Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (129 page)
See
Appendix B
(dye-kloe′fen-ak)
Flector
Cambia, Cataflam, Rapide
, Zipsor
Apo-Dilo, Novo-Difenac, Nu-Diclo, PENNSAID, Sandoz Diclofenac, Solaraze Topical Gel, Voltaren, Voltaren Topical Gel, Voltaren XR
Func. class.:
Nonsteroidal antiinflammatory products (NSAIDs), nonopioid analgesic
Chem. class.:
Phenylacetic acid
Do not confuse:
Cataflam
/Catapres
Inhibits COX-1, COX-2 by blocking arachidonate resulting in analgesic, antiinflammatory, antipyretic effects
Acute, chronic RA; osteoarthritis; ankylosing spondylitis; analgesia; primary dysmenorrhea; patch: mild to moderate pain
Unlabeled uses:
Arthralgia, headache, migraine, bone pain, myalgia
Hypersensitivity to aspirin, iodides, other NSAIDs, bovine protein, asthma, serious CV disease; eczema, exfoliative dermatitis, skin abrasions (gel, patch)
Black Box Warning:
Treatment of perioperative pain (CABG), surgery
Precautions:
Pregnancy (C) (tabs, del rel tab, ext rel tab, top gel), (volteren, ophthalmic sol); pregnancy (B) (top gel)(solaraze); top patch, top sol, cap, powder for oral sol (C <30 wk, D >30 wk); breastfeeding, children, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents, CCr <30 ml/min, accidental exposure, acute bronchospasm, hypersensitivity to benzyl alcohol
Black Box Warning:
GI bleeding, MI, stroke
Calculator
•
Adult: PO
(Cataflam) 50 mg bid-tid, max 150 mg/day;
DEL REL
(Voltaren) 50 mg bid-tid or 75 mg bid, max 150 mg/day;
EXT REL
(Voltaren-XR) 100 mg daily, max 150 mg/day;
TOP GEL
1% (Voltaren gel) 4 g for each of lower extremities qid, max 16 g/day; 2 g for each of upper extremities qid, max 8 g/day;
TOP SOL
(Pennsaid) apply 40 drops to each affected knee qid; apply 10 drops at a time, spread over entire knee
•
Adult: PO
(Cataflam) 50 mg tid-qid, max 200 mg/day;
DEL REL
(Voltaren) 50 mg tid-qid or 75 mg bid, max 200 mg/day;
EXT REL
(Voltaren-XR) 100 mg daily, may increase to 200 mg/day, max 200 mg/day
•
Adult: PO DEL REL
(Voltaren) 25 mg qid and 25 mg at bedtime, max 125 mg/day
•
Adult: PO
(powder for oral sol) (Cambia) 50 mg as a single dose, mix contents of packet in 1-2 oz water
•
Adult: PO
(Zipsor) 25 mg qid
•
Adult: PO
(Cataflam) 50 mg tid or 100 mg initially then 50 mg tid, max 200 mg 1st day then 150 mg/day
•
Adult: TOP PATCH
(Flector) apply patch to area bid
•
Adult: TOP GEL
(Solaraze) apply to area bid
•
Adult: PO
50 mg tid × 3 wk
• Avoid:
Use of topical gel, patch, sol, potassium oral tab for advanced renal disease
Available forms:
Epolamine:
topical patch 1.3%;
potassium:
tabs 50 mg; tabs liquid filled 25 mg; oral powder for sol 50 mg;
sodium:
delayed rel tabs (enteric-coated) 25, 50, 75, 100 mg; Pennsaid: top sol 1.5%, ext rel 100 mg; topical gel 1%, 3%
•
Do not break, crush, or chew enteric products
•
Take with a full glass of water to enhance absorption, remain upright for 1/2 hr; if dose missed, take as soon as remembered within 2 hr if taking 1-2×/day; do not double doses
•
Store at room temperature
•
Wash hands before handling patch
•
Remove and release liner before administration
•
Use only on normal, intact skin
•
Remove before bath, shower, swimming
•
Discard removed patch in trash away from children, pets
•
Store at room temperature
•
Apply to intact skin
•
Use only for osteoarthritis, mild to moderate pain
•
Store at room temperature, avoid heat, do not freeze
•
Apply to clean, dry skin
•
Wait until dry before applying clothing, other creams/lotions
•
Wait ≥30 min after use before bathing, swimming
•
Store at room temperature
CNS:
Dizziness, headache
, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, nervousness, paresthesia, muscle weakness
CV:
CHF,
tachycardia, peripheral edema, palpitations,
dysrhythmias,
hypo/hypertension, fluid retention,
MI, stroke
EENT:
Tinnitus, hearing loss, blurred vision,
laryngeal edema
GI:
Nausea, anorexia, vomiting, diarrhea,
jaundice, cholestatic hepatitis,
constipation, flatulence, cramps, dry mouth, peptic ulcer,
GI bleeding, hepatotoxicity
GU:
Nephrotoxicity: dysuria, hematuria, oliguria, azotemia, cystitis, UTI
HEMA:
Blood dyscrasias,
epistaxis, bruising
INTEG:
Purpura, rash, pruritus, sweating, erythema, petechiae, photosensitivity, alopecia
META:
Hyperglycemia, hypoglycemia
RESP:
Dyspnea, hemoptysis, pharyngitis,
bronchospasm,
rhinitis, SOB
SYST:
Anaphylaxis
PO:
Peak 2-3 hr;
TOP Patch:
peak 12 hr; elimination half-life 2.5 hr, 99% bound to plasma proteins, metabolized in liver to metabolite, excreted in urine
•
Need for dosage adjustment: antidiabetics
Increase:
hyperkalemia—potassium-sparing diuretics
Increase:
anticoagulant effect—anticoagulants, NSAIDs, platelet inhibitors, salicylates, thrombolytics, SSRIs
Increase:
toxicity—phenytoin, lithium, cycloSPORINE, methotrexate, digoxin, lithium
Increase:
GI side effects—aspirin, other NSAIDs, bisphosphonates, corticosteroids
Decrease:
antihypertensive effect—β-blockers, diuretics, ACE inhibitors
Decrease:
effect of diuretics
Increase:
bleeding risk—garlic, ginger, ginkgo; monitor for bleeding
Black Box Warning:
CABG:
do not use oral, top, gel, patch, in perioperative pain in coronary artery bypass graft surgery for 10-14 days
Black Box Warning:
Stroke/MI:
may increase CHF and hypertension, increased CV thrombotic events that may be fatal; those with CV disease may be at greater risk
•
Pain:
location, character, aggravating/alleviating factors, ROM before and 1 hr after dose
•
Patients with asthma, aspirin hypersensitivity, nasal polyps; may develop hypersensitivity
•
LFTs (may be elevated), uric acid (may be decreased—serum; increased—urine) periodically; also BUN, creatinine, electrolytes (may be elevated)
Blood dyscrasias (thrombocytopenia):
bruising, fatigue, bleeding, poor healing; blood counts during therapy; watch for decreasing platelets; if low, therapy may need to be discontinued, restarted after hematologic recovery; stool guaiac
•
Therapeutic response: decreased inflammation in joints, after cataract surgery
•
That product must be continued for prescribed time to be effective; to contact prescriber before surgery regarding when to discontinue this product
•
To report bleeding, bruising, fatigue, malaise;
blood dyscrasias
do occur
•
To avoid aspirin, alcoholic beverages, NSAIDs, or other OTC medications unless approved by prescriber
•
To take with food, milk, or antacids to avoid GI upset; to swallow whole
•
To use caution when driving; drowsiness, dizziness may occur
•
To report
hepatotoxicity:
flulike symptoms, nausea, vomiting, jaundice, pruritus, lethargy
•
To use sunscreen to prevent photosensitivity
•
To notify all providers of product use
•
To notify prescriber if pregnancy is planned or suspected (C, tabs) (C, <30 wk, D, >30 wk caps, topical patch/solution, powder for oral solution)
