Mosby's 2014 Nursing Drug Reference (163 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(es-zop′i-klone)
Lunesta
Func. class.:
Sedative/hypnotic, nonbenzodiazepine
Chem. class.:
Cyclopyrrolone
Interacts with GABA receptors
Insomnia
Hypersensitivity, ethanol intoxication
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, severe hepatic disease, abrupt discontinuation, COPD, depression, labor, sleep apnea, substance abuse, suicidal ideation
Calculator
• Adult:
PO
2 mg immediately before bed, may increase to 3 mg if needed
• Adult:
PO
1 mg immediately before bed with severe hepatic disease
Available forms:
Tabs 1, 2, 3 mg
•
Do not break, crush, or chew tab
•
Immediately before bedtime; avoid use with food; for short-term use only
CNS:
Worsening depression, hallucinations, headache, daytime drowsiness,
suicidal thoughts/actions,
migraine, restlessness, anxiety, sleep driving, sleepwalking
CV:
Peripheral edema, chest pain
GI:
Dry mouth, bitter taste (dysgeusia)
GU:
Gynecomastia, dysmenorrhea
INTEG:
Rash,
angioedema
Onset rapid; peak 1 hr; duration 6 hr; extensively metabolized in the liver by CYP3A4, CYP2E1; excreted via kidneys; half-life 6 hr, geriatric patients 9 hr, protein binding 52%-59%
Increase:
CNS depression—CNS depressants
Increase:
toxicity due to decreased eszopiclone elimination—CYP3A4 inhibitors (clarithromycin, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin, SSRIs)
Decrease:
product action—food
•
Sleep pattern:
ability to go to sleep, stay asleep, early morning awakenings, conservative methods used
•
For abuse of this product, other products
•
Anaphylaxis, angioedema:
monitor during first dose
•
Alternative methods to improve sleep: reading, quiet environment, warm bath, milk
•
Assistance with ambulation, night light, call bell within reach
•
Check to see that product swallowed
•
Therapeutic response: ability to fall asleep and stay asleep throughout the night
•
That daytime drowsiness may occur; not to engage in hazardous activities until effect is known; that memory problems may occur
•
That all other medications and supplements should be avoided unless approved by prescriber; to avoid alcohol
•
To notify prescriber if pregnancy is suspected or planned
•
To avoid use after a high fat meal
•
To swallow tab whole
•
Not to stop drug abruptly, tolerance may occur
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(eh-tan′er-sept)
Enbrel
Func. class.:
Antirheumatic agent (disease modifying)(DMARDs)
Chem. class.:
Anti-TNF agent
Binds tumor necrosis factor (TNF), which is involved in immune and inflammatory reactions
Acute, chronic rheumatoid arthritis that has not responded to other disease-modifying agents, polyarticular course of juvenile rheumatoid arthritis (JRA), ankylosing spondylitis, plaque psoriasis, psoriatic arthritis
Unlabeled uses:
Crohn’s disease; plaque psoriasis (child ≥4 yr)
Sepsis, active infections
Black Box Warning:
Hypersensitivity to product, latex needle cap, benzyl alcohol
Precautions:
Pregnancy (B), breastfeeding, children <4 yr, geriatric patients, malignancies, CHF, seizures, multiple sclerosis
Black Box Warning:
Infection, lymphoma, neoplastic disease
Calculator
• Adult:
SUBCUT
50 mg/wk or 25 mg 2×/wk, 3-4 days apart
• Child 2-17 yr:
SUBCUT
0.8 mg/kg/wk, max 50 mg/wk
• Adult:
SUBCUT
50 mg 2×/wk × 3 mo
• Adolescent/child 4-17 yr (unlabeled):
SUBCUT
0.8 mg/kg/wk, max 50 mg/wk
• Adolescent/child 2-17 yr:
SUBCUT
0.8 mg/kg/wk, max 50 mg/wk
Available forms:
Powder for inj 25 mg; inj 50 mg/ml; autoinjector, single use
•
After reconstituting 1 ml of supplied diluent, slowly inject diluent into vial, swirl contents; do not shake, sol should be clear/colorless, do not use if cloudy, discolored
•
Do not admix with other sol or medications, do not use filter
•
May be injected SUBCUT into upper arm, abdomen, thigh; rotate inj sites
CNS:
Headache
, asthenia, dizziness
GI:
Abdominal pain, dyspepsia, vomiting
HEMA:
Pancytopenia, anemia, thrombocytopenia, leukopenia, neutropenia
INTEG:
Rash,
inj site reaction
, keratoderma blenorrhagicum
RESP:
Pharyngitis, cough, URI, non-URI
, sinusitis,
rhinitis
SYST:
Serious infections, sepsis, death, malignancies
Elimination half-life 102 hr, 60% absorbed (SUBCUT)
•
Increase:
neutropenia—sulfaSALAzine
•
Do not give concurrently with vaccines; immunizations should be brought up to date before treatment
•
Avoid use with anakinra, cyclophosphamide, rilonacept
•
RA:
pain, stiffness, ROM, swelling of joints before, during, after treatment
•
For inj site pain, swelling; usually occurs after 2 inj (4-5 days)
Black Box Warning:
Infection:
patients using immunosuppressives, corticosteroids, methotrexate at greater risk; assess for fever
•
Hypersensitivity:
to this product, latex needle cap, benzyl alcohol; usual reactions to product last 3-5 days
•
Therapeutic response: decreased inflammation, pain in joints
•
That product must be continued for prescribed time to be effective
•
To use caution when driving; dizziness may occur
•
Not to receive live vaccinations during treatment
•
About self-administration if appropriate: inj should be made in thigh, abdomen, upper arm; rotate sites at least 1 in from previous site
•
To notify prescriber of possible infection (upper respiratory, other)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert