Mosby's 2014 Nursing Drug Reference (81 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(kar′boe-prost)
Hemabate
Func. class.:
Oxytocic, abortifacient
Chem. class.:
Prostaglandin
Stimulates uterine contractions, causes complete abortion in approximately 16 hr
Abortion at 13-20 wk gestation, postpartum hemorrhage caused by uterine atony not controlled by other methods
Unlabeled uses:
Hemorrhagic cystitis
Hypersensitivity to this product or benzyl alcohol, severe CV/respiratory/renal/hepatic disease, PID
Precautions:
Pregnancy (C), asthma, anemia, jaundice, diabetes mellitus, hypo/hypertension, seizure disorders, past uterine surgery
Calculator
• Adult:
IM
100 mcg (0.4 ml) test dose, then 250 mcg, then 250 mcg q11/2-31/2hr; may increase to 500 mcg if no response, max 12 mg total dose
• Adult:
IM
250 mcg, repeat at 15- to 90-min intervals; max total dosage 2 mg
• Adult:
INTRAVESICULAR
0.8 mg/dl in 50 ml of saline instilled into the bladder for 60 min, q6hr × 4 doses
Available forms:
Inj 250 mcg/ml
•
Only by trained personnel in a hospital that can provide emergency services
•
Incomplete abortion may occur in 20% of patients
•
Give antiemetics to prevent nausea/vomiting
•
In deep muscle mass; aspirate before inj, rotate inj sites if additional doses given
CNS:
Fever, chills
, headache
GI:
Nausea, vomiting, diarrhea
Peak 15-60 min, excreted in urine (major metabolites)
Increase:
action—other oxytocics
•
B/P, pulse; watch for change that may indicate hemorrhage
•
For length, duration of contractions; notify prescriber of contractions that last more than 1 min or absence of contractions; watch for signs of uterine rupture
•
For incomplete abortion, pregnancy must be terminated by another method; product is teratogenic
•
Storage in refrigerator
•
Therapeutic response: expulsion of fetus, control of bleeding
•
To report increased blood loss, abdominal cramps, increased temp, foul-smelling lochia
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(kar-gloo′mik)
Carbaglu
Func. class.:
Antihyperammonemic agent
The enzyme
N
-acetylglutamate synthase (NAGS) produces
N
-acetylglutamate (NAG), which is an essential activator of carbamoyl phosphate synthetase 1 (CPS 1). CPS 1 is the first enzyme of the urea cycle, and the enzyme converts ammonia to urea. Patients with NAGS deficiency do not produce enough NAG, resulting in hyperammonemia. Carglumic acid is a synthetic structural analog of NAG that works to activate CPS 1 and thus convert ammonia to urea.
Acute or chronic hyperammonemia in persons with
N
-acetylglutamate synthetase deficiency
Precautions:
Breastfeeding, pregnancy (C), geriatric patients
Calculator
• Adult/child:
PO 100-250 mg/kg/day (rounded to the nearest 100 mg) initially, divided; bid-qid, given immediately before meals, titrate to ammonia level; usual maintenance dose <100 mg/kg/day
Available forms:
Tabs 200 mg
•
Do not give whole or crushed tablets, disperse each tablet in ≥2.5 ml of water immediately before use. The tablets do not dissolve completely in water, and undissolved tablet particles can remain; rinse the mixing container with water and give to the patient, do not mix with foods or other fluids
•
Mix each tablet in ≥2.5 ml of water (80 mg/ml), shake gently, give the correct volume immediately through the NG tube, flush with additional water, discard any unused portion
•
Mix each tablet in ≥2.5 ml of water (80 mg/ml), shake gently, draw up the appropriate volume in an oral syringe and give immediately, refill syringe with ≥1-2 ml and give immediately, discard any unused portion
CNS:
Headache, fever, asthenia
EENT:
Tonsillitis, ear infections
GI:
Abdominal pain, vomiting, taste change, anorexia, diarrhea
OTHER:
Infection, anemia, weight loss, rash
Peak 3 hr, half-life 5.6 hr
Decrease:
Hgb level
Neurologic symptoms and ammonia levels:
Headache, fever, change in level of consciousness
Infection:
Assess for upper respiratory infections, influenza, pneumonia
•
Decreasing ammonia levels
•
Not to swallow whole or crush, but disperse in water
•
That blood for lab tests will be drawn regularly
•
To advise prescriber if pregnancy is planned or suspected, not to breastfeed
•
That a high-calorie, low-protein diet is necessary when ammonia levels are elevated
•
To report adverse reactions of vomiting, infection, ear pain, headache
•
Store unopened containers in refrigerator; opened bottle may be stored at room temperature for up to 1 mo; product stored at controlled room temperature should not be returned to a refrigerator; protect from moisture; discard opened bottle after 30 days
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(kar-eye-soe-proe′dole)
Soma
Func. class.:
Skeletal muscle relaxant, central acting
Chem. class.:
Meprobamate congener
Do not confuse:
Soma
/Soma Compound
Depresses CNS by blocking interneuronal activity in descending reticular formation, spinal cord, thereby producing sedation
Relieving pain, stiffness with musculoskeletal disorders
Hypersensitivity, intermittent porphyria
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, Asian patients, renal/hepatic disease, addictive personality
Calculator
• Adult/adolescent ≥16 yr:
PO
250-350 mg tid and at bedtime, max 3 wk of use
Available forms:
Tabs 350 mg
•
With meals for GI symptoms
•
For short term (2-3 wk), potential for habituation
•
Storage in tight container at room temp
CNS:
Dizziness, weakness, drowsiness
, headache, tremor, depression, insomnia, ataxia, irritability,
seizures
CV:
Postural hypotension, tachycardia
EENT:
Diplopia, temporary loss of vision
GI:
Nausea
, vomiting, hiccups, epigastric discomfort
HEMA:
Eosinophilia
INTEG:
Rash, pruritus, fever, facial flushing,
erythema multiforme
RESP:
Asthmatic attacks
SYST:
Angioedema, anaphylaxis
PO:
Onset 1/2 hr; peak 4 hr; duration 4-6 hr; extensively metabolized by liver, substrate of CYP2C19; excreted in urine; crosses placenta; excreted in breast milk (large amounts); half-life 8 hr
•
Do not use together with meprobamate
Increase:
CNS depression—alcohol, tricyclics, opioids, barbiturates, sedatives, hypnotics
Increase:
carisoprodol effect—CYP2C19 inhibitors (FLUoxetine, fluvoxaMINE, isoniazid, modafinil)
Decrease:
carisoprodol effect—CYP219 inducers (rifampin)
Increase:
CNS depression—kava, valerian
Increase:
metabolism of carisoprodol—St. John’s wort
Increase:
eosinophils
Increase:
RBC, WBC, platelets
•
Pain,
stiffness, mobility, activities of daily living at baseline and throughout treatment
•
ECG in seizure patients:
poor seizure control has occurred among patients taking this product
•
BUN, creatinine at baseline and periodically
•
Idiosyncratic reaction:
(weakness, dizziness, blurred vision, confusion, euphoria), anaphylaxis within a few minutes or hours of 1st to 4th dose, withhold and notify prescriber
•
Allergic reactions:
rash, fever, respiratory distress, anaphylaxis, angioedema
•
CNS depression:
dizziness, drowsiness, psychiatric symptoms, abuse potential
•
Abrupt discontinuation:
withdrawal reactions do occur but may be mild, dependence may occur
•
Assistance with ambulation if dizziness, drowsiness occurs, especially for geriatric patients
•
Therapeutic response: decreased pain, spasticity; increased ROM
•
To avoid hazardous activities if drowsiness, dizziness occur; not to drive while taking product, to avoid rapid position changes, postural hypotension occurs
•
To avoid using OTC medications (cough preparations, antihistamines) unless directed by prescriber; not to take with alcohol, other CNS depressants
•
To report allergic reaction immediately: rash, swelling of tongue/lips, hives, dyspnea
•
To take with food for GI symptoms
Activated charcoal, dialysis, lavage