Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (401 page)
Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Overactive bladder (urinary frequency, urgency), urinary incontinence
Hypersensitivity, uncontrolled closed-angle glaucoma, urinary retention, gastric retention
Precautions:
Pregnancy (C), breastfeeding, children, renal/hepatic disease, controlled closed-angle glaucoma, blad
der obstruction, QT prolongation, decreased GI motility
Calculator
• Adult and geriatric:
PO
2 mg bid; may decrease to 1 mg bid;
EXT REL
4 mg/day, may decrease to 2 mg/day if needed, max 4 mg/day
• Adult:
PO
1 mg bid (50% dose) or EXT REL 2 mg/day; CCr ≤30 ml/min, reduce by 50%
Available forms:
Tabs 1, 2 mg; ext rel caps 2, 4 mg
•
Whole; take with liquids; do not crush, chew or break ext rel product; without regard to meals
CNS:
Anxiety, paresthesia, fatigue,
dizziness, headache;
increasing dementia, memory impairment
CV:
Chest pain, hypertension,
QT prolongation
EENT:
Vision abnormalities, xerophthalmia
GI:
Nausea, vomiting, anorexia
, abdominal pain, constipation, dry mouth, dyspepsia
GU:
Dysuria, urinary retention, frequency, UTI
INTEG:
Rash, pruritus
RESP:
Bronchitis, cough, pharyngitis, upper respiratory tract infection
SYST:
Angioedema, Stevens-Johnson syndrome
Rapidly absorbed; highly protein bound; extensively metabolized by CYP2D6; a portion of the population may be poor metabolizers; excreted in urine, feces
•
Do not use in those with known hypersensitivity-festerodine
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, methadone, chloroquine, clarithromycin, droperidol, erythromycin, pentamidine
Increase:
action of tolterodine—antiretroviral protease inhibitors, macrolide antiinfectives, azole antifungals
Increase:
anticholinergic effect—antimuscarinics
Increase:
urinary frequency—diuretics
•
Food increases bioavailability of tolterodine
•
Urinary patterns:
distention, nocturia, frequency, urgency, incontinence
Serious skin disorders:
angioedema, Stevens-Johnson syndrome; allergic reactions: rash; if this occurs, product should be discontinued
•
LFTs at baseline, periodically
QT prolongation:
ECG, ejection fraction; assess for chest pain, palpitations, dyspnea
•
Decreasing dysuria, frequency, nocturia, incontinence
•
To avoid hazardous activities; dizziness may occur
•
Not to drink liquids before bedtime
•
About the importance of bladder maintenance
•
Not to breastfeed
•
To report signs of infection, skin effects
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tole-vap′tan)
Samsca
Func. class.:
Antihypertensive
Chem. class.:
Vasopressin receptor antagonist, V2
Arginine vasopressin (AVP) antagonist with affinity for V2 receptors; level of circulating AVP in circulating
blood is critical for the regulation of water and the electrolyte balance, and it is usually elevated with euvolemic/hypervolemic hyponatremia
Hypervolemic/euvolemic hyponatremia with heart failure, cirrhosis, SIADH
Hypersensitivity, hypovolemia, anuria
Precautions:
Pregnancy (C), breast-feeding, children, dehydration, geriatric, hepatic disease, hyperkalemia
Black Box Warning:
Alcoholism, malnutrition
Calculator
• Adult:
PO
15 mg daily; after 24 hr, may increase to 30 mg daily; max 60 mg/day
Available forms:
Tab 15, 30 mg
•
PO with/without food
•
Avoid fluid restriction for first 24 hr
•
Initiate in hospital setting
CNS:
Fever
CV:
Ventricular fibrillation, DIC, stroke, thrombosis
GI:
Nausea, vomiting, constipation, colitis
GU:
Polyuria
HEMA:
Bleeding
META:
Dehydration, hyperglycemia, hyperkalemia, hypernatremia
MS:
Rhabdomyolysis
RESP:
Respiratory depression, pulmonary embolism
Peak 2-4 hr, protein binding 99%, metabolized by CYP3A4, terminal half-life 12 hr
Increase:
concentrations of tolvaptan—CYP3A4 inhibitors (efavirenz, fosamprenavir, quiNINE); P-gp inhibitors (cycloSPORINE, azithromycin, mefloquine, palperidone, propafenone, quiNIDine, testosterone)
Decrease:
conc of tolvaptan—CYP3A4 inducers (carBAMazepine, dexamethasone, etravirine, flutamide, griseofulvin, metyrapsone, modafinil, nafacillin, nevirapine, OXcarbazepine, phenytoin, rifampin, rifabutin, rifapendine, topiramate)
Decreased:
tolvaptan effect: CYP3A4 inducer (St. John’s wort)
•
Grapefruit juice: do not use together
•
Renal, hepatic function
•
Frequent sodium vol status; overly rapid correction of sodium conc (12 mEq/L per 24 hr), may result in osmotic demyelination syndrome, may occur in alcoholism, severe malnutrition, advanced liver disease, syndrome of inappropriate antidiuretic hormone
•
CV status: ventricular fibrillation, hypertension; monitor B/P, pulse
•
Monitor electrolytes (sodium, potassium)
•
Therapeutic response: correction of serum sodium levels
•
To avoid pregnancy, breastfeeding while taking this product
•
About administration procedure and expected results
•
To report difficulty swallowing, speaking, seizures, dizziness, drowsiness; embolism may be the cause
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert