Mosby's 2014 Nursing Drug Reference (44 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
•
Do not crush or chew ext rel tab or caps
•
Caps may be opened and contents mixed with jelly
•
100 mg undiluted by direct IV over at least 1 min; rapid inf may cause fainting
•
Diluted with D
5
W, D
5
NaCl, NS, LR, Ringer’s, sodium lactate and given over 15 min
Metoclopramide, aminophylline, theophylline
Y-site compatibilities:
Warfarin
CNS:
Headache, insomnia, dizziness, fatigue, flushing
GI:
Nausea, vomiting, diarrhea, anorexia, heartburn, cramps
GU:
Polyuria, urine acidification, oxalate/urate renal stones, dysuria
HEMA:
Hemolytic anemia in patients with G6PD
INTEG:
Inflammation at inj site
PO/INJ:
Readily absorbed PO, metabolized in liver; unused amounts excreted in urine (unchanged), metabolites; crosses placenta, breast milk
False positive:
negatives in glucose tests
False negative:
occult blood, urine bilirubin, leukocyte determination
•
I&O ratio; urine pH (acidification)
•
Ascorbic acid levels throughout treatment if continued deficiency is suspected
•
Nutritional status: citrus fruits, vegetables
•
Inj sites for inflammation
•
Thrombophlebitis if receiving large dose
•
Therapeutic response: absence of anorexia, irritability, pallor, joint pain, hyperkeratosis, petechiae, poor wound healing
•
Necessary foods to include in diet, such as citrus fruits
•
That smoking decreases vit C levels; not to exceed prescribed dose; that excesses will be excreted in urine, except when taking timed-release forms
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(a-sen′a-peen)
Saphris
Func. class.:
Antipsychotic, atypical
Chem. class.:
Dibenzapine
Unknown; may be mediated through both DOPamine type 2 (D2) and serotonin type 2 (5-HT2A) antagonism
Bipolar 1 disorder, schizophrenia
Breastfeeding, hypersensitivity
Precautions:
Pregnancy (C), children, geriatric patients, cardiac/renal/hepatic disease, breast cancer, Parkinson’s disease, dementia, seizure disorder, CNS
depression, agranulocytosis, QT prolongation, torsades de pointes, suicidal ideation, substance abuse
Black Box Warning:
Increased mortality in elderly patients with dementia-related psychosis
• Adult: SL
5 mg bid, max 20 mg/day
• Adult:
SL
10 mg bid, may decrease to 5 mg bid as needed, max 20 mg/day
Available forms:
SL tab 5, 10 mg
•
Anticholinergic agent to be used for EPS
•
SL tab:
remove tab; place tab under tongue; after it dissolves, swallow; advise patient not to chew, crush, swallow tabs, not to eat, drink for 10 min
CNS:
EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia; drowsiness, insomnia, agitation, anxiety, headache
,
seizures, neuroleptic malignant syndrome,
dizziness
CV:
Orthostatic hypotension,
sinus tachycardia; heart failure, QT prolongation, stroke, bundle branch block
GI:
Nausea
, vomiting,
constipation
, weight gain, increased appetite; oral hypoesthesia/parasthesia, mucosal ulcers, increased salivation (SL)
GU:
Hyperprolactinemia, hyperglycemia, hyponatremia
HEMA:
Thrombocytopenia
INTEG:
Serious allergic reactions
Extensively metabolized by liver, protein binding 95%, peak 0.5-1.5 hr, terminal half-life 24 hr
Increase:
sedation—other CNS depressants, alcohol
Increase:
EPS—CYP2D6 inhibitors/substrates (SSRIs)
Increase:
EPS—other antipsychotics
Increase:
asenapine excretion—carBAMazepine
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, methadone, chloroquine, clarithromycin, droperidol, erythromycin, pentamidine
Decrease:
asenapine action—CYP2D6 inducers (carBAMazepine, barbiturates, phenytoins, rifampin)
Increase:
CNS depression—kava
Increase:
EPS—betel palm, kava
Increase:
prolactin levels, glucose LFTs
Mental status before initial administration; watch for suicidal thoughts and behaviors; dementia and death may occur among elderly patients
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
•
B/P standing and lying; also pulse, respirations; take these q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes; QT prolongation may occur
•
Dizziness, faintness, palpitations, tachycardia on rising
•
EPS,
including akathisia, tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
•
Neuroleptic malignant syndrome:
hyperthermia, increased CPK, altered mental status, muscle rigidity
•
Constipation daily; increase bulk, water in diet if needed
•
Weight gain, hyperglycemia, metabolic changes with diabetes
•
Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for a long time
•
Storage in tight, light-resistant container
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech
•
That orthostatic hypotension may occur; to rise from sitting or lying position gradually
•
To avoid hot tubs, hot showers, tub baths; hypotension may occur
•
To avoid abrupt withdrawal of this product; EPS may result; product should be withdrawn slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber; serious product interactions may occur; to avoid use of alcohol; increased drowsiness may occur
•
To avoid hazardous activities if drowsy, dizzy
•
About compliance with product regimen
•
That heat stroke may occur in hot weather; to take extra precautions to stay cool
•
To use contraception; to inform prescriber if pregnancy is planned, suspected
Black Box Warning:
To report suicidal thoughts/behaviors immediately
Lavage if orally ingested; provide airway;
do not induce vomiting
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTasparaginase (Rx)
(a-spare′a-gi-nase)
Elspar
Func. class.:
Antineoplastic
Chem. class.: Escherichia coli
enzyme
Acute lymphocytic leukemia in combination with other antineoplastics
Hypersensitivity to product or
E. coli
protein, thromboembolic disease, infants, breastfeeding, pancreatitis
• Adult and child: IM/IV
25,000 international units/m
2
/wk × 2 wk or 6000 international units/m
2
every other day × 3-4 wk or 1000-20,000 international units/m
2
for 10-12 days
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
Erwinia chrysanthemi
Erwinaze
Func. class.:
Antineoplastic, natural and semisynthetic
Contains an asparaginase specific enzyme L-asparaginase derived from Erwinia chrysanthemi, which catalyzes of asparagine to aspartic acid and ammonia and causes reduced circulating concentrations of asparagine; efficacy of asparaginase
Erwinia chrysanthemi
may be leukemic cell cytotoxicity from asparagine deficiency
Treatment of acute lymphocytic leukemia (ALL) in combination with other chemotherapeutic agents in patients who have developed hypersensitivity to
E. coli
–derived asparaginase