Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (415 page)
(var-e-ni′kleen)
Champix
, Chantix
Func. class.:
Smoking cessation agent
Chem. class.:
Nicotine receptor agonist
Partial agonist for nicotine receptors; partially activates receptors to help curb cravings; occupies receptors to prevent nicotine binding
Smoking deterrent
Hypersensitivity, eating disorders
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, renal disease, recent MI, angioedema
Black Box Warning:
Bipolar disorder, depression, schizophrenia, suicidal ideation
Calculator
• Adult:
PO
therapy should begin 1 wk prior to smoking stop date (i.e., take product plus tobacco for 7 days); titrate for 1 wk; days 1 through 3, 0.5 mg/day; days 4 through 7, 0.5 mg bid; day 8 through end of treatment, 1 mg bid; treatment is for 12 wk and may be repeated for another 12 wk
• Adult:
PO
CCr ≤50 ml/min, titrate to max 0.5 mg bid
Available forms:
Tabs 0.5, 1 mg; Chantix continuing month PAK; Chantix starting month PAK
•
Do not break, crush, or chew tabs
•
Increased fluids, bulk in diet if constipation occurs
•
After eating with a full glass of water
•
Sugarless gum, hard candy, or frequent sips of water for dry mouth
CNS:
Headache, agitation, dizziness, insomnia, abnormal dreams, fatigue, malaise, behavior changes, depression, suicidal ideation,
suicide,
amnesia, hallucinations, hostility, mania, psychosis, tremor
CV:
Dysrhythmias, hypo/hypertension, palpitations, tachycardia, angina,
MI
EENT:
Blurred vision
, tinnitus
GI:
Nausea, vomiting
, anorexia,
dry mouth
, increased/decreased appetite,
constipation
, flatulence, GERD
GU:
Erectile dysfunction, urinary frequency, menstrual irregularities
INTEG:
Rash, pruritus,
angioedema, Stevens-Johnson syndrome
MISC:
Weight loss or gain
RESP:
Dyspnea, rhinorrhea
Elimination half-life 24 hr; metabolism minimal; 93% excreted unchanged in urine; steady state 4 days
•
Smoking history:
motivation for smoking cessation, years used, amount each day
•
Renal function in geriatric patients; cardiac status in cardiac disease
•
Smoking cessation after 12 wk; if progress not made, product may be used for additional 12 wk
Black Box Warning:
Neuropsychiatric symptoms: mood, sensorium, affect; behavior changes, agitation, depression, suicidal ideation; suicide has occurred; possible worsening of depression, schizophrenia, bipolar disorder
•
Therapeutic response: smoking cessation
•
That treatment for smoking cessation lasts 12 wk and that another 12 wk may be required
•
To use caution when driving, performing other activities requiring alertness; blurred vision may occur
•
To set a date to quit smoking and to initiate treatment 1 wk before that date
•
How to titrate product
•
Not to use with nicotine patches unless directed by prescriber; may increase B/P
•
To notify prescriber if pregnancy planned or suspected
•
About common side effects to be expected
Black Box Warning:
To notify prescriber immediately of change in thought/behavior (suicidal ideation, hostility, depression), stop product
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(vay-soe-press′in)
Pitressin, Pressyn
Func. class.:
Pituitary hormone
Chem. class.:
Lysine vasopressin
Promotes the reabsorption of water via action on the renal tubular epithelium; causes vasoconstriction
Diabetes insipidus (nonnephrogenic/nonpsychogenic), abdominal distention postoperatively, bleeding esophageal varices
Hypersensitivity, chronic nephritis
Precautions:
Pregnancy (C), breastfeeding, CAD, asthma, vascular/renal disease, migraines, seizures
Calculator
• Adult:
IM/SUBCUT
5-10 units bid-qid as needed;
CONT IV INF
0.0005 units/kg/hr (0.05 milliunit/kg/hr), double dose q30min as needed
• Child:
IM/SUBCUT
2.5-10 units bid-qid as needed;
IM/SUBCUT
1.25-2.5 units q2-3days (Pitressin Tannate) for chronic therapy
• Adult:
IM
5 units then q3-4hr, increasing to 10 units if needed (aqueous)
Available forms:
sol for inj 20 units/ml; 10 units/0.5 ml
CNS:
Drowsiness, headache, lethargy, flushing, vertigo
CV:
Increased B/P, dysrhythmias,
cardiac arrest, shock,
chest pain,
MI
EENT:
Nasal irritation, congestion, rhinitis
GI:
Nausea, heartburn, cramps, vomiting, flatus
GU:
Vulval pain, uterine cramping
MISC:
Tremor, sweating, vertigo, urticaria, bronchial constriction
Nasal:
Onset 1 hr; duration 3-8 hr; half-life 15 min; metabolized in liver, kidneys; excreted in urine
Increase:
antidiuretic effect—tricyclics, carBAMazepine, chloropromide, fludrocortisone, clofibrate, urea
Decrease:
antidiuretic effect—lithium, demeclocycline
•
Pulse, B/P when giving product IV or IM
•
I&O ratio, weight daily; fluid/electrolyte balance; check for edema in extremities; if water retention is severe, diuretic may be prescribed
•
Water intoxication:
lethargy, behavioral changes, disorientation, neuromuscular excitability
•
Small doses may precipitate coronary adverse effects; keep emergency equipment nearby
•
Therapeutic response: absence of severe thirst, decreased urine output, osmolality
•
To measure and record I&O
•
To avoid alcohol, all OTC medications unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert