Mosby's 2014 Nursing Drug Reference (18 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(a-seat-a-mee′noe-fen)
Acephen, Apacet, APAP, Apra, Children’s Feverall, Equaline Children’s Pain Relief, Equaline Infant’s Pain Relief, Genapap, GoodSense Acetaminophen, GoodSense Children’s Pain Relief, Infantaire, Leader Children’s Pain Reliever, Mapap, Neopap, Ofirmev, Q-Pap, Q-Pap Children’s, Redutemp, Ridenol, Silapap, Tempra, T-Painol, Tylenol, Walgreen’s Non-Aspirin, XS pain reliever
Func. class.:
Nonopioid analgesic, antipyretic
Chem. class.:
Nonsalicylate, paraaminophenol derivative
May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis; does not possess antiinflammatory properties; antipyretic action results from inhibition of prostaglandins in the CNS (hypothalamic heat-regulating center)
Mild to moderate pain or fever, arthralgia, dental pain, dysmenorrhea, headache, myalgia, osteoarthritis
Unlabeled uses:
Migraine
Hypersensitivity
Precautions:
Pregnancy (B), (C) IV; breastfeeding, geriatric patients, anemia, renal/hepatic disease, chronic alcoholism
Calculator
• Adult/child >12 yr: PO/RECT
325-650 mg q4-6hr prn, max 4 g/day; weight ≥50 kg IV 1000 mg q6hr or 650 mg q4hr prn, max single dose 1000 mg, min dosing interval 4 hr; weight <50 kg IV 15 mg/kg/dose q6hr or 12.5 mg/kg/dose q4hr, max single dose 15 mg/kg, min dosing interval 4 hr, max 75 mg/kg/day from all sources, ext rel 650-1300 mg q 8 hr as needed, max 4 g/day
• Child ≥2 yr and <50 kg: IV
15 mg/kg/dose q6hr or 12.5 mg/kg/dose q4hr, max single dose 15 mg/kg, min dosing interval 4 hr, max 75 mg/kg/day from all sources
• Child 1-12 yr: PO
10-15 mg/kg q4-6hr, max 5 doses/24 hr
• Child 1-12 yr: RECT
10-20 mg/kg/dose q4-6hr
• Neonate: RECT
10-15 mg/kg/dose q6-8hr
• Adult and adolescent: PO/RECT
500-1000 mg, max 1 g/dose or max 4 g/day
Available forms:
Rect supp 120, 325, 650 mg; soft chew tabs 80 mg; caps 500 mg; elix 120, 160, 325 mg/5 ml; oral disintegrating tab 80, 160 ml; oral drops 80 mg/0.8 ml, liquid 500 mg/5 ml, 160/5 ml, 1000/30 ml; ext rel 650 mg, 80 mg/ml; tabs 325, 500, 650 mg; sol for inj 1000 mg/100 ml
•
Crushed or whole, do not crush EXT REL product; chewable tabs may be chewed; give with full glass of water
•
With food or milk to decrease gastric symptoms if needed
•
Susp after shaken well; check elixir, liquid, suspension concentration carefully, susp and cups are bioequivalent
•
No further dilution needed; do not add other medications to vial or inf device
•
For doses equal to single vial, averted IV set may be used to deliver directly from vial; for doses less than a single vial, withdraw dose and place in an empty sterile syringe, plastic IV container, or glass bottle; infuse over 15 min
•
Discard unused portion; if seal is broken, vial penetrated, or drug transferred to another container, give within 6 hr
GI:
Nausea, vomiting, abdominal pain;
hepatotoxicity, hepatic seizure (overdose), GI bleeding
GU:
Renal failure (high, prolonged doses)
HEMA:
Leukopenia, neutropenia, hemolytic anemia (long-term use), thrombocytopenia, pancytopenia
INTEG:
Rash, urticaria
SYST:
Hypersensitivity
TOXICITY:
Cyanosis, anemia, neutropenia, jaundice, pancytopenia, CNS stimulation, delirium followed by vascular collapse, seizures, coma, death
85%-90% metabolized by liver, excreted by kidneys; metabolites may be toxic if overdose occurs; widely distributed; crosses placenta in low concentrations; excreted in breast milk; half-life 1-4 hr
PO:
Onset 10-30 min, peak 1/2-2 hr, duration 4-6 hr, well absorbed
RECT:
Onset slow, peak 1-2 hr, duration 4-6 hr, absorption varies
•
Avoid use with salicylates
•
Renal adverse reactions: NSAIDs, salicylates
Increase:
Hypoprothrombinemia: warfarin, long-term use, high doses of acetaminophen
Increase:
hepatotoxicity—barbiturates, alcohol, carbamazepine, hydantoins, rifampin, rifabutin, isoniazid, diflunisal, zidovudine, lamotrigine, imatinib
Decrease:
absorption—colestipol, cholestyramine
Increase:
heptatotoxicity—St. John’s wort, due to acetaminophen metabolism
Increase:
hepatotoxicity—echinacea (rare)
Interference:
5-HIAA
Increase:
LFTs, potassium, bilirubin, LDH, pro-time
Decrease:
Hgb/Hct, WBC, RBC, platelets; albumin, magnesium, phosphate (pediatrics)
•
Hepatic studies: AST, ALT, bilirubin, creatinine before therapy if long-term therapy is anticipated; may cause hepatic toxicity at doses >4 g/day with chronic use
•
Renal studies: BUN, urine creatinine, occult blood, albumin, if patient is on long-term therapy; presence of blood or albumin indicates nephritis
•
Blood studies: CBC, PT if patient is on long-term therapy
•
I&O ratio; decreasing output may indicate renal failure (long-term therapy)
•
For fever and pain: type of pain, location, intensity, duration
•
Chronic poisoning:
rapid, weak pulse; dyspnea; cold, clammy extremities; report immediately to prescriber
•
Hepatotoxicity:
dark urine; clay-colored stools; yellowing of skin, sclera; itching; abdominal pain; fever; diarrhea if patient is on long-term therapy
•
Allergic reactions:
rash, urticaria; if these occur, product may have to be discontinued
•
Storage of suppositories <80° F (27° C)
•
Therapeutic response: absence of pain using pain scoring; fever
Not to exceed recommended dosage; the elixir, liquid, suspension come in several concentrations, read label carefully; acute poisoning with liver damage may result; tell parents of children to check products carefully; that acute toxicity includes symptoms of nausea, vomiting, abdominal pain and that prescriber should be notified immediately; that toxicity may occur when used with other combination products
•
Not to use with alcohol, herbals, OTC products without approval of prescriber
•
May be used when breastfeeding, short-term
•
To recognize signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat
•
That those with diabetes may notice blood glucose monitoring changes
•
To notify prescriber of pain or fever lasting more than 3 days, not to be used in patients <2 yr unless approved by prescriber
Product level, gastric lavage, activated charcoal; administer oral acetylcysteine to prevent hepatic damage
(
see acetylcysteine monograph
);
monitor for bleeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-set-a-zole′a-mide)
Diamox Sequels
Func. class.:
Diuretic, carbonic anhydrase inhibitor, antiglaucoma agent, antiepileptic
Chem. class.:
Sulfonamide derivative
Do not confuse:
acetaZOLAMIDE
/
acetoHEXAMIDE
Diamox
/
Trimox/Dobutrex
Inhibits carbonic anhydrase activity in proximal renal tubules to decrease reabsorption of water, sodium, potassium, bicarbonate resulting in increased urine volume and alkalinization of urine; decreases carbonic anhydrase in CNS, increasing seizure threshold; able to decrease secretion of aqueous humor in eye, which lowers intraocular pressure
Open-angle glaucoma, angle-closure glaucoma (preoperatively, if sur
gery delayed), seizures (petit mal, grand mal, mixed, absence), edema in CHF, product-induced edema, acute altitude sickness
Unlabeled uses:
Urine alkalinization, metabolic alkalosis in mechanical ventilation, decrease CSF production in infants with hydrocephalus, familial periodic paralysis, nystagmus
Hypersensitivity to sulfonamides, severe renal/hepatic disease, electrolyte imbalances (hyponatremia, hypokalemia), hyperchloremic acidosis, Addison’s disease, long-term use for closed-angle glaucoma, adrenocortical insufficiency
Precautions:
Pregnancy (C), breastfeeding, hypercalciuria, respiratory acidosis, pulmonary obstruction/emphysema, COPD
Calculator
• Adult: PO/IV
250 mg q4hr or 250 mg bid for short-term therapy
• Adult: PO/IV
250 mg/day in divided doses for amounts of more than 250 mg or 500 mg
EXT REL
bid, max 1 g/day
• Adult: PO/IV
250-375 mg/day or 5 mg/kg in
AM,
give for 2 days, then 1-2 days drug free
• Child: PO/IV
5 mg/kg/day or 150 mg/m
2
in
AM
• Adult: PO/IV
8-30 mg/kg/day, in 1-4 divided doses, usual range 375-1000 mg/day;
ER
not recommended with seizures
• Child: PO/IV
8-30 mg/kg/day in divided doses tid or qid, or 300-900 mg/m
2
/day, not to exceed 1 g/day
• Adult: PO
250 mg q6-12hr;
EXT REL
500 mg q12-24hr, start therapy 24-48 hr before ascent and give for ≥48 hr after arrival at high altitude
• Geriatric:
PO
250 mg bid, use lowest effective dose
• Adult: PO/IV
CCr 50-80 ml/min give dose ≥6 hr reg rel of IV; CCr 10-50 ml/min give dose q12hr; CCr <10 ml/min, avoid use
• Infant: PO/IV
5 mg/kg q6hr, may increase by 25 mg/kg/day; max 100 mg/kg/day
•Adult: IV
5 mg/kg/dose, repeat 2-3× over 24 hr
• Adult: PO
250-375 mg/day in divided doses
•Adult: IV
500 mg as a single dose or 250 mg q6hr × 4 doses
• Adult: PO
250 mg, increase by 250 mg q3days; max 3 g/day in divided doses
Available forms:
Tabs 125, 250 mg; ext rel caps 500 mg; inj 500 mg
•
In
AM
to avoid interference with sleep if using product as diuretic
•
Potassium replacement if potassium level is <3 mg/dl
•
Do not break, crush, or chew ext rel caps; this product should be used for altitude sickness, glaucoma
•
With food if nausea occurs; absorption may be decreased slightly
•
After diluting 500 mg in ≥5 ml sterile water for inj;
direct IV:
give at 100-500 mg/min;
intermittent INF:
may be diluted further in LR, D
5
W, D
10
W, 0.45% NaCl, 0.9% NaCl, or Ringer’s sol and infused over 15-30 min; use within 24 hr of dilution
Additive compatibilities:
cimetidine, ranitidine
CNS:
Anxiety,
confusion
,
seizures,
depression
, dizziness,
drowsiness, fatigue
, headache,
paresthesia
, stimulation
EENT:
Myopia, tinnitus
ENDO:
Hyperglycemia
GI:
Nausea, vomiting, anorexia, diarrhea
, melena,
weight loss
,
hepatic insufficiency, cholestatic jaundice, fulminant hepatic necrosis,
taste alterations
,
bleeding
GU:
Frequency, polyuria
,
uremia,
glucosuria, hematuria, dysuria, crystalluria, renal calculi
HEMA:
Aplastic anemia, hemolytic anemia, leukopenia, thrombocytopenia, purpura, pancytopenia
INTEG:
Rash
, pruritus, urticaria, fever,
Stevens-Johnson syndrome,
photosensitivity, flushing,
toxic epidermal necrolysis
META:
Hypokalemia, hyperchloremic acidosis
, hyponatremia, sulfonamide-like reactions, metabolic acidosis
65% absorbed if fasting (oral), 75% absorbed if given with food; half-life 2½-5½ hr; excreted unchanged by kidneys (80% within 24 hr), crosses placenta
PO:
Onset 1-1½ hr, peak 2-4 hr, duration 8-12 hr
PO-EXT REL:
Onset 2 hr, peak 8-12 hr, duration 18-24 hr
IV:
Onset 2 min, peak 15 min, duration 4-5 hr
Increase:
action of—amphetamines, flecainide, memantine, phenytoin, procainamide, quinidine, anticholinergics, methenamine, mecamylamine, ePHEDrine, memantine, mexiletene, quiNIDine, folic acid antagonists
Increase:
excretion of lithium, primidone
Increase:
osteomalacia—carBAMazepine, ethotoin
Increase:
toxicity—salicylates, cycloSPORINE
Increase:
hypokalemia—corticosteroids, amphotericin B, corticotropin, ACTH
Increase:
cardiac toxicity if hypokalemia develops—arsenic trioxide, cardiac glycosides, levomethadyl
Increase:
renal stone formation, heat stroke—topiramate (avoid concurrent use)
Decrease:
primidone levels
Increase:
glucose, bilirubin, calcium, uric acid
Decrease:
thyroid iodine uptake
False positive:
urinary protein, 17 hydroxysteroid
•
Edema: weight daily, I&O daily to determine fluid loss; effect of product may be decreased if used daily; monitor geriatric patients for dehydration
•
Ocular status: intraocular pressure, ophthalmologic examination
•
For cross-sensitivity with other sulfonamides and this product
•
B/P lying, standing; postural hypotension may occur
•
Electrolytes: potassium, sodium, chloride; also BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, LFTs; I&O, platelet count, patient may need to be on a high-potassium diet; identify signs of hypokalemia (vomiting, fatigue, weakness)
•
Seizures:
neurologic status, provide seizure precaution
•
Storage in dark, cool area; use reconstituted solution within 24 hr
•
Therapeutic response: improvement in edema of feet, legs, sacral area daily if medication is being used for CHF; decrease in aqueous humor if medication is being used for glaucoma; decreased frequency of seizures, prevention of altitude sickness
•
To take exactly as prescribed; if dose is missed, take as soon as remembered; do not double dose
•
Altitude sickness: to avoid rapid ascent
•
Diabetic: that drug may increase blood glucose and to monitor blood glucose
•
To use sunscreen to prevent photosensitivity
•
To avoid hazardous activities if drowsiness occurs
•
To increase fluids to 2-3 L/day if not contraindicated
To report nausea, vertigo, rapid weight gain, change in stools, weakness, numbness, rash, sore throat, bleeding/bruising; Stevens-Johnson syndrome, toxic epidermal necrolysis (blistering, red rash that spreads)
Lavage if taken orally; monitor electrolytes; administer dextrose in saline; monitor hydration, CV, renal status