Mosby's 2014 Nursing Drug Reference (293 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(nye-troe-gli′ser-in)
Nitro-Time
Nitro-Bid
Rectiv
Nitrostat
Nitrolingual
Minitran, Nitro-Dur
Func. class.:
Coronary vasodilator, antianginal
Chem. class.:
Nitrate
Do not confuse:
Nitro-Bid
/Nicobid
Decreases preload and afterload, which are responsible for decreasing left ventricular end-diastolic pressure, systemic vascular resistance; dilates coronary arteries, improves blood flow through coronary vasculature, dilates arterial and venous beds systemically
Chronic stable angina pectoris, prophylaxis of angina pain, CHF, acute MI, controlled hypotension for surgical procedures, anal fissures
Unlabeled uses:
Pulmonary hypertension, hemorrhoids, retained placenta
Hypersensitivity to this product or nitrites; severe anemia, increased intracranial pressure, cerebral hemorrhage, closed-angle glaucoma, cardiac tamponade, cardiomyopathy, constrictive pericarditis
Precautions:
Pregnancy (C), breastfeeding, children, postural hypotension, severe renal/hepatic disease, acute MI, abrupt discontinuation, hyperthyroidism
Calculator
• Adult:
SL
Dissolve tab under tongue when pain begins; may repeat q5min until relief occurs; take ≤3 tabs/15 min; use 1 tab prophylactically 5-10 min before activities;
SUS CAP
q6-12hr on empty stomach;
TOP
1-2 in q8hr, increase to 4 in q4hr as needed;
IV
5 mcg/min then increase by 5 mcg/min q3-5min; if no response after 20 mcg/min, increase by 10-20 mcg/min until desired response;
TRANS PATCH
apply a pad daily to a site free of hair; remove patch at bedtime to provide 10-12 hr nitrate-free interval to avoid tolerance
• Child:
IV
Initially 0.25-0.5 mcg/kg/min, titrate to patient response, usual dose 1-3 mcg/kg/min transmucosal
• Adult:
Rectal
Apply 1 inch of 0.4% ointment q12hr × 3 wk
Available forms:
Translingual aero 0.4 mg/metered spray; sus rel tabs 2.6, 6.5, 9 mg; SL tabs 0.3, 0.4, 0.6 mg; topical oint 2%; trans syst 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr; inj sol 25 mg/250 ml, 50 mg/250 ml, 50 mg/500 ml, 100 mg/250 ml, 200 mg/500 ml; rectal ointment 0.4% (Rectiv)
•
Topical ointment
should be measured on papers supplied, use paper to spread on nonhairy area of chest, abdomen, thigh skin; thin layer spread over 2-3 inches, do not rub
•
Swallow sus rel products whole; do not break, crush, or chew
•
With 8 oz water on empty stomach (oral tablet) 1 hr before or 2 hr after meals
•
SL:
should be dissolved under tongue, not swallowed
•
Aerosol
sprayed under tongue
(nitrolingual),
not inhaled; prime before
1st-time use or if product has not been used in >6 wk; press valve head with forefinger
•
Apply new TD patch daily, remove after 12-14 hr to prevent tolerance
•
Cover finger with plastic wrap, disposable glove, or finger cot; lay finger alongside 1-inch dosing line on carton, squeeze tube until equal to 1-inch dosing line; insert covered finger gently into anal canal no further than 1st finger joint and apply to sides; wash hands thoroughly; if too painful, apply directly to outside of anus
•
Diluted in D
5
, D
5
W, 0.9% NaCl for inf to 200-400 mcg/ml, depending on patient’s fluid status; common dilution 50 mg/250 ml, use controlled inf device; use glass inf bottles, non–polyvinyl-chloride inf tubing; titrate to patient response; do not use filters
Y-site compatibilities:
Acyclovir, alfen-tanil, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atenolol, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cloNIDine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, drotrecogin alfa, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, mezlocillin, micafungin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, mycophenolate, nafcillin, nalbuphine, naloxone, nesiri-tide, netilmicin, niCARdipine, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, ritodrine, rocuronium, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, warfarin, zoledronic acid
CNS:
Headache, flushing, dizziness
CV:
Postural hypotension
, tachycardia,
collapse,
syncope, palpitations
GI:
Nausea, vomiting
INTEG:
Pallor, sweating, rash
Metabolized by liver, excreted in urine, half-life 1-4 min
SUS REL:
Onset 20-45 min, duration 3-8 hr
SL:
Onset 1-3 min, duration 30 min
TRANSDERMAL:
Onset 30 min-1 hr, duration 12-24 hr
AEROSOL:
Onset 2 min, duration 30-60 min
TOPICAL OINT:
Onset 30-60 min, duration 2-12 hr
IV:
Onset 1-2 min, duration 3-5 min
•
Severe hypotension, CV collapse: alcohol
Increase:
effects of β-blockers, diuretics, antihypertensives, calcium channel blockers
Increase:
fatal hypotension—sildenafil, tadalafil, vardenafil; do not use together
Increase:
nitrate level—aspirin
Decrease:
heparin—IV nitroglycerin
Increase:
urine catecholamine, urine VMA
False increase:
cholesterol
•
Pain:
duration, time started, activity being performed, character
•
Orthostatic B/P, pulse prior to and after administration
•
Tolerance if taken over long period
•
Headache, lightheadedness, decreased B/P; may indicate a need for decreased dosage
•
Therapeutic response: decrease, prevention of anginal pain
•
To place buccal tab between lip and gum above incisors or between cheek and gum
•
To keep tabs in original container; to replace q6mo because effectiveness is lost; to keep away from heat, moisture, light
•
That if 3 SL tabs in 15 min do not relieve pain, to seek immediate medical attention
•
To avoid alcohol
•
That product may cause headache; that tolerance usually develops; to use nonopioid analgesic
•
That product may be taken before stressful activity: exercise, sexual activity
•
That SL may sting when product comes in contact with mucous membranes
•
To avoid hazardous activities if dizziness occurs
•
To comply with complete medical regimen
•
To make position changes slowly to prevent fainting
Never to use erectile dysfunction products (sildenafil, tadalafil, vardenafil); may cause severe hypotension, death
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert