Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (74 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(byoo-tor′fa-nole)
Func. class.:
Opioid analgesic
Chem. class.:
Mixed opioid antagonist, partial agonist
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Moderate to severe pain, general anesthesia induction/maintenance, headache, migraine, preanesthesia
Unlabeled uses:
Pruritus
Hypersensitivity to product, preservative; addiction (opioid)
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, addictive personality, increased intracranial pressure, respiratory depression, renal/hepatic disease, bowel impaction, CHF, MI
Calculator
• Adult: IM
1-4 mg q3-4hr prn;
IV
0.5-2 mg q3-4hr prn;
INTRANASAL
1 spray in 1 nostril, may give another dose 1-1½ hr
later; repeat if needed 3-4hr after last dose
• Geriatric: IV
1/2 adult dose at 2× the interval;
INTRANASAL
if no relief after 90-120 min, may repeat with 1 spray
• Adult: INTRANASAL
max 1 mg followed by 1 mg after 90-120 min;
IM/IV
give 50% of dose (0.5 mg
IV,
1 mg
IM
), do not repeat within 6 hr
• Adult: INTRANASAL
1 mg (1 spray) in each nostril q4-6hr
• Adult: INTRANASAL
1-4 mg/day
Available forms:
Inj 1, 2 mg/ml; nasal spray 10 mg/ml
•
With antiemetic if nausea, vomiting occur
•
When pain beginning to return; determine dosage interval according to patient response
•
Prime before first use, point sprayer away from the face, pump activator 7 times until a fine, wide spray occurs if not used for 48 hr, reprime by pumping 1-2 ×
•
If more than 1 spray is needed, use other nostril
•
Do not share with others
•
Nasal congestion/irritation may occur
•
Deeply in large muscle mass
•
Undiluted at a rate of <2 mg/>3-5 min, titrate to patient response; inject directly in vein or tubing of free-flowing compatible IV inf
Syringe compatibilities:
Atropine, chlorproMAZINE, cimetidine, diphenhydrAMINE, droperidol, fentaNYL, hydrOXYzine, meperidine, methotrimeprazine, metoclopramide, midazolam, morphine, pentazocine, perphenazine, prochlorperazine, promethazine, scopolamine, thiethylperazine
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B liposome (AmBisome), anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefepime, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone phosphate, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, lactated Ringer’s injection, levofloxacin, lidocaine, linezolid injection, LORazepam, magnesium, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins injection, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed,
penicillin G potassium/sodium, pentazocine, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, Ringer’s injection, ritodrine, riTUXimab, rocuronium, sargramostim, sodium acetate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole
CNS:
Drowsiness, dizziness, confusion, headache, sedation, euphoria, weakness, hallucinations
, insomnia (nasal)
CV:
Palpitations, bradycardia, hypotension
EENT:
Tinnitus, blurred vision, miosis, diplopia, nasal congestion, unpleasant taste
GI:
Nausea, vomiting, anorexia, constipation, cramps
GU:
Dysuria, urinary retention
INTEG:
Rash, urticaria, bruising, flushing, diaphoresis, pruritus
RESP:
Respiratory depression,
URI, sinusitis
Metabolized by liver, excreted by kidneys, crosses placenta, excreted in breast milk, half-life 2-9 hr, protein binding 80%
IM:
Onset 5-15 min, peak 30-60 min, duration 3-4 hr
INTRANASAL:
Onset within 15 min, peak 1-2 hr, duration 4-5 hr
IV:
Onset 1 min, peak 4-5 min, duration 2-4 hr
Increase:
Severe, fatal reactions: MAOIs
Increase:
CNS effects—alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants, other CNS depressants
•
For decreasing output; may indicate urinary retention
For withdrawal symptoms in opioid-dependent patients; PE, vascular occlusion, abscesses, ulcerations
•
CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
Allergic reactions: rash, urticaria
•
Respiratory dysfunction: respiratory depression, character, rate, rhythm; notify prescriber if respirations are <10/min
•
Need for pain medication, physical dependence
•
Storage in light-resistant container at room temp
•
Safety measures: night-light, call bell within easy reach, assistance with ambulation, especially for geriatric patients
•
Therapeutic response: decrease in pain
•
To report any symptoms of CNS changes, allergic reactions
•
That physical dependency may result when used for extended periods
•
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
•
How to use nasal product
•
To avoid hazardous activities
Naloxone HCl (Narcan) 0.2-0.8 mg IV, O
2
, IV fluids, vasopressors
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert