Mosby's 2014 Nursing Drug Reference (346 page)

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Ext rel tabs:
do not break, crush, chew tabs; take product as prescribed; do not double or skip dose

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Without regard to meals, bid; do not use with grapefruit juice

Increase:
ranolazine action—diltiazem, ketoconazole, macrolide antibiotics, dofetilide, PARoxetine, protease inhibitors, quiNIDine, sotalol, thioridazine, verapamil, ziprasidone

Increase:
action of digoxin, simvastatin

Increase:
ranolazine absorption, toxicity—antiretroviral protease inhibitors

• Do not use with grapefruit, grapefruit juice

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Angina:
characteristics of pain (intensity, location, duration, alleviating/precipitating factors)

 
QT prolongation:
ECG for QT prolongation, ejection fraction; assess for chest pain, palpitations, dyspnea

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Cardiac status: B/P, pulse, respirations

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LFTs, serum creatinine/BUN, magnesium, potassium before treatment, periodically

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Therapeutic response: decreased anginal pain

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To avoid hazardous activities until stabilized on product, dizziness no longer a problem

 
To avoid OTC drugs, grapefruit juice, products prolonging QTc (quiNIDine, dofetilide, sotalol, erythromycin, thioridazine, ziprasidone or protease inhibitors, diltiazem, ketoconazole, macrolide antibiotics, verapamil) unless directed by prescriber; to notify prescriber of palpitations, fainting

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To comply with all areas of medical regimen

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To take as directed; not to skip dose, double doses

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Not to chew or crush, not to use with grapefruit juice

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To notify all health care providers of product use

• To notify prescriber of palpitations, dizziness, edema, dyspnea

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For acute angina, take other products prescribed, this product does not decrease acute attack

• Adult:
PO
1 mg/day

• Adult:
PO
0.5 mg/day, may increase 1 mg/day; change of levodopa dose for adjunct therapy; reduced levodopa dose may be needed

• Adult:
PO
0.5 mg for mild hepatic disease

• Adult:
PO
0.5 mg; plasma concentrations of rasagiline may double

 
With meals to prevent nausea; continuing therapy usually reduces or eliminates nausea; do not give with foods/liquids containing large amounts of tyramine

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Reduced dose of carbidopa/levodopa cautiously

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Renal failure: in dialysis, increase dose slowly

Increase:
levels of rasagiline up to 2-fold—ciprofloxacin, CYP1A2 inhibitors (atazanavir, mexiletine, taurine)

Increase:
severe CNS toxicity with antidepressants (tricyclics, SSRIs, SNRIs, mirtazapine, cyclobenzaprine)

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Do not give with St. John’s wort, yohimbe

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Do not give with foods/liquids that have large amounts of tyramine

Increase:
LFTs

Decrease:
WBCs

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Parkinson’s symptoms:
tremor, ataxia, muscle weakness and rigidity at
baseline, periodically; increased dyskinesia, postural hypotension if used in combination with levodopa

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Mental status: hallucinations, confusion, notify prescriber

 
Hypertensive crisis:
severe headache, blurred vision, seizures, chest pain, difficulty thinking, nausea, vomiting, signs of stroke; any unexplained severe headache should be considered to be hypertensive crisis

 
Melanomas;
periodic skin exams by a dermatologist

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Cardiac status: B/P, ECG periodically during beginning treatment

 
Tyramine products:
foods, other medications may lead to hypertensive crisis (tachycardia, bradycardia, chest pain, nausea, vomiting, sweating, dilated pupils)

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Therapeutic response: improved symptoms in patients with Parkinson’s disease

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To change positions slowly to prevent orthostatic hypotension

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To avoid hazardous activities until stabilized on product; that dizziness can occur

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To rinse mouth frequently; to use sugarless gum to alleviate dry mouth

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To take as prescribed; not to miss dose or double doses; to take missed dose as soon as remembered if several hours before next dose

 
To prevent hypertensive crisis by avoiding high-tyramine foods (>150 mg)

• To report signs of hypertensive crisis

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To avoid CNS depressants, alcohol

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To notify all providers of product use; to avoid elective surgery, other procedures involving CNS depressants