Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (77 page)
calcium chloride (Rx)
Func. class.:
Electrolyte replacement—calcium product
Caution needed for maintenance of nervous, muscular, skeletal function; enzyme reactions; normal cardiac contractility; coagulation of blood; affects secretory activity of endocrine, exocrine glands
Prevention and treatment of hypocalcemia, hypermagnesemia, hypoparathyroidism, neonatal tetany, cardiac toxicity caused by hyperkalemia, lead colic, hyperphosphatemia, vit D deficiency, osteoporosis prophylaxis, calcium antagonist toxicity (calcium channel blocker toxicity)
Unlabeled uses:
Electrolyte abnormalities in cardiac arrest, CPR
Hypercalcemia, digoxin toxicity, ventricular fibrillation, renal calculi
Precautions:
Pregnancy (C), breastfeeding, children, respiratory/renal disease, cor pulmonale, digitalized patient, respiratory failure, diarrhea, dehydration
Calculator
• Adult:
IV
500 mg-1 g q1-3days as indicated by serum calcium levels, give at <1 ml/min;
IV
200-800 mg injected in ventricle of heart
• Adult:
IV
5-20 ml;
IM
2-5 ml
• Adult:
PO
0.5-2 g bid-qid;
IV
0.5-2 g at 0.5 ml/min (10% solution); max
IV
dose 3 g
• Child:
PO/IV
500 mg/kg/day in divided doses
• Adult:
PO
325 mg-1.3 g tid with meals
• Child:
PO
500 mg/kg/day in divided doses
Available forms:
Many; check product listings
•
Give in 3-4 divided doses with or 1 hr after meals, follow with full glass of water; if using as phosphate binder in renal dialysis, do not follow with water, do not give oral medications within 1 hr of oral calcium;
chew tab:
chew thoroughly;
effervescent tab:
dissolve in full glass of water;
oral powder:
mix and give with food;
oral solution:
give before meals;
oral suspension:
shake well
•
Glycerophosphate, lactate may be given IM
•
Do not give chloride, gluconate IM
•
Use only if IV is not feasible
•
Inject into gluteal region (adult), lateral thigh (child)
•
Aspirate before inj
•
Do not give chloride subcut
•
Undiluted or diluted with equal amounts of NS to a 5% sol for inj, give 0.5-1 ml/min
•
Through small-bore needle into large vein; if extravasation occurs, necrosis will result (IV)
•
Remain recumbent 1/2 hr after IV dose
Additive compatibilities:
Amikacin, amphotericin B, ampicillin, ascorbic acid, cefTRIAXone, cephapirin, chloramphenicol, DOPamine, hydrocortisone, isoproterenol, lidocaine, methicillin, norepinephrine, penicillin G potassium, penicillin G sodium, pentobarbital, PHENobarbital, verapamil, vit B/C
Syringe compatibilities:
Milrinone
Y-site compatibilities:
Inamrinone, DOBUTamine, EPINEPHrine, esmolol, morphine, PACLitaxel
Additive compatibilities:
Ascorbic acid inj, isoproterenol, lidocaine, norepinephrine, phytonadione, sodium bicarbonate
Additive compatibilities:
Amikacin, aminophylline, ascorbic acid inj, cephapirin, chloramphenicol, cisatracurium, corticotropin, dimenhyDRIN
A
TE, DOXOrubicin liposome, erythromycin, furosemide, heparin, hydrocortisone, lidocaine, magnesium sulfate, methicillin, norepinephrine, penicillin G potassium, penicillin G sodium, PHENobarbital, potassium chloride, remifentanil, tobramycin, vancomycin, verapamil, vit B/C
Syringe compatibilities:
Aldesleukin, allopurinol, amifostine, aztreonam, ceFAZolin, cefepime, ciprofloxacin, cladribine, DOBUTamine, enalaprilat, EPINEPHrine, famotidine, filgrastim, granisetron, heparin/hydrocortisone, labetalol, melphalan, midazolam, netilmicin, piperacillin/tazobactam, potassium chloride, prochlorperazine, propofol, sargramostim, tacrolimus, teniposide, thiotepa, tolazoline, vinorelbine, vit B/C
CV:
Shortened QT, heart block,
hypotension, bradycardia,
dysrhythmias; cardiac arrest (IV)
GI:
Vomiting, nausea, constipation
HYPERCALCEMIA:
Drowsiness, lethargy, muscle weakness, headache, constipation,
coma,
anorexia, nausea, vomiting, polyuria, thirst
INTEG:
Pain, burning at IV site, severe venous thrombosis, necrosis, extravasation
Crosses placenta, enters breast milk, excreted via urine and feces, half-life unknown, protein binding 40%-50%
PO:
Onset, peak, duration unknown, absorption from GI tract
IV:
Onset immediate, duration 1/2-2 hr
Increase:
milk-alkali syndrome—antacids
Increase:
dysrhythmias—digoxin glycosides
Increase:
toxicity—verapamil
Increase:
hypercalcemia—thiazide diuretics
Decrease:
absorption of fluoroquinolones, tetracyclines, iron salts, phenytoin, thyroid hormones when calcium is taken PO
Decrease:
effects of atenolol, verapamil
Increase:
action/side effects—lily of the valley, pheasant’s eye, shark cartilage, squill
Increase:
calcium
•
ECG for decreased QT and T wave inversion:
hypercalcemia, product should be reduced or discontinued, consider cardiac monitoring
•
Calcium levels during treatment (8.5-11.5 g/dl is normal level); urine calcium if hypercaluria occurs
•
Cardiac status: rate, rhythm, CVP (PWP, PAWP if being monitored directly)
•
Hypocalcemia:
muscle twitching, paresthesia, dysrhythmias, laryngospasm
•
Digitalized patients frequently; an increase in calcium increases digoxin toxicity risk
•
Seizure precautions: padded side rails, decreased stimuli (noise, light); place airway suction equipment, padded mouth gag if calcium levels are low
•
Store at room temp
•
Therapeutic response: decreased twitching, paresthesias, muscle spasms; absence of tremors, seizures, dysrhythmias, dyspnea, laryngospasm; negative Chvostek’s sign, negative Trousseau’s sign
•
To add foods high in vit D
•
To add calcium-rich foods to diet: dairy products, shellfish, dark green leafy vegetables; to decrease oxalate- and zinc-rich foods: nuts, legumes, chocolate, spinach, soy
•
To prevent injuries; to avoid immobilization
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
calfactant (Rx)
(cal-fak′tant)
Infasurf
Func. class.:
Natural lung surfactant extract
Prevention and treatment (rescue) of respiratory distress syndrome in premature infants
Calculator
• Newborn:
INTRATRACHEAL INSTILL:
3 ml/kg of birth weight given as 2 doses of 1.5 ml/kg; repeat doses of 3 ml/kg of birth wt until up to 3 doses 12 hr apart have been given
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(can-deh-sar′tan)
Atacand
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin II receptor (type AT
1
) antagonist
Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT
1
receptor found in tissues
Hypertension, alone or in combination; CHF NYHA Class II-IV and ejection fraction ≤40%
Hypersensitivity
Black Box Warning:
Pregnancy (D) 2nd/3rd trimesters
Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children, geriatric patients, hypersensitivity to ACE inhibitors, volume depletion, renal/hepatic impairment
Calculator
• Adult:
PO
single agent 16 mg/day initially in patients who are not volume depleted, range 8-32 mg/day; with diuretic or volume depletion 2-32 mg/day as single dose or divided bid
• Adolescent and child ≥6 yr and weight >50 kg:
PO
8-16 mg/day or divided bid, adjust to B/P; usual range 4-32 mg/day, max 32 mg/day
• Child ≥6 yr, weight <50 kg:
PO
4-8 mg/day or divided bid, adjust to B/P
• Child ≥1 yr and <6 yr:
PO
0.2 mg/kg/day in 1 dose or in 2 divided doses, adjust to B/P, max 0.4 mg/kg/day
• Adult:
PO
4 mg/day, may be doubled ≥2 wk, target dose 32 mg/day
• Adult:
PO
≤8 mg/day for severe renal disease/moderate hepatic disease, adjust dose as needed
Available forms:
Tabs 4, 8, 16, 32 mg
•
Without regard to meals
•
Oral liquid: shake well, do not freeze
CNS:
Dizziness
, fatigue, headache
CV:
Chest pain, peripheral edema, hypotension
EENT:
Sinusitis, rhinitis, pharyngitis
GI:
Diarrhea
, nausea, abdominal pain, vomiting
GU:
Renal failure
MS:
Arthralgia, pain
RESP:
Cough, upper respiratory infection
SYST:
Angioedema
Peak 3-4 hr, protein binding 99%, half-life 9-12 hr, extensively metabolized, excreted in urine (33%) and feces (67%)
Increase:
lithium level—lithium
Increase:
hyperkalemia—potassium, potassium-sparing diuretics
Increase:
hypotension—ACE inhibitors, β-blockers, calcium channel blockers, α-blockers
Decrease:
effect—salicylates, NSAIDs
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra
Serious hypersensitivity reaction:
angioedema, anaphylaxis: facial swelling, difficulty breathing (rare)
Black Box Warning:
For pregnancy; this product can cause fetal death when given during pregnancy (D), 2nd/3rd trimester
•
Response and adverse reactions, especially with renal disease
•
B/P, pulse q4hr; note rate, rhythm, quality; electrolytes: potassium, sodium, calcium; baselines of renal/hepatic studies before therapy begins
•
Heart failure:
jugular venous distention, weight, edema, dyspnea, crackles
•
Therapeutic response: decreased B/P
•
To comply with dosage schedule, even if feeling better
•
To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain
•
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension; that product may cause dizziness, fainting, lightheadedness
Black Box Warning:
To notify prescriber immediately if pregnant; not to use if breastfeeding
•
To avoid all OTC medications unless approved by prescriber; to inform all health care providers of medication use
•
To use proper technique for obtaining B/P; to understand acceptable parameters