Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (49 page)
Lipitor
/Levatol
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis; high doses lead to plaque regression
As adjunct for primary hypercholesterolemia (types Ia, Ib), dysbetalipoproteinemia, elevated triglyceride levels, prevention of CV disease by reduction of heart risk in those with mildly elevated cholesterol
Unlabeled uses:
Atherosclerosis
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Precautions:
Previous hepatic disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalance
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• Adult: PO
10-20 mg/day, usual range 10-80 mg/day, dosage adjustments may be made in 2-4 wk intervals, max 80 mg/day; patients who require >45% reduction in LDL may be started at 40 mg/day
• Adult: PO
80 mg/day
Available forms:
Tabs 10, 20, 40, 80 mg
•
Total daily dose at any time of day without regard to meals
CNS:
Headache, asthenia
EENT:
Lens opacities
GI:
Abdominal cramps, constipation, diarrhea, flatus, heartburn
, dyspepsia,
liver dysfunction, pancreatitis,
nausea, increased serum transaminase
GU:
Impotence
INTEG:
Rash, pruritus, alopecia; photosensitivity (rare)
MISC:
Hypersensitivity
MS:
Arthralgia, myalgia,
rhabdomyolysis
RESP:
Pharyngitis, sinusitis
Peak 1-2 hr, metabolized in liver, highly protein bound, excreted primarily in urine, half-life 14 hr, protein binding 98%
Increase:
rhabdomyolysis—azole antifungals, cycloSPORINE, erythromycin, niacin, gemfibrozil, clofibrate
Increase:
serum level of digoxin
Increase:
levels of oral contraceptives
Increase:
levels of atorvastatin—erythromycin
Increase:
effects of warfarin
Decrease:
atorvastatin levels—colestipol
Decrease:
effect—St. John’s wort
•
Possible toxicity when used with grapefruit juice; oat bran may reduce effectiveness
Increase:
bilirubin, alk phos, ALT, AST, CK
Interference:
thyroid function tests
•
Hypercholesterolemia:
diet, obtain diet history including fat, cholesterol in diet; cholesterol triglyceride levels periodically during treatment; check lipid panel 6-12 wk after changing dose
•
Hepatic studies q1-2mo, at initiation, 6, 12 wk after initiation or change in dose, periodically thereafter; AST, ALT, LFTs may be increased
•
Renal studies in patients with compromised renal system: BUN, I&O ratio, creatinine
•
Bowel status: constipation, stool softeners may be needed; if severe, add fiber, water to diet
Rhabdomyolysis:
for muscle pain, tenderness, obtain CPK baseline; if markedly increased, product may need to be discontinued
•
Storage in cool environment in tight container protected from light
•
Therapeutic response: decrease in LDL, total cholesterol, triglycerides, CAD; increase in HDL
•
That blood work and eye exam will be necessary during treatment
•
To report blurred vision, severe GI symptoms, headache, muscle pain, weakness
•
That previously prescribed regimen will continue: low-cholesterol diet, exercise program, smoking cessation
•
Not to take product if pregnant (X), breastfeeding; to avoid alcohol
•
To stay out of the sun; to use sunscreen, protective clothing to prevent photosensitivity (rare)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-toe′va-kwon)
Mepron
Func. class.:
Antiprotozoal
Chem. class.:
Aromatic diamide derivative, analog of ubiquinone
Interferes with DNA/RNA synthesis in protozoa
Pneumocystis jiroveci
infections in patients intolerant of trimethoprim-sulfamethoxazole, prophylaxis,
Toxoplasma gondii
, toxoplasmosis
Unlabeled uses:
Babesiosis, malaria treatment/prophylaxis, toxoplasmosis prophylaxis,
Plasmodium
sp.
Hypersensitivity or history of developing life-threatening allergic reactions to any component of the formulation, benzyl alcohol sensitivity
Precautions:
Pregnancy (C), breastfeeding, neonates, hepatic disease, GI disease, respiratory insufficiency
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Pneumocystis jiroveci
pneumonia
• Adult and adolescent 13-16 yr: PO
750 mg with food bid for 21 days
pneumonia, prophylaxis
• Adult and adolescent: PO
1500 mg/day with meal
• Adult: PO
750 mg q12hr with azithromycin (500-1000 mg on day 1 then 250 mg/day × 7-14 days)
• Adult: PO
1500 mg alone or in combination
(unlabeled)
• Adult: PO
250 mg with proguanil daily
• Child: PO
17 mg/kg with proguanil daily
Available forms:
Susp 750 mg/5 ml
•
With high-fat food to increase absorption of product and higher plasma concentrations
•
Oral susp, shake before using
•
All contents of foil pouch
CNS:
Dizziness, headache, anxiety, insomnia
, asthenia, fever
CV:
Hypotension
GI:
Nausea, vomiting, diarrhea
, anorexia, increased AST/ALT,
acute pancreatitis,
constipation, abdominal pain
HEMA:
Anemia,
neutropenia
INTEG:
Pruritus, urticaria,
rash
META:
Hyperkalemia, hypoglycemia, hyponatremia
OTHER:
Cough, dyspnea
Excreted unchanged in feces (94%), highly protein bound (99%), half-life 2-3 days
Increase:
level of—zidovudine, monitor for toxicity
Decrease:
effect of atovaquone—rifampin, rifabutin, tetracycline, avoid concurrent use
Increase:
AST, ALT, alk phos
Decrease:
glucose, neutrophils, Hgb, sodium
Infection:
WBC, vital signs; sputum baseline, periodically; obtain specimens needed before giving 1st dose
•
Bowel pattern before, during treatment
•
Respiratory status: rate, character, wheezing, dyspnea; risk for respiratory infection
•
Allergies before treatment, reaction to each medication
•
Therapeutic response: decreased temp, ability to breathe
•
To take with food to increase plasma concentrations
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert