Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (65 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
)
(bis-a-koe′dill)
Alophen, Correctol, Dacodyl, Dulcolax, Ex-Lax Ultra Tab, Femilax, Feminine, Good Sense Women’s, Leader Laxative, Top Care Laxative, Veracolate, Walgreens Gentle, Walgreens Women’s
Func. class.:
Laxative, stimulant
Chem. class.:
Diphenylmethane
Acts directly on intestine by increasing motor activity; thought to irritate colonic intramural plexus
Short-term treatment of constipation; bowel or rectal preparation for surgery, examination
Hypersensitivity, rectal fissures, abdominal pain, nausea, vomiting, appendicitis, acute surgical abdomen, ulcerated hemorrhoids, acute hepatitis, fecal impaction, intestinal/biliary tract obstruction
Precautions:
Pregnancy (C), breastfeeding
Calculator
• Adult and child ≥12 yr: PO
10-15 mg in
PM
or
AM
; may use up to 30 mg for bowel or rectal preparation;
RECT
10 mg as a single dose; 30-ml enema
• Child 3-11 yr: PO
5-10 mg as a single dose;
RECT
5-10 mg as a single dose
Available forms:
Tabs del rel 5, 10 mg; enteric-coated tabs 5 mg; supp 5, 10 mg; enema 10 mg/30 ml
•
Swallow tabs whole with full glass of water; do not break, crush, chew tabs
•
Alone only with water for better absorption; do not take within 1 hr of other products or within 1 hr of antacids, milk, H
2
antagonists; do not take enteric product with proton-pump inhibitors
•
In
AM
or
PM
•
Insert high in rectum
CNS:
Muscle weakness
GI:
Nausea, vomiting, anorexia, cramps
, diarrhea, rectal burning (suppositories)
META:
Protein-losing enteropathy, alkalosis, hypokalemia,
tetany;
electrolyte, fluid imbalances
Small amounts metabolized by liver; excreted in urine, bile, feces, breast milk
PO:
Onset 6-10 hr
RECT:
Onset 15-60 min
Increase:
gastric irritation—antacids, milk, H
2
-blockers, gastric acid pump inhibitors
•
Increase irritation—dairy products separate by 2 hr
Increase:
Sodium phosphate
Decrease:
Calcium, magnesium
•
Blood, urine electrolytes if product is used often by patient
•
I&O ratio to identify fluid loss
•
Cause of constipation; identify whether fluids, bulk, exercise missing from lifestyle; determine use of constipating products
•
GI symptoms:
cramping, rectal bleeding, nausea, vomiting; if these symptoms occur, product should be discontinued
•
Multiple products/routes may be used for bowel prep
•
Therapeutic response: decrease in constipation
•
Not to use laxatives for long-term therapy because bowel tone will be lost, 1 wk use is usually sufficient
•
That normal bowel movements do not always occur daily
•
Not to use in presence of abdominal pain, nausea, vomiting
•
To notify prescriber if constipation is unrelieved or if symptoms of electrolyte imbalance occur: muscle cramps, pain, weakness, dizziness
•
To take with a full glass of water, do not take with dairy products
•
Identify bulk, water, constipating products, exercise in patient’s life
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
)
(bis′muth sub-sal-iss′uh-late)
Bismatrol, Equaline Stomach Relief, Good Sense Stomach Relief, GNP Pink Bismuth, Leader Pink Bismuth, Peptic Relief, Pepto-Bismol, Pink Bismuth, Top Care Stomach Relief, Walgreens Soothe
Func. class.:
Antidiarrheal, weak antacid
Chem. class.:
Salicylate
Do not confuse:
Kaopectate
/Kayoxalate
Inhibits the prostaglandin synthesis responsible for GI hypermotility, intestinal inflammation; stimulates absorption of fluid and electrolytes; binds toxins produced by
Escherichia coli
Diarrhea (cause undetermined), prevention of diarrhea when traveling; may be included to treat
Helicobacter pylori
, heartburn, indigestion, nausea
Children <3 yr, children with chickenpox, history of GI bleeding, renal disease, flulike symptoms, hypersensitivity to product or salicylates
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, anticoagulant therapy, immobility, gout, diabetes mellitus, bleeding disorders, previous hypersensitivity to NSAIDs,
Clostridium-difficile–
associated diarrhea when used with antiinfectives for
H. pylori
Calculator
• Adult: PO
2 tabs or 30 ml (15 ml extra/max strength) q30min or 2 tabs q60min, max 4.2 g/24 hr
• Adult/adolescent: PO
525 mg qid, max 4.2 g/24 hr; given with metroNIDAZOLE or tetracycline and acid-suppressive therapy × 14 days
Available forms:
Tabs 262 mg; chewable tabs 262 mg; susp 87 mg/5 ml, 130 mg/15 ml, 262 mg/15 ml, 525 mg/15 ml
•
Increased fluids to rehydrate patient
•
Susp:
shake liquid before using
•
Tabs can be chewed, dissolved in mouth; caplets to be swallowed whole with water
CNS:
Confusion, twitching,
neurotoxicity (high doses)
EENT:
Hearing loss, tinnitus, metallic taste, blue gums, black tongue
GI:
Increased fecal impaction (high doses), dark stools, constipation, diarrhea, nausea
HEMA:
Increased bleeding time
PO:
Onset 1 hr, peak 2 hr, duration 4 hr
Increase:
toxicity—salicylates, methotrexate
Increase:
effects of oral anticoagulants, oral antidiabetics
Decrease:
absorption of tetracycline, quinolones, separate for ≥2 hr
Interference:
radiographic studies of GI system
•
Diarrhea:
bowel pattern before product therapy, after treatment
•
Electrolytes potassium, sodium, chloride if diarrhea is severe or continues long term; assess skin turgor, other signs of dehydration
•
Therapeutic response: decreased diarrhea, absence of diarrhea when traveling; resolution of ulcers
•
To chew, dissolve medication in mouth; not to swallow whole; to shake liquid before using
•
To avoid other salicylates unless directed by prescriber; not to give to children, possibility of Reye’s syndrome
•
That stools may turn black; that tongue may darken; that impaction may occur in debilitated patients
•
To stop use if symptoms do not improve within 2 days or become worse or if diarrhea is accompanied by high fever
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert