Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (83 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(kar-ved′i-lole)
Coreg, Coreg CR
Func. class.:
Antihypertensive, α-/β-adrenergic blocker
Do not confuse:
carvedilol
/captopril/carteolol
A mixture of nonselective α-/β-adrenergic blocking activity; decreases cardiac output, exercise-induced tachycardia, reflex orthostatic tachycardia; causes vasodilation, reduction in peripheral vascular resistance
Essential hypertension alone or in combination with other antihypertensives, CHF, LV dysfunction after MI, cardiomyopathy
Unlabeled uses:
Angina, pediatric patients
Hypersensitivity, asthma, class IV decompensated cardiac failure, 2nd- or 3rd-degree heart block, cardiogenic shock, severe bradycardia, pulmonary edema
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, cardiac failure, hepatic injury, peripheral vascular disease, anesthesia, major surgery, diabetes mellitus, thyrotoxicosis, emphysema, chronic bronchitis, renal disease
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult:
PO
6.25 mg bid × 7-14 days; if tolerated well, then increase to 12.5 mg bid × 7-14 days; if tolerated well, may be increased (if needed) to 25 mg bid; not to exceed 50 mg/day;
EXT REL
cap 20 mg/day, may increase after 7-14 days to 40 mg/day
• Adult:
PO
3.125 mg bid × 2 wk; if tolerated well, give 6.25 mg bid × 2 wk, then double q2wk to max dose of 25 mg bid <85 kg or 50 mg bid >85 kg;
EXT REL
caps (Coreg CR) 10 mg/day × 2 wk, increase to 20, 40, 80 mg/day over successive intervals of 2 wk
• Adult:
PO
6.25 mg bid with food × 3-10 days, lower starting dose may be used if indicated; titrate upward as tolerated; may increase to 12.5 mg bid then titrate to 25 mg bid;
PO EXT REL
20 mg daily with food, lower starting dose of 10 mg/day may be used, titrate upward after 3-10 days, increase to 40 mg daily as required
• Adult:
PO
25-50 mg bid
Available forms:
Tabs 3.125, 6.25, 12.5, 25 mg; ext rel cap 10, 20, 40, 80 mg
•
With food in morning; tabs may be crushed or swallowed whole; give ext rel every
AM
with food; do not break, crush, chew ext rel cap; separate alcohol (including OTC products that contain ethanol) by ≥2 hr; caps may be opened and sprinkled over applesauce
Black Box Warning:
Do not discontinue before surgery
CNS:
Dizziness
, fatigue, weakness, somnolence, insomnia, ataxia, hyperesthesia, paresthesia, vertigo, depression, headache
CV:
Bradycardia,
postural hypotension
, dependent edema, peripheral edema,
AV block,
extrasystoles, hypo/hypertension, palpitations, peripheral ischemia,
CHF, pulmonary edema
GI:
Diarrhea
, abdominal pain, increased alk phos, ALT, AST
GU:
Decreased libido,
impotence
, UTI
INTEG:
Rash
MISC:
Injury, back pain, viral infection, hypertriglyceridemia,
thrombocytopenia,
hyperglycemia
RESP:
Rhinitis, pharyngitis, dyspnea,
bronchospasm,
cough,
lung edema
Peak 1-2 hr; readily and extensively absorbed PO; >98% protein binding; extensively metabolized by liver; excreted through bile into feces; terminal half-life 7-10 hr with increases in geriatric patients, hepatic disease
Increase:
conduction disturbances—calcium channel blockers
Increase:
bradycardia, hypotension—levodopa, MAOIs, reserpine
Increase:
hypoglycemia—antidiabetic agents
Increase:
concentrations of digoxin, cycloSPORINE, CYP2D6 inhibitors (FLUoxetine, quiNIDine)
Increase:
toxicity of carvedilol—cimetidine, other antihypertensives, nitrates, acute alcohol ingestion
Decrease:
heart rate, B/P—cloNIDine
Decrease:
carvedilol levels—rifampin, NSAIDs, thyroid medications
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra (ma huang)
Increase:
blood glucose, BUN, potassium, triglycerides, uric acid, bilirubin, cholesterol, creatinine
Decrease:
sodium, HDL
•
Hypertension:
B/P when beginning treatment, periodically thereafter; pulse: note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of significant changes
•
CHF:
edema in feet, legs daily; fluid overload: dyspnea, weight gain, jugular venous distention, fatigue, crackles
•
Therapeutic response: decreased B/P with hypertension
•
To comply with dosage schedule even if feeling better; that improvement may take several weeks
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
•
To report bradycardia, dizziness, confusion, depression, fever, weight gain, SOB, cold extremities, rash, sore throat, bleeding, bruising
•
To weigh, take pulse, B/P at home; to advise if weight gain of >2 lb/day or 5 lb/wk and when to notify prescriber
Black Box Warning:
Not to discontinue product abruptly; to taper over 1-2 wk; life-threatening dysrhythmias may occur
•
To avoid hazardous activities until stabilized on medication; dizziness may occur
•
To avoid all OTC medications unless approved by prescriber
•
To carry emergency ID with product name, prescriber information at all times
•
To inform all health care providers of products, supplements taken
•
To report if pregnancy is planned or suspected, pregnancy (C) avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(cas-po-fun′gin)
Cancidas
Func. class.:
Antifungal, systemic
Chem. class.:
Echinocandin
Inhibits an essential component in fungal cell walls; causes direct damage to fungal cell wall
Treatment of invasive aspergillosis and candidemia that has not responded to other treatment, including peritonitis, intraabdominal abscesses; susceptible species:
Aspergillus flavus, A. fumigatus, A. terreus, Candida albicans, C. glabrata, C. krusei, C. lusitaniae, C. parapsilosis, C. tropicalis
, esophageal candidiasis; empirical therapy for presumed fungal infection in febrile, neutropenic patients
Unlabeled uses:
Aspergillus niger
, fungal infections in premature neonates, neonates, infants, children <2 yr
Hypersensitivity to this product, other echinocandins, including mannitol
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, severe hepatic disease
Calculator
• Adult:
IV
loading dose 50-70 mg on day 1 then 50 mg/day maintenance dose, depending on condition; max 70 mg/day
• Adolescent/child/infant ≥3 mo:
IV INF
70 mg/m
2
loading dose then 50 mg/m
2
/day; max 70 mg/day
• Neonate and infant <3 mo (unlabeled):
IV
25 mg/m
2
/day
• Adult:
IV
50 mg × 7-14 days over 1 hr
• Child:
3 mo-17 yr: IV
70 mg/m
2
may increase to max 70 mg/m
2
Available forms:
Powder for inj 50, 70 mg
•
Do not mix or coinfuse with other medications, do not use dextrose-containing products to dilute, do not give as bolus
•
Allow to warm to room temp
•
May administer loading dose on day 1
•
Reconstitute
50-mg vial or 70-mg vial with 10.8 ml 0.9% NaCl, sterile water for inj or bacteriostatic water for inj (5 mg/ml or 7 mg/ml);
swirl
to dissolve, withdraw 10 ml reconstituted sol, and
further dilute
with 250 ml 0.9% NaCl, 0.45% NaCl, 0.225% NaCl, RL;
run
over 1 hr or more
CNS:
Dizziness,
headache
CV:
Sinus tachycardia
GI:
Abdominal pain,
nausea, anorexia, vomiting, diarrhea, increased AST/ALT, alk phos
HEMA:
Thrombophlebitis,
vasculitis,
anemia
INTEG:
Rash, pruritus, inj site pain
META:
Hypokalemia
MS:
Myalgia
RESP:
Acute respiratory distress syndrome (ARDS)
SYST:
Anaphylaxis
Metabolized in liver to inactive metabolites; excretion in feces, urine; phase II terminal half-life 9-11 hr; phase III terminal half-life 40-50 hr; protein binding 97%
Increase:
caspofungin levels—cycloSPORINE; may need dosage reduction
Decrease:
levels of tacrolimus, sirolimus
Decrease:
caspofungin levels—carBAMazepine, dexamethasone, efavirenz, nelfinavir, nevirapine, phenytoin, rifampin
Increase:
AST, ALT, RBC, eosinophils
Decrease:
HCT/Hgb, WBC, potassium
•
Infection;
clearing of cultures during treatment; obtain culture at baseline, throughout treatment; product may be started as soon as culture is taken (esophageal candidiasis); monitor cultures during HSCT for prevention of
Candida
infections
•
Hepatic studies before, during treatment: bilirubin, AST, ALT, alk phos, as needed; obtain baseline renal studies
•
Hypersensitivity:
rash, pruritus, facial swelling; also for phlebitis
•
GI symptoms: frequency of stools, cramping; if severe diarrhea occurs, electrolytes may need to be given
•
Storage at room temp for up to 24 hr or refrigerated for 48 hr; store reconstituted sol at room temp for 1 hr before preparation of sol for administration
•
Therapeutic response: decreased symptoms of
Candida, Aspergillus
infections
•
To notify prescriber if pregnancy is suspected or planned
•
To inform prescriber of renal/hepatic disease
•
To report bleeding, facial swelling, wheezing, difficulty breathing, itching, rash, hives, increasing warmth, flushing; anaphylaxis can occur