Mosby's 2014 Nursing Drug Reference (386 page)

Black Box Warning:

Hepatic disease, hepatitis

• Adult:
PO
300 mg/day with meal; if used with didanosine, give tenofovir 2 hr before or 1 hr after didanosine

• Child ≥2 yr:
PO
8 mg/kg daily approximate; ≥35 kg 300 mg daily; 28-34 kg 250 mg daily; 22-27 kg 200 mg daily; 17-21 kg 150 mg daily

• Adult:
PO
CCr 30-49 ml/min, 300 mg q48hr; CCr 10-29 ml/min, 300 mg q72-96hr; CCr <10 ml/min, not recommended

• 
Without regard to food

• 
2 hr before or 1 hr after didanosine (if used)

• 
Oral powder:
use scoop provided, mix powder into 2-4 oz (1/4-1/2 cup) of applesauce, yogurt, do not mix with liquid, product is bitter, use immediately after mixing, clean scoop

Increase:
tenofovir level—cidofovir, acyclovir, valacyclovir, ganciclovir, valganciclovir

Increase:
level of didanosine when given with tenofovir

Increase:
tenofovir level—any product that decreases renal function

• 
Viral load, CD4+ T-cell count, plasma HIV RNA, serum creatinine/BUN/phosphate

• 
Resistance testing at start of therapy and at treatment failure

• 
Hepatic studies: AST, ALT, bilirubin; amylase, lipase, triglycerides periodically during treatment

• 
Bone, renal toxicity: if bone abnormalities are suspected, obtain tests; serum phosphorus, creatinine

• 
Lactic acidosis, severe hepatomegaly with steatosis, Fanconi syndrome:
obtain baseline liver function tests; if elevated, discontinue treatment; discontinue even if liver function tests normal but lactic acidosis, hepatomegaly present, may be fatal

• 
Storage at 25° C (77° F)

• 
Therapeutic response: decrease in signs, symptoms of HIV

• 
To take without regard to food

• 
That GI complaints resolve after 3-4 wk of treatment

• 
Not to breastfeed while taking this product

• 
That product must be taken daily even if patient feels better

• 
That follow-up visits must be continued because serious toxicity may occur; that blood counts must be done q2wk

• 
That product will control symptoms but is not a cure for HIV; that patient is still infectious, may pass HIV virus on to others

• 
That other products may be necessary to prevent other infections

• 
That changes in body fat distribution may occur

• 
To notify prescriber of symptoms of lactic acidosis

• Adult:
PO
1 mg at bedtime, may increase dose slowly to desired response; max 20 mg/day

• Adult:
PO
1 mg at bedtime, gradually increase up to 5-10 mg; max 20 mg

• 
Give dose at bedtime; patient should not operate machinery because fainting may occur

• 
If treatment is interrupted for several days, restart with initial dose

• 
Without regard to food; feeding tube: place cap in 60 ml of warm tap water, stir until liquid spills from ruptured shell (5 min), stir until cap dissolves, draw solution into oral syringe, give through feeding tube, flush with water

Increase:
hypotensive effects—β-blockers, nitroglycerin, verapamil, other antihypertensives, alcohol

Decrease:
hypotensive effects—estrogens, NSAIDs, sympathomimetics, salicylates

Increase:
antihypertensive effect—hawthorn

Decrease:
antihypertensive effect—ephedra

Decrease:
Hgb, WBC, platelets, albumin

• 
BPH:
urinary patterns (hesitancy, frequency, change in stream, dribbling, dysuria, urgency)

• 
Hypertension:
crackles, dyspnea, orthopnea q30min; orthostatic B/P, pulse, jugular venous distention q4hr; weight daily, I&O

• 
BUN, uric acid if patient receiving long-term therapy

• 
Cool storage in tight container

• 
Therapeutic response: decreased B/P, edema in feet, legs; decreased symptoms of BPH

• 
That fainting occasionally occurs after 1st dose; not to drive or operate machinery for 4 hr after 1st dose or after an increase in dose; to take 1st dose at bedtime

• 
To rise slowly from sitting or lying position

• 
Not to discontinue abruptly

• 
Hypertension:
to continue with regimen including diet, exercise

• Adult:
PO
250 mg/day × 6 wk (fingernail); × 12 wk (toenail)

• 
PO:
without regard to food

• 
Granules:
take with food, sprinkle packet contents on pudding or nonacidic soft food, swallow without chewing, do not use fruit-based foods

Increase:
levels of dextromethorphan

Increase:
terbinafine clearance—rifampin

Increase:
clearance of cycloSPORINE

Decrease:
terbinafine clearance—cimetidine

Decrease:
metabolism of—CYP2D6 (antidysrthymics IC, III, amoxapine, atomoxetine, cloZAPine

• 
Side effects: cola nut, guarana, yerba maté, tea (black, green), coffee

Increase:
LFTs

• 
Hepatic studies (ALT, AST) prior to beginning treatment; do not use in presence of hepatic disease

• 
CBC in treatment >6 wk

• 
Continuing infection: increased size, number of lesions

• 
Storage at <25° C (77° F), protect from light

• 
Therapeutic response: decrease in size, number of lesions

• 
That treatment may take 10 wk (toenail), 4 wk (fingernail)

• 
To notify prescriber of nausea, vomiting, fatigue, jaundice, dark urine, clay-colored stool, RUQ pain; may indicate hepatic dysfunction