Mosby's 2014 Nursing Drug Reference (365 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(se-le′ji-leen)
Eldepryl, Emsam, Zelapar
Func. class.:
Antiparkinson agent
Chem. class.:
MAOI, type B
Do not confuse:
Eldepryl
/enalapril
Increased dopaminergic activity by inhibition of MAO type B activity; not fully understood
Adjunct management of Parkinson’s disease for patients being treated with levodopa/carbidopa who had poor response to therapy; depression (transdermal)
Unlabeled uses:
Alzheimer’s disease, depression
Children/adolescents (suicide/hypertensive crisis), hypersensitivity, breastfeeding
Precautions:
Pregnancy (C)
Calculator
• Adult:
PO
10 mg/day given with levodopa/carbidopa in divided doses, 5 mg at breakfast and lunch; after 2-3 days, begin to reduce dose of levodopa/carbidopa 10%-30%;
ORAL DISINTEGRATING
1.25 mg (1 tab) × 6 wk or more initially then 2.5 mg (2 tabs) dissolved on tongue daily before breakfast; max 2.5 mg/day;
TRANSDERMAL
6 mg/24 hr initially, increase by 3 mg/24 hr at ≥2 wk, up to 12 mg/24 hr if needed
• Adult:
PO
5 mg bid
AM, PM
Available forms:
Tabs 5 mg; caps 5 mg; oral disintegrating tabs 1.25 mg; transdermal 6 mg/24 hr (20 mg/20 cm
2
), 9 mg/24 hr (30 mg/30 cm
2
), 12 mg/24 hr (40 mg/40 cm
2
)
Do not use in children due to risk for hypertensive crisis
•
Product until NPO before surgery
•
Adjust dosage to response
•
With meals; limit protein taken with product
•
Dosing bid in
AM
and afternoon; avoid
PM
or bedtime dosing
•
At doses of <10 mg/day because of risks associated with nonselective inhibition of MAO
•
Oral disintegrating tab:
peel back foil; remove tab, do not push through foil; place tab on tongue, allow to dissolve, swallow with saliva
•
Apply to dry, intact skin on upper torso, upper thigh, or outer surface of upper arm q12hr
CNS:
Increased tremors, chorea, restlessness, blepharospasm, increased bradykinesia, grimacing, tardive dyskinesia, dystonic symptoms, involuntary movements, increased apraxia, hallucinations,
dizziness
, mood changes, nightmares, delusions, lethargy, apathy, overstimulation, sleep disturbances, headache, migraine, numbness, muscle cramps, confusion, anxiety, tiredness, vertigo, personality change, back/leg pain,
suicide in child/adolescent, suicidal ideation in adults
CV:
Orthostatic hypotension, hypo/hypertension, dysrhythmia, palpitations, angina pectoris,
tachycardia,
edema,
sinus bradycardia,
syncope,
hypertensive crisis (children)
EENT:
Diplopia, dry mouth, blurred vision, tinnitus
GI:
Nausea, vomiting, constipation, weight loss, anorexia, diarrhea, heartburn, rectal bleeding, poor appetite, dysphagia, xerostomia
GU:
Slow urination, nocturia, prostatic hypertrophy, urinary hesitation, retention, frequency, sexual dysfunction
INTEG:
Increased sweating, alopecia, hematoma, rash, photosensitivity, facial hair
RESP:
Asthma, SOB
Absorption (tab) 40-90 min, (oral disintegrating tab) 10-15 min; peak 1/2-2 hr; rapidly metabolized (active metabolites:
N
-desmethyldeprenyl, amphetamine, methamphetamine); metabolites excreted in urine; half-life 10 hr, orally disintegrating tab 1.3 hr; protein binding up to 85%
Fatal interaction: opioids (especially meperidine); do not administer together
Serotonin syndrome (confusion, seizures, fever, hypertension, agitation); death—FLUoxetine, PARoxetine, sertraline, fluvoxaMINE (discontinue 5 wk before selegiline treatment); do not use together
Fatal interaction: do not use with tricyclics
Increase:
side effects of levodopa/carbidopa
Increase:
unusual behavior, psychosis —dextromethorphan
Increase:
hypotension—antihypertensives
Decrease:
VMA
False positive:
urine ketones, urine glucose
False negative:
urine glucose (glucose oxidase)
False increase:
uric acid, urine protein
•
Parkinson’s symptoms:
decreased rigidity, unsteady gait, weakness, tremors
•
Cardiac status: tachycardia/bradycardia; B/P, respiration throughout treatment
•
Mental status: affect, mood, behavioral changes, depression; perform suicide assessment on all patients,
suicidal ideation may occur
Opioids; if patient has received, do not administer selegiline, fatal reactions have occurred
•
Assistance with ambulation during beginning therapy
•
Therapeutic response: decrease in akathisia, improved mood
•
To change positions slowly to prevent orthostatic hypotension
•
Hypertensive crisis:
nausea, vomiting, sweating, agitation, change in mental status, headache, chest pain; to notify prescriber immediately
•
Serotonin syndrome:
to report twitching, sweating, shivering, diarrhea to prescriber immediately
•
To use product exactly as prescribed; if discontinued abruptly, parkinsonian crisis may occur
•
Pregnancy:
to report if pregnancy is planned or suspected, pregnancy (C), avoid breastfeeding
•
To use during the day to prevent insomnia
•
To avoid heating pads, hot tubs when using transdermal products
•
To avoid hazardous activities until response is known
•
To avoid foods high in tyramine: cheese, pickled products, wine, beer, large amounts of caffeine
Not to exceed recommended dose of 10 mg (PO) because this might precipitate hypertensive crisis; to report severe headache, other unusual symptoms
IV fluids for hypertension, IV dilute pressure agent for B/P titration