Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (398 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTtirofiban (Rx)
(tie-roh-fee′ban)
Aggrastat
Func. class.:
Antiplatelet
Chem. class.:
Glycoprotein IIb/IIIa inhibitor
Antagonist of platelet glycoprotein (GP) IIb/IIIa receptor that prevents binding of fibrinogen and von Willebrand’s factor, which inhibits platelet aggregation
Acute coronary syndrome in combination with heparin
Hypersensitivity, active internal bleeding, stroke, major surgery, severe trauma within 30 days, intracranial neoplasm, aneurysm, hemorrhage, acute pericarditis, platelets <100,000/mm
3
, history of thrombocytopenia, coagulopathy, systolic B/P >180 mm Hg or diastolic B/P >110 mm Hg
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, renal disease, bleeding tendencies, hypertension, platelets <150,000/mm
3
Calculator
• Adult:
IV
0.4 mcg/kg/min × 30 min then 0.1 mcg/kg/min for 12-24 hr after angioplasty or atherectomy
• Adult:
IV
CCr <30 ml/min, 0.2 mcg/kg/min × 30 min then 0.05 mcg/kg/min during angiography and for ≤24 hr after angioplasty
Available forms:
Inj 50 ml vials; inj premixed bag 50 mcg/ml in 100, 250 ml
•
Dilute inj: withdraw and discard 100 ml from 500-ml bag of sterile 0.9% NaCl or D
5
W and replace this vol with 100 ml of tirofiban inj from 2 vials
•
Tirofiban inj for sol is premixed in containers of 500-ml 0.9% NaCl (50 mg/ml), infuse over 30 min
•
Minimize other arterial/venous punctures; IM inj, catheter use, intubation, to reduce bleeding risk
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, ampicillin, ampicillin/sulbactam, anidulafungin, argatroban, arsenic trioxide, atracurium, atropine, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, capreomycin, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposome, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, methylhexital, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoXANtrone, morphine, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate,
streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, tobramycin, topotecan, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Dizziness, headache
CV:
Bradycardia, hypotension
GI:
Nausea, vomiting
HEMA:
Bleeding, thrombocytopenia
INTEG:
Rash
MISC:
Dissection, edema, pain in legs/pelvis, sweating
SYST:
Anaphylaxis
Half-life 2 hr; excretion via urine, feces; plasma clearance 20%-25% lower in geriatric patients with CAD; renal insufficiency decreases plasma clearance
Increase:
bleeding—aspirin, heparin, NSAIDs, abciximab, eptifibatide, clopidogrel, ticlopidine, dipyridamole, cefamandole, cefoTEtan, cefoperazone, valproic acid, heparins, thrombin inhibitors, SSRIs, SNRIs
•
Multiple sclerosis, spinal cord injury:
muscle spasms, dizziness, drowsiness, difficulty moving, coordination, balance
Bleeding:
platelet counts, Hct, Hgb before treatment, within 6 hr of loading dose, and at least daily thereafter; watch for bleeding from puncture sites, catheters or in stools, urine; discontinue if platelets <100,000/mm
3
•
Therapeutic response: treatment of acute coronary syndrome
•
That it is necessary to quit smoking to prevent excessive vasoconstriction
•
About signs, symptoms of bleeding and low platelets
•
That there are many product and herbal interactions
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ti-za′nih-deen)
Zanaflex
Func. class.:
Skeletal muscle relaxant, α
2
-adrenergic agonist
Chem. class.:
Imidazoline
Do not confuse:
tiZANidine
/tiaGABine
Increases presynaptic inhibition of motor neurons and reduces spasticity by α
2
-adrenergic agonism
Acute/intermittent management of increased muscle tone associated with spasticity, symptoms of MS
Unlabeled uses:
Tension headache, low back pain, trigeminal neuralgia
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, hypotension, renal/hepatic disease
Calculator
• Adult:
PO
8 mg q6-8hr, max 36 mg/24 hr
• Adult:
PO
CCr <25 ml/min, start with lower dose
Available forms:
Tabs 2, 4 mg; caps 2, 4, 6 mg
•
Consistently either with/without food; food may affect absorption
•
Titrate doses carefully
•
Avoid use with other CNS depressants
CNS:
Somnolence, dizziness, speech disorder, dyskinesia, nervousness, hallucination, psychosis
CV:
Hypotension, bradycardia
GI:
Dry mouth, vomiting, increased ALT, abnormal LFTs, constipation
OTHER:
Blurred vision, urinary frequency, pharyngitis, rhinitis, tremor, rash, muscle weakness
Completely absorbed, widely distributed, peak 1-2 hr, duration 3-6 hr, half-life 2.5 hr, protein binding 30%, metabolized by liver; excreted in urine, feces
Increase:
CNS depression—alcohol, other CNS depressants
Increase:
tiZANidine levels—other CYP1A2 inhibitors (acyclovir, amiodarone, famotidine, mexiletine, enoxacin, norfloxacin, propafenone, tacrine, verapamil, zileuton, oral contraceptives ciprofloxacin), fluvoxaMINE; avoid concurrent use
Increase:
hypotension—antihypertensives
Increase:
effect of rasagiline
Increase:
CNS depression—kava, St. John’s wort
Increase:
alk phos, AST, ALT, serum glucose
•
Muscle spasticity
at baseline and throughout treatment
•
Hypotension;
gradual dosage increase should lessen hypotensive effects; have patient rise slowly from supine to upright; watch those patients receiving antihypertensives for increased effects
•
Increased sedation, dizziness, hallucinations, psychosis; product may need to be discontinued
•
Vision by ophthalmic exam; corneal opacities may occur
•
Hepatic studies: 1, 3, 6 mo during treatment and periodically thereafter
•
Therapeutic response: decreased muscle spasticity
•
To rise slowly from lying or sitting to upright position to prevent orthostatic hypotension
•
To ask for assistance if dizziness, sedation occur; to avoid drinking alcohol; to avoid operating machinery, driving until effects known
•
To discontinue gradually