Mosby's 2014 Nursing Drug Reference (81 page)

• Adult:
IM
100 mcg (0.4 ml) test dose, then 250 mcg, then 250 mcg q11/2-31/2hr; may increase to 500 mcg if no response, max 12 mg total dose

• Adult:
IM
250 mcg, repeat at 15- to 90-min intervals; max total dosage 2 mg

• Adult:
INTRAVESICULAR
0.8 mg/dl in 50 ml of saline instilled into the bladder for 60 min, q6hr × 4 doses

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Only by trained personnel in a hospital that can provide emergency services

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Incomplete abortion may occur in 20% of patients

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Give antiemetics to prevent nausea/vomiting

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In deep muscle mass; aspirate before inj, rotate inj sites if additional doses given

Increase:
action—other oxytocics

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B/P, pulse; watch for change that may indicate hemorrhage

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For length, duration of contractions; notify prescriber of contractions that last more than 1 min or absence of contractions; watch for signs of uterine rupture

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For incomplete abortion, pregnancy must be terminated by another method; product is teratogenic

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Storage in refrigerator

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Therapeutic response: expulsion of fetus, control of bleeding

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To report increased blood loss, abdominal cramps, increased temp, foul-smelling lochia

• Adult/child:
PO 100-250 mg/kg/day (rounded to the nearest 100 mg) initially, divided; bid-qid, given immediately before meals, titrate to ammonia level; usual maintenance dose <100 mg/kg/day

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Do not give whole or crushed tablets, disperse each tablet in ≥2.5 ml of water immediately before use. The tablets do not dissolve completely in water, and undissolved tablet particles can remain; rinse the mixing container with water and give to the patient, do not mix with foods or other fluids

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Mix each tablet in ≥2.5 ml of water (80 mg/ml), shake gently, give the correct volume immediately through the NG tube, flush with additional water, discard any unused portion

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Mix each tablet in ≥2.5 ml of water (80 mg/ml), shake gently, draw up the appropriate volume in an oral syringe and give immediately, refill syringe with ≥1-2 ml and give immediately, discard any unused portion

Decrease:
Hgb level

Neurologic symptoms and ammonia levels:
Headache, fever, change in level of consciousness

Infection:
Assess for upper respiratory infections, influenza, pneumonia

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Decreasing ammonia levels

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Not to swallow whole or crush, but disperse in water

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That blood for lab tests will be drawn regularly

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To advise prescriber if pregnancy is planned or suspected, not to breastfeed

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That a high-calorie, low-protein diet is necessary when ammonia levels are elevated

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To report adverse reactions of vomiting, infection, ear pain, headache

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Store unopened containers in refrigerator; opened bottle may be stored at room temperature for up to 1 mo; product stored at controlled room temperature should not be returned to a refrigerator; protect from moisture; discard opened bottle after 30 days

• Adult/adolescent ≥16 yr:
PO
250-350 mg tid and at bedtime, max 3 wk of use

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With meals for GI symptoms

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For short term (2-3 wk), potential for habituation

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Storage in tight container at room temp

Increase:
CNS depression—alcohol, tricyclics, opioids, barbiturates, sedatives, hypnotics

Increase:
carisoprodol effect—CYP2C19 inhibitors (FLUoxetine, fluvoxaMINE, isoniazid, modafinil)

Decrease:
carisoprodol effect—CYP219 inducers (rifampin)

Increase:
CNS depression—kava, valerian

Increase:
metabolism of carisoprodol—St. John’s wort

Increase:
eosinophils

Increase:
RBC, WBC, platelets

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Pain,
stiffness, mobility, activities of daily living at baseline and throughout treatment

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ECG in seizure patients:
poor seizure control has occurred among patients taking this product

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BUN, creatinine at baseline and periodically

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Idiosyncratic reaction:
(weakness, dizziness, blurred vision, confusion, euphoria), anaphylaxis within a few minutes or hours of 1st to 4th dose, withhold and notify prescriber

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Allergic reactions:
rash, fever, respiratory distress, anaphylaxis, angioedema

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CNS depression:
dizziness, drowsiness, psychiatric symptoms, abuse potential

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Abrupt discontinuation:
withdrawal reactions do occur but may be mild, dependence may occur

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Assistance with ambulation if dizziness, drowsiness occurs, especially for geriatric patients

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Therapeutic response: decreased pain, spasticity; increased ROM

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To avoid hazardous activities if drowsiness, dizziness occur; not to drive while taking product, to avoid rapid position changes, postural hypotension occurs

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To avoid using OTC medications (cough preparations, antihistamines) unless directed by prescriber; not to take with alcohol, other CNS depressants

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To report allergic reaction immediately: rash, swelling of tongue/lips, hives, dyspnea

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To take with food for GI symptoms