Mosby's 2014 Nursing Drug Reference (360 page)

• Adult:
SUBCUT
The initial dosage is 1 mcg/kg SC every wk (based on actual body weight); increase the weekly dosage by 1 mcg/kg until the patient achieves a platelet count ≥50,000/mm
³
; do not exceed a maximum weekly dosage of 10 mcg/kg; use the lowest dosage needed to achieve and maintain a platelet count ≥50,000/mm
³
; monitor CBC, including platelet counts, every wk until a stable platelet count is achieved with platelets ≥50,000/mm
³
≥4 wk without dosage adjustment; then monitor the CBC, including platelet counts, monthly; once a stable dosage is achieved, if the platelet count falls to <50,000/mm
³
, increase the dosage by 1 mcg/kg/wk; if the platelet count increases to >200,000/mm
³
for 2 consecutive weeks, reduce the dosage by 1 mcg/kg; if the platelet count is >400,000/mm
³
, temporarily stop romiPLOStim and continue to monitor the platelet count every wk; once the platelets are <200,000/mm
³
, restart, but reduce the previous dosage by 1 mcg/kg/wk; romiPLOStim may be administered concomitantly with other medical ITP therapies; if platelet counts exceed 50,000/mm
³
, other medical ITP therapies may be reduced or discontinued; discontinue romiPLOStim if the platelet count does not increase to avoid important bleeding after 4 wk of therapy at max dosage of 10 mcg/kg

• 
Blood studies: CBC during treatment weekly and for 2 wk after discontinuing

• 
Bone marrow suppression:
If cytopenias occur, product should be discontinued, may use a bone marrow biopsy and staining for fibrosis

• 
Thromboembolic disease:
Do not use to normalize patients, use only in those with thrombocytopenia in idiopathic thrombocytopenic purpura, maintain platelets ≥ 50,000/mm
³

• 
Refrigerated storage of vials, do not freeze; protect from light; diluted sol is stable refrigerated or at room temp for 24 hr

• 
Therapeutic response: increase in platelet counts, absence of bleeding

• 
To report bleeding

• 
About the reason for product and expected results, to avoid hazardous activities that may cause bleeding

• 
To report a missed dose to prescriber due to increased risk of bleeding

• 
That lab tests will be done weekly and dose may be changed; if dose is not changed, lab will be checked monthly; after drug is discontinued, labs will be checked weekly × 2 wk

• 
To advise prescriber if spleen has been removed, bleeding or clotting problems

• 
To notify prescriber if pregnancy is planned or suspected, pregnancy category (C); if pregnancy occurs, call registry 1-877-675-2831

• Adult:
PO (regular release
) Initially, 0.25 mg PO tid × 1 wk; gradually titrate at weekly intervals:
Week 2
, 0.5 mg tid;
Week 3,
0.75 mg tid;
Week 4
, 1 mg tid;
After week 4
, may increase by 1.5 mg/day each week, max 9 mg/day total dosage, and then by 3 mg/day each week, max 24 mg/day

• Adult:
PO
Currently taking 0.75–2.25 mg/day imm rel: give 2 mg/day ext rel

• Adult:
PO (reg rel)
Initially, 0.25 mg every day 1-3 hr before bedtime; days 3–7, may increase to 0.5 mg every day; at the beginning of wk 2 (day 8) the dosage may be increased to 1 mg every day × 1 wk; weeks 3–6, dosage may be titrated up by 0.5 mg each wk (from 1.5–3 mg over the 5-wk period) as needed to achieve desired effect; wk 7, may increase dosage to 4 mg/day; dosage is titrated based on clinical response; give all doses 1–3 hr before bedtime

• 
Product until NPO before surgery

• 
Adjust dosage to patient response; taper when discontinuing

• 
With meals to reduce nausea

• 
Extended release:
do not chew, crush, or divid
e

Increase:
rOPINIRole effect—cimetidine, ciprofloxacin, diltiazem, enoxacin, erythromycin, fluvoxaMINE, mexiletine, norfloxacin, tacrine, digoxin, theophylline,
L
-dopa

Decrease:
rOPINIRole effects—butyrophenones, metoclopramide, phenothiazines, thioxanthenes

• 
Parkinsonism:
akinesia, tremors, staggering gait, muscle rigidity, drooling

• 
B/P, respirations during initial treatment; hypo/hypertension should be reported

 
Sleep attacks:
drowsiness, falling asleep without warning even during hazardous activities

• 
Mental status: affect, mood, behavioral changes, depression; complete suicide assessment; worsening of symptoms in restless leg syndrome

• 
Testing for diabetes mellitus, acromegaly if patient receiving long-term therapy

• 
Therapeutic response: improvement in movement disorder

• 
To notify prescriber if pregnancy is planned or suspected, pregnancy category (C)

• 
To take with food to prevent nausea

• 
To report hallucinations, confusion (usually in geriatric patients)

• 
That therapeutic effects may take several weeks to a few months

• 
To change positions slowly to prevent orthostatic hypotension

• 
To use product exactly as prescribed; if product is discontinued abruptly, parkinsonian crisis may occur

• 
That drowsiness, sleep attacks may occur; to avoid driving, other hazardous activities until response known

• 
To avoid alcohol, CNS depressants cough and cold products

 
To notify prescriber if unusual urges occur