Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (60 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ben-aze′uh-pril)
Lotensin
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin-converting enzyme (ACE) inhibitor
Do not confuse:
benazepril
/Benadryl
Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE, thus preventing conversion of angiotensin I to angiotensin II
Hypertension, alone or in combination with thiazide diuretics
Unlabeled uses:
CHF, diabetic nephropathy, proteinuria, renal impairment
Breastfeeding, children, hypersensitivity to ACE inhibitors, angioedema
Black Box Warning:
Pregnancy (D)
Precautions:
Geriatric patients, impaired renal/hepatic function, dialysis patients, hypovolemia, blood dyscrasias, CHF, COPD, asthma, bilateral renal artery stenosis
Calculator
• Adult: PO
10 mg/day initially, then 20-40 mg/day divided bid or daily (without a diuretic); reduce initial dose to 5 mg
PO
daily (with a diuretic); max 80 mg/day
• Geriatric: PO
used on the basis of the clinical response
• Child ≥6 yrs: PO
0.2 mg/kg/day max 5 mg/day
• Adult: PO
CCr <30 ml/min 5 mg
PO
daily, max 40 mg/day
• Adult: PO
10 mg/day
• Adult: PO
2-20 mg/day
Available forms:
Tabs 5, 10, 20, 40 mg
•
May give without regard to food
•
Do not discontinue product abruptly
CNS:
Anxiety, hypertonia, insomnia, paresthesia, headache, dizziness, fatigue
CV:
Hypotension, postural hypotension, syncope, palpitations, angina
GI:
Nausea, constipation, vomiting, gastritis, melena, diarrhea
GU:
Increased BUN, creatinine, decreased libido, impotence, UTI
HEMA:
Agranulocytosis, neutropenia
INTEG:
Rash, flushing, sweating
META:
Hyperkalemia, hyponatremia
MISC:
Angioedema
MS:
Arthralgia, arthritis, myalgia
RESP:
Cough, asthma, bronchitis, dyspnea, sinusitis
Peak 1-2 hr fasting, 2-4 hr after food; protein binding 89%-95%; half-life 10-11 hr; metabolized by liver (metabolites); excreted in urine 33%
Increase:
hypotension—phenothiazines, nitrates, acute alcohol ingestion, diuretics, other antihypertensives
Increase:
hyperkalemia—potassium-sparing diuretics, potassium supplements
Increase:
myelosuppression—azaTHIOprine
Increase:
serum levels of lithium, digoxin
Decrease:
hypotensive effects—NSAIDs
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra (Ma huang)
Increase:
AST, ALT, alk phos, bilirubin, uric acid, blood glucose
Positive:
ANA titer
False positive:
ANA titer
•
Hypertension:
B/P, pulse at baseline, periodically; orthostatic hypotension, syncope when used with diuretic; notify prescriber of changes; monitor compliance
•
Blood dyscrasias:
neutrophils, decreased platelets; WBC with differential at baseline, q3mo; if neutrophils <1000/mm
3
, discontinue treatment; recommended with
collagen-vascular disease
•
Renal studies: protein, BUN, creatinine; increased levels may indicate nephrotic syndrome; monitor urine for protein; LFTs, uric acid, glucose may be increased; diuretic should be discontinued 3 days before initiation of benazepril, if hypertension is not controlled, a diuretic can be added; measure B/P at peak 2-4 hr and trough (before next dose); this product is less effective in African descent patients
•
Potassium levels, although hyperkalemia rarely occurs
•
Allergic reactions:
rash, fever, pruritus, urticaria; product should be discontinued if antihistamines fail to help;
angioedema is more common in patients of African descent
•
Renal symptoms: polyuria, oliguria, frequency, dysuria
•
CHF (unlabeled):
edema in feet, legs daily; weight daily
•
Storage in tight container at 86° F (30° C) or less
•
Therapeutic response: decrease in B/P
•
Not to use OTC products (cough, cold, allergy) unless directed by prescriber; not to use salt substitutes that contain potassium without consulting prescriber
•
The importance of complying with dosage schedule, even if feeling better
Black Box Warning:
To notify prescriber of pregnancy (D); product will need to be discontinued
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
•
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, bruising, bleeding, swelling of face, tongue, lips, difficulty breathing
•
To report excessive perspiration, dehydration, vomiting, diarrhea; may lead to fall in B/P; to use caution in hot weather
•
That product may cause dizziness, fainting, lightheadedness; that this may occur during first few days of therapy
•
That product may cause skin rash or impaired perspiration
•
How to take B/P, and normal readings for age-group
•
To avoid potassium-containing products (salt substitutes)
0.9% NaCl IV INF, hemodialysis
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTbendamustine (Rx)
(ben-da-muss′teen)
Treanda
Func. class.:
Antineoplastic alkylating agent
Chem. class.:
Mechlorethamine derivative
Cross-linking DNA that causes single strand and double strand breaks, inhibits several mitotic checkpoints, combines alkylating and antimetabolite properties
Chronic lymphocytic leukemia, non-Hodgkin’s lymphoma
Unlabeled uses:
Mantle cell lymphoma (MCL)
Pregnancy (D), fetal harm may occur; breastfeeding, children, hepatic disease, renal impairment, hypersensitivity to product or mannitol
Precautions:
Hyperuricemia, infusion-related reactions, myelosuppression, infection, skin reactions
Calculator
• Adult: IV INF
100 mg/m
2
over 30 min on days 1, 2 q28days up to 6 cycles
• Adult: IV INF
120 mg/m
2
over 60 min on days 1, 2 q21days up to 8 cycles
• Adult: IV INF
90 mg/m
2
on days 1, 2 with rituximab on day 1 q28days for 6 cycles
• Adult: IV INF
CCr <40 ml/min, do not use; AST or ALT 2.5-10 × upper limit normal or bilirubin 1.5-3 × ULN, do not use
Available forms:
Powder for inj 25, 100 mg
•
Allopurinol for 1-2 wk to those at high risk for tumor lysis syndrome, usually develops in first treatment cycle
•
Blood transfusions, RBC colony-stimulating factors to counter anemia
•
Antiemetic 30-60 min before giving product to prevent vomiting
•
All medications PO; if possible, avoid IM inj if platelets are <100,000/mm
3
•
Prepare in biologic cabinet wearing gown, gloves, mask; avoid contact with skin, can cause burning, stain the skin brown; use cytotoxic handling procedures
•
After
reconstituting
100 mg product/20 ml or 25 mg/5 ml sterile water for inj (5 mg/ml), sol should be clear, colorless to pale yellow, completely dissolve in 5 min; if particulate is present, do not use
•
Within 30 min of reconstitution, withdraw volume needed and
further dilute
in 500 ml NS or D
2.5/0.45
%NS to a final conc of 0.2-0.6 mg/ml; doses of ≤100 mg/m
2
,
give
over 30 min; doses of >100 mg/m
2
,
give
over 60 min
•
Monitor for inf reactions; may use antihistamines or corticosteroids for grade 1, 2 reactions; if grade 3 or 4 occurs, discontinue if needed
CNS:
Asthenia,
fatigue
, fever,
headache
, chills, hypertension
CV:
Hypertension,
hypertensive crisis
GI:
Nausea, vomiting, diarrhea
, hyperbilirubinemia,
constipation
, stomatitis,
anorexia
, weight loss
GU:
Renal failure
HEMA:
Thrombocytopenia, leukopenia, anemia, lymphocytopenia, neutropenia, secondary malignancy, toxic epidermal necrolysis, tumor lysis syndrome
INTEG:
Bulbous rash, pruritus
, extravasation
META:
Hyperuricemia
SYST:
Anaphylaxis,
infection, dehydration,
severe skin toxicities, tumor lysis syndrome, Stevens-Johnson syndrome
95% protein binding, metabolized by hydrolysis via CYP450 1A2, 2 metabolites are produced, half-life 40 min, 90% excreted unchanged (feces)
Increase:
agranulocytosis risk—cloZAPine (do not use concurrently)
Increase:
bleeding risk—aspirin, anticoagulants, NSAIDs, platelet inhibitors, thrombolytics
Increase:
myelosuppression—myelosuppressive agents
Increase:
toxicity—other antineoplastics, radiation
Increase:
adverse reactions, decreased antibody reaction—live vaccines
Increase:
bendamustine—CYP1A2 inhibitors (atazanavir, cimetidine, ciprofloxacin, enoxacin, ethyl estradiol, fluvoxaMINE, mexiletine, norfloxacin, tacrine, thiabendazole, zileuton)
Decrease:
bendamustine—CYP1A2 inducers (barbiturates, carBAMazepine, rifampin)
Increase:
LFTs
•
Blood dyscrasias:
CBC, differential, platelet count weekly; withhold product if WBC is <1000 or if platelet count is <75,000; notify prescriber of results
•
Hepatic studies: AST, ALT, bilirubin
•
Renal studies: BUN, serum uric acid, urine CCr before, during therapy; I&O ratio; report fall in urine output of 30 or 40 ml/hr; electrolytes
•
Monitor for cold, cough, fever (may indicate beginning infection)
•
For malignancy regression
•
Bleeding: hematuria, guaiac, bruising, petechiae, mucosa, orifices q8hr
•
Serious skin toxicities:
toxic epidermal necrolysis, Stevens-Johnson syndrome; product should be discontinued
•
Tumor lysis syndrome:
monitor uric acid, potassium; may occur during 1st treatment cycle; use allopurinol for patients at high risk for this condition, usually during the 1st 2 wk; provide adequate hydration
•
Storage of reconstituted sol in refrigerator for 24 hr or at room temp for 3 hr; protect from light; store vials at room temp
•
Therapeutic response: improvement in blood counts, morphology
•
To avoid hazardous activity that requires mental alertness
•
To avoid crowds, persons with upper respiratory infections
•
To report immediately fever, sore throat, flulike symptoms, indicates infection
•
To report immediately allergic reaction, facial swelling, difficulty breathing, itchy rash
•
Until reaction is known, not to breastfeed, males should also use contraception during and for 3 months after
•
To use contraception during therapy and for 3 mo after pregnancy (D)
•
To avoid use of aspirin, ibuprofen, razors, commercial mouthwash
•
To report signs of anemia (fatigue, irritability, SOB, faintness)
•
To report signs of infection, myelosuppression, skin toxicities, diarrhea, nausea, vomiting