Mosby's 2014 Nursing Drug Reference (133 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

dimenhyDRINATE (
OTC
, Rx)

(dye-men-hye′dri-nate)

Apo-Dimenhydrinate
, Dramamine, Driminate, Gravol

Motion sickness

TripTone, Wal-Dram

Func. class.:
Antiemetic, anti-histamine, anticholinergic

Chem. class.:
H
1
-receptor antagonist, ethanolamine derivative

Do not confuse:
dimenhyDRINATE
/diphenhydrAMINE

ACTION:

Competes with histamine for H
1
receptors in GI tract, blood vessels,
respiratory tract; central anticholinergic activity, which results in decreased vestibular stimulation and blockade of chemoreceptor trigger zone

USES:

Motion sickness, nausea, vomiting, vertigo

Unlabeled uses:
Hyperemesis gravidarum, Ménière’s syndrome

CONTRAINDICATIONS:

Hypersensitivity, infants, neonates, tartrazine dye hypersensitivity

Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, cardiac dysrhythmias, asthma, prostatic hypertrophy, bladder-neck obstruction, closed-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction

DOSAGE AND ROUTES
Calculator


Adult: PO
50-100 mg q4hr;
IM/IV
50 mg q4hr as needed (Canada only)

• Child 6-12 yr: PO
25-50 mg q6-8hr prn, max 150 mg/day

• Child 2-5 yr: PO
12.5-25 mg q6-8hr, max 75 mg/day

Available forms:
Tabs 50 mg; inj 50 mg/ml
; elixir 15 mg/5 ml
; chew tabs 50 mg

Administer:

• 
IM inj in large muscle mass; aspirate to avoid IV administration (Canada only)

• 
Tablets may be swallowed whole, chewed, or allowed to dissolve

IV route (Canada only)

• 
After diluting 50 mg/10 ml of NaCl inj, give ≤50 mg over 2 min

SIDE EFFECTS

CNS:
Drowsiness
, restlessness, headache, dizziness, insomnia, confusion, nervousness, tingling, vertigo

CV:
Hypertension,
hypotension
, palpitation

EENT:
Dry mouth
, blurred vision, diplopia, nasal congestion, photosensitivity, xerostomia

GI:
Nausea, anorexia, vomiting,
constipation

INTEG:
Rash, urticaria, fever, chills, flushing

MISC:
Anaphylaxis

PHARMACOKINETICS

PO/IM:
Onset 15-30 min, duration 4-6 hr

INTERACTIONS

Increase:
effect—alcohol, anticholinergic, tricyclics, MAOIs, opiates, sedative/hypnotics, other CNS depressants

Drug/Lab Test

False negative:
allergy skin testing

NURSING CONSIDERATIONS
Assess:

• 
VS, B/P; check patients with cardiac disease more often


 
Signs of toxicity
of other products or masking of symptoms of disease: brain tumor, intestinal obstruction

• 
Observe for drowsiness, dizziness

Evaluate:

• 
Therapeutic response: absence of nausea, vomiting, or vertigo

Teach patient/family:

• 
To avoid hazardous activities, activities requiring alertness because dizziness may occur; to request assistance with ambulation

• 
To avoid alcohol, other CNS depressants

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

dinoprostone (Rx)

(dye-noe-prost′one)

Cervidil, Prepidil, Prostin E-2

Func. class.:
Oxytocic, abortifacient

Chem. class.:
Prostaglandin E
2

Do not confuse:
Prepidil
/bepridil

ACTION:

Stimulates uterine contractions, causing abortion; acts within 30 hr for complete abortion

USES:

Abortion during 2nd trimester, benign hydatidiform mole, expulsion of
uterine contents in fetal deaths to 28 wk, missed abortion, to efface and dilate the cervix in pregnancy at term

CONTRAINDICATIONS:

Hypersensitivity, C-section, surgery, fetal distress, multiparity, vaginal bleeding, cephalopelvic disproportion

Precautions:
Pregnancy (C), cardiac/renal/hepatic disease, asthma, anemia, jaundice, diabetes mellitus, seizure disorders, hypertension, glaucoma, uterine fibrosis, cervical stenosis, pelvic surgery, pelvic inflammatory disease, respiratory disease

 

Black Box Warning:

Requires a specialized setting and an experienced clinician

DOSAGE AND ROUTES
Calculator
Abortifacient/2nd trimester/missed abortion/benign hydatidiform mole/intrauterine fetal death

• 
Adult: VAG SUPP
20 mg, repeat q3-5hr until abortion occurs, max dose is 240 mg

Cervical ripening

• 
Adult: GEL
0.5 mg vag gel placed in cervical canal, may repeat after 6 hr, max 1.5 mg/24 hr; vag insert 10 mg high in vagina, remove at onset of active labor or within 12 hr

Available forms:
VAG SUPP 20 mg; gel 0.5 mg/3 g (prefilled syringe); vag insert 10 mg

Administer:

• 
By gel:
after warming to room temp, remove seal from end of syringe, remove protective end cap and insert into plunger stopper assembly; make sure patient is in dorsal position;
insert:
must be kept frozen until use

• 
Antiemetic/antidiarrheal before administration of this product

SIDE EFFECTS

CNS:
Headache
, dizziness, chills, fever, flushing

CV:
Hypotension,
dysrhythmias, DIC

EENT:
Blurred vision

SYST:
Anaphylactoid syndrome of pregnancy

FETAL:
Bradycardia (i.e., deceleration)

GI:
Nausea, vomiting, diarrhea

GU:
Vaginitis, vaginal pain, vulvitis, vaginismus

INTEG:
Rash, skin color changes

MS:
Leg cramps, joint swelling
, weakness

GEL:
Uterine contractile abnormality, GI side effects, back pain, fever

INSERT:
Uterine hyperstimulation, fever, nausea, vomiting, diarrhea, abdominal pain

SUPPOSITORY:
Uterine rupture, anaphylaxis

INTERACTIONS

Increase:
effect—other oxytocics

Decrease:
oxytocic effect—alcohol

PHARMACOKINETICS

Metabolized in spleen, kidney, lungs; excreted in urine

GEL:
Onset 10 min, peak 30-45 min

SUPP:
Onset 10 min, duration 2-3 hr

NURSING CONSIDERATIONS
Assess:

 

Black Box Warning:

Specialized setting, specialized clinician: use only with emergency equipment nearby, by a clinician experienced when used in pregnancy termination; complete abortion should result within 17 hr

• 
Cervical ripening:
dilation, effacement of cervix and uterine contraction, fetal heart tones, check for contractions over 1 min


 
For fever that occurs 1/2 hr after suppository insertion (abortion)

• 
Respiratory rate, rhythm, depth; notify prescriber of abnormalities, pulse, B/P, temp

• 
Vaginal discharge:
check for itching, irritation; indicates vaginal infection

Evaluate:

• 
Therapeutic response: expulsion of fetus

Teach patient/family:

• 
To remain supine for 10-15 min after
insertion of supp, 2 hr after insert, 15-30 min after gel


 
To report excessive cramping, bleeding, chills, fever

• 
About some methods of pain, comfort control

• 
To avoid intercourse, tub baths, douches, tampon use for at least 2 wk

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