Mosby's 2014 Nursing Drug Reference (383 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(tel-mih-sar′tan)
Micardis
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin II receptor (Type AT
1
) antagonist
Blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT
1
receptor found in tissues
Hypertension, alone or in combination; stroke, MI prophylaxis (>55 yr) in patients unable to take ACE inhibitors
Unlabeled uses:
Heart failure
Hypersensitivity
Black Box Warning:
Pregnancy (D) 2nd/3rd trimesters
Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children, geriatric patients; hypersensitivity to ACE inhibitors; renal/hepatic disease, renal artery stenosis, dialysis, CHF, hyperkalemia, hypotension, hypovolemia
Calculator
• Adult:
PO
40 mg/day; range 20-80 mg/day
• Adult >55 yr:
PO
80 mg/day
Available forms:
Tabs 20, 40, 80 mg
•
Without regard to meals
•
Increased dose to African American patients or consider alternative agent; B/P response may be reduced
CNS:
Dizziness, insomnia,
anxiety
, headache, fatigue
GI:
Diarrhea, dyspepsia,
anorexia, vomiting
MS:
Myalgia, pain
RESP:
Cough,
upper respiratory infection
, sinusitis, pharyngitis
Onset of antihypertensive activity 3 hr, peak 0.5-1 hr, extensively metabolized, terminal half-life 24 hr, protein binding 99.5%, excreted in feces >97%, B/P response is less in African American patients
Increase:
digoxin peak/trough concentrations—digoxin
Increase:
antihypertensive action—diuretics, other antihypertensives, NSAIDs
Increase:
hyperkalemia—potassium-sparing diuretics, potassium salt substitutes
Decrease:
antihypertensive effect—NSAIDs, salicylates
Increase:
LFTs
•
B/P, pulse standing, lying; note rate, rhythm, quality; if severe hypotension occurs, place in supine position and give IV NS
•
Baselines of renal, hepatic studies before therapy begins
•
CHF:
edema in feet, legs daily; jugular venous distention; dyspnea, crackles
•
Therapeutic response: decreased B/P
•
To comply with dosage schedule, even if feeling better; to take at same time of day; that therapeutic effect may take 2-4 wk
•
To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain, decreased urine output
•
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in blood pressure; to consult prescriber if these occur
•
That product may cause dizziness, fainting, lightheadedness
Black Box Warning:
To notify prescriber if pregnancy is planned or suspected, pregnancy category (D) 2nd/3rd trimester
•
To notify prescriber of all prescriptions, OTC products, and supplements taken
•
Overdose:
dizziness, bradycardia or tachycardia
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(te-maz′e-pam)
Restoril
Func. class.:
Sedative/hypnotic
Chem. class.:
Benzodiazepine, short to intermediate acting
Do not confuse:
temazepam
/flurazepam
Produces CNS depression at limbic, thalamic, hypothalamic levels of the CNS; may be mediated by neurotransmitter γ-aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
Insomnia, short-term treatment (generally 7-10 days)
Pregnancy (X), breastfeeding, hypersensitivity to benzodiazepines, intermittent porphyria
Precautions:
Children <15 yr, geriatric patients, anemia, renal/hepatic disease, suicidal individuals, drug abuse, psychosis, acute closed-angle glaucoma, seizure disorders, angioedema, sleep-related behaviors (sleepwalking), pulmonary disease
Calculator
• Adult:
PO
7.5 to 30 mg at bedtime
• Geriatric:
PO
7.5 mg at bedtime
Available forms:
Caps 7.5, 15, 22.5, 30 mg
•
1/2-1 hr before bedtime for sleeplessness
•
On empty stomach for fast onset; may be taken with food if GI symptoms occur
•
Avoid use with CNS depressants; serious CNS depression may result
CNS:
Lethargy, drowsiness, daytime sedation
, dizziness, confusion, light-headedness, headache, anxiety, irritability, complex sleep-related reactions (sleep driving, sleep eating), fatigue
CV:
Chest pain, pulse changes, hypotension
EENT:
Blurred vision
GI:
Nausea, vomiting, diarrhea, heartburn, abdominal pain, constipation, anorexia
SYST:
Severe allergic reactions
Onset 30 min, peak 1-2 hr, duration 6-8 hr, half-life 10-20 hr, metabolized by liver, excreted by kidneys, crosses placenta, excreted in breast milk, 98% protein binding
Increase:
effects of cimetidine, disulfiram, oral contraceptives
Increase:
action of both products—alcohol, CNS depressants
Increase:
effect of temazepam—probenecid
Decrease:
effect of antacids, theophylline, rifampin
Increase:
CNS depression—hops, kava, valerian, chamomile, skullcap
Decrease:
temazepam effect—caffeine
Increase:
ALT, AST
•
Mental status: mood, sensorium, affect, memory (long, short), orientation
•
Type of sleep problem: falling asleep, staying asleep, baseline, periodically
•
Dependency:
restrict amount given to patient, assess for physical/psychological dependency; high-level risk for abuse
•
Assistance with ambulation after receiving dose
•
Storage in tight container in cool environment
•
Therapeutic response: ability to sleep at night, decreased early morning awakening if taking product for insomnia
•
To avoid driving, other activities requiring alertness until stabilized
•
To avoid alcohol ingestion, other CNS depressants
•
That effects may take 2 nights for benefits to be noticed
•
To limit to 7-10 days of continuous use
•
About alternative measures to improve sleep: reading, exercise several hours before bedtime, warm bath, warm milk, TV, self-hypnosis, deep breathing
•
Not to discontinue abruptly, withdraw gradually
•
That complex sleep-related behaviors may occur: sleep driving/eating
•
That hangover, memory impairment are common in geriatric patients but less common than with barbiturates
To notify prescriber if pregnancy is planned or suspected, pregnancy (X); to use contraception while taking this product
Lavage, activated charcoal; monitor electrolytes, VS