Mosby's 2014 Nursing Drug Reference (260 page)

Do not confuse:
methimazole
/metoprolol/minoxidil

Precautions:
Infection, bone marrow suppression, hepatic disease, bleeding disorders

• Adult and child:
PO
same as hyperthyroidism with iodine and propranolol

• 
With meals to decrease GI upset

• 
At same time each day to maintain product level

• 
Lowest dose that relieves symptoms; discontinue before RAIU

Increase:
bone marrow depression—radiation, antineoplastic agents

Increase:
response to digoxin

Decrease:
effectiveness—amiodarone, potassium iodide

Decrease:
Anticoagulant effect—warfarin

Increase:
PT, AST, ALT, alk phos

• 
Hyperthyroidism:
palpitation, nervousness, loss of hair, insomnia, heat intolerance, weight loss, diarrhea

• 
Hypothyroidism:
constipation, dry skin, weakness, fatigue, headache, intolerance to cold, weight gain; adjustment may be needed

• 
Pulse, B/P, temp

• 
I&O ratio; check for edema: puffy hands, feet, periorbits; these indicate hypothyroidism

• 
Weight daily; same clothing, scale, time of day

• 
T
₃
, T
₄
, which are increased; serum TSH, which is decreased; free thyroxine index, which is increased if dosage too low; discontinue product 3-4 wk before RAIU

 
Blood dyscrasias:
CBC, leukopenia, thrombocytopenia, agranulocytosis; if these occur, product should be discontinued and other treatment initiated, may occur at higher doses

• 
Hypersensitivity:
rash, enlarged cervical lymph nodes; product may have to be discontinued

• 
Hypoprothrombinemia:
bleeding, petechiae, ecchymosis

• 
Clinical response:
after 3 wk should include increased weight; decreased T
₄
, pulse

 
Bone marrow suppression:
sore throat, fever, fatigue

• 
Storage in light-resistant container

• 
Increased fluids to 3-4 L/day unless contraindicated

• 
Therapeutic response: weight gain, decreased pulse, decreased T
₄
, B/P

• 
Not to breastfeed

• 
To take pulse daily

• 
To report redness, swelling, sore throat, mouth lesions, fever, which indicate blood dyscrasias

• 
To keep graph of weight, pulse, mood

• 
To avoid OTC products, seafood that contains iodine, other iodine products

• 
Not to discontinue product abruptly because thyroid crisis may occur; stress patient response

• 
That response may take several months if thyroid is large

• 
Symptoms and signs of overdose:
periorbital edema, cold intolerance, mental depression

• 
Symptoms of inadequate dose:
tachycardia, diarrhea, fever, irritability

• 
To take medication as prescribed; not to skip or double dose

Black Box Warning:

Renal disease, ascites, diarrhea, exfoliative dermatitis, infection, intrathecal administration, lymphoma, pleural effusion, pulmonary disease, radiation therapy, stomatitis, tumor lysis syndrome, renal impairment

• Adult and child:
PO/IM/IV
3.3 mg/m
²
/day × 4-6 wk until remission then 20-30 mg/m
²
PO/IM
weekly in 2 divided doses or 2.5 mg/kg
IV
× 2 wk

• Adult and child:
PO/IM
15-30 mg/day × 5 days then off 1 wk; may repeat

• Adult and child:
12 mg/m
²
INTRATHECALLY
q2-5days until CSF is normal then 1 additional dose, max 15 mg

• Adult:
PO/IM/IV
0.625-2.5 mg/kg/day

• Adult and child:
IV
12 g/m
²
given over 4 hr then leucovorin rescue

• Adult:
PO
5-50 mg q wk or 15-37.5 mg twice weekly;
IV/IM
50 mg q week or 15-37.5 mg twice weekly

• Adult:
PO/IM/IV
10-25 mg/wk or 2.5 mg
PO
q12hr × 3 doses/wk, may increase to 25 mg/wk

• Adult:
IV
40-60 mg/m
²
on day 1 of every 21-28 days with other antineoplastics

• Adult/child:
IV
40 mg/m
²
on days 1 and 15, q21days alone or in combination with bleomycin, CISplatin

• Adult:
PO
25-50 mg/m
²
q7days

• Child:
PO
7.5-30 mg/m
²
q7-14days

• Adult:
PO
7.5 mg/wk or in divided doses of 2.5 mg q12hr × 3 given per wk; max 20 mg/wk

• Child:
PO/IM
10 mg/m
²
/wk

• Adult/adolescent/child:
IV
200 mg/m
²
days 8 and 15 q21days with bleomycin, cyclophosphamide, vinCRIStine, dexamethasone

• Adult:
IV
30 mg/m
²
on days 1, 15, 22 q28days in combination with vinBLAStine, DOXOrubicin, CISplatin (MVAC) regimen

• Adult:
IM
25 mg/wk;
SUBCUT
15 mg/kg/wk × 16 wk

• Adult and child:
IV
15 mg/m
²
on day 1 after transplant then 10 mg/m
²
on days 3, 6, 11

• Adult:
IM
50 mg/m
²
may be used in combination with mifepristone

• Adult:
IM
50 mg/m
²
then intravaginal misoprostol 5-7 days later

• Adult:
PO
5-7.5 mg weekly

• 
Using chemotherapeutic handling

• 
Antiemetic 30-60 min before product

• 
Allopurinol or sodium bicarbonate to maintain uric acid levels, alkalinization of urine (pH >7.5), adequate fluids

Additive compatibilities:
Cephalothin, cyclophosphamide, cytarabine, fluorouracil, hydrOXYzine, mercaptopurine, ondansetron, sodium bicarbonate, vinCRIStine

Solution compatibilities:
Amino acids, 4.25%/D
₂₅
, D
₅
W, sodium bicarbonate 0.05 mol/L, sodium chloride 0.9%

Syringe compatibilities:
Bleomycin, CISplatin, cyclophosphamide, doxapram, DOXOrubicin, fluorouracil, furosemide, heparin, leucovorin, mitoMYcin, vinBLAStine, vinCRIStine

Y-site compatibilities:
Allopurinol, amifostine, amphotericin B cholesteryl, asparaginase, aztreonam, bleomycin, cefepime, cefTRIAXone, cimetidine, CISplatin, cyclophosphamide, cytarabine, DAUNOrubicin, dexchlorpheniramine, diphenhydrAMINE, DOXOrubicin, DOXOrubicin liposome, etoposide, famotidine, filgrastim, fludarabine, fluorouracil, furosemide, gallium, ganciclovir, graniset-ron, heparin, HYDROmorphone, imipenem-cilastatin, leucovorin, LORazepam, melphalan, mesna, methylPREDNISolone, metoclopramide, mitoMYcin, morphine, ondansetron, oxacillin, PACLitaxel, piperacillin/tazobactam, prochlorperazine, ranitidine, sargramostim, teniposide, thiotepa, vinBLAStine, vinCRIStine, vinorelbine

Increase:
toxicity—salicylates, sulfa products, other antineoplastics, radiation, alcohol, probenecid, NSAIDs, phenylbutazone, theophylline, penicillins

Increase:
hypoprothrombinemia—oral anticoagulants

Increase:
hepatitis—acitretin, avoid concurrent use

Decrease:
effect of oral digoxin, vaccines, phenytoin, fosphenytoin

Decrease:
effect of methotrexate—folic acid supplements

• 
Make sure product is taken weekly in RA, JRA

Black Box Warning:

Infection:
those with active infections should be treated for infection before product use; monitor temperature, fever may indicate beginning of infection

• 
Make sure drug-drug interacting products are discontinued before therapy, and do not resume until methotrexate level is safe

 
CBC, differential, platelet count weekly; avoid use until WBC is >1500/mm
³
or platelet count is >75,000/mm
³
, neutrophils >200/mm
³
; notify prescriber; WBC, platelet nadirs occur on day 7; monitor

Black Box Warning:

Renal disease:
avoid use in renal failure, BUN, serum uric acid, urine CCr, electrolytes before, during therapy; I&O ratio; report fall in urine output to <30 ml/hr

• 
Bleeding time, coagulation time during treatment; bleeding: hematuria, guaiac, bruising, or petechiae in mucosa or orifices

• 
Effects of alopecia on body image; discuss feelings about body changes

Black Box Warning:

Pulmonary toxicity:
those with ascites or pleural effusion at greater risk for toxicity; fluid should be removed before treatment; monitor plasma methotrexate levels

Black Box Warning:

Tumor lysis syndrome:
hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, decreased urine output; use aggressive hydration, allopurinol to correct severe electrolyte imbalances, renal toxicity

Black Box Warning:

Hepatotoxicity:
jaundiced skin and sclera, dark urine, clay-colored stools, pruritus, abdominal pain, fever, diarrhea, hepatic studies before and during therapy: bilirubin, alk phos, AST, ALT; liver biopsy should be done before start of therapy (psoriasis)

• 
Monitor methotrexate levels, adjust leucovorin dose based on level

• 
Buccal cavity for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia

Black Box Warning:

Serious skin reaction:
Stevens-Johnson syndrome, exfoliate dermatitis, skin necrosis, erythema multiform may occur within days of receiving product by any route, product should be discontinued

• 
Strokelike encephalopathy:
common in high-dose therapy; assess for confusion, hemiparesis, seizures, coma; usually transient

• 
Rheumatoid arthritis:
ROM, pain, joint swelling before, during treatment

• 
Psoriasis:
skin lesions before, during treatment

• 
Increased fluid intake to 2-3 L/day to prevent urate deposits, calculi formation unless contraindicated

• 
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss

• 
Storage in tightly closed container in cool environment; store injection, powder for inj in dark, dry area

• 
Therapeutic response: decreased tumor size, spread of malignancy; decreased joint inflammation, pain in RA

Black Box Warning:

To report any complaints, side effects to nurse or prescriber: black tarry stools, chills, fever, sore throat, bleeding, bruising, cough, SOB, dark or bloody urine, seizures

• 
That hair may be lost during treatment; that wig or hairpiece may make patient feel better; that new hair may be different in color, texture (alopecia rare)

• 
To avoid foods with citric acid, hot or rough texture if stomatitis is present

• 
To report stomatitis and any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily; to report symptoms to nurse; to use good oral hygiene

Black Box Warning:

That contraceptive measures are recommended during therapy and for at least 8 wk after cessation of therapy for women and men; to discontinue breastfeeding; that toxicity to infant may occur; pregnancy (X)

• 
To drink 10-12 glasses of fluid/day

• 
To avoid alcohol, salicylates, live vaccines

• 
To avoid use of razors, commercial mouthwash

• 
To use sunblock to prevent burns

• 
To use good dental care, to prevent overgrowth of infection in the mouth

• 
How to use this product with leucovorin rescue

• 
To continue leucovorin until told it is safe to stop

• 
To report CNS symptoms, vision changes

• 
To report fever, other symptoms of infection

• 
To report decreased urine output