Mosby's 2014 Nursing Drug Reference (219 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
EENT:
Blurred vision, dry mouth
INTEG:
Flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy, swelling, redness
META:
Hypoglycemia
, rebound hyperglycemia (Somogyi effect 12-72 hr or longer)
MISC:
Peripheral edema
SYST:
Anaphylaxis
Insulin glulisine:
Onset 15-30 min, peak 1/2-1½ hr, duration 3-4 hr
Insulin aspart:
Onset 10-20 min, peak 1-3 hr, duration 3-5 hr
Insulin lispro:
Onset 15-30 min, peak 1/2-1½ hr, duration 3-5 hr
Insulin regular:
Onset 30 min, peak 2.5-5 hr, duration up to 7 hr
Insulin, isophane suspension (NPH):
Onset 1.5-4 hr, peak 4-12 hr, duration ≤24 hr
Insulin detemir:
Onset 0.8-2 hr, peak unknown, duration ≤24 hr (conc dependent)
Insulin glargine:
Onset 1.5 hr, no peak identified, duration ≥24 hr
Insulin, isophane suspension and regular insulin (70/30):
Onset 10-20 min, peak 2.4 hr, duration ≤24 hr
Insophane insulin suspension (NPH) and insulin mixtures (50/50):
Onset 1/2-1 hr, peak dual, duration 10-16 hr
Increase:
hypoglycemia—salicylate, alcohol, β-blockers, anabolic steroids, fenfluramine, phenylbutazone, sulfinpyrazone, guanethidine, oral hypoglycemics, MAOIs, tetracycline
Decrease:
hypoglycemia—thiazides, thyroid hormones, oral contraceptives, corticosteroids, estrogens, DOBUTamine, EPINEPHrine
Increase:
VMA
Decrease:
potassium, calcium
Interference:
LFTs, thyroid function studies
•
Fasting blood glucose; A1c may be drawn to identify treatment effectiveness q3mo
•
Urine ketones during illness; insulin requirements may increase during stress, illness, surgery
•
Hypoglycemic reaction that can occur during peak time (sweating, weakness, dizziness, chills, confusion, headache, nausea, rapid weak pulse, fatigue, tachycardia, memory lapses, slurred speech, staggering gait, anxiety, tremors, hunger)
•
Hyperglycemia:
acetone breath; polyuria; fatigue; polydipsia; flushed, dry skin; lethargy
•
Store at room temp for <1 mo (some insulins); keep away from heat and sunlight; refrigerate all other supply; NPH, premixed insulins are cloudy; regular, rapid-acting analogs, long-acting analogs are clear; do not freeze—IV route, regular only
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait
•
That blurred vision occurs; not to change corrective lens until vision is stabilized after 1-2 mo
•
To keep insulin, equipment available at all times; to carry a glucagon kit, candy, or lump of sugar to treat hypoglycemia
•
That product does not cure diabetes but controls symptoms
•
To carry emergency ID as diabetic
•
To recognize hypoglycemia reaction: headache, tremors, fatigue, weakness
•
To recognize hyperglycemia reaction: frequent urination, thirst, fatigue, hunger
•
About the dosage, route, mixing instructions, diet restrictions (if any), disease process
•
About the symptoms of
ketoacidosis:
nausea; thirst; polyuria; dry mouth; decreased B/P; dry, flushed skin; acetone breath; drowsiness; Kussmaul respirations
•
That a plan is necessary for diet, exercise; that all food on diet should be eaten; that exercise routine should not vary
•
About blood glucose testing; how to determine glucose level
•
To avoid OTC products unless directed by prescriber
Glucose 25 g IV, via dextrose 50% sol, 50 ml or glucagon 1 mg
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(in-ter-feer′on al′fa-kon)
Infergen
Func. class.:
Recombinant type 1 interferon
Induces biologic responses and has antiviral, antiproliferative, and immunomodulatory effects
Chronic hepatitis C infections in those ≥18 yr with compensated liver disease who have anti-HCV antibodies or HCV RNA, may use in combination with ribavirin
Unlabeled uses:
Hairy-cell leukemia when used with G-CSF
Hypersensitivity to α-interferons or products from
Escherichia coli;
decompensated hepatic disease, autoimmune hepatitis
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, thyroid disorders, myelosuppression, hepatic disease, seizure disorder, alcoholism, hepatitis
Black Box Warning:
Cardiac disease, autoimmune disease, infection, depression
Calculator
• Adult: SUBCUT monotherapy
9 mcg as single inj 3×/wk × 24 wk; leave ≥48 hr between injections; for patients who did not respond or relapsed after discontinuation, give 15 mcg 3×/wk × 48 wk;
combination: SUBCUT
15 mcg daily with ribavirin 1000 mg/day PO (<75 kg), 1200 mg/day PO (≥75 kg); give in 2 divided doses for up to 48 wks, use stepwise dose reduction of the interferon dose from 15 mcg to 9 mcg to 6 mcg for serious adverse reactions
Available forms:
Inj 9 mcg/0.3 ml, 15 mcg/0.5 ml
•
Premedicate with acetaminophen or ibuprofen
•
Do not shake vial; use 1 dose per vial; discard unused portion; use proper inj sites; rotate sites, discard unused product
•
Do not miss doses
CNS:
Depression, headache, fatigue, fever, rigors, insomnia, dizziness, agitation, nervousness, anxiety, lability, abnormal thinking
CV:
Hypertension, palpitation, tachycardia
EENT:
Tinnitus, earache, conjunctivitis, eye pain
GI:
Abdominal pain, nausea, diarrhea, anorexia, dyspepsia, vomiting, constipation, flatulence, hemorrhoids, decreased salivation
GU:
Dysmenorrhea, vaginitis, menstrual disorders
HEMA:
Granulocytopenia, thrombocytopenia, leukopenia,
ecchymosis,
aplastic anemia
INTEG:
Alopecia, pruritus, rash, erythema, dry skin
MISC:
Anaphylaxis, angioedema,
flulike illness
MS:
Back, limb, neck skeletal pain; rigors
RESP:
Pharyngitis, upper respiratory infection, cough, sinusitis, rhinitis, respiratory tract congestion, epistaxis, dyspnea, bronchitis
Peak 1-4 hr, peak biologic response 24-36 hr
Increase:
hearing loss—eflornithine (systemic), consider serial audiograms
Increase:
NRTI, use together cautiously
Increase:
myelosuppression—myelosuppressives
Increase:
toxicity—aldesleukin, IL-2 eflornithine, theophylline
Decrease:
effect of—antiretrovirals (NNRTs, NRTIs, protease inhibitors)
Black Box Warning:
Past or present history of depression, seizures; use with caution with these disorders
Black Box Warning:
Hemolytic anemia:
ribavirin may be used with this product and cause hemolytic anemia, cardiac symptoms
•
Ophthalmologic status; report periodically
•
Pregnancy:
determine if patient is pregnant before use with ribavirin, pregnancy (X), when used with ribavirin
•
CBC, LFTs, ECG, platelet counts, heme concentration, ANC, serum creatinine, albumin, bilirubin, TSH, T
4
, triglycerides at baseline and periodically
•
Myelosuppression: hold dose if neutrophil count is <500 × 10
6
/L or if platelets are <50 × 10
9
/L, monitor for infection
•
For hypersensitivity: discontinue immediately if hypersensitivity occurs
•
Therapeutic response: decreased chronic hepatitis C signs/symptoms
•
With detailed written information about product
•
To report signs, symptoms of infection, thyroid/liver dysfunction, changes in behavior
•
To report if pregnancy is planned or suspected (C), when combined with ribavirin pregnancy (X)
•
To use OTC analgesics to decrease flulike symptoms
•
If patient will be self-administering injection, teach all aspects of product use, administration, disposal, provide medication guide
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert