Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (424 page)
HIGH ALERT(war′far-in)
Coumadin, Jantoven
Func. class.:
Anticoagulant
Chem. class.:
Coumarin derivative
Do not confuse:
Coumadin
/Cardura/Compazine
Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit-K–dependent coagulation factors (II, VII, IX, X)
Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI,
stroke prophylaxis, thrombosis prophylaxis
Unlabeled uses:
Angina, unstable angina
Pregnancy (X), breastfeeding, hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, hepatic disease (severe), malignant hypertension, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia, hemorrhagic tendencies; surgery of CNS, eye; traumatric surgery with large open surface, bleeding tendencies of GI/GU/respiratory tract, stroke, aneurysms, pericardial effusion, spinal puncture, major regional/lumbar block anesthesia
Black Box Warning:
Bleeding
Precautions:
Geriatric patients, alcoholism, CHF, debilitated patients, trauma, indwelling catheters, severe hypertension, active infections, protein C deficiency, polycythemia vera, vasculitis, severe diabetes, Asian patients (CYP2C9), protein C, S deficiency
Calculator
• Adult:
PO/IV
2.5-10 mg/day × 2-4 days then titrated to INR/PT
• Adolescent/child/infant:
PO/IV
0.2 mg/kg/day × 2 days titrated to INR
Available forms:
Tabs 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg; inj 5 mg powder for inj
•
At same time each day to maintain steady blood levels without regard to food; food decreases rate but not extent of absorption; do not change brands
•
Tabs whole or crushed
•
Avoiding all IM inj that may cause bleeding
•
Reconstitute with 2.7 ml sterile water for inj (2 mg/ml); do not use sol that is discolored or that has particulates
•
Give over 1-2 min into peripheral vein
Y-site compatibilities:
Amikacin, ascorbic acid, bivalirudin, ceFAZolin, cefTRIAXone, DOPamine, EPINEPHrine, heparin, lidocaine, metaraminol, morphine, nitroglycerin, oxytocin, potassium chloride, ranitidine
CNS:
Fever
, dizziness, fatigue, headache, lethargy
CV:
Angina, chest pain, edema, hypotension, syncope
GI:
Diarrhea
, nausea, vomiting, anorexia, stomatitis, cramps,
hepatitis,
cholestatic jaundice
GU:
Hematuria
HEMA:
Hemorrhage, agranulocytosis, leukopenia, eosinophilia,
anemia, ecchymosis, petechiae
INTEG:
Rash
, dermatitis, urticaria, alopecia, pruritus
MISC:
Epistaxis, hemoptysis, mouth ulcers, taste disturbances, priapism, dyspnea
MS:
Bone fractures
SYST:
Anaphylaxis,
coma, cholesterol, microembolism,
exfoliative dermatitis, purple toe syndrome
PO:
Onset 12-24 hr, peak 1½-4 days, duration 3-5 days, effective half-life 20-60 hr; metabolized in liver; excreted in urine, feces (active/inactive metabolites); crosses placenta, 99% bound to plasma proteins
Increase:
warfarin action—allopurinol, amiodarone, chloral hydrate, chloramphenicol, cimetidine, clofibrate, cotrimoxazole, COX-2 selective inhibitors, dextrothyroxine, diflunisal, disulfiram, erythromycin, ethacrynic acids, furosemide, glucagon, heparin, HMG-CoA reductase inhibitors, indomethacin, isoniazid, mefenamic acid, metroNIDAZOLE, mifepristone, NSAIDs, oxyphenbutazones, penicillins, phenylbutazone, quiNIDine, quinolone antiinfectives, RU-486,
salicylates, sulfinpyrazone, sulfonamides, sulindac, SSRIs, steroids, thrombolytics, thyroid, tricyclics
Increase:
toxicity—oral sulfonylureas, phenytoin
Decrease:
warfarin action—aprepitant, azaTHIOprine, barbiturates, bile acid sequestrants, bosentan, carBAMazepine, dicloxacillin, estrogens, ethchlorvynol, factor IX/VIIa, griseofulvin, nafcillin, oral contraceptives, phenytoin, rifampin, sucralfate, sulfaSALAzine, thyroid, vit K, vit K foods
Increase:
risk for bleeding—angelica, anise, basil, chamomile, chondroitin, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, kava, licorice, melatonin, red yeast rice, saw palmetto
Decrease:
anticoagulant effect—coenzyme Q10, St. John’s wort
Increase:
T
3
uptake, LFTs
Decrease:
uric acid
Black Box Warning:
Blood studies (Hct, PT, platelets, occult blood in stools) q3mo; INR: in hospital daily after 2nd or 3rd dose; when in therapeutic range for 2 consecutive days, monitor 2-3× wk for 1-2 wk then less frequently, depending on stability of INR results;
Outpatient:
monitor every few days until stable dose then periodically thereafter, adepending on stability of INR results, usually at least monthly
Black Box Warning:
Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria; fatal hemorrhage can occur
Fever, skin rash, urticaria
•
Storage in tight container
•
Therapeutic response: decrease in deep venous thrombosis
•
To avoid OTC preparations that may cause serious product interactions unless directed by prescriber
•
To carry emergency ID identifying product taken
•
About the importance of compliance
•
To report any signs of bleeding: gums, under skin, urine, stools; to use soft-bristle toothbrush to avoid bleeding gums; to use electric razor
•
To avoid hazardous activities (eg, football, hockey, skiing), dangerous work
•
About the importance of avoiding unusual changes in vitamin intake, diet, or lifestyle
•
To inform all health care providers of anticoagulant intake
Administer vit K
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(za-feer′loo-cast)
Accolate
Func. class.:
Bronchodilator
Chem. class.:
Leukotriene receptor antagonist
Antagonizes the contractile action of leukotrienes (LTD
4
, LTE
4
) in airway smooth muscle; inhibits bronchoconstriction caused by antigens
Prophylaxis and chronic treatment of asthma in adults/children >5 yr
Unlabeled uses:
Allergic rhinitis
Hypersensitivity, hepatic encephalopathy
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, hepatic disease, Churg-Strauss syndrome, acute bronchospasm
Calculator
• Adult and child ≥12 yr:
PO
20 mg bid
• Child 5-11 yr:
PO
10 mg bid
Available forms:
Tabs 10, 20 mg
•
1 hr before or 2 hr after meals; absorption may be decreased if given with food
CNS:
Headache, dizziness,
suicidal ideation,
insomnia, fever
GI:
Nausea, diarrhea, abdominal pain, vomiting, dyspepsia,
hepatic failure, hepatitis
HEMA:
Agranulocytosis
OTHER:
Infections, pain, asthenia, myalgia, fever, increased ALT, urticaria, rash,
angioedema
Rapidly absorbed, peak 3 hr, 99% protein binding (albumin), extensively metabolized, inhibits CYP2C9 and 3A4 enzyme systems, excreted in feces, clearance reduced in geriatric patients, hepatic impairment, half-life 10 hr
Increase:
plasma levels of zafirlukast—aspirin
Increase:
PT—warfarin
Decrease:
plasma levels of zafirlukast—erythromycin, theophylline
Decrease:
bioavailability
Adult patients carefully for symptoms of Churg-Strauss syndrome
(rare), including eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, neuropathy, may be caused by reducing oral corticosteroids
•
Respiratory rate, rhythm, depth; auscultate lung fields bilaterally; notify prescriber of abnormalities, not to be used for acute bronchospasm in acute asthma
•
Hepatic disease:
monitor liver function tests
•
Therapeutic response: ability to breathe more easily
•
To check OTC medications, current prescription medications that may increase stimulation
•
To avoid hazardous activities because dizziness may occur
•
That, if GI upset occurs, to take product with 8 oz water; to avoid taking with food if possible because absorption may be decreased
•
To notify prescriber of nausea, vomiting, diarrhea, abdominal pain, fatigue, jaundice, anorexia, flulike symptoms (hepatic dysfunction)
•
Not to use for acute asthma episodes
•
Not to take if breastfeeding
•
To take even if symptom free