Mosby's 2014 Nursing Drug Reference (428 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(zole′pih-dem)
Ambien, Ambien CR, Edluar, Zolpimist
Func. class.:
Sedative/hypnotic
Chem. class.:
Imidazopyridine
Produces CNS depression at limbic, thalamic, hypothalamic levels of 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; insomnia with difficulty of sleep onset/maintenance (ext rel)
Hypersensitivity to benzodiazepines
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, anemia, renal/hepatic disease, suicidal individuals, drug abuse, psychosis, seizure disorders, angioedema, depression, respiratory disease, sleep apnea, sleep-related behaviors (sleepwalking), myasthenia gravis
Calculator
• Adult:
PO
5 mg (women), 5-10 mg (men) at bedtime × 7-10 days only; total max dose 10 mg;
EXT REL
6.25 (women), 6.25-12.5 mg (men) immediately before bedtime, may be useful for ≤24 wk in people 18-64 yr with primary insomnia;
oral spray
(Zolpimist) 5 mg (women), 5-10 mg (men) immediately before bedtime, max 10 mg/day;
SL
(Edluar) 5 mg (women), 5-10 mg (men) just before bedtime
• Geriatric:
PO
5 mg at bedtime;
EXT REL
6.25 mg; SL: 5 mg at bedtime
Available forms:
Tabs 5, 10 mg; ext rel tabs 6.25, 12.5 mg; SL: 5, 10 mg; oral spray 5 mg/spray
•
Do not break, crush, or chew ext rel
•
Take with full glass of water
•
½-1 hr before bedtime (PO); right before retiring (ext rel)
•
On empty stomach for fast onset; may be taken with food if GI symptoms occur
•
Prime before first use or if pump is not used for ≥14 days
•
Do not use spray with or after a meal
•
Separate blister pack at perforation, peel paper and push product through, place product under tongue, allow to dissolve before swallowing; do not take with water
CNS:
Headache, lethargy, drowsiness, daytime sedation, dizziness, confusion, lightheadedness, anxiety, irritability, amnesia, poor coordination, complex sleep-related reactions (sleep driving, sleep eating), depression, somnolence,
suicidal ideation,
abnormal thinking/behavioral changes
CV:
Chest pain, palpitations
GI:
Nausea, vomiting, diarrhea, heartburn, abdominal pain, constipation
HEMA:
Leukopenia, granulocytopenia (rare)
MISC:
Myalgia
SYST:
Severe allergic reactions, angioedema, anaphylaxis
PO:
Onset up to 1.5 hr, metabolized by liver, excreted by kidneys (inactive metabolites), crosses placenta, excreted in breast milk, half-life 2-3 hr
Increase:
action of both products—alcohol, CNS depressants
Increase or decrease:
zolpidem levels—CYP3A4 inhibitors/inducers
Decrease:
zolpidem effect—rifamycins
Mental status: mood, sensorium, affect, memory (long, short term), excessive sedation, impaired coordination,
suicidal thoughts/behaviors
•
Blood dyscrasias: fever, sore throat, bruising, rash, jaundice, epistaxis (rare)
•
Type of sleep problem: falling asleep, staying asleep
•
Storage in tight container in cool environment
•
Therapeutic response: ability to sleep at night, decreased amount of early morning awakening if taking product for insomnia
•
That dependence is possible after long-term use
That complex sleep-related behaviors may occur (sleep driving/eating)
•
To avoid driving or other activities requiring alertness until dosage is stabilized
•
To avoid alcohol ingestion
•
That effects may take 2 nights for benefits to be noticed
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Not to use during pregnancy, breastfeeding
•
That hangover is common in geriatric patients but less common than with barbiturates; that rebound insomnia may occur for 1-2 nights after discontinuing product; not to discontinue abruptly; to taper
•
Not to crush, chew, break ext rel tabs
•
To prime spray pump before using
Lavage, activated charcoal; monitor electrolytes, VS
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(zone-is′a-mide)
Zonegran
Func. class.:
Anticonvulsant
Chem. class.:
Sulfonamides
May act through action at sodium and calcium channels, but exact action is unknown; serotonergic action
Epilepsy, adjunctive therapy for partial seizures
Unlabeled uses:
Bipolar disorder (mania)
Hypersensitivity to this product or sulfonamides; psychiatric condition, hepatic failure
Precautions:
Pregnancy (C), breastfeeding, children <16 yr, geriatric patients, allergies, renal/hepatic disease
Calculator
• Adult and child >16 yr:
100 mg/day, may increase after 2 wk to 200 mg/day, may increase q2wk, max dose 600 mg/day
Available forms:
Caps 25, 50, 100 mg
CNS:
Dizziness, insomnia, paresthesias, depression, fatigue, headache, confusion, somnolence, agitation, irritability, speech disturbance,
suicidal ideation, seizures, status epilepticus
EENT:
Diplopia, verbal difficulty, speech abnormalities, taste perversion, amblyopia, pharyngitis, rhinitis, tinnitus, nystagmus
GI:
Nausea, constipation, anorexia, weight loss, diarrhea, dyspepsia, dry mouth, abdominal pain
GU:
Kidney stones
HEMA:
Aplastic anemia, granulocytopenia
(rare); ecchymosis
INTEG:
Rash, pruritus
MISC:
Flulike symptoms
SYST:
Stevens-Johnson syndrome,
metabolic acidosis
Peak 2-6 hr, half-life in RBCs 105 hr, metabolized by liver, excreted by kidneys, protein binding 40%
Decrease:
half-life of zonisamide—carBAMazepine, phenytoin, PHENobarbital
Altered product levels:
CYP3A4 inhibitors/inducers
Increase:
CNS depression—alcohol
Increase:
effect of this product—St. John’s wort
•
Do not use with grapefruit
Increase:
BUN, creatinine
•
Seizures:
duration, type, intensity, precipitating factors
•
Renal function: albumin conc, BUN, creatinine, serum bicarbonate at baseline and periodically
Mental status: mood, sensorium, affect, memory (long, short term),
suicidal thoughts/behaviors
•
Stevens-Johnson syndrome, aplastic anemia, fulminant hepatic necrosis; may cause death; monitor for rashes and hypersensitive reactions
•
Rash, hypersensitivity reactions
•
Obtain bicarbonate before treatment/periodically; metabolic acidosis may occur in child
•
Therapeutic response: decrease in severity of seizures
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Not to discontinue product abruptly because seizures may occur
•
To avoid hazardous activities until stabilized on product
•
To carry emergency ID stating product use
•
To notify prescriber of rash immediately; to notify prescriber of back pain, abdominal pain, blood in urine; to increase fluid intake to reduce risk of kidney stones
•
To notify prescriber if pregnancy planned, suspected
•
To avoid grapefruit
•
To notify prescriber of sore throat, fever, easy bruising
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert