Mosby's 2014 Nursing Drug Reference (310 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

HIGH ALERT
pancuronium (Rx)

(pan-kyoo-roe′nee-um)

Func. class.:
Neuromuscular blocker (nondepolarizing)

Chem. class.:
Synthetic curariform

ACTION:

Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine

USES:

Facilitation of endotracheal intubation, skeletal muscle relaxation during mechanical ventilation, surgery, or general anesthesia

CONTRAINDICATIONS:

Hypersensitivity to bromide ion

Precautions:
Pregnancy (C), breastfeeding, children <2 yr, neuromuscular/ cardiac/renal/hepatic disease, electrolyte imbalances, dehydration, previous anaphylactic reactions (other neuromuscular blockers)

 

Black Box Warning:

Respiratory insufficiency

DOSAGE AND ROUTES
Calculator

• Adult/child/infant
>
1 mo:
IV
0.04-0.1 mg/kg initially or 0.05 mg/kg after initial dose of succinylcholine; maintenance 0.01 mg/kg 60-100 min after initial dose then 0.01 mg/kg q25-60min as needed; for obese patients, use ideal body weight

• Neonate
<
1 mo:
IV
Test dose 0.02 mg/kg then 0.03 mg/kg/dose initially, repeat 2× as needed at 5-10 min intervals; maintenance 0.03-0.09 mg/kg/dose q30min-4 hr as needed

Available forms:
Inj 1, 2 mg/ml

Administer:
Direct IV route

• 
May be given undiluted over 1-2 min (1 mg/ml [10-ml vial], 2 mg/ml [2-, 5-ml vial])

Intermittent IV INF route

• 
Add 100 mg of product to 250 ml D
5
W, NS, LR (0.4 mg/ml)

Additive compatibilities:
Verapamil, ciprofloxacin

Y-site compatibilities:
Aminophylline, ceFAZolin, cefuroxime, cimetidine, DOBUTamine, DOPamine, EPINEPHrine, esmolol, fenoldopam, fentaNYL, fluconazole, gentamicin, heparin, hydrocortisone, isoproterenol, levofloxacin, LORazepam, midazolam, morphine, nitroglycerin, ranitidine, trimethoprim-sulfamethoxazole, vancomycin

SIDE EFFECTS

CV:
Bradycardia; tachycardia; increased, decreased B/P; ventricular extrasystoles, edema, hypertension

EENT:
Increased secretions

INTEG:
Rash, flushing, pruritus, urticaria, sweating, salivation

MS:
Weakness to prolonged skeletal muscle relaxation

RESP:
Prolonged apnea, bronchospasm, cyanosis, respiratory depression,
dyspnea

SYST:
Anaphylaxis

PHARMACOKINETICS

IV:
Onset 3-5 min, dose dependent, peak 3-5 min; metabolized (small amounts), excreted in urine (unchanged), crosses placenta

INTERACTIONS

• 
Dysrhythmias: theophylline

Increase:
neuromuscular blockade—aminoglycosides, clindamycin, enflurane, isoflurane, lincomycin, lithium, local anesthetics, opioid analgesics, polymyxin antiinfectives, quiNIDine, thiazides

Drug/Lab Test

Decrease:
cholinesterase

NURSING CONSIDERATIONS
Assess:

• 
Respiratory recovery:
decreased paralysis of face, diaphragm, leg, arm, rest of body; allow to recover fully before neurologic assessment

• 
Electrolyte imbalances (K, Mg); may lead to increased action of product

• 
VS (B/P, pulse, respirations, airway) until fully recovered; rate, depth, pattern of respirations, strength of hand grip

• 
I&O ratio; check for urinary retention, frequency, hesitancy

 
Allergic reactions, anaphylaxis:
rash, fever, respiratory distress, pruritus; product should be discontinued

Perform/provide:

• 
Storage in refrigerator; do not store in plastic; use only fresh sol

• 
Reassurance if communication is difficult during recovery from neuromuscular blockade

• 
Frequent (q2hr) instillation of artificial tears, covering of eyes to prevent drying of cornea

Evaluate:

• 
Therapeutic response: paralysis of jaw, eyelid, head, neck, rest of body

TREATMENT OF OVERDOSE:

Neostigmine, atropine, monitor VS; may require mechanical ventilation

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

panitumumab (Rx)

(pan-i-tue′moo-mab)

Vectibix

Func. class.:
Antineoplastic—miscellaneous

Chem. class.:
Multikinase inhibitor, signal transduction inhibitor

ACTION:

Decreases growth and survival of cancer cells by competitive inhibition of EGF receptor

USES:

EGFR expressing metastatic colorectal cancer; not beneficial with KRAS mutations in codon 12 or 13

CONTRAINDICATIONS:

Hypersensitivity

Precautions:
Pregnancy (C), breastfeeding, children, hepatic disease, acute bronchospasm, diarrhea, hamster protein allergy, hypomagnesemia, hypotension, pulmonary fibrosis, sepsis, KRAS mutations

 

Black Box Warning:

Exfoliative dermatitis, infusion-related reactions

DOSAGE AND ROUTES
Calculator

• Adult:
IV INF
6 mg/kg over 60 min every 2 wk; doses >1000 mg over 90 min

Available forms:
Sol for inj 20 mg/ml (100 mg/5 ml, 400 mg/20 ml)

Administer:
Intermittent IV INF route

• 
Give in hospital or clinic setting with full resuscitation equipment

• 
Only as IV inf using controlled IV inf pump; do not give IV push or bolus; use low-protein binding 0.2- or 0.22-micron in-line filter; flush line with 0.9% NaCl before and after administration

• 
Give over 60 min through a peripheral line or indwelling catheter; infuse doses of >1000 mg over 90 min

• 
Dilute in 100 ml of 0.9% NaCl; dilute doses >1000 mg in 150 ml of 0.9%
NaCl; mix by inverting; do not exceed 10 mg/ml; use within 6 hr if stored at room temp; can be stored between 2° C and 8° C for up to 24 hr

• 
Dosage adjustment for infusion/dermatologic reaction

• 
Grade 1 or 2: reduce infusion by 50%; Grade 3 or 4: terminate, permanently discontinue depending on severity/resistance

SIDE EFFECTS

CNS:
Fatigue

CV:
Peripheral edema

EENT:
Ocular irritation,
ocular toxicity

GI:
Nausea, diarrhea, vomiting
, anorexia, mouth ulceration, abdominal pain, constipation

HEMA:
Thrombophlebitis

INTEG:
Rash
, pruritus,
exfoliative dermatitis,
skin fissure,
angioedema, severe/fatal INF reactions

META:
Hypocalcemia, hypomagnesemia, antibody formation

RESP:
Bronchospasm, cough,
dyspnea,
hypoxia, pulmonary fibrosis/embolism,
pneumonitis, wheezing, interstitial lung disease

PHARMACOKINETICS

Bioavailability 38%-49%; elimination half-life 7.5 days; peak 3 hr; high-fat meal decreases bioavailability; plasma protein binding 99.5%; metabolized in liver; oxidative metabolism by CYP3A4, glucuronidation by UGT1A9; 77% excreted in feces

INTERACTIONS

• 
Do not use in combination with other antineoplastics

NURSING CONSIDERATIONS
Assess:

 

Black Box Warning:

Serious skin disorders:
fever, sore throat, fatigue, then lesions in mouth, lips; withhold product, notify prescriber

• 
Serum electrolytes periodically (calcium, magnesium)

• 
Infection:
increased temp

 

Black Box Warning:

Inf reactions:
bronchospasm, fever, chills, hypotension; may require discontinuation, have emergency equipment available

• 
Ocular toxicity:
ocular irritation, hyperemia

• 
Pulmonary fibrosis:
dyspnea, cough, wheezing; may require discontinuation

Perform/provide:

• 
Storage of unopened vials in refrigerator; do not shake; protect from direct sunlight; do not freeze

Evaluate:

• 
Therapeutic response: decrease in colon carcinoma progression

Teach patient/family:

 
To report adverse reactions immediately: difficulty breathing, mouth sores, skin rash, ocular toxicity

• 
About reason for treatment, expected results, adverse reactions

• 
To use contraception while taking product, for 6 mo after treatment; not to breastfeed for ≥2 mo after stopping treatment

• 
To avoid the sun, use sunscreen while taking product

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