Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (98 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(klare-ith′row-my-sin)
Biaxin, Biaxin Filmtab, Biaxin XL
Func. class.:
Antiinfective
Chem. class.:
Macrolide
Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Mild to moderate infections of the upper and lower respiratory tract, uncomplicated skin and skin-structure infections caused by
Streptococcus pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Listeria monocytogenes, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, Mycobacterium avium
complex (MAC); complex infection in AIDS patients;
Mycobacterium avium intracellulare, Helicobacter pylori
in combination with omeprazole,
H. parainfluenzae
Unlabeled uses:
Endocarditis prophylaxis, dyspepsia, gastric ulcer, Legionnaire’s disease, pertussis, SARS
Hypersensitivity to this product or macrolide antibiotics, torsades de pointes, QT prolongation
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, renal/hepatic disease
Calculator
• Adult:
PO
250-500 mg q12hr × 7-14 days or 1000 mg/day × 7 days (XL)
• Adult:
PO
250 mg q12hr × 10 days
• Adult:
PO
250 mg q12hr × 7-14 days or 1000 mg/day × 7 days (XL)
• Adult:
PO
500 mg bid; will require an additional antiinfective for active infection
infection
• Adult:
PO
500 mg bid plus omeprazole 2 × 20 mg every
AM
(days 1-14), then omeprazole 20 mg every
AM
(days 15-28)
• Adult:
PO
500 mg q12hr × 14 days
• Child:
PO
7.5 mg/kg q12hr × 10 days, max 500 mg/dose for MAC
• Adult and child:
PO
CCr <30 ml/min, reduce dose by 50%, if used with ritonavir reduce by 75%
(H. pylori)
(unlabeled)
• Adult:
PO
500 mg q12hr; may be used in combination for some of these conditions
• Adult:
PO
500 mg 1 hr before procedure
Available forms:
Tabs 250, 500 mg; oral susp 125 mg/5 ml, 250 mg/5 ml; ext rel tab (XL) 500 mg
•
Do not break, crush, or chew tabs
•
Adequate intake of fluids (2 L) during diarrhea episodes
•
q12hr to maintain serum levels
CV:
Ventricular dysrhythmias, QT prolongation
GI:
Nausea, vomiting, diarrhea
,
hepatotoxicity,
abdominal pain
, stomatitis, heartburn, anorexia,
abnormal taste
,
pseudomembranous colitis
GU:
Vaginitis, moniliasis
HEMA:
Leukopenia, thrombocytopenia, increased INR
INTEG:
Rash, urticaria, pruritus,
Stevens-Johnson syndrome, toxic epidermal necrolysis
MISC:
Headache
, hearing loss
Peak 2-2.5 hr; duration 12 hr; half-life 3-4 hr; metabolized by liver; excreted in bile, feces; possible inhibition of P-glycoprotein
Increase:
dysrhythmias—cisapride, pimozide
Increase:
levels, increase toxicity—ALPRAZolam, busPIRone, carBAMazepine, cycloSPORINE, digoxin, disopyramide, ergots, felodipine, fluconazole, omeprazole, tacrolimus, theophylline
Increase:
oral anticoagulants effect—digoxin, theophylline, carBAMazepine
Increase:
levels of HMG-CoA reductase inhibitors
Increase:
action, risk for toxicity—all products metabolized by CYP3A enzyme system
Increase:
effect of calcium channel blockers, midazolam, benzodiazepines, tacrolimus
Increase:
QT prolongation—class IA, III antidysrhythmics
Increase or decrease action:
zidovudine
Decrease:
levels—rifampin, rifabutin
Increase:
17-OHCS/17-KS, AST, ALT, BUN, creatinine, LDH, total bilirubin
Decrease:
folate assay, WBC
•
Infection:
wound characteristics, urine, stool, sputum, WBC, temp; C&S before product therapy; product may be given as soon as culture is taken; C&S may be repeated after treatment
•
For ulcers: abdominal pain, bleeding in stools, emesis
•
Renal, hepatic studies; report hematuria, oliguria
•
Bowel pattern before, during treatment
•
Respiratory status: rate, character, wheezing, tightness in chest; discontinue product
•
Allergies before treatment, reaction to each medication
•
QT prolongation, ventricular dysrhythmias:
monitor ECG, cardiac status in those with underlying cardiac abnormalities
•
Serious skin reaction:
Stevens-Johnson syndrome, toxic epidermal necrolysis; product should be discontinued immediately
•
Storage at room temp
•
Therapeutic response: C&S negative for infection
•
To take with full glass of water; may give with food to decrease GI symptoms
To report sore throat, fever, fatigue; may indicate superinfection
To notify prescriber of diarrhea, dark urine, pale stools, yellow discoloration of eyes or skin, severe abdominal pain
•
To take at evenly spaced intervals; to complete dosage regimen
•
To notify prescriber if pregnancy is suspected or planned
Withdraw product, maintain airway, administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(klev-id’i-peen)
Cleviprex
Func. class.:
Calcium channel blocker (L-type)
Chem. class.:
Dihydropyridine
L-type calcium channels mediate the influx of calcium during depolarization in arterial smooth muscle; reduces mean arterial B/P by decreasing systemic vascular resistance
Reduction of B/P when oral therapy not feasible
Hypersensitivity to this product, eggs, soya lecithin; defective lipid metabolism; severe aortic stenosis, pancreatitis
Precautions:
Pregnancy (C), labor, breastfeeding, children <18 yr, heart failure, hyperlipidemia, chronic hypertension, pheochromocytoma
Calculator
• Adult:
CONT IV
1-2 mg/hr; dose may be doubled q90sec initially; as B/P reaches goal, adjust dose less frequently (q5-10min) with smaller increases in dose; most patients require 4-6 mg/hr, max 32 mg/hr; no more than 1000 ml should be infused per 24-hr period due to lipid load restrictions
Available forms:
Single-dose vial 50, 100 ml (0.5 mg/ml); IV emulsion
•
Do not give through same line as other medications, do not dilute
•
Gently invert several times before use; do not use if discolored or if particulate matter is present
•
Give through central or peripheral line at 1-2 mg/hr, use infusion device
CNS:
Headache
CV:
MI, sinus tachycardia,
syncope,
reflex tachycardia, atrial fibrillation
GI:
Nausea, vomiting
Onset 2-4 min; half-life initially 1 min, terminal 15 min; metabolized via esterases in blood, extravascular tissues; excreted in urine 63%-74%, feces 7%-22%; protein binding >99%
•
Cardiac status: B/P, pulse, respiration, ECG; some patients have developed severe angina, acute MI after calcium channel blockers if obstructive CAD is severe; if not transitioned to other antihypertensive therapies after clevidipine inf, patients should be monitored ≥8 hr for rebound hypertension; monitor for rebound hypertension after product stoppage
•
Storage of vials in refrigerator, do not freeze; leave vials in carton until use; product is photosensitive but protection from light during administration is not required
•
Therapeutic response: decreased B/P
•
To notify prescriber immediately if neurological symptoms, visual changes, or symptoms of CHF occur
•
To continue follow-up for hypertension
•
To notify prescriber if pregnancy is planned, suspected, or if breastfeeding