Mosby's 2014 Nursing Drug Reference (407 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(treh-prah′stin-ill)
Remodulin, Tyvaso
Func. class.:
Antiplatelet agent
Chem. class.:
Tricyclic benzidine prostacyclin analog
Direct vasodilation of pulmonary, systemic arterial vascular beds; inhibition of platelet aggregation
Pulmonary arterial hypertension (PAH) NYHA class II through IV
Unlabeled uses:
Pulmonary arterial hypertension in children/adolescents, pediatric patients transitioning from epoprostenol to treprostinil, claudication
Hypersensitivity to this product, other prostacyclin analogs
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, past renal/hepatic disease, thromboembolic disease, abrupt discontinuation, IV administration
Calculator
• Adult:
SUBCUT INF
1.25 ng/kg/min by
CONT INF,
may reduce to 0.625 ng/kg/min if not tolerated; may increase by 1.25 ng/kg/min q wk for first 4 wk then 2.5 ng/kg/min/wk for remainder of inf;
ORAL INH
3 breaths via Tyvaso inh system qid
• Adult:
SUBCUT INF
0.625 ng/kg ideal body weight/min; increase cautiously
Available forms:
Inj 1, 2.5, 5, 10 mg/ml; neb sol 1.74 mg/2.9 ml
•
Sudden decreased doses, abrupt withdrawal may worsen pulmonary arterial hypertension symptoms
•
By continuous inf
•
No dilution required
•
Avoid skin, eyes; do not take orally; use Tyvaso Inhalation System only
•
Patient should have backup Optineb-ir device to avoid interruptions
•
Follow instructions for use, cleaning
•
Do not mix with other medications in Optineb-ir device
•
Twist off cap, squeeze total contents into medicine cup; vol is sufficient for 4 treatments
•
By surgically placed CV catheter using ambulatory inf pump
•
IV pump, product, patient education can be obtained from Priority Healthcare in United States
•
Must be diluted with sterile water for inj or 0.9% NaCl
•
Conc should be calculated using this formula: diluted conc = [dose (ng/kg/min) × weight (kg) × 0.00006] / inf rate (ml/hr)]
CNS:
Dizziness, headache, syncope
CV:
Vasodilation, hypotension, edema, right ventricular heart failure
GI:
Nausea,
diarrhea
INTEG:
Rash
, pruritus
OTHER:
Jaw pain, cough, throat irritation
SYST:
Inf site reactions, pain; increased risk for infection
Metabolized by liver; excreted in urine, feces; terminal half-life 2-4 hr; 90% protein binding
•
Excessive hypotension: diuretics, antihypertensives, vasodilators, MAOIs, β-blockers, calcium channel blockers
Increase:
bleeding tendencies—anticoagulants, aspirin, NSAIDs, thrombin inhibitors, SSRIs
•
Hypertension:
monitor B/P, baseline and periodically
•
Hepatic studies: AST, ALT, bilirubin, creatinine with long-term therapy
Blood studies: CBC; CBC q2wk × 3 mo, Hct, Hgb, PT with long-term therapy, ABGs
Bleeding time at baseline, throughout treatment; levels may be 2-5× normal limit
•
Avoid abrupt discontinuation
•
Therapeutic response: decreased pulmonary arterial hypertension (PAH)
•
That blood work will be necessary during treatment, that treatment may last for years
•
To report side effects such as diarrhea, skin rashes
•
That therapy will be needed for prolonged periods of time, sometimes years
•
To prevent infection, aseptic technique must be used for preparation, administration of treprostinil
•
That there are many product, herbal interactions
•
About signs, symptoms of bleeding; blood in urine, stools
•
How to use inhaled solution, how to care for equipment
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tret′i-noyn)
Avita, Renova, Retin-A, Retin-A Micro, Stieva-A
Func. class.:
Vit A acid, acne product; antineoplastic (miscellaneous)
Chem. class.:
Tretinoin derivative
(Topical) Decreases cohesiveness of follicular epithelium, decreases microcomedone formation; (PO) induces maturation of acute promyelocytic leukemia, exact action is unknown
(Topical) Acne vulgaris (grades 1-3); (PO) acute promyelocytic leukemia, facial wrinkles, photoaging
Unlabeled uses:
Acne rosacea, actinic keratosis, ichthyosis, Kaposi’s sarcoma, keloids, keratosis follicularis, melasma
Hypersensitivity to retinoids or sensitivity to parabens
Black Box Warning:
Pregnancy (D) (PO)
Precautions:
Pregnancy (C) (topical), breastfeeding, eczema, sunburn, sun exposure
Black Box Warning:
Rapid-evolving leukocytosis, respiratory compromise, acute promyelocytic leukemia differentiation syndrome
Calculator
• Adult and child:
TOP
cleanse area, apply 0.025%-0.1% cream or 0.05% liquid gel at bedtime, cover lightly
• Adult:
PO
45 mg/m
2
/day given as 2 evenly divided doses until remission, discontinue treatment 30 days after remission or 90 days of treatment, whichever is first
Available forms:
Cream 0.01%, 0.02%, 0.025%, 0.05%, 0.1%; gel 0.01%, 0.025%, 0.04%, 0.05%, 0.1%; liquid 0.05%; caps 10 mg
•
Once daily before bedtime; cover area lightly using gauze; use gloves to apply
CNS:
Headache, fever, sweating
, fatigue
CV:
Cardiac dysrhythmias, pericardial effusion
GI:
Nausea, vomiting
,
hemorrhage,
abdominal pain, diarrhea, constipation, dyspepsia, distention, hepatitis
INTEG:
Rash, stinging, warmth, redness, erythema, blistering, crusting, peeling, contact dermatitis, hypo/hyperpigmentation, dry skin, pruritus, scaly skin, retinoic acid syndrome (RAS)
META:
Hypercholesterolemia, hypertriglyceridemia
RESP:
Pneumonia, upper respiratory tract disease
PO:
Terminal half-life 0.5-2 hr
TOPICAL:
Poor systemic absorption
•
Use with caution: medicated, abrasive soaps; cleansers that have a drying effect; products with high conc of alcohol astringents (topical)
Increase:
peeling—medication containing agents such as sulfur, benzoyl peroxide, resorcinol, salicylic acid (topical)
Increase:
plasma concentrations of tretinoin—ketoconazole (PO)
Increase:
ICP, risk of pseudotumor cerebri—tetracyclines; do not use together
Increase:
photosensitivity—retinoids, quinolones, phenothiazines, sulfonamides, sulfonylureas, thiazide diuretics
Increase:
thrombotic complications—aninocaproic acid, aprotinin, tranexamic acid
Increase:
AST, ALT
•
Area of body involved, what helps or aggravates condition; cysts, dryness, itching; lesions may worsen at beginning of treatment
•
Hepatic function, coagulation, hematologic parameters; also cholesterol, triglycerides
•
Storage at room temp
•
Handwashing after application
•
Therapeutic response: decrease in size, number of lesions
•
To avoid application on normal skin; to avoid getting cream in eyes, nose, other mucous membranes; not to use product on areas with cuts, scrapes
•
To use cream/gel by applying a thin layer to affected skin; to rub gently; to use liquid; to apply with fingertip or cotton swab
•
To avoid sunlight, sunlamps; to use protective clothing, sunscreen
•
That treatment may cause warmth, stinging; that dryness, peeling will occur
•
That cosmetics may be used over product; not to use shaving lotions
•
That rash may occur during first 1-3 wk of therapy
•
That product does not cure condition, only relieves symptoms
•
That therapeutic results may be seen in 2-3 wk but may not be optimal until after 6 wk
Black Box Warning:
To notify prescriber if pregnancy is planned or suspected; pregnancy (D) PO