Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (73 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(byoo-spye′rone)
BuSpar, BuSpar Dividose
Func. class.:
Antianxiety, sedative
Chem. class.:
Azaspirodecanedione
Do not confuse:
busPIRone
/buPROPion
Acts by inhibiting the action of serotonin (5-HT); has shown little potential for abuse; a good choice with substance abuse
Management and short-term relief of generalized anxiety disorders
Unlabeled uses:
Autism
Children <18 yr, hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, impaired hepatic/renal function
Calculator
• Adult: PO
7.5 mg bid; may increase by 5 mg/day q2-3days, max 60 mg/day
• Adult: PO
5-15 mg tid after titration, max 60 mg/day
• Child ≥5 yr: PO
0.2-0.6 mg/kg/day, max 60 mg/day; titrate to higher dose
• Adult: PO
reduce by 25%-50% for mild-moderate hepatic disease; do not use for severe hepatic disease; CCr 11-70 ml/min reduce by 25%-50%, CCr <10 ml/min do not use
Available forms:
Tabs 5, 7.5, 10, 15, 30 mg
•
With food, milk for GI symptoms; avoid grapefruit juice; give drug at same time of day, with/without food consistently
•
Crushed if patient unable to swallow medication whole
•
Sugarless gum, hard candy, frequent sips of water for dry mouth
CNS:
Dizziness, headache, depression, stimulation, insomnia, nervousness, lightheadedness, numbness, paresthesia, incoordination
, nightmares,
tremors
, excitement, involuntary movements, confusion, akathisia, hostility
CV:
Tachycardia, palpitations
, hypo/hypertension,
CVA, CHF, MI
EENT:
Sore throat, tinnitus, blurred vision, nasal congestion;
red, itching eyes; change in taste, smell
GI:
Nausea, dry mouth, diarrhea, constipation
, flatulence, increased appetite, rectal bleeding
GU:
Frequency, hesitancy, menstrual irregularity, change in libido
INTEG:
Rash
, edema, pruritus, alopecia, dry skin
MISC:
Sweating
, fatigue, weight gain, fever,
serotonin syndrome
MS:
Pain, weakness
, muscle cramps, spasms
RESP:
Hyperventilation, chest congestion, shortness of breath
Peak 40-90 min, half-life 2-3 hr, rapidly absorbed, metabolized by liver (CYP3A4), excreted in feces, protein binding 86%
Increase:
busPIRone—product metabolized by CYP3A4 (erythromycin, itraconazole, nefazodone, ketoconazole, ritonavir, several other protease inhibitors)
Increase:
B/P—procarbazine, MAOIs; do not use together
Increase:
CNS depression—psychotropic products, alcohol (avoid use)
Increase:
serotonin syndrome—SSRIs, SNRIs, serotonin receptor agonists
Decrease:
busPIRone effects—rifampin
Decrease:
busPIRone action—products induced by CYP3A4 (rifampin, phenytoin, PHENobarbital, carBAMazepine, dexamethasone)
Increase:
peak concentration of busPIRone—grapefruit juice
•
B/P lying, standing; pulse; if systolic B/P drops 20 mm Hg, hold product, notify prescriber
•
CNS reactions because some may be unpredictable
•
Mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness; withdrawal symptoms when dose reduced, product discontinued
•
Safety measures if drowsiness, dizziness occurs
•
Therapeutic response: decreased anxiety, restlessness, sleeplessness
•
That product may be taken consistently with/without food
•
To avoid OTC preparations, alcohol ingestion, other psychotropic medications unless approved by prescriber; to avoid large amounts of grapefruit juice
•
To avoid activities that require alertness because drowsiness may occur
•
Not to discontinue medication abruptly after long-term use; if dose missed, do not double
•
To rise slowly because fainting may occur, especially among geriatric patients
•
That drowsiness may worsen at beginning of treatment; that 1-2 wk of therapy may be required before therapeutic effects occur
•
Serotonin syndrome: to report immediately (fever, tremor, sweating, diarrhea, delirium)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTbusulfan (Rx)
(byoo-sul′fan)
Busulfex, Myleran
Func. class.:
Antineoplastic alkylating agent
Chem. class.:
Bifunctional alkylating agent
Do not confuse:
Myleran
/Leukeran
Changes essential cellular ions to covalent bonding with resultant alkylation; this interferes with the normal biological function of DNA; activity is not phase-specific; action is due to myelosuppression
Chronic myelocytic leukemia, bone marrow ablation, stem cell transplant preparation with CML
Pregnancy (D) 3rd trimester, breastfeeding, radiation, chemotherapy, blastic phase of chronic myelocytic leukemia, hypersensitivity
Precautions:
Women of childbearing age, leukopenia, anemia, hepatotoxicity, renal toxicity, seizures, tumor lysis syndrome, hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
Black Box Warning:
Thrombocytopenia, neutropenia, secondary malignancy
Calculator
• Adult: PO
4-8 mg/day or 1.8-4 mg/m
2
/day initially, reduce dose if WBC reaches 30,000-40,000/mm
3
, discontinue if WBC ≤20,000/mm
3
, maintenance 1-3 mg/day
• Child: PO
0.06-0.12 mg/kg/day or 1.8-4.6 mg/m
2
/day; reduce if WBC reaches 30,000-40,000/mm
3
, discontinue if WBC ≤20,000/mm
3
• Adult: IV
0.8 mg/kg over 2 hr, q6hr × 4 days (total 16 doses); give cyclophosphamide
IV
60 mg/kg over 1 hr daily for 2 days starting after 16th dose of busulfan;
PO
(unlabeled) 1 mg/kg q6hr × 16 doses
• Adolescent and child (unlabeled) >12 kg: IV
0.8 mg/kg over 2 hr q6hr × 16 doses (4 days) then high-dose cyclophosphamide 50 mg/kg/day × 4 days
• Infant/child ≤12 kg (unlabeled): IV
1.1 mg/kg over 2 hr q6hr × 16 doses (4 days) then high-dose cyclophosphamide 50 mg/kg/day × 4 days
Available forms:
Tabs 2 mg; inj 6 mg/ml
•
Give at same time daily on empty stomach
•
Prepare in biologic cabinet while wearing gloves, gown, mask;
dilute
with 10 times volume of product with D
5
W, 0.9% NaCl, (0.5 mg/ml); when withdrawing product, use needle with 5-micron
filter provided, remove amount needed, remove filter, and
inject
product into diluent; always add product to diluent (not vice versa); stable for 8 hr at room temp (using D
5
W) or 12 hr refrigerated;
give
by central venous catheter over 2 hr q6hr × 4 days, use inf pump, do not admix
•
Give antiemetics before IV route on schedule
•
In those with history of seizures, give phenytoin before IV drug to prevent seizures (using 0.9% NaCl)
Y-site compatibilities:
Acyclovir, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, atenolol, bivalirudin, bleomycin, caspofungin, codeine, DAPTOmycin, dexmedetomidine, diltiazem, DOCEtaxel, ertapenem, fenoldopam, gatifloxacin, granisetron, HYDROmorphone, levofloxacin, linezolid, LORazepam, meperidine, metroNIDAZOLE, milrinone, nesiritide, octreotide acetate, ondansetron, palonosetron, pancuronium, piperacillin-tazobactam, riTUXimab, sodium acetate, tacrolimus, tigecycline, tirofiban, trastuzumab, vasopressin
CV:
Hypotension
,
thrombosis,
chest pain
,
tachycardia, atrial fibrillation, heart block, pericardial effusion, cardiac tamponade
(high dose with cyclophosphamide)
GI:
Anorexia, constipation, diarrhea, dry mouth, nausea, vomiting
RESP:
Alveolar hemorrhage,
atelectasis, cough, hemoptysis, hypoxia, pleural effusion, pneumonia, sinusitis,
pulmonary fibrosis
CNS:
Cerebral hemorrhage, coma, seizures,
anxiety, depression, dizziness, headache
, encephalopathy,
weakness
, mental changes
EENT:
Pharyngitis, epistaxis
, cataracts
GI:
Nausea, vomiting,
diarrhea, weight loss
GU:
Impotence, sterility, amenorrhea, gynecomastia,
renal toxicity,
hyperuremia, adrenal-insufficiency–like syndrome
HEMA:
Thrombocytopenia, leukopenia, pancytopenia, severe bone marrow depression
INTEG:
Dermatitis, hyperpigmentation, alopecia
OTHER:
Chromosomal aberrations
RESP:
Irreversible pulmonary fibrosis,
pneumonitis
Well absorbed orally, excreted in urine, crosses placenta, excreted in breast milk, half-life 2.5 hr
Increase:
hepatotoxicity—thioguanine
Increase:
cardiac tamponade—cyclophosphamide
Increase:
toxicity—other antineoplastics, radiation
Increase:
risk for bleeding—anticoagulants, salicylates
Increase:
antibody response—live virus vaccines
Decrease:
busulfan level—phenytoin
Decrease:
busulfan clearance—acetaminophen, itraconazole
False positive:
breast, bladder, cervix, lung cytology tests
Black Box Warning:
CBC, differential, platelet count weekly; withhold product if WBC is <15,000/mm
3
or platelet count is <150,000/mm
3
; notify prescriber of results; institute thrombocytopenia precautions; levels for withholding product will be different for children
Black Box Warning:
Bone marrow status before chemotherapy; seizure history; bone marrow suppression may be prolonged (up to 2 mo)
•
Pulmonary fibrosis:
pulmonary function tests, chest x-ray films before, during therapy; chest film should be obtained q2wk during treatment; pulmonary fibrosis may occur up to 10 yr after treatment with busulfan
•
Renal studies: BUN, serum uric acid, urine CCr before, during therapy; monitor ALT, alk phos, bilirubin, uric acid before and during treatment; I&O ratio; report fall in urine output of <30 ml/hr; hyperuricemia
Black Box Warning:
For secondary malignancy within 5-8 yr of chronic oral therapy, long-term follow-up may be required
•
Monitor for cold, fever, sore throat (may indicate beginning infection)
•
Bleeding: hematuria, guaiac, bruising, petechiae; mucosa, orifices q8hr; no rectal temps
•
Dyspnea, crackles, nonproductive cough, chest pain, tachypnea
•
Inflammation of mucosa, breaks in skin; use viscous xylocaine for oral pain
•
Comprehensive oral hygiene
•
Strict medical asepsis, protective isolation if WBC levels low
•
Increased fluid intake to 2-3 L/day to prevent urate deposits, calculi formation
•
Storage in tight container
•
Therapeutic response: decreased exacerbations of chronic myelocytic leukemia
•
To avoid use of products that contain aspirin, ibuprofen; razors; commercial mouthwash
•
To use effective contraception during and for at least 3 mo after treatment; to avoid breastfeeding; may cause infertility, discuss family planning before initiating therapy, pregnancy (D)
•
To report signs of
anemia
(fatigue, headache, irritability, faintness, shortness of breath); symptoms of
infection;
jaundice; persistent cough, congestion, skin pigmentation, darkening of skin; sudden weakness, weight loss (may resemble adrenal insufficiency)
•
To report symptoms of bleeding (hematuria, tarry stools)
•
To avoid vaccinations, crowds, persons with known infections
•
That impotence, amenorrhea can occur; that these are reversible after discontinuing treatment