Mosby's 2014 Nursing Drug Reference (167 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ex-em′eh-stane)
Aromasin
Func. class.:
Antineoplastic
Chem. class.:
Aromatase inhibitor
Do not confuse:
exemestane
/ezetimibe/estramustine
Lowers serum estradiol concentrations; many breast cancers have strong estrogen receptors
Advanced breast carcinoma not responsive to other therapy (postmenopausal)
Pregnancy (X), breastfeeding, premenopausal women, hypersensitivity
Precautions:
Children, geriatric patients, renal/hepatic disease
Calculator
• Adult:
PO
25 mg/day after meals; may need 50 mg/day if taken with a potent CYP3A4 inducer
Available forms:
Tabs 25 mg
•
After meals at same time of day
CNS:
Headache, depression, insomnia, anxiety, fatigue, hot flashes, diaphoresis
, dizziness
CV:
Hypertension, edema
GI:
Nausea
, vomiting, diarrhea, constipation, abdominal pain, increased appetite
HEMA:
Lymphopenia
MS:
Fracture, bone loss
RESP:
Cough,
dyspnea
Half-life 24 hr; excreted in feces, urine
Decrease:
exemestane action—CYP3A4 inducers, estrogens
•
B/P; hypertension may occur
•
Bone mineral density, x-ray of thoracic or lumbar spine if bone changes suspected
•
At room temp
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report any complaints, side effects to prescriber
•
That hot flashes are reversible after discontinuing treatment
•
To use reliable contraception (pregnancy X); not to breastfeed
•
That vit D, calcium may be used for bone loss
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ex-en′a-tide)
Bydureon, Byetta
Func. class.:
Antidiabetic
Chem. class.:
Incretin mimetic
Binds and activates known human GLP-1 receptor, mimics natural physiology for self-regulating glycemic control
Type 2 diabetes mellitus given in combination with metFORMIN, a sulfonylurea, or a thiazolidinedione
Unlabeled uses:
Once-weekly dosing
Hypersensitivity
Precautions:
Pregnancy (C), geriatric patients, severe renal/hepatic/GI disease, pancreatitis
Calculator
• Adult:
SUBCUT
5 mcg bid 1 hr before morning and evening meal; may increase to 10 mcg bid after 1 mo of therapy; ext rel SUBCUT (Bydureon) 2 mg q7days; ext rel inj 2 mg q7days
Available forms:
Inj 5, 10 mcg pen; ext rel powder for susp for inj 2 mg
•
May be used as monotherapy or combined with other products
•
SUBCUT only, do not give IV/IM
•
Pen needles must be purchased separately, compatible; prime before use; in
ject into thigh, abdomen, upper arm; rotate sites
•
Product 1 hr before meals, approximately 6 hr apart; if patient is NPO, may need to hold dose to prevent hypoglycemia
•
If added to insulin glargine, insulin, or detemir, a dosage reduction in these products may be required
•
Use at same time of day q7days without regard to meals
•
Give every 7 days (weekly); the dose can be given at any time of day without regard to meals
•
Available as a single-dose tray containing a vial of 2 mg, a pre-filled syringe delivering 0.65 ml diluent, a vial connector, and two custom needles (23GX 5/16′) specific to this delivery system (one is a spare needle); do not substitute needles or any other components
•
Inject immediately after the white to off-white powder is suspended in the diluent and transferred to the syringe
•
Inject subcut into the thigh, abdomen, or upper arm, rotate sites to prevent lipodystrophy
CNS:
Headache, dizziness
, feeling jittery, restlessness, weakness
ENDO:
Hypoglycemia
GI:
Nausea, vomiting, diarrhea, dyspepsia, anorexia, gastroesophageal reflux, weight loss,
pancreatitis
SYST:
Angioedema, anaphylaxis, inj site reactions
Peak 2.1 hr, elimination by glomerular filtration
•
May decrease effect of acetaminophen
•
Do not use with erythromycin, metoclopramide
Increase:
hypoglycemia—ACE inhibitors, disopyramide, sulfonylureas, androgens, fibric acid derivatives, alcohol
Increase:
hyperglycemia—phenothiazines, corticosteroids, anabolic steroids
Decrease:
action of digoxin, lovastatin, acetaminophen (elixir)
Decrease:
hypoglycemia—niacin, dextrothyroxine, thiazide diuretics, triamterene, estrogens, progestins, oral contraceptives, MAOIs
•
Fasting blood, glucose, A1c levels, postprandial glucose during treatment to determine diabetes control
•
Pancreatitis:
severe abdominal pain, with or without vomiting, product should be discontinued
•
Renal studies: urinalysis, creatinine
•
Hypo/hyperglycemic reaction that can occur soon after meals; for severe hypoglycemia, give IV D
50
W then IV dextrose solution
•
Nausea, vomiting, diarrhea, ability to tolerate product, may cause dehydration
•
Storage in refrigerator for unopened pen; may store at room temp after opening for up to 30 days
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia, clear sensorium, improving A1c, weight; absence of dizziness, stable gait
•
About the symptoms of hypo/hyperglycemia, what to do about each; to have glucagon emergency kit available; to carry a glucose source (candy, sugar cube) to treat hypoglycemia
•
That product must be continued on a daily basis; about consequences of discontinuing product abruptly
•
That diabetes is a lifelong illness; product will not cure disease; to carry emergency ID with prescriber and medication information
•
To continue weight control, dietary restrictions, exercise, hygiene
•
That regular blood glucose monitoring and A1c testing is needed
•
To notify prescriber if pregnant or intending to become pregnant (X)
•
About the importance of reading “Information for the Patient” and “Pen User Manual;” about self-injection
•
Pancreatitis:
If severe abdominal pain with or without vomiting occurs seek medical attention immediately
•
Review injection procedure, to store product in refrigerator, room temperature after first use, discard 30 days after first use, do not freeze, protect from light (Byetta)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert