
Renal/hepatic disease, hypersensitivity to tetracyclines, ventilator-associated/hospital-acquired pneumonias
Calculator
• Adult:
IV
100 mg then 50 mg q12hr,
IV INF
given over 30-60 min q12hr; given for 5-14 days, depending on infection
• Adult:
IV
(Child-Pugh C) 100 mg then 25 mg q12hr
Available forms:
Powder for inj, lyophilized 50 mg
•
Tigecycline allergy test before using, obtain C&S, do not begin treatment before results or if susceptible organism is strongly suspected
•
Reconstitute each vial with 5.3 ml of 0.9% NaCl or D
5
(10 mg/ml); swirl to dissolve; immediately withdraw 5 ml of reconstituted sol and add to 100-ml IV bag for inf (1 mg/ml); may be yellow or orange; if not, sol should be discarded; do not give if particulate matter is present, use a dedicated IV line or
Y
-site, flush with NS before and after use, give over 1/2 hr
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B liposome, ampicillin, ampicillin/sulbactam, argatroban, azithromycin, aztreonam, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOrubicin hydrochloride, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, DOXOrubicin hydrochloride, DOXOrubicin liposome, droperidol, enalaprilat, EPINEPHrine, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, lansoprazole, lepirudin, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methyldopa, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mitoXANtrone, morphine, moxifloxacin, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, pemtamidine, pentazocin, PENTobarbital, PHENobarbital, phenylephrine, piperacillin/tazobactam, potassium acetate/chloride/phosphate, procainamide, prochlorperazine, promethazine, propofol, propranolol, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphate, streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tirofiban, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, vinBLAStine, vinCRIStine, vinorelbine, zidovudine, zoledronic acid
CNS:
Headache, dizziness, insomnia
CV:
Hypo/hypertension, phlebitis
EENT:
Tooth discoloration
GI:
Nausea, vomiting, diarrhea
, anorexia, constipation, dyspepsia, abdominal pain,
hepatotoxicity, hepatic failure, pseudomembranous colitis
HEMA:
Anemia, leukocytosis, thrombocytopenia
INTEG:
Rash
, pruritus, sweating, photosensitivity
META:
Increased ALT, AST, BUN, lactic acid, alk phos, amylase; hyperglycemia, hypokalemia, hypoproteinemia, bilirubinemia
MISC:
Back pain, fever, abnormal healing, abdominal pain, abscess, asthenia, infection, pain, peripheral edema, local reactions
RESP:
Cough, dyspnea
SYST:
Anaphylaxis
Not extensively metabolized, 22% of unchanged product excreted in urine, terminal half-life 42 hr, primarily biliary excreted, protein binding 71%-89%
Increase:
effect of warfarin
Decrease:
effect of oral contraceptives
Increase:
amylase, LFTs, alk phos, BUN, creatinine, LDH, WBC, INR, PTT, PT
Decrease:
potassium, calcium, sodium, Hgb/Hct, platelets
Pseudomembranous colitis:
diarrhea, abdominal pain, fever, fatigue, anorexia; possible anemia, elevated WBC level, low serum albumin; stop product; usually either vancomycin or IV metroNIDAZOLE is given
•
Signs of anemia: Hct, Hgb, fatigue
•
Blood studies: PT, CBC, AST, ALT, BUN creatinine
Allergic reactions:
rash, itching, pruritus, angioedema
•
Serious allergic skin reactions: Stevens-Johnson anaphylaxis
•
Nausea, vomiting, diarrhea; administer antiemetic, antacids as ordered
•
Toxicity:
pseudotumor cerebri, photosensitivity, antianabolic actions (azotemia, BUN, hypophosphatemia, metabolic acidosis) tigecycline is structurally similar to tetracycline; pancreatitis, hyperamylasemia; (may be fatal) if these occur, discontinue, improvement usually occurs after product is discontinued
•
Overgrowth of infection:
fever, malaise, redness, pain, swelling, drainage, perineal itching, diarrhea, changes in cough or sputum
•
Storage in tight, light-resistant container at room temp, diluted sol at room temp for up to 24 hr, 6 hr in vial, and remaining time in IV bag, ≤48 hr refrigerated
•
Therapeutic response: decreased temp, absence of lesions, negative C&S
•
To avoid sun exposure; sunscreen does not seem to decrease photosensitivity
To avoid pregnancy while taking this product; fetal harm may occur; avoid breastfeeding
•
To report infection, increase in temp; to report burning, pain at inj site