Mosby's 2014 Nursing Drug Reference (230 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(kee-toe-tye′fen)
Alaway, Zaditor, Zyrtec Itchy Eye, Claritin Eye
Func. class.:
Antihistamine (ophthalmic)
Chem. class.:
Histamine 1 receptor antagonist/mast cell stabilizer
A topically active, direct H
1
- receptor antagonist and mast cell stabilizer; by reducing these inflammatory mediators, relieves the ocular pruritus associated with allergic conjunctivitis
For the temporary relief of ocular pruritus due to ragweed, pollen, grass, animal hair, animal dander
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, contact lenses
Calculator
• Adult/child
≥
3 yr:
OPHTH instill 1 drop in affected eye(s) every 8-12 hr
Available forms:
Ophthalmic solution 0.025%
•
For topical ophthalmic use only
•
Wash hands before and after use; tilt the head back slightly and pull the lower eyelid down with the index finger; squeeze the prescribed number of drops into the conjunctival sac and gently close eyes for 1–2 min, do not blink
•
Do not touch the tip of the dropper to the eye, fingertips, or other surface
•
Wait ≥10 min after instilling the ophthalmic solution before inserting contact lenses; contact lenses should not be worn if eye is red
•
Do not share ophthalmic drops with others
CNS:
Headache
EENT:
Conjunctival hyperemia, rhinitis, allergic reactions, ocular irritation consisting of burning or stinging, conjunctivitis, eyelid disorder, flu syndrome, keratitis, lacrimation disorder, mydriasis, ocular discharge, ocular pain, pharyngitis, photophobia, pruritus, rash, xerophthalmia (dry eyes)
•
Eyes: for itching, redness, use of soft or hard contact lens
•
Absence of redness, itching in the eyes
•
That product is for topical ophthalmic use only
•
To wash hands before and after use; tilt the head back slightly and pull the lower eyelid down with the index finger; squeeze the prescribed number of drops into the conjunctival sac and gently close eyes for 1–2 min; not to blink
•
Not to touch the tip of the dropper to the eye, fingertips, or other surface
•
To wait ≥10 min after instilling the ophthalmic solution before inserting contact lenses; contact lenses should not be worn if eye is red
•
Not to share ophthalmic drops with others
•
To remove contact lenses before use because the preservative benzalkonium chloride may be absorbed by soft contact lenses; that product should not be used to treat contact lens–related irritation
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(la-bet′a-lole)
Trandate
Func. class.:
Antihypertensive, antianginal
Chem. class.:
α-1/β-Blocker
Do not confuse:
Trandate
/Tridrate
Produces decreases in B/P without reflex tachycardia or significant reduction in heart rate through mixture of α-blocking, β-blocking effects; elevated plasma renins are reduced
Mild to moderate hypertension; treatment of severe hypertension (IV)
Unlabeled uses:
Hypertension in patients with pheochromocytoma, hypertension during cloNIDine withdrawal, pediatric hypertension
Hypersensitivity to β-blockers, cardiogenic shock, heart block (2nd or 3rd degree), sinus bradycardia, CHF, bronchial asthma
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, major surgery, diabetes mellitus, thyroid/renal/hepatic disease, COPD, well-compensated heart failure, CAD, nonallergic bronchospasm, peripheral vascular disease
Black Box Warning:
Abrupt discontinuation
Calculator
• Adult:
PO
100 mg bid; may be given with diuretic; may increase to 200 mg bid after 2 days; may continue to increase q1-3days; max 2400 mg/day in divided doses
• Child/adolescent (unlabeled):
PO
1-3 mg/kg/day, titrate to max 10-20 mg/kg/day based on B/P;
IV
0.2-1 mg/kg over 2 min, max 40 mg/dose;
IV INF
0.25-3 mg/kg/hr
• Adult:
IV INF
200 mg/160 ml D
5
W, run at 2 mg/min or 1.6 ml/min; stop inf at desired response, repeat q6-8hr as needed;
IV BOL
20-80 mg over 2 min, may repeat q10min, not to exceed 300 mg
Available forms:
Tabs 100, 200, 300 mg; inj 5 mg/ml
•
PO before meals, at bedtime; tab may be crushed or swallowed whole; give with meals to increase absorption
•
Reduced dosage for renal dysfunction
•
Do not discontinue before surgery
•
Give undiluted (5 mg/ml) over 2 min
•
Diluted in LR, D
5
W, D
5
in 0.2%, 0.9%, 0.33% NaCl, Ringer’s inj; inf is titrated to patient response; 200 mg of product/160 ml sol = 1 mg/ml; 300 mg of product/240 ml sol = 1 mg/ml; 200 mg of product/250 ml sol = 2 mg/3 ml; use inf pump
•
Keep patient recumbent during and for 3 hr after administration; monitor VS q5-15min
Y-site compatibilities:
Amikacin, aminophylline, amiodarone, ampicillin, butorphanol, calcium gluconate, cefTAZidime, ceftizoxime, cimetidine, diltiazem, DOBUTamine, DOPamine, enalaprilat, EPINEPHrine, erythromycin, esmolol, famotidine, fentaNYL, gentamicin, HYDROmorphone, lidocaine, LORazepam, magnesium sulfate, meperidine, metroNIDAZOLE, midazolam, milrinone, morphine, niCARdipine, nitroglycerin, norepinephrine, nitroprusside, oxacillin, potassium chloride, potassium phosphate, propofol, ranitidine, sodium acetate, tobramycin, vancomycin, vecuronium
CNS:
Dizziness, mental changes, drowsiness, fatigue, headache, catatonia, depression, anxiety, nightmares, paresthesias, lethargy
CV:
Orthostatic hypotension, bradycardia
,
CHF,
chest pain,
ventricular dysrhythmias,
AV block, scalp tingling
EENT:
Tinnitus
, visual changes; sore throat; double vision; dry, burning eyes, floppy iris syndrome
GI:
Nausea, vomiting, diarrhea
, dyspepsia, taste distortion
GU:
Impotence, dysuria, ejaculatory failure
HEMA:
Agranulocytosis, thrombocytopenia, purpura
(rare)
INTEG:
Rash, alopecia, urticaria, pruritus, fever,
exfoliative dermatitis
RESP:
Bronchospasm,
dyspnea, wheezing
Half-life 2.5-8 hr, metabolized by liver (metabolites inactive), excreted in urine, crosses placenta, excreted in breast milk, protein binding 50%
PO:
Onset 30 min, peak 2-4 hr, duration 8-12 hr
IV:
Onset 5 min, peak 15 min, duration 2-4 hr
•
Do not use within 2 wk of MAOIs
Increase:
myocardial depression—hydantoins, general anesthetics, verapamil, class I antidysrhythmics
Increase:
tremor—tricyclic antidepressants
Increase:
hypotension—diuretics, other antihypertensives, cimetidine, nitroglycerin, alcohol, nitrates
Decrease:
effects of—sympathomimetics, lidocaine, theophylline, β-blockers, bronchodilators, xanthines
Decrease:
antihypertensive effect—NSAIDs, salicylates
Increase or decrease:
effects of—antidiabetics
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra
Increase:
ANA titer, blood glucose, alk phos, LDH, AST, ALT, BUN, potassium, triglyceride, uric acid, serum lipoprotein
False increase:
urinary catecholamines
•
Hypertension:
B/P during beginning treatment, periodically thereafter; note pulse, rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes
CHF: I&O, weight daily; fluid overload: weight gain, jugular venous distention, edema, crackles in lungs
Black Box Warning:
Abrupt discontinuation:
product should be tapered to prevent adverse reactions
•
Baselines of renal/hepatic studies before therapy begins
•
Storage in dry area at room temp; do not freeze
•
Therapeutic response: decreased B/P after 1-2 wk
Black Box Warning:
Not to discontinue product abruptly; to taper over 2 wk; may cause precipitate angina
•
Not to use OTC products containing α-adrenergic stimulants (nasal decongestants, OTC cold preparations) unless directed by prescriber
•
To report bradycardia, dizziness, confusion, depression, fever
•
To take pulse at home; advise when to notify prescriber
•
To avoid alcohol, smoking, increased sodium intake
•
To comply with weight control, dietary adjustments, modified exercise program
•
To carry emergency ID to identify product, allergies
•
To avoid hazardous activities if dizziness is present
•
To report symptoms of CHF:
difficulty breathing, especially on exertion or when lying down; night cough; swelling of extremities
•
To take medication at bedtime to prevent effect of orthostatic hypotension; to rise slowly
•
To avoid driving or other hazardous activities until response is known; dizziness, drowsiness, may occur
•
To wear support hose to minimize effects of orthostatic hypotension
Lavage, IV glucagonor atropine for bradycardia, IV theophylline for bronchospasm; digoxin, O
2
, diuretic for cardiac failure; hemodialysis useful for removal/hypotension; administer vasopressor