Mosby's 2014 Nursing Drug Reference (327 page)

BOOK: Mosby's 2014 Nursing Drug Reference
10.47Mb size Format: txt, pdf, ePub

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

pravastatin (Rx)

(pra′va-sta-tin)

Pravachol

Func. class.:
Antilipemic

Chem. class.:
HMG-CoA reductase enzyme

Do not confuse:
Pravachol
/Prevacid/propranolol

ACTION:

Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis

USES:

As an adjunct for primary hypercholesterolemia (types IIa, IIb, III, IV), to reduce the risk for recurrent MI, atherosclerosis, primary/secondary CV events, stroke, TIAs

CONTRAINDICATIONS:

Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease

Precautions:
Past hepatic disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances

DOSAGE AND ROUTES
Calculator

• Adult:
PO
40 mg/day at bedtime (range 10-80 mg/day); start at 10 mg/day if patient also taking immunosuppressants

• Adolescent 14-18 yr:
PO
40 mg/day

• Child 8-13 yr:
PO
20 mg/day

• Geriatric/renal/hepatic disease:
PO
10 mg/day initially

Renal dose

• Adult:
PO
10-20 mg daily at bedtime, increase at 4-wk intervals

Available forms:
Tabs 10, 20, 40, 80 mg

Administer:

• 
Without regard to meals, at bedtime

• 
Give 4 hr after bile acid sequestrants

SIDE EFFECTS

CNS:
Headache, dizziness, fatigue

CV:
Chest pain

EENT:
Lens opacities

GI:
Nausea, constipation, diarrhea, flatus, abdominal pain, heartburn,
hepatic dysfunction,
pancreatitis,
hepatitis

GU:
Renal failure (myoglobinuria)

INTEG:
Rash, pruritus

MS:
Muscle cramps, myalgia,
myositis, rhabdomyolysis

RESP:
Common cold, rhinitis, cough

PHARMACOKINETICS

Peak 1-1½ hr; metabolized by liver; protein binding 50%; excreted in urine 20%, feces 70%, breast milk; crosses placenta; half-life 1.25-2.25 hr

INTERACTIONS

Increase:
myopathy, rhabdomyolysis risk—erythromycin, niacin, cycloSPORINE, gemfibrozil, clofibrate, clarithromycin, itraconazole, protease inhibitors

Decrease:
bioavailability of pravastatin —bile acid sequestrants

Drug/Herb

Increase:
adverse reactions—red yeast rice

Increase:
hepatotoxicity—eucalyptus

Decrease:
effect—St. John’s wort

Drug/Lab Test

Increase:
CK, LFTs

Altered:
thyroid function tests

NURSING CONSIDERATIONS
Assess:

• 
Fasting lipid profile: LDL, HDL, triglycerides, cholesterol at baseline, q12wk, then q6mo when stable; obtain diet history

• 
Hepatic studies: baseline, q12wk, then q6mo for remainder of yr; AST, ALT, LFTs may increase

• 
Renal studies of patients with compromised renal systems: BUN, I&O ratio, creatinine

 
Rhabdomyolysis:
muscle tenderness, pain; obtain CPK at baseline and if these occur, therapy should be discontinued

Perform/provide:

• 
Storage in cool environment in tight container protected from light

Evaluate:

• 
Therapeutic response: decrease in LDL total cholesterol, triglycerides; increase in HDL

Teach patient/family:

• 
That blood work will be necessary during treatment

 
To report blurred vision, severe GI symptoms, dizziness, headache, muscle pain, weakness, fever

• That regimen will continue: low-cholesterol diet, exercise program

 
To report suspected, planned pregnancy; not to use product during pregnancy, pregnancy category (X); not to breastfeed

• 
Hepatic disease:
to notify prescriber of lack of appetite, yellow sclera/skin, dark urine, abdominal pain, weakness

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

prazosin (Rx)

(pray′zoe-sin)

Minipress

Func. class.:
Antihypertensive

Chem. class.:
α
1
-Adrenergic blocker, peripheral

ACTION:

Blocks α-mediated vasoconstriction of adrenergic receptors, thereby inducing peripheral vasodilation

USES:

Hypertension

Unlabeled uses:
Benign prostatic hypertrophy to decrease urine outflow obstruction, heart failure, hypertensive urgency, Raynaud’s phenomenon, posttraumatic stress disorder (PTSD)

CONTRAINDICATIONS:

Hypersensitivity

Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal/hepatic disease, prostate cancer, ocular surgery, orthostatic hypotension

DOSAGE AND ROUTES
Calculator
Hypertension

• Adult:
PO
1 mg bid or tid increasing to 20 mg/day in divided doses, if required; usual range 6-15 mg/day, max 1 mg initially; max 20 mg/day, some may require 40 mg/day

• Child (unlabeled):
PO
5 mcg/kg q6hr; max 400 mcg/kg/day or 15 mg/day

Benign prostatic hyperplasia (unlabeled)

• Adult:
PO
2 mg bid

Raynaud’s phenomenon (unlabeled)

• Adult:
PO
0.5-3 mg bid

CHF (unlabeled)

• Adult:
PO
1 mg bid-tid, may gradually increase to max 20 mg/day

• Child:
PO
5 mcg/kg q6hr, may gradually increase to 25 mcg/kg q6hr

Hypertensive urgency (unlabeled)

• Adult:
PO
10-20 mg, may repeat after 30 min

Available forms:
Caps 1, 2, 5 mg

Administer:

• 
1st dose at bedtime to avoid fainting

• 
Without regard to meals

• 
Store at room temperature

SIDE EFFECTS

CNS:
Dizziness, headache, drowsiness
, anxiety, depression, vertigo,
weakness
, fatigue

CV:
Palpitations
, orthostatic hypotension, tachycardia, edema, rebound hypertension

EENT:
Blurred vision, epistaxis, tinnitus, dry mouth, red sclera

GI:
Nausea
, vomiting, diarrhea, constipation, abdominal pain

GU:
Urinary frequency, incontinence, impotence, priapism; water, sodium retention

PHARMACOKINETICS

Onset 2 hr, peak 2-4 hr, duration 6-12 hr, half-life 2-4 hr; metabolized in liver, excreted via bile, feces (>90%), urine (<10%); protein binding 97%

INTERACTIONS

Increase:
hypotensive effects—β-blockers, nitroglycerin, alcohol, phosphodiesterase inhibitors (vardenafil, tadalafil, sildenafil); diuretics, other antihypertensives, MAOIs

Decrease:
antihypertensive effect—NSAIDs

Increase:
antihypertensive effect—hawthorn

Drug/Lab Test

Increase:
urinary norepinephrine, VMA

NURSING CONSIDERATIONS
Assess:

• 
Hypertension/CHF:
B/P (sitting, standing) during initial treatment, periodically thereafter; pulse, jugular venous distention

• 
BUN, uric acid if patient receiving long-term therapy

• 
Weight daily, I&O; edema in feet, legs daily

• 
Benign prostatic hypertrophy (unlabeled):
urinary patterns, frequency, stream, dribbling; flow before, during, and after therapy

Evaluate:

• 
Therapeutic response: decreased B/P

Teach patient/family:

• 
That fainting occasionally occurs after 1st dose; to take 1st dose at bedtime; not to drive or operate machinery for 4 hr after 1st dose; that full effect may take 4-6 wk

• 
To change positions slowly to prevent orthostatic hypotension

• 
To avoid OTC medications unless approved by prescriber

TREATMENT OF OVERDOSE:

Administer volume expanders or vasopressors, discontinue product, place patient in supine position

Other books

Imola by Richard Satterlie
Unmarked by Kami Garcia
Hunter Moon (The Moon Series) by Battista, Jeanette
The Fire Chronicle by John Stephens
Out of the Dark by David Weber
Nikolski by Nicolas Dickner
Centaur Rising by Jane Yolen
HF - 03 - The Devil's Own by Christopher Nicole