Mosby's 2014 Nursing Drug Reference (265 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
See
Appendix B
(met-oh-kloe-pra′mide)
Apo-Metoclop
, Metozolv ODT, Reglan
Func. class.:
Cholinergic, antiemetic
Chem. class.:
Central dopamine receptor antagonist
Do not confuse:
metoclopramide
/metolazone
Reglan
/Megace/Renagel
Enhances response to acetylcholine of tissue in upper GI tract, which causes the contraction of gastric muscle; relaxes pyloric, duodenal segments; increases peristalsis without stimulating secretions; blocks dopamine in chemoreceptor trigger zone of CNS
Prevention of nausea, vomiting induced by chemotherapy, radiation, delayed gastric emptying, gastroesophageal reflux
Unlabeled uses:
Hiccups, migraines, breastfeeding induction, lung cancer
Hypersensitivity to this product, procaine, or procainamide; seizure disorder, pheochromocytoma, breast cancer (prolactin dependent), GI obstruction
Precautions:
Pregnancy (B), breastfeeding, GI hemorrhage, CHF, Parkinson’s disease
Black Box Warning:
Tardive dyskinesia
Calculator
• Adult:
IV
1-2 mg/kg 30 min before administration of chemotherapy, then q2hr × 2 doses, then q3hr × 3 doses
• Child (unlabeled):
IV
1-2 mg/kg/dose
• Adult and child >14 yr:
IV
10 mg over 1-2 min
• Child <6 yr:
IV
0.1 mg/kg
• Child 6-14 yr:
IV
2.5-5 mg
• Adult:
PO
10 mg 30 min before meals, at bedtime × 2-8 wk
• Geriatric:
PO
5 mg 30 min before meals, at bedtime, increase to 10 mg if needed
• Adult:
PO
10-15 mg qid 30 min before meals and at bedtime
• Child:
PO
0.4-0.8 mg/kg/day in 4 divided doses
• Adult:
CCr <40 ml/min 50% of dose
• Adult:
PO
10 mg bid-tid, may increase to 20-45 mg/day in divided doses
• Adult:
IV
(Sensamide IV) 2 mg/kg given 1 hr prior to radiation therapy 3×/wk
• Adult:
PO/IM/IV
10 mg q6hr
Available forms:
Tabs 5, 10 mg; syr 5 mg/5 ml; inj 5 mg/ml; conc sol 10 mg/ml; orally disintegrating tab 5, 10 mg
•
1/2-1 hr before meals for better absorption
•
Gum, hard candy, frequent rinsing of mouth for dry oral cavity
•
Oral disintegrating:
place on tongue, allow to dissolve, swallow, remove from bottle immediately before use
•
Give for post-operative nausea, vomiting prior to end of surgery
•
DiphenhydrAMINE IV or benztropine IM for EPS
•
Undiluted if dose ≤10 mg; give over 2 min
•
>10 mg may be diluted in ≥50 ml D
5
W, NaCl, Ringer’s, LR, given over ≥15 min
Y-site compatibilities:
Alfentanil, amifostine, amikacin, aminophylline, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxapram, DOXOrubicin hydrochloride, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, folic acid, foscarnet, gallium nitrate, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, metaraminol, methadone, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoprolol, metroNIDAZOLE, miconazole, midazolam, milrinone, minocycline, mitoMYcin, morphine, moxalactam, multiple vitamins, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pantoprazole, papaverine, PEMEtrexed, penicillin G, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quinupristin/dalfopristin, ranitidine, remi-fentanil, riTUXimab, rocuronium, sargramostim, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, topotecan, trastuzumab, trimethaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine
CNS:
Sedation, fatigue, restlessness, headache, sleeplessness, dystonia
, dizziness, drowsiness,
suicidal ideation, seizures,
EPS,
neuroleptic malignant syndrome; tardive dyskinesia (>3 mo, high doses)
CV:
Hypotension, supraventricular tachycardia
GI:
Dry mouth, constipation, nausea, anorexia, vomiting, diarrhea
GU:
Decreased libido, prolactin secretion, amenorrhea, galactorrhea
HEMA:
Neutropenia, leukopenia, agranulocytosis
INTEG:
Urticaria, rash
Metabolized by liver, excreted in urine, half-life 4 hr
PO:
Onset 1/2-1 hr, duration 1-2 hr
IM:
Onset 10-15 min, duration 1-2 hr
IV:
Onset 1-3 min, duration 1-2 hr
•
Avoid use with MAOIs
Increase:
sedation—alcohol, other CNS depressants
Increase:
risk for EPS—haloperidol, phenothiazines
Decrease:
action of metoclopramide—anticholinergics, opiates
Increase:
prolactin, aldosterone, thyrotropin
Black Box Warning:
EPS, tardive dyskinesia; more likely to occur in treatment >3 mo, geriatric patients and may be irreversible; assess for involuntary movements often
•
Neuroleptic malignant syndrome:
hyperthermia, change in B/P, pulse, tachycardia, sweating, rigidity, altered consciousness (rare)
•
Mental status: depression, anxiety, irritability
•
GI complaints: nausea, vomiting, anorexia, constipation
•
Protect from light with aluminum foil during inf
•
Discard open ampules
•
Therapeutic response: absence of nausea, vomiting, anorexia, fullness
•
To avoid driving, other hazardous activities until stabilized on product
•
To avoid alcohol, other CNS depressants that will enhance sedating properties of this product
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(me-tole′a-zone)
Zaroxolyn
Func. class.:
Diuretic, antihypertensive
Chem. class.:
Thiazide-like quinazoline derivative
Do not confuse:
metolazone
/methotrexate/metoclopramide
Acts on distal tubule by increasing excretion of water, sodium, chloride, potassium, magnesium, bicarbonate
Edema, hypertension
Unlabeled uses:
Heart failure, nephrotic syndrome
Hypersensitivity to thiazides, sulfonamides; anuria, coma
Black Box Warning:
Hepatic encephalopathy
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, hypokalemia, renal/hepatic disease, gout, COPD, lupus erythematosus, diabetes mellitus, hypotension, history of pancreatitis; hypersensitivity to sulfonamides, thiazides; electrolyte imbalance
Calculator
• Adult:
PO
5-10 mg/day; max 20 mg/day
• Adult:
PO
2.5-5 mg/day
Available forms:
Tabs 2.5, 5, 10 mg
•
In
AM
to avoid interference with sleep if using product as diuretic
•
Potassium replacement if potassium <3 mg/dl
•
With food if nausea occurs; absorption may be decreased slightly
CNS:
Anxiety, depression,
headache, dizziness, fatigue, weakness
CV:
Orthostatic hypotension, palpitations, volume depletion, hypotension, chest pain
EENT:
Blurred vision
ELECT:
Hypokalemia
, hypercalcemia, hyponatremia
GI:
Nausea, vomiting, anorexia
, constipation, diarrhea, cramps, pancreatitis, GI irritation, dry mouth, jaundice
GU:
Urinary frequency
, polyuria,
uremia, glucosuria,
nocturia, impotence
HEMA:
Aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis, neutropenia
INTEG:
Rash
, urticaria, purpura, photosensitivity, fever, dry skin
META:
Hyperglycemia
, increased creatinine, BUN
MS:
Muscle cramps, joint pain, swelling
Onset 1 hr, peak 2 hr, duration 12-24 hr, excreted unchanged by kidneys, crosses placenta, enters breast milk, half-life 14 hr
Increase:
hypokalemia—mezlocillin, piperacillin, amphotericin B, glucocorticoids, digoxin, stimulant laxatives
Increase:
hypotension—alcohol (large amounts), nitrates, antihypertensives, barbiturates, opioids
Increase:
toxicity—lithium
Increase:
metolazone effects—loop diuretics
Decrease:
action of metolazone—NSAIDs, salicylates
•
Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily
•
CHF:
improvement in edema of feet, legs, sacral area daily if product being used
•
Hypertension:
B/P lying, standing; postural hypotension may occur
•
Electrolytes: potassium, magnesium, sodium, chloride; include BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid, calcium
•
Hypokalemia:
postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness
•
Rashes, fever daily
•
Confusion, especially among geriatric patients; take safety precautions if needed
Black Box Warning:
Hepatic encephalopathy:
do not use in hepatic coma or precoma; fluctuations in electrolytes can occur rapidly and precipitate hepatic coma; use caution in patients with im-paired hepatic function
•
Therapeutic response: decreased edema, B/P
•
To increase fluid intake to 2-3 L/day unless contraindicated; to rise slowly from lying or sitting position
•
To notify prescriber of muscle weakness, cramps, nausea, dizziness
•
That product may be taken with food or milk
•
To use sunscreen for photosensitivity
•
That blood glucose may be increased in diabetics
•
To take early in day to avoid nocturia
•
To avoid alcohol
•
To avoid sodium foods, to increase potassium foods in diet
Lavage if taken orally; monitor electrolytes; administer dextrose in saline; monitor hydration, CV, renal status