Mosby's 2014 Nursing Drug Reference (348 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Inhibits ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus
In combination with other products for general anesthesia to provide analgesia
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children <12 yr, geriatric patients, increased intracranial pressure, acute MI, severe heart disease, GI/renal/hepatic disease, asthma, respiratory conditions, seizures disorders, bradyarrhythmias
Calculator
• Adult:
Induction
IV
0.5-1 mcg/kg/min with hypnotic or volative agent; maintenance with isoflurane (0.4-1.5 MAC) or propofol (100-200 mcg/kg/min);
CONT INF
0.25-0.4 mcg/kg/min
• Child 1-12 yr:
CONT IV INF
0.25 mcg/kg/min with isoflurane
• Full-term neonate and infant up to 2 mo:
CONT IV INF
0.4 mcg/kg/min with nitrous oxide
Available forms:
Powder for inj lyophilized 1, 2, 5 mg
•
Add 1 ml diluent per mg remifentanil
•
Shake well; further dilute to a final concentration of 20, 25, 50 or 250 mcg/mg
•
Interruption of inf results in rapid reversal (no residual opioid effect within 5-10 min)
•
To be used only during maintenance of general anesthesia; inject into tubing close to venous cannula; give to nonintubated patients over 30-60 sec
•
Use inf device, max 16 hr; do not use same tubing as blood, do not admix
Y-site compatibilities:
Acyclovir, alfentanil, amikacin, aminophylline, ampicillin, ampicillin/sulbactam, aztreonam, bumetanide, buprenorphine, butorphanol, calcium gluconate, ceFAZolin, cefepine, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, ciprofloxacin, cisatracurium, clindamycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOPamine, doxacurium, doxycycline, droperidol, enalaprilat, EPINEPHrine, esmolol, famotidine, fentaNYL, fluconazole, furosemide, ganciclovir, gatifloxacin, gentamicin, haloperidol, heparin, hydrocortisone sodium succinate, HYDROmorphone, hydrOXYzine, imipenem-cilastatin, inamrinone, isoproterenol, ketorolac, lidocaine, LORazepam, magnesium sulfate, mannitol, meperidine, methylPREDNISolone sodium succinate, metoclopramide, metroNIDAZOLE, midazolam, morphine, nalbuphine, nitroglycerin, norepinephrine, ondansetron, phenylephrine, piperacillin, potassium chloride, procainamide, prochlorperazine, promethazine, ranitidine, SUFentanil, theophylline, thiopental, ticarcillin/clavulanale, tobramycin, vancomycin, zidovudine
Solution compatibilities:
D
5
, 0.45% NaCl, LR, D
5
LR, 0.9% NaCl
CNS:
Drowsiness,
dizziness
, confusion,
headache
, sedation, euphoria, delirium, agitation, anxiety
CV:
Palpitations,
bradycardia
, change in B/P, facial flushing, syncope,
asystole
EENT:
Tinnitus, blurred vision, miosis, diplopia
GI:
Nausea, vomiting
, anorexia, constipation, cramps, dry mouth
GU:
Urinary retention, dysuria
INTEG:
Rash, urticaria, bruising, flushing, diaphoresis, pruritus
MS:
Rigidity
RESP:
Respiratory depression, apnea
70% protein binding, terminal half-life 3-10 min, excreted in urine; onset: 1-3 min
Increase:
respiratory depression, hypotension, profound sedation: alcohol, sedatives, hypnotics, other CNS depressants; antihistamines, phenothiazines, MAOIs
Increase:
CNS depression—kava
•
I&O ratio; check for decreasing output; may indicate urinary retention, especially in geriatric patients
•
CNS changes; dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
GI status: nausea, vomiting, anorexia, constipation
•
Allergic reactions: rash, urticaria
•
Respiratory dysfunction:
respiratory depression, character, rate, rhythm; notify prescriber if respirations <12/min; CV status; bradycardia, syncope
•
Storage in light-resistant area at room temp
•
Therapeutic response: maintenance of anesthesia
•
To call for assistance when ambulating or smoking; that drowsiness, dizziness may occur
•
To make position changes slowly to prevent orthostatic hypotension
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(re-pag′lih′nide)
Gluconorm
, Prandin
Func. class.:
Antidiabetic
Chem. class.:
Meglitinide
Causes functioning β-cells in pancreas to release insulin, thereby leading to a drop in blood glucose levels; closes ATP-dependent potassium channels in the β-cell membrane; this leads to the opening of calcium channels; increased calcium influx induces insulin secretion
Type 2 diabetes mellitus
Hypersensitivity to meglitinides; diabetic ketoacidosis, type 1 diabetes
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, thyroid/cardiac disease, severe renal/hepatic disease, severe hypoglycemic reactions
Calculator
• Adult:
PO
1-2 mg with each meal, max 16 mg/day; adjust at weekly intervals; oral-hypoglycemic–naive patients or patients with A1c <8% should start with 0.5 mg with each meal
• Adult:
PO
CCr 20-39 ml/min, 0.5 mg/day; titrate upward cautiously
Available forms:
Tabs 0.5, 1, 2 mg
•
Up to 15-30 min before meals; 2, 3, or 4×/day preprandially
•
Skip dose if meal skipped; add dose if meal added
CNS:
Headache, weakness
, paresthesia
ENDO:
Hypoglycemia
GI:
Nausea, vomiting, diarrhea, constipation, dyspepsia
INTEG:
Rash, allergic reactions
MISC:
Chest pain, UTI, allergy
MS:
Back pains, arthralgia
RESP:
URI, sinusitis, rhinitis, bronchitis
Completely absorbed by GI route; onset 30 min; peak 1 hr; duration <4 hr; half-life 1 hr; metabolized in liver; excreted in urine, feces (metabolites); crosses placenta; 98% protein bound
Do not use with gemfibrozil
Increase:
repaglinide effect—CYP3A4, OATP101, CYP2C9 inhibitors
Increase:
in both—levonorgestrel/ethinyl estradiol
Increase:
repaglinide metabolism—CYP3A4 inducers: rifampin, barbiturates, carBAMazepine
Increase:
repaglinide effect—NSAIDs, salicylates, sulfonamides, chloramphenicol, MAOIs, coumarins, β-blockers, probenecid, gemfibrozil, simvastatin, fenofibrate, deferasirox
Decrease:
repaglinide metabolism—CYP3A4 inhibitors: antifungals (ketoconazole, miconazole), erythromycin, macrolides
Decrease:
repaglinide action—calcium channel blockers, corticosteroids, oral contraceptives, thiazide diuretics, thyroid preparations, estrogens, phenothiazines, phenytoin, rifampin, isoniazid, PHENobarbital, sympathomimetics
Increase:
antidiabetic effect—garlic, chromium, horse chestnut
Decrease:
repaglinide level; give before meals
Increase/decrease:
glucose
Hypo/hyperglycemic reaction,
which can occur soon after meals: dizziness, weakness, headache, tremor, anxiety, tachycardia, hunger, sweating, abdominal pain, A1c, fasting, postprandial glucose during treatment
•
Storage in tight container at room temp
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; blood glucose, A1c improvement
•
About technique for blood glucose monitoring; how to use blood glucose meter
•
About the symptoms of hypo/hyperglycemia, what to do about each
•
That product must be continued on daily basis; about the consequences of discontinuing product abruptly
•
To avoid OTC medications unless ordered by prescriber
•
That diabetes is a lifelong illness; that product will not cure disease
•
That all food included in diet plan must be eaten to prevent hypoglycemia; that if a meal is omitted, dose should be omitted; to have glucagon emergency kit available; to take repaglinide 15-30 min before meals 2, 3, or 4×/day; to carry emergency ID
Glucose 25 g IV via dextrose 50% solution, 50 ml or 1 mg glucagon