Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (87 page)
CNS:
Headache, dizziness, weakness, paresthesia, fever, chills,
seizures,
dyskinesia (cefdinir);
neurotoxicity (renal disease) cefepime
CV:
Heart failure,
syncope (cefdinir)
EENT:
Oral candidiasis
GI:
Nausea, vomiting, diarrhea, anorexia
, pain, glossitis,
bleeding;
increased AST, ALT, bilirubin, LDH, alk phos; abdominal pain,
pseudomembranous colitis;
cholestasis (cefotaxime)
GU:
Proteinuria,
vaginitis, pruritus,
candidiasis
, increased BUN,
nephrotoxicity, renal failure
HEMA:
Leukopenia, thrombocytopenia, agranulocytosis,
anemia,
neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia
INTEG:
Rash, urticaria, dermatitis
MS:
Arthralgia (cefditoren)
RESP:
Dyspnea
SYST:
Anaphylaxis, serum sickness, Stevens-Johnson syndrome, toxic epidermal necrolysis
Unchanged in urine; crosses placenta, blood-brain barrier; eliminated in breast milk, not metabolized; 60%-70% protein binding, half-life 1.7 h
Well absorbed when broken down (prodrug), wide distribution, half-life 100 min, onset rapid, peak 0.5-3 hr, duration 12 hr, 88% protein bindin
Peak 79 min; half-life 2 hr; 20% bound by plasma proteins; 90% excreted unchanged in urine; crosses placenta, blood-brain barrier; excreted in breast milk, not metabolize
PO:
Peak 1-2 hr, half-life 3-4 hr, 65% bound by plasma proteins, 50% eliminated unchanged in urine, crosses placenta, excreted in breast milk
Half-life 1 hr, 35%-65% is bound by plasma proteins, 40%-65% is eliminated unchanged in urine in 24 hr, 25% metabolized in the liver to active metabolites, excreted in breast milk (small amounts
IM:
Onset 30 min
IV:
Onset 5 min
Half-life 3 hr, 21%-29% bound by plasma proteins, 30% eliminated unchanged in urine in 8 hr, crosses placenta, excreted in breast milk
IM/IV:
Peak 1 hr, half-life 1-1½ hr, 90% bound by plasma proteins, 80% eliminated unchanged in urine, crosses placenta, excreted in breast milk
PO:
Peak 2-3 hr; plasma protein binding 65%, elimination half-life 2 hr, extensively metabolized to an active metabolite
Half-life 1.6 hr, 30% bound by plasma proteins, 36%-60% eliminated unchanged in urine, crosses placenta, excreted in breast milk
IM:
Peak 1 hr
IV:
Onset 5 min
Half-life 6-9 hr, 90% protein binding 58%-96%, eliminated unchanged in
urine, crosses placenta, excreted in breast milk
IM:
Peak 2-3 hr
IV:
Onset 5 min
Increase:
bleeding—anticoagulants, thrombolytics, plicamycin, valproic acid, NSAIDs
Increase:
toxicity—aminoglycosides, furosemide, probenecid
Decrease:
absorption of cefdinir—iron
Decrease:
absorption—iron-rich cereal, infant formula
Increase:
ALT, AST, alk phos, LDH, bilirubin, BUN, creatinine
False increase:
creatinine (serum urine), urinary 17-KS
False positive:
urinary protein, direct Coombs’ test, urine glucose
Interference:
cross-matching
•
Sensitivity to penicillin, other cephalosporins
Nephrotoxicity:
increased BUN, creatinine; urine output: if decreasing, notify prescriber
•
Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phos, Coombs’ test monthly if patient is on long-term therapy
•
Electrolytes: potassium, sodium, chloride monthly if patient is on long-term therapy
•
Pseudomembranous colitis:
bowel pattern daily; if severe diarrhea occurs, product should be discontinued
•
IV site for extravasation, phlebitis
Anaphylaxis:
rash, urticaria, pruritus, chills, fever, joint pain, angioedema; may occur a few days after therapy begins
•
Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
•
Therapeutic response: decreased symptoms of infection; negative C&S
•
If diabetic, to check blood glucose
To report sore throat, bruising, bleeding, joint pain, may indicate
blood dyscrasias (rare);
diarrhea with mucus, blood, may indicate
pseudomembranous colitis
•
That cefditoren can be taken with oral contraceptives
EPINEPHrine, antihistamines; resuscitate if needed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ser′tue-liz′oo-mab pegh′ol)
Cimzia
Func. class.:
Biologic response modifier
Chem. class:
Anti-tissue necrosis factor (anti-TNF) agent
Monoclonal antibody that neutralizes the activity of tumor necrosis factor α (TNF-α) found in Crohn’s disease; decreases infiltration of inflammatory cells
Crohn’s disease (moderate to severe) that has not responded to conventional therapy, rheumatoid arthritis (moderate to severe)
Unlabeled uses:
Moderate to severe chronic plaque psoriasis, fistulizing Crohn’s disease
Influenza, IV administration, sepsis, hypersensitivity
Black Box Warning:
Infection, neoplastic disease
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, AIDS, coagulopathy, diabetes, fungal infection, heart failure, hepatitis, human antichimeric antibody, immunosuppression, leukopenia, MS, cancer, neurologic/renal disease, surgery, thrombocytopenia, TB, vaccinations
Calculator
• Adult:
SUBCUT
400 mg given as 2 inj at wk 0, 2, 4; if clinical response occurs, give 400 mg q4wk
• Adult:
SUBCUT
400 mg q2wk × 3 doses then 200 mg q2wk; given with methotrexate
• Adult:
SUBCUT
400 mg wk 0, 2, 4 then 400 mg q4wk
Available forms:
Powder for inj 400-mg kit
•
Give by subcut inj only
•
Reconstitution: allow to warm to room temp; add 1 ml sterile water for inj to each vial; 2 vials will be needed for patients with Crohn’s disease
•
Gently swirl; do not shake; full reconstitution may take up to 30 min; reconstituted product may remain at room temp for up to 2 hr or refrigerated up to 24 hr
•
If reconstituted product has been refrigerated, allow to warm to room temp
•
Use 2 syringes and two 20G needles
•
Withdraw reconstituted sol from each vial into separate syringes; each will contain 200 mg; switch 20G to 23G needle; inject into 2 separate sites in abdomen or thigh
•
Store in refrigerator; do not freeze
CNS:
Dizziness
, syncope, peripheral neuropathy, fever,
seizures, demyelinating disease of CNS
CV:
Hypotension,
heart failure, MI, cardiac dysrhythmia
EENT:
Optic neuritis, retinal hemorrhage, uveitis
GI:
Increased LFTs,
hepatitis, bowel obstruction
GU:
UTI, renal disease
HEMA:
Anemia, aplastic anemia, pancytopenia, thrombocytopenia
INTEG:
Rash, urticaria
,
angioedema
MISC:
Anaphylaxis,
antibody formation, arthralgia, bleeding, infection, lupuslike symptoms, lymphadenopathy,
malignancies, serum sickness, suicidal ideation
RESP:
Dyspnea, upper respiratory tract infection
Peak 54-171 hr, terminal half-life 14 days
•
Do not administer live vaccines, toxoids concurrently
Increase:
possible infections—abatacept, adalimumab, anakinra, etanercept, immunosuppressive agents, infliximab, rilonacept; do not use concurrently
Increase:
possible malignancies—adalimumab, etanercept, infliximab
•
Antinuclear antibody test (ANA), hepatitis B serology, CBC
•
For rheumatoid arthritis, ROM, pain
•
GI symptoms: nausea, vomiting, abdominal pain, hepatitis, increased LFTs
•
Periodic blood counts (CBC)
•
CV status: B/P, pulse, chest pain
Allergic reaction, anaphylaxis:
rash, dermatitis, urticaria, dyspnea, hypotension, fever, chills; discontinue if severe; administer EPINEPHrine, corticosteroids, antihistamines; assess for allergies to murine proteins before starting therapy
Black Box Warning:
Infection: discontinue if infection occurs; do not administer to patients with active infection
Black Box Warning:
Identify TB, risk for HBV before beginning treatment; TB test should be obtained; if present, TB should be treated prior to certolizumab treatment
•
Therapeutic response: absence of fever, mucus in stools
•
Not to breastfeed while taking this product
Black Box Warning:
To notify prescriber of GI symptoms, hypersensitivity reactions, infections, fluid retention; redness, pain, swelling at inj site
Black Box Warning:
Not to operate machinery, drive if dizziness, vertigo occur