Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (41 page)
(a-nid-yoo-luh-fun′jin)
Eraxis
Func. class.:
Antifungal, systemic
Chem. class.:
Echinocandin
Inhibits fungal enzyme synthesis; causes direct damage to fungal cell wall
Esophageal candidiasis,
Candida albicans, C. glabrata, C. parapsilosis, C. tropicalis
Unlabeled uses:
Fungal prophylaxis, disseminated candidiasis, oropharyngeal candidiasis,
Aspergillosis
sp.
Hypersensitivity to product, other echinocandins
Precautions:
Pregnancy (C), breastfeeding, children, severe hepatic disease
Calculator
Candida
infections
• Adult:
IV
200 mg loading dose on day 1 then 100 mg/day × 14 days or more until last positive culture
• Adult: IV
100 mg loading dose on day 1 then 50 mg/day × 14 days, for at least 7 days after symptoms resolved
• Adolescent and child 2-17 yr: IV
1.5 mg/kg over 90 min then 0.75 mg/kg/day over 45 min × 5-28 days
Powder for inj, lyophilized 50, 100 mg
•
Reconstitution:
If dehydrated alcohol diluents supplied, use supplied diluent (dehydrated alcohol in water for inj); reconstitute each 50-mg vial/15 ml of diluents or 100-mg vial/30 ml (3.33 mg/ml); if diluents not supplied, reconstitute each 50-mg vial/15 ml sterile water for inj or 100-mg vial/30 ml of sterile water for inj (3.33 mg/ml)
•
Dilution: 200 mg loading dose inf with vials (dehydrated alcohol),
withdraw contents of 4 (50-mg reconstituted vials) or 2 (100-mg reconstituted vials)/500 ml of D
5
W or NS (0.36 mg/ml);
200 mg loading dose inf with vials (sterile water for inj),
withdraw contents of 4 (50-mg reconstituted vials) or 2 (100-mg reconstituted vials)/200 ml of D
5
W or NS, total volume 260 ml;
100 mg daily inf with vials (dehydrated alcohol),
withdraw contents of 1 (100-mg reconstituted vial) or 2 (50-mg reconstituted vial) and add to 250 ml D
5
W or NS (0.36 mg/ml);
100 mg daily inf with vials (sterile water),
withdraw contents of 1 (100-mg reconstituted vial)
or 2 (50-mg reconstituted vials)/100 ml D
5
W or NS (total volume 130 ml);
50 mg daily inf (dehydrated alcohol),
withdraw contents of 1 (50-mg reconstituted vial)/100 ml D
5
W or NS final conc (0.43/ml)
•
Inf rate max 1.1 mg/min (dehydrated alcohol); inf rate 1.4 mg/min (sterile water) or 84 ml/hr
•
Give only as IV inf, not for IV bolus
•
Do not use if cloudy or precipitated; do not admix
Acyclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin sulbactam, argatroban, arsenic trioxide, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin liposome, DAUNOrubicin hydrochloride, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUtamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gallium nitrate, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid injection, LORazepam, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, mitoXANtrone, mivacurium, morphine, moxifloxacin, mycophenolate mofetil, nafcillin, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, piperacillin-tazobactam, polymyxin B, potassium acetate/chloride, procainamide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate, streptozocin, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tirofiban, tobramycin, topotecan, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
Candida
infections
CNS:
Seizures,
dizziness,
headache
CV:
DVT,
atrial fibrillation, right bundle branch block,
hypotension,
sinus arrhythmia, thrombophlebitis superficial, ventricular extrasystoles, QT prolongation (rare)
GI:
Nausea, anorexia, vomiting, diarrhea, increased AST, ALT
META:
Hypokalemia
CNS:
Headache
GI:
Nausea, anorexia, vomiting, diarrhea
,
hepatic necrosis
HEMA:
Neutropenia, thrombocytopenia, leukopenia, coagulopathy
INTEG:
Rash
, urticaria, itching, flushing
META:
Hypocalcemia, hyperglycemia, hyperkalemia, hypernatremia, hypomagnesium (rare)
MS:
Back pain, rigors
Steady state after loading dose, distribution half-life 0.5-1 hr, terminal half-life 40-50 hr, protein binding 99%
Increase:
plasma concentrations—cycloSPORINE
Increase:
amylase, bilirubin, CPK, creatinine, ECG, lipase, PT
Decrease:
platelets, magnesium, potassium, transferase, urea
•
Infection:
clearing of cultures during treatment; obtain culture at baseline and throughout treatment; product may be started as soon as culture is taken, those with HIV pharyngeal candidiasis may need antifungals
Blood dyscrasias (rare):
CBC (RBC, Hct, Hgb), differential, platelet count periodically; notify prescriber of results
•
Hepatic studies before, during treatment: bilirubin, AST, ALT, alk phos, as needed; also uric acid
Bleeding:
hematuria, heme-positive stools, bruising/petechiae of mucosa or orifices; blood dyscrasias can occur
•
GI symptoms: frequency of stools, cramping; if severe diarrhea occurs, electrolytes may need to be given
•
Store reconstituted vials at 59° F-86° F for up to 24 hr, do not freeze (dehydrated alcohol); store reconstituted vials at 36° F-46° F (sterile water) for up to 24 hr, do not freeze
•
Therapeutic response: decreased symptoms of
Candida
infection, negative culture
•
To notify prescriber if pregnancy is suspected, planned; use nonhormonal form of contraception while taking this product
•
To avoid breastfeeding while taking this product
•
To inform prescriber of renal/hepatic disease
•
To report bleeding
•
To report signs of infection: increased temp, sore throat, flulike symptoms
•
To notify prescriber of nausea, vomiting, diarrhea, jaundice, anorexia, clay-colored stools, dark urine; hepatotoxicity may occur
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ah-poe-more′feen)
Apokyn
Func. class.:
Antiparkinson agent
Chem. class.:
Dopamine agonist, non-ergot
Has similarities to dopamine that are thought to contribute to its central dopamine receptor agonist properties; exhibits a high affinity for dopamine D
4
receptors, a moderate affinity for dopamine D
2
, D
3
, and D
5
receptors, and a low affinity for D
1
receptors; treats erectile dysfunction by activating dopamine receptors in the hypothalamus and limbic and neural pathways to increase erections
For use as rescue of “off” episodes associated with advanced Parkinson’s disease
Hypersensitivity to this product, sulfites, or benzyl alcohol, IV use, major psychotic disorder; concurrent treatment with drugs of the 5-HT
3
antagonist class (e.g., ondansetron, granisetron, alosetron)
History of suicidal ideation or depression, CNS/respiratory depression, decreased alertness, gag reflex depression, seizures, seizure disorder, coma, asthma, emphysema, atrial fibrillation, hypertension, bradycardia, orthostatic hypotension, QT prolongation, vasovagal syncope, acute circulatory failure, orthostatic hypotension, cardiac disease, congenital heart disease, cardiac arrhythmias, cardiac depression, heart failure, shock, hepatic/renal disease, pregnancy C, breastfeeding, debilitated/geriatric patients, abrupt discontinuation
• Adult:
Test dose:
SUBCUT
0.2 ml (2 mg) (test dose) where B/P can be closely monitored (before dose and 20, 40, 60 min after); if tolerated and patient response, then begin with 0.2 ml (2 mg); may increase by 1 mg every few days, max 0.6 ml (6 mg). If the test dose of 0.2 ml (2 mg) is tolerated but the patient does not respond, give a test dose of 0.4 ml (4 mg) no sooner than 2 hr after the 0.2 ml (2 mg) test dose, where BP can be closely monitored (before dose and 20, 40, and 60 min after the dose); If the 0.4 ml (4 mg) test dose is tolerated, the starting dose should be 0.3 ml (3 mg); may be increased by 1 mg every few days as required, max 0.6 ml (6 mg). If the 0.4 ml (4 mg) test dose is not tolerated, administer a test dose of 0.3 ml (3 mg) no sooner than 2 hr after the 0.4 ml (4 mg) test dose where BP can be closely monitored (before dose and 20, 40, and 60 min after the dose). If the 0.3 ml (3 mg) test dose is tolerated, begin with 0.2 ml (2 mg); may be increased by 0.1 ml (1 mg) every few days as required, max 0.4 ml (4 mg; outpatient)
•
Usual dosage: 0.3-0.6 ml (3 to 6 mg), average frequency three times a day.
Penfill sol for inj 10 mg/ml
•
To reduce nausea/vomiting, give trimethobenzamide × 3 days before the first dose, and continued ≥2 months of treatment
•
For subcut use only; do use IM or IV
•
Wash hands before and after use, skin contact can cause an allergic skin reaction
•
To be used by those qualified and who have received instruction on the use
•
Dosing pen (Apokyn Pen) is dosed in ml, not mg
. The pen allows the patient’s usual dose to be dialed in, even if there is not enough medicine in the pen to do so. If there is not enough medicine for the usual dose, the device must be “rearmed” and the remaining amount needed should be dialed in. This process should be avoided if possible to avoid dosage errors. Keep a record of doses used so the cartridges can be replaced as needed
•
Do not inject into infected, erythematous, or irritated skin
•
Double-check dosage in syringe before use
•
Aspirate before injection to avoid injection into a blood vessel; inject subcut, taking care not to inject ID
•
Rotate injection sites with each injection (abdomen, upper arm, thigh)
CNS:
Drowsiness, dizziness, flushing, hallucinations, confusion, worsening psychiatric/behavioral effects, dyskinesias, sweating
CV:
Hypotension, CHF, edema, MI, cardiac arrest
GI:
Nausea, vomiting, constipation or diarrhea
INTEG:
Contact dermatitis, ecchymosis, injection reaction
MISC:
Yawning, rhinorrhea, respiratory depression
MS:
Arthralgia, back pain
Onset 20 min, peak 20-60 min, duration 2 hr, half-life 30-60 min
Do not use with dronedarone
Increase:
Hypotension, unconsciousness—serotonin-receptor antagonists (alosetron, dolasetron, granisetron, ondansetron, palonosetron), do not use together
Increase:
QT interval—antiemetics (dolasetron, ondansetron, palonosetron), other products that increase QT, can occur at high doses
Increase:
Hypotension—antihypertensives, vasodilators
Decrease:
Apomorphine effect—antipsychotics
•
Assess for the acute, intermittent treatment of hypomobility, “off” episodes (“end-of-dose wearing off” and unpredictable “on/off” episodes) associated with advanced Parkinson’s disease
•
During the test dosing to determine dose titration, B/P should be closely monitored (before dose and 20, 40, and 60 min after the injection)
•
Monitor for patient response to the injection (i.e., reduction in “off” episode symptoms)
•
Contact the health care provider if patient’s symptoms do not respond to the first dose for a particular “off” episode; do not use a second dose for that episode
•
If the patient has not received an apomorphine injection in more than 1 wk, must reinstitute following the initial test dosage and titration instructions
•
Positive therapeutic outcome—reduction of “off” episode symptoms in Parkinson’s disease
•
Not to rise quickly, fainting can occur
•
To use with antiemetic, nausea and vomiting are common
•
All persons involved in care, how to use subcut pen
•
To report hallucinations, other psychiatric symptoms to prescriber immediately
•
Not to consume alcohol or kava, CNS effects can worsen
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ap-re′pi-tant)
Emend
Emend
Func. class.:
Antiemetic
Chem. class.:
Miscellaneous
Selective antagonist of human substance P/neurokinin 1 (NK
1
) receptors that decreases emetic reflex
Prevention of nausea/vomiting associated with cancer chemotherapy (highly emetogenic/moderately emetogenic), including high-dose CISplatin; used in combination with other antiemetics; postoperative nausea/vomiting
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, hepatic disease
• Adult: PO
Day 1 (1 hr before chemotherapy) aprepitant 125 mg with 12 mg dexamethasone
PO,
with 32 mg ondansetron IV; day 2 aprepitant 80 mg with 8 mg dexamethasone
PO;
day 3 aprepitant 80 mg with 8 mg dexamethasone
PO;
day 4 only dexamethasone 8 mg
PO; IV INF
115 mg over 15 min, 30 min before chemotherapy as alternative to 1st dose of aprepitant on day 1 of regimen (fosaprepitant)
• Adult: PO
Day 1 125 mg aprepitant with dexamethasone 12 mg
PO,
with ondansetron 8 mg
PO
× 2; days 2 and 3 80 mg aprepitant only (aprepitant);
IV INF
115 mg over 15 min, 30 min before chemotherapy as alternative to 1st dose of aprepitant on day 1 of regimen (fosaprepitant)
• Adult: PO
40 mg within 3 hr of induction of anesthesia
Caps 40, 80, 125 mg; powder for inj 115, 150 mg; combo pack cap 80-125 mg
•
Do not break, crush, or chew
•
PO on 3-day schedule, give with full glass of water 1 hr before chemotherapy, with or without food, given with other antiemetics
•
Only approved as a substitute for the 1st dose of aprepitant in 3-day regimen
•
Reconstitution:
use aseptic technique; inject 5 ml 0.9% NaCl into the vial, directing stream to wall of vial to prevent foam; swirl (do not shake)
•
Prepare inf bag with 110 ml NS/115 mg; 145 ml/150 mg; do not dilute, reconstitute with any divalent cations such as calcium, magnesium, including LR, Hartmann’s sol
•
Withdraw entire volume from vial, transfer to inf bag; total volume 115 ml (1 mg/1 ml)
•
Gently invert bag 2-3 times; reconstituted sol stable for 24 hr at lower room temp or <25° C
•
Visually inspect for particulates, discoloration
•
Infuse over 15 min, stable for 24 hr at room temperature
CNS:
Headache, dizziness
, insomnia, anxiety, depression, confusion, peripheral neuropathy
CV:
Bradycardia, tachycardia, DVT, hypo/hypertension
GI:
Diarrhea, constipation
, abdominal pain, anorexia, gastritis, increased AST, ALT
, nausea
, vomiting, heartburn
GU:
Increased BUN, serum creatine, proteinuria, dysuria
HEMA:
Anemia,
thrombocytopenia, neutropenia
INTEG:
Pruritus, rash, urticaria
MISC:
Asthenia, fatigue, dehydration, fever, hiccups, tinnitus, alopecia
SYST:
Anaphylaxis
Absorption 60%-65%, peak 4 hr, metabolized in liver by CYP3A4 enzymes to active metabolite, half-life 9-12 hr, 95% protein bound, not excreted in kidneys, crosses blood-brain barrier
Increase:
aprepitant action—CYP3A4 inhibitors (ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir, diltiazem)
Increase:
action of CYP3A4 substrates (pimozide, cisapride, dexamethasone, methylPREDNISolone, midazolam, ALPRAZolam, triazolam, docetaxel, PACLitaxel, etoposide, irinotecan, imatinib, ifosfamide, vinorelbine, vinBLAStine, vinCRIStine)
Decrease:
aprepitant action—CYP3A4 inducers (rifampin, carBAMazepine, phenytoin)
Decrease:
action of CYP2C9 substrates (warfarin, TOLBUTamide, phenytoin), oral contraceptives
Decrease:
action of both products—paroxetine
Decrease:
effect—grapefruit juice
For hypersensitive reactions:
pruritus, rash, urticaria, anaphylaxis
•
CV status: hypo/hypertension, bradycardia, tachycardia, DVT
•
For absence of nausea, vomiting during chemotherapy
•
CBC, LFTs, creatinine baseline and periodically
•
Storage at room temp; keep in original bottles, blisters (PO)
•
Therapeutic response: absence of nausea, vomiting during cancer chemotherapy
•
To report diarrhea, constipation
•
To take only as prescribed; to take 1st dose 1 hr before chemotherapy
•
To report all medications and herbals to prescriber before taking this medication
•
To use nonhormonal form of contraception while taking this agent and for 1 mo thereafter; oral contraceptive effect may be decreased
•
That those patients also taking warfarin should have clotting monitored closely during 2-wk period after administration of aprepitant
•
To avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ar-for-moe′ter-ole)
Brovana
Func. class.:
Long-acting adrenergic β
2
-agonist, sympathomimetic, bronchodilator
Brovana
/Boniva
Causes bronchodilation by action on β
2
(pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscle; produces bronchodilation and CNS, cardiac stimulation as well as increased diuresis and gastric acid secretion; longer acting than isoproterenol
Maintenance bronchospasm prevention in COPD, including chronic bronchitis, emphysema
Hypersensitivity to sympathomimetics, product, racemic formoterol; tachydysrhyhmias, severe cardiac disease, heart block, children, monotherapy in asthma
Precautions:
Pregnancy (C), breastfeeding, cardiac disorders, hyperthyroidism, diabetes mellitus, hypertension, prostatic hypertrophy, angle-closure glaucoma, seizures, hypoglycemia
Black Box Warning:
Asthma-related death
• Adult: NEB
15 mcg, bid,
AM, PM
Available forms:
Inh sol 15 mcg/2 ml
•
By nebulization only; no dilution needed, give over 10-15 min; sol should be colorless
CNS:
Tremors, anxiety
, insomnia, headache, dizziness, stimulation,
restlessness
, hallucinations, flushing, irritability
CV:
Palpitations, tachycardia, hypertension, angina, hypotension, dysrhythmias,
AV block heart failure, prolonged QT supraventricular tachycardia
EENT:
Dry nose, irritation of nose, throat
GI:
Heartburn, nausea, vomiting
MISC:
Flushing, sweating, anorexia, bad taste/smell changes, hypokalemia,
anaphylaxis,
hypoglycemia
MS:
Muscle cramps
RESP:
Cough, wheezing, dyspnea,
bronchospasm,
dry throat
Onset 5 min; peak 1-1½ hr; duration 4-6 hr; terminal half-life (COPD) 26 hr; extensively metabolized by direct conjugation by CYP2D6, CYP2C19; crosses placenta; protein binding 52%-65%; excreted in urine 63%, feces 11%
Increase:
QT prolongation—Class IA/III antidysrthymics, MAOIs, tricyclics
Increase:
severe hypotension—oxytocics
Increase:
toxicity—theophylline
Increase:
ECG changes/hypokalemia—potassium-losing diuretics
Increase:
action of nebulized bronchodilators
Increase:
action of arformoterol—tricyclics, MAOIs, other adrenergics; do not use together
Decrease:
arformoterol action, asthma-related death—other β-blockers
Increase:
stimulation—caffeine (cola nut, green/black tea, guarana, yerba maté, coffee, chocolate)
Black Box Warning:
Respiratory function: vital capacity, forced expiratory volume, ABGs; lung sounds, heart rate, rhythm, B/P, sputum (baseline, peak); actively deteriorating COPD may occur, a rescue inhaler should be readily available
•
Whether patient has received theophylline therapy, other bronchodilators before giving dose
•
Patient’s ability to self-medicate
•
For evidence of allergic reactions; anaphylaxis may occur
•
For
paradoxical bronchospasm;
hold medication, notify prescriber if bronchospasm occurs
•
Storage in refrigerator; if stored at room temp, discard after 6 wk or if past expiration date, whichever is sooner
•
Therapeutic response: absence of dyspnea, wheezing after 1 hr, improved airway exchange, improved ABGs
•
To use exactly as prescribed; that death has resulted from asthma with products similar to this one, to have a rescue inhaler always
•
Not to use OTC medications because excess stimulation may occur
•
An opened unit-dose vial should be used right away
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTargatroban (Rx)
(are-ga-troe′ban)
Func. class.:
Anticoagulant
Chem. class.:
Thrombin inhibitor