Mosby's 2014 Nursing Drug Reference (168 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(ehz-eh-tim′bee)
Ezetrol
, Zetia
Func. class.:
Antilipemic; cholesterol absorption inhibitor
Inhibits absorption of cholesterol by the small intestine, causes reduced hepatic cholesterol stores
Hypercholesterolemia, homozygous familial hypercholesterolemia (HoFH), homozygous sitosterolemia
Hypersensitivity, severe hepatic disease
Precautions:
Pregnancy (C), breastfeeding, children, hepatic disease
Calculator
• Adult/adolescent/child >10 yr:
PO
10 mg/day; may be given with HMG-CoA reductase inhibitor at same time; may be given with bile acid sequestrant; give ezetimibe 2 hr before or 4 hr after bile acid sequestrant
Available forms:
Tabs 10 mg
•
Without regard to meals
CNS:
Fatigue, dizziness, headache
GI:
Diarrhea, abdominal pain
MISC:
Chest pain
MS:
Myalgias, arthralgias
, back pain,
myopathy, rhabdomyolysis
RESP:
Pharyngitis, sinusitis, cough,
URI
SYST:
Angioedema
Metabolized in small intestine, liver; excreted in feces 78%, urine 11%; peak 4-12 hr; half-life 22 hr
Increase:
action of ezetimibe—fibric acid derivatives, cycloSPORINE
Decrease:
action of ezetimibe—antacids, cholestyramine
Increase:
LFTs
•
Hypercholestrolemia:
diet history: fat content, lipid levels (triglycerides, LDL, HDL, cholesterol); LFTs at baseline, periodically during treatment
•
Myopathy/rhabdomyolysis:
increased CPK, myalgia, muscle cramps, musculoskeletal pain, lethargy, fatigue, fever; more common when combined with statins
•
Therapeutic response: decreased cholesterol, LDL; increased HDL
•
That compliance is needed
•
That risk factors should be decreased: high-fat diet, smoking, alcohol consumption, absence of exercise
•
To notify prescriber if pregnancy suspected, planned or if breastfeeding
•
To notify prescriber if unexplained weakness, muscle pain present
•
To notify prescriber of dietary/herbal supplements
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(e-zog′a-been)
Potiga
Func. class.:
Anticonvulsant
The exact mechanism of anticonvulsant effects is not fully known. However, studies indicate that the drug enhances transmembrane potassium currents, which may stabilize the resting membrane potential and reduce brain excitability. May also augment GABA-mediated currents.
Partial seizures, migraines
Hypersensitivity
Precautions:
Suicidal ideation/behavior, prostatic hypertrophy, dementia, psychotic disorders, QT prolongation, congestive heart failure, ventricular hypertrophy, hypokalemia, hypomagnesemia, abrupt discontinuation, renal impairment, hepatic disease, geriatrics pregnancy category C, breastfeeding, neonates, infants, children, adolescents
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• Adult/geriatric patient ≤65 years of age:
PO
Initially, 100 mg tid, increase by ≤50 mg tid per day at weekly intervals depending on response, up to a maintenance dose of 200-400 mg tid depending on response; max is 400 mg tid (1200 mg/day).
• Geriatric patient > 65 years of age:
PO
initially, 50 mg tid, increase by ≤ 50 mg tid per day at weekly intervals depending on response; max 250 mg tid (750 mg/day).
Available forms:
Film-coated tabs 50, 200, 300, 400 mg
•
Tab should be swallowed whole without regard to meals
•
Give in 3 equally divided doses
CNS:
Dizziness, drowsiness, memory impairment, tremor, vertigo, abnormal coordination, disturbance in attention, gait disturbance, aphasia, dysarthria, balance disorder, paresthesias, amnesia, dysphagia, myoclonia, hypokinesia, confusion, anxiety, hallucinations,
suicidal thoughts/behaviors,
fatigue, asthenia, malaise
EENT:
Diplopia, blurred vision
GU:
Urinary retention, hydronephrosis, dysuria, urinary hesitation, hematuria, chromaturia
GI:
Nausea, constipation, dyspepsia, xerostomia, constipation, weight gain, appetite stimulation
MISC:
Influenza, dyspnea,
QT prolongation
MS:
Muscle spasms, weakness
80% protein bound; extensively distributed in the body; extensively metabolized by glucuronidation and acetylation; inactive N-glucuronides are the primary metabolites; elimination half-lives of ezogabine and its N-acetyl metabolite are 7 hr and 11 hr, respectively; 36% excreted renally as exogabine, 18% as NAMR, 24% as the N-glururonides of ezogabine and NAMR, 14% fecal excretion; rapidly absorbed, peak 0.5-2 hr, bioavailability 60%; high-fat food increases peak concentration; increased in hepatic/renal disease, geriatric patients, young adult females
Increase:
QT prolongation—arsenic trioxide, chloroquine, chlorproMAZINE, mesoridazine thioridazine, clarithromycin, Class IA antiarrhythmics (disopyramide, procainamide, quiNIDine), Class III antiarrhythmics (amiodarone, dofetilide, ibutilide, sotalol), dextromethorphan, dronedarone, droperidol, erythromycin, grepafloxacin, halofantrine, levomethadyl, methadone, pentamidine, pimozide, posaconazole, probucol, propafenone, quiNIDine, saquinavir, sparfloxacin, terfenadine, troleandomycin, ziprasidone
Decrease:
effect of phenytoin
Decrease:
effect of ezogabine—carBAMazepine
Increase:
effect of digoxin
Increase:
urinary retention—antimuscarinics, amantadine, H1-blockers
Increase:
CNS depression—anxiolytics, sedatives, hypnotics, buprenorphine, butorphanol, dronabinol, mirtazapine, nabilone, nalbuphine, opiate agonists, pentazocine, pregabalin, skeletal muscle relaxants, traMADol, traZODone, ethanol
Seizures:
Assess for type, duration, location, activity, presence of aura
QT prolongation:
Monitor in those with known QT prolongation, congestive heart failure, ventricular hypertrophy, hypokalemia, hypomagnesemia, and in patients receiving medications known to cause QT prolongation. QT prolongation can occur within 3 hr of dose
Abrupt withdrawal:
Withdraw gradually to minimize increased seizure frequency
Suicidal thoughts/behaviors:
Assess for any unusual changes in moods or behaviors, including emotional lability or emerging or worsening depression and suicidal ideation
•
To avoid driving or operating machinery or performing other tasks that require mental alertness until reaction is known
•
To avoid concurrent use of alcohol
•
To avoid abruptly discontinuing this product
Suicidal thought/behaviors:
Advise patient to notify prescriber immediately of suicidal thought/behaviors
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert