Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (188 page)
Do not confuse:
Monopril
/minoxidil/Accupril/Monoket
Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial, venous vessels
Hypertension, alone or in combination with thiazide diuretics, systolic CHF
Unlabeled uses:
Proteinuria in nondiabetic nephropathy
Breastfeeding, children, hypersensitivity to ACE inhibitors, history of ACE-inhibitor–induced angioedema
Black Box Warning:
Pregnancy (D)
Precautions:
Geriatric patients, impaired hepatic function, hypovolemia, blood dyscrasias, CHF, COPD, asthma, angioedema, hyperkalemia, renal artery stenosis, renal disease
Calculator
• Adult:
PO
10 mg/day then up to 40 mg/day increased over several weeks; use lower dose for those diuresed before fosinopril
• Adult:
PO
10 mg/day initially then 20-40 mg/day divided bid or daily, max 80 mg/day
Available forms:
Tabs 10, 20, 40 mg
•
May be taken without regard to meals
CNS:
Headache, dizziness
, fatigue
CV:
Hypotension
, orthostatic hypotension, tachycardia
GI:
Nausea
, constipation, vomiting, diarrhea,
hepatotoxicity, cholestatic jaundice, fulminant hepatic necrosis, hepatic failure, death
GU:
Increased BUN, creatinine, azotemia,
renal artery stenosis
HEMA:
Decreased Hct, Hgb;
eosinophilia, leukopenia, neutropenia
META:
Hyperkalemia
RESP:
Cough
SYST:
Anaphylaxis, angioedema
Peak 3 hr, serum protein binding 97%, half-life 11.5-14 hr, metabolized by liver (metabolites excreted in urine, feces)
Increase:
hypotension—diuretics, other antihypertensives, ganglionic blockers, adrenergic blockers, nitrates, acute alcohol ingestion
Increase:
toxicity—vasodilators, hydrALAZINE, prazosin, potassium-sparing diuretics, sympathomimetics, digoxin, lithium, NSAIDs
Decrease:
absorption—antacids
Decrease:
antihypertensive effect—salicylates
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra
Increase:
AST, ALT, alk phos, glucose, bilirubin, uric acid
False positive:
urine acetone
Positive:
ANA titer
•
Hypertension:
B/P, orthostatic hypotension, syncope
•
Blood studies: neutrophils, decreased platelets; obtain WBC with differential baseline and monthly × 6 mo then q2-3mo × 1 yr; if neutrophils <1000/mm
3
, discontinue (recommended with collagen–vascular disease)
•
Renal studies: protein, BUN, creatinine; increased levels may indicate nephrotic syndrome
•
Baselines of renal, hepatic studies before therapy begins
•
Potassium levels, although hyperkalemia rarely occurs
•
CHF:
edema in feet, legs daily; weigh daily
•
Allergic reactions:
rash, fever, pruritus, urticaria; product should be discontinued if antihistamines fail to help
•
Storage in tight container at ≤86° F (30° C)
•
Supine position for severe hypotension
•
Therapeutic response: decrease in B/P
•
Not to discontinue product abruptly; to take at same time of day
•
Not to use OTC products (cough, cold, allergy) unless directed by prescriber; not to use salt substitutes containing potassium without consulting prescriber
•
About the importance of complying with dosage schedule, even if feeling better
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
•
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, nonproductive cough
•
To report excessive perspiration, dehydration, vomiting, diarrhea; may lead to fall in B/P
•
That product may cause dizziness, fainting, lightheadedness during first few days of therapy
•
That product may cause skin rash or impaired perspiration
•
How to take B/P; normal readings for age group
Black Box Warning:
To notify prescriber if pregnancy is planned or suspected, pregnancy (D)
0.9% NaCl IV inf, hemodialysis
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(foss-fen′i-toy-in)
Func. class.:
Anticonvulsant
Chem. class.:
Hydantoin, phosphate phenytoin ester
Inhibits spread of seizure activity in motor cortex by altering ion
transport; increases AV conduction, prodrug of phenytoin
Generalized tonic-clonic seizures, status epilepticus, partial seizures
Pregnancy (D), hypersensitivity, psychiatric conditions, bradycardia, SA and AV block, Stokes-Adams syndrome, absence seizures
Precautions:
Breastfeeding, allergies, renal/hepatic disease, myocardial insufficiency, hypoalbuminemia, hypothyroidism, Asian patients positive for HLA-B 1502
Black Box Warning:
Rapid IV inf
Calculator
All doses in PE (phenytoin sodium equivalent)
• Adult and adolescent:
IV
15-20 mg PE/kg
• Child <12 yr (unlabeled):
IV
15-20 mg PE/kg
• Adult and adolescent >16 yr:
IM/IV
10-20 mg PE/kg; 4-6 mg PE/kg/day (maintenance); start maintenance 12 hr after loading dose; give in 2-3 divided doses
Available forms:
Inj 150 mg (100 mg phenytoin equiv), 750 mg (500 mg phenytoin equiv), 50-mg/ml vials
•
Give IM/IV; the dosage, concentration, and infusion rate of fosphenytoin should always be expressed, prescribed, and dispensed in phenytoin sodium equivalents (PE); exercise extreme caution when preparing and administering fosphenytoin; the concentration and dosage should be carefully confirmed; fatal overdoses have occurred in children when the per ml concentration of the product (50 mg PE/mL) was misinterpreted as the total amount of drug in the vial
•
Visually inspect for particulate matter and discoloration before use
•
Before infusion, dilute in 5% dextrose or 0.9% saline solution to a concentration ranging from 1.5 to 25 mg PE/ml
•
Because of the risk of hypotension, do not exceed recommended infusion rates. Continuous monitoring of ECG, B/P, and respiratory function is recommended, especially throughout the period where phenytoin concentrations peak (about 10–20 min after the end of the infusion)
•
Loading doses should always be followed by maintenance doses of oral or parenteral phenytoin or parenteral fosphenytoin
• Adult:
IV
Infuse at a max rate of 150 mg PE/min
• Elderly or debilitated adults:
IV
Infuse at a max 3 mg PE/kg/min or 150 mg PE/min, whichever is less
• Child:
IV
Infuse at a rate of 0.5–3 mg PE/kg/min or max 150 mg PE/min, whichever is less
• Infant/neonate:
IV
Infuse at a rate max 0.5–3 mg PE/kg/min
Y-site compatibilities:
Aminocaproic acid, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, atenolol, bivalirudin, bleomycin, CARBOplatin, CISplatin, cyclophosphamide, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, diltiazem, DOCEtaxel, doxacurium, eptifibatide, ertapenem, etoposide, fludarabine, fluorouracil, gatifloxacin, gemcitabine, gemtuzumab, granisetron, ifosfamide, levofloxacin, linezolid, LORazepam, mechlorethamine, meperidine, methotrexate, metroNIDAZOLE, nesiritide, octreotide, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pantoprazole, PEMEtrexed, PHENobarbital, piperacillin-tazobactam, rocuronium, sodium acetate, tacrolimus, teniposide, thiotepa, tigecycline, tirofiban, vinCRIStine, vinorelbine, voriconazole, zoledronic acid
CNS:
Drowsiness
, dizziness, insomnia, paresthesias, depression,
suicidal tendencies,
aggression, headache, confusion, paresthesia
CV:
Hypo/hypertension,
ventricular fibrillation, CHF, shock
EENT:
Nystagmus, diplopia, blurred vision
GI:
Nausea, vomiting, diarrhea, constipation, anorexia, weight loss, hepatitis, jaundice, gingival hyperplasia
HEMA:
Agranulocytosis, leukopenia, aplastic anemia, thrombocytopenia, megaloblastic anemia
INTEG:
Rash, lupus erythematosus,
Stevens-Johnson syndrome,
hirsutism, hypersensitivity, pruritus
SYST:
Hyperglycemia, hypokalemia, SJS/TEN Asian patients positive for HLA-B 1502;
drug reaction with eosinophilia and systemic symptoms (DRESS), purple glove syndrome, anaphylaxis
Metabolized by liver, excreted by kidneys, protein binding 95%-99%, rapidly converted to phenytoin
Increase:
fosphenytoin level—cimetidine, amiodarone, chloramphenicol, estrogens, H
2
antagonists, phenothiazines, salicylates, sulfonamides, tricyclics, CYP1A2 inhibitors
Decrease:
fosphenytoin effects—alcohol (chronic use), antihistamines, antacids, traMADol, antineoplastics, rifampin, folic acid, carBAMazepine, theophylline, CYP1A2 inducers
Decrease:
virologic response, resistance—delavirdine, do not use concurrently
Increase:
anticonvulsant effect—ginkgo
Decrease:
anticonvulsant effect—ginseng, valerian
Increase:
glucose, alk phos
Decrease:
dexamethasone, metyrapone test serum, PBI, urinary steroids
•
Drug level: target level 10-20 mcg/ml, toxic level 30-50 mcg/ml, wait >2 hr after dose before testing, 4 hr after IM dose
•
Blood studies: CBC, platelets q2wk until stabilized, then monthly × 12 mo, then q3mo; discontinue product if neutrophils <1600/mm
3
; serum calcium, albumin, phosphorus
Mental status: mood, sensorium, affect, memory (long, short),
suicidal thoughts/behaviors
•
Serious skin reactions:
usually occurring within 28 days of treatment; if a rash develops, patient should be evaluated for DRESS
•
Seizure activity including type, location, duration, character; provide seizure precaution
•
Renal studies: urinalysis, BUN, urine creatinine
•
Hepatic studies: ALT, AST, bilirubin, creatinine
•
Allergic reaction: red, raised rash; product should be discontinued
•
Toxicity/bone marrow depression:
nausea, vomiting, ataxia, diplopia, cardiovascular collapse, slurred speech, confusion
•
Respiratory depression: rate, depth, character of respirations
Blood dyscrasias:
fever, sore throat, bruising, rash, jaundice
•
Continuous monitoring of ECG, B/P, respiratory function
•
Rash; discontinue as soon as rash develops, serious adverse reactions such as
Stevens-Johnson syndrome
can occur
•
Therapeutic response: decrease in severity of seizures
•
About the reason for, expected outcomes of treatment
•
Not to use machinery or engage in hazardous activity, since drowsiness, dizziness may occur
•
To carry emergency ID denoting product use, name of prescriber
•
To notify prescriber of rash, bleeding, bruising, slurred speech, jaundice of skin or eyes, joint pain, nausea, vomiting, severe headaches
•
To keep all medical appointments, including those for lab work, physical assessment
•
To notify prescriber if pregnancy is planned, suspected
•
To use contraception while using this product
