Mosby's 2014 Nursing Drug Reference (216 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(in-dap′a-mide)
Lozide
Func. class.:
Diuretic—thiazide-like, antihypertensive
Chem. class.:
Indoline
Acts on proximal section of distal renal tubule by inhibiting reabsorption of sodium; may act by direct vasodilation caused by blocking of calcium channels
Edema of CHF, hypertension
Hypersensitivity to this product or sulfonamides; anuria, hepatic coma, pregnancy (D)
Precautions:
Breastfeeding, hypokalemia, dehydration, ascites, hepatic disease, severe renal disease, CCr <30 ml/min (not effective), diabetes mellitus, gout
Calculator
• Adult: PO
2.5 mg/day in
AM
; may be increased to 5 mg/day if needed after 1 wk
• Adult: PO
1.25-5 mg/day; may increase to 5 mg/day over 8 wk
Available forms:
Tabs 1.25, 2.5 mg
•
In
AM
to avoid interference with sleep
•
With food if nausea occurs; absorption may be decreased slightly
CNS:
Headache
, dizziness, fatigue, weakness, nervousness, agitation, extremity numbness, depression
CV:
Orthostatic hypotension, volume depletion, palpitations, dysrhythmias, PVCs, vasculitis
EENT:
Blurred vision, nasal congestion, increased intraocular pressure
ELECT:
Hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypercalcemia, hyponatremia
, hypokalemia, hyperglycemia
GI:
Nausea
, diarrhea, dry mouth, vomiting, anorexia, cramps, constipation, abdominal pain
GU:
Polyuria
, nocturia, urinary frequency, impotence
INTEG:
Rash, pruritus
MS:
Cramps
Well absorbed (PO); widely distributed; metabolized by liver; excreted by kidney (small amounts); onset 1-2 hr; peak 2 hr; duration up to 36 hr; excreted in urine, feces; half-life 14-18 hr
Increase:
hyperglycemia—diazoxide
Increase:
toxicity of muscle relaxants, steroids, lithium, digoxin
Increase:
hypokalemia—corticosteroids, amphotericin B, loop diuretics, thiazide diuretics
Decrease:
effects—antidiabetics, antigout agents, anticoagulants
Decrease:
absorption—cholestyramine, colestipol
Decrease:
hypotensive effect—indomethacin, NSAIDs
•
Severe photosensitivity: St. John’s wort
Increase:
calcium, parathyroid test, glucose, uric acid
•
Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily
•
Rate, depth, rhythm of respirations, effect of exertion
•
B/P lying, standing; postural hypotension may occur
•
Electrolytes: potassium, magnesium, sodium, chloride: include BUN, CBC, serum creatinine, blood pH, ABGs, uric acid, Ca, glucose
•
Signs of metabolic alkalosis, hypokalemia
•
Rashes, fever daily; allergy to sulfa products
•
Confusion, especially in geriatric patients; take safety precautions if needed
•
Hydration: skin turgor, thirst, dry mucous membranes
•
Therapeutic response: improvement in edema of feet, legs, sacral area daily; decreased B/P
•
To consume diet high in potassium; to rise slowly from lying or sitting position
•
To recognize adverse reactions: muscle cramps, weakness, nausea, dizziness
•
To take with food, milk for GI symptoms; to take early in day to prevent nocturia
•
To notify prescriber if urinary output decreases; to monitor daily weight
Lavage if taken orally; monitor electrolytes, administer IV fluids; monitor hydration, CV, renal status
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(en-den′a-veer)
Crixivan
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
Do not confuse:
indinavir
/Denavir
Inhibits human immunodeficiency virus (HIV-1) protease; this prevents the maturation of the virus
HIV-1 in combination with at least 2 other antiretrovirals
Unlabeled uses:
Prevention of HIV-1 after exposure
Hypersensitivity, breastfeeding
Precautions:
Pregnancy (C), children, renal/hepatic disease, history of renal stones, diabetes, hypercholesterolemia, hemophilia, autoimmune disease, immune reconstitution syndrome
Calculator
• Adult: PO
800 mg q8hr; 400 mg bid with ritonavir 400 mg bid or 800 mg bid with ritonavir 100-200 mg bid; decrease dose to 600 mg bid when given with lopinavir, ritonavir
•
Adult: PO
600 mg q8h
Available forms:
Caps 200, 400 mg
•
Do not break, crush, or chew caps
•
With water, 1 hr before or 2 hr after meals; may be given with other liquids or small meal; do not give with high-fat, high-protein meals
•
Dosage adjustment will need to be considered when given with efavirenz
•
Increase water to 1.5 L/day minimum to prevent nephrolithiasis
CNS:
Headache, insomnia
, dizziness, somnolence
GI:
Diarrhea, abdominal pain, nausea, vomiting
, anorexia, dry mouth
GU:
Nephrolithiasis
INTEG:
Rash
MS:
Pain
OTHER:
Asthenia,
insulin-resistant hyperglycemia,
hyperlipidemia,
ketoacidosis,
lipodystrophy
Terminal half-life 2 hr; 60% protein binding; metabolized liver; excreted <20% unchanged in urine, 83% in feces
Life-threatening dysrhythmias: ergots, midazolam, rifampin, triazolam, amiodarone, pimozide, alfazosin
Increase:
myopathy—statins (atorvastatin, lovastatin, simvastatin)
Increase:
indinavir levels—CYP3A4 inhibitors (arepitant, protease inhibitors, azole antifungals, nefazodone, verapamil); phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil)
Increase:
levels of both products—clarithromycin, zidovudine
Increase:
levels of isoniazid, oral contraceptives
Decrease:
indinavir levels—CYP3A4 inducers (barbiturates, carBAMazepine, nonnucleoside reverse transcriptase inhibitors, phenytoins, rifamycins, modafinil)
Decrease:
effect of both products—anticonvulsants
Decrease:
effect—CYP3A4 substrates (calcium channel blockers, immunosuppressants, benzodiazepines, azole antifungals, macrolides, SSRIs, statins)
Decrease:
indinavir levels—St. John’s wort; avoid concurrent use
Decrease:
indinavir absorption—grapefruit juice; high-fat, high-protein foods
Increase:
AST, ALT, amylase, total bilirubin
•
Complaints of lower back, flank pain; indicates kidney stones
•
Signs of infection, anemia, presence of other sexually transmitted diseases
•
Blood/hepatic studies: ALT, AST; total bilirubin, amylase, blood glucose, serum cholesterol/lipid profile, may be elevated
•
Plasma HIV RNA, viral load, CD4 during treatment
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
•
Skin eruptions; rash, urticaria, itching
•
Allergies before treatment, reaction of each medication; place allergies on chart
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
That product must be taken in equal intervals around the clock to maintain blood levels for duration of therapy
That hyperglycemia may occur; to watch for increased thirst, weight loss, hunger, and dry, itchy skin; to notify prescriber
•
To increase fluids to prevent kidney stones; if stone formation occurs, that treatment may need to be interrupted
•
That product does not cure AIDS, only controls symptoms; not to donate blood