Mosby's 2014 Nursing Drug Reference (151 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(en′ta-kah-pone)
Comtan
Func. class.:
Antiparkinson agent
Chem. class.:
COMT inhibitor
Inhibits COMT (catechol
O
-methyltransferase) and alters the plasma pharmacokinetics of levodopa; given with levodopa/carbidopa
Parkinson’s disease for those experiencing end of dose; decreased effect as adjunct to levodopa/carbidopa
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, renal/hepatic disease, affective disorders, psychosis
Calculator
• Adult:
PO
200 mg given with carbidopa/levodopa, max 1600 mg/day; may allow for 25% dosage reduction in levodopa therapy
Available forms:
Tabs, film coated 200 mg
•
Only after MAOIs have been discontinued for 2 wk
•
Give with dose of levodopa/carbidopa; product has no effect on its own
CNS:
Involuntary choreiform movements, hand tremors, fatigue, headache, anxiety, twitching, numbness, dyskinesia, hypokinesia, hyperkinesia, weakness, confusion, agitation, nightmares
, psychosis, hallucination, hypo
mania, severe depression, dizziness,
neuroleptic malignant syndrome
CV:
Orthostatic hypotension
GI:
Nausea, vomiting, anorexia, abdominal distress, dry mouth, flatulence, bitter taste, diarrhea, constipation, dyspepsia
, gastritis, GI disorder
INTEG:
Rash, sweating, alopecia
MISC:
Dark urine and other body fluids, back pain, dyspnea, purpura, fatigue, asthenia, bacterial infection,
rhabdomyolysis
Duration up to 8 hr; excreted in urine, feces; well absorbed; protein binding 98%; metabolized in liver extensively; enters breast milk; half-life of levodopa extended, half-life 0.5 hr initial, 2.5 hr second
•
Prevents catecholamine metabolism—nonselective MAOIs; do not use together
Increase:
B/P, tachycardia, dysrhythmias, avoid use—bitolterol, DOPamine, DOBUTamine, EPINEPHrine, methyldopa, isoetharine, norepinephrine
Decrease:
excretion of entacapone—ampicillin, chloramphenicol, probenecid, erythromycin, rifampin
Increase:
B/P—ma huang
Decrease:
effect—kava
Neuroleptic malignant syndrome:
high temp, increased CPK, rigidity, change in LOC usually during rapid withdrawal
•
Involuntary movements of Parkinson’s disease:
akinesia, tremors, staggering gait, muscle rigidity, drooling when given with levodopa/carbidopa
•
B/P, respirations during initial treatment
•
Mental status: affect, mood, behavioral changes, depression; complete suicide assessment
•
Rhabdomyolysis:
muscle pain, tenderness, weakness; swelling of affected muscles; may lead to decreased B/P, shock
•
Assistance with ambulation during beginning therapy
•
Therapeutic response: decrease in akathisia, increased mood when given with levodopa/carbidopa
•
That hallucinations, mental changes, nausea, dyskinesia can occur; may mean patient is overmedicated
•
To change positions slowly to prevent orthostatic hypotension; not to drive, operate machinery until stabilized on medication and mental performance not affected
•
To use product exactly as prescribed; if dose is missed, to take as soon as remembered up to 2 hr before next dose; not to discontinue abruptly; to withdraw gradually
•
That urine, sweat may darken
•
To notify prescriber if pregnancy is suspected; if lactating, that product excreted in breast milk
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(en-te′ka-veer)
Baraclude
Func. class.:
Antiretroviral nucleoside reverse transcriptase inhibitor (NRTIs)
Chem. class.:
Guanosine nucleoside analog
Inhibits hepatitis B virus DNA polymerase by competing with natural substrates and by causing DNA termination after its incorporation into viral DNA; causes viral DNA death
Chronic hepatitis B (HBV)
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, severe renal disease
Black Box Warning:
Hepatic disease, hepatitis, HIV, lactic acidosis
Calculator
• Adult and adolescent ≥16 yr:
PO
0.5 mg/day
• Adult and adolescent ≥16 yr:
PO
1 mg/day
• Adult:
PO
CCr ≥50 ml/min, 0.5 mg/day; CCr 30-49 ml/min, 0.25 mg/day, 0.5 mg/day or 1 mg q48hr for lamiVUDine-refractory patient; CCr 10-29 ml/min, 0.15/day, 0.3 mg or 1 mg q72hr for lamiVUDine-refractory patient; CCr <10 ml/min, 0.05 mg/day, 0.1 mg/day or 1 mg q7days for lamiVUDine-refractory patient
Available forms:
Tabs, film coated 0.5, 1 mg; oral sol 0.05 mg/ml
•
After hemodialysis
•
By mouth on empty stomach 2 hr before or after food
•
Store at room temperature
•
Oral liquid:
use calibrated oral dosing spoon provided; may be used interchangeably with tabs
CNS:
Headache
, fatigue, dizziness, insomnia
ENDO:
Hyperglycemia
GI:
Dyspepsia
, nausea, vomiting, diarrhea, elevated liver function enzymes
INTEG:
Alopecia, rash
SYST:
Lactic acidosis, severe hepatomegaly with steatosis
Peak 0.5-1.5 hr, steady state 6-10 days, 100% bioavailability, extensively distributed to tissues, protein binding 13%, terminal half-life 128-149 hr, excreted unchanged (62%-73%) via kidneys
Decrease:
absorption—high-fat meal
Increase:
ALT, AST, total bilirubin, amylase, lipase, creatinine, blood glucose, urine glucose
Decrease:
platelets, albumin
•
For nephrotoxicity:
increasing CCr, BUN
Black Box Warning:
For HIV before beginning treatment because HIV resistance may occur in chronic hepatitis B patients; monitor HIV RNA
Black Box Warning:
For lactic acidosis, severe hepatomegaly with stenosis; increased serum lactate, increased hepatic enzymes, palpate line; discontinue if present
•
Geriatric patients more carefully; may develop renal, cardiac symptoms more rapidly
Black Box Warning:
For exacerbations of hepatitis (jaundice, pruritus, fatigue) after discontinuing treatment, monitor LFTs
•
Therapeutic response: decreased symptoms of chronic hepatitis B, improving LFTs
•
Not to take with food
•
To take exactly as prescribed
•
Not to stop medication without approval of prescriber
•
That optimal duration of treatment is unknown
•
To avoid use with other medications unless approved by prescriber
•
To notify prescriber of decreased urinary output, blood in urine
Black Box Warning:
Symptoms of lactic acidosis: muscle pain, severe tiredness, weakness, trouble breathing, stomach pain with nausea/vomiting, coldness in arms/legs, fast/irregular heartbeat, dizziness
Black Box Warning:
Symptoms of hepatotoxicity: eyes/skin turning yellow, dark urine, light bowel movements, no appetite for days, nausea, stomach pain
•
That product does not cure but lowers amount of HBV in body
•
That product does not stop spread of HBV to others by sex, sharing needles, or being exposed to blood
•
Not to breastfeed
