Mosby's 2014 Nursing Drug Reference (196 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

gentamicin (ophthalmic)

(jen-ta-mye′sin)

Gentak, Garamycin

Func. class.:
Ophthalmic anti-infective

Chem. class.:
Aminoglycoside

Do not confuse:
clindamycin/tobramycin/erythromycin/vancomycin/GenTeal

ACTION:

Inhibits protein synthesis, thereby decreasing bacterial replication

USES:

External ocular infections

CONTRAINDICATIONS:

Hypersensitivity to this product or aminoglycosides

Precautions:
Pregnancy (C), breastfeeding

DOSAGE AND ROUTES
Calculator
Ophthalmic (solution)

• Adult/adolescent/child ≥1 mo:
SOL
1–2 drops in affected eye(s) every 4 hr while awake × 2 days, then every 4 hr; severe injections ≤2 drops every 1 hr

• 
Ointment:
apply a small amount (1/2″) to lower conjunctival sac bid or tid

Available forms:
Ophthalmic ointment, ophthalmic solution 0.3%

Administer:
Ophthalmic route

• 
Commercially available ophthalmic solutions are not for injection subconjunctivally or into the anterior chamber of the eye

• 
Apply topically to the eye, taking care to avoid contamination

• 
Do not to touch the tip of the dropper to the eye, fingertips, or other surface

• 
Apply pressure to lacrimal sac for 1 min after instillation

• 
To apply the ointment: pull down gently on lower eyelid, and apply a thin film of the ointment

SIDE EFFECTS

EENT:
Burning, hypersensitivity, stinging, blurred vision, hyperemia, corneal ulcers

PHARMACOKINETICS

Unknown

NURSING CONSIDERATIONS
Assess:

• 
Allergic reaction
: hypersensitivity, discontinue product

Evaluate:

• 
Decreased ophthalmic infection

Teach patient/family:
Ophthalmic route

• 
To apply topically to the eye, taking care to avoid contamination; for ophthalmic use only

• 
Not to touch the tip of the dropper to the eye, fingertips, or other surface

• 
To apply pressure to lacrimal sac for 1 min after instillation

• 
To apply the ointment by pulling down gently on lower eyelid, and applying a thin film of the ointment

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

gentamicin (topical)

(jen-ta-mye′sin)

Func. class.:
Topical anti-infective

Chem. class.:
Aminoglycoside

Do not confuse:
gentamicin/clindamycin

ACTION:

Antibacterial activity results from inhibition of protein synthesis; bactericidal

USES:

Superficial infections

CONTRAINDICATIONS:

Hypersensitivity to this product or other aminoglycosides

Precautions:
Infections

DOSAGE AND ROUTES
Calculator

• Adult/child >1 yr:
Apply to affected areas tid-qid

Available forms:
Topical cream, ointment 0.1%

Administer:

• 
For external use only; do not use skin products near the eyes, nose, or mouth

• 
Wash hands before and after use; wash affected area and gently pat dry

• 
Cream/Ointment:
Apply to the cleansed affected area, massage gently into affected areas

SIDE EFFECTS

INTEG:
Rash, irritation

PHARMACOKINETICS

Unknown

NURSING CONSIDERATIONS
Assess:

• 
Allergic reaction
: hypersensitivity, product may need to be discontinued

• 
Infection
: skin infection

Evaluate:

• 
Decreased skin infection

Teach patient/family:

• 
To use for external use only; do not use skin products near the eyes, nose, or mouth

• 
To wash hands before and after use, wash affected area and gently pat dry

• 
Cream/Ointment:
To apply to the cleansed affected area and massage gently into affected areas

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

glatiramer (Rx)

(glah-tear′a-meer)

Copaxone

Func. class.:
Multiple sclerosis agent

Chem.. class.:
Biological response modifier

ACTION:

Unknown; may modify the immune responses responsible for multiple sclerosis (MS)

USES:

Reduction of the frequency of relapses in patients with relapsing or remitting MS after first clinical episode with MRI results consistent with MS

CONTRAINDICATIONS:

Hypersensitivity to this product or mannitol, IV use

Precautions:
Pregnancy (B), breastfeeding, children <18 yr, immune disorders, renal disease, infection, vaccinations, geriatric patients

DOSAGE AND ROUTES
Calculator

• Adult:
SUBCUT
20 mg/day

Available forms:
Inj, premixed 20 mg/ml and 40 mg mannitol in single use syringe

Administer:
SUBCUT route

• 
If refrigerated, allow to warm for 20 min; visually inspect for particulate or cloudiness, if present discard; prefilled syringe contents is for single use; administer SUBCUT into hip, thigh, arm; discard unused portion

• 
Use SUBCUT route only; do not give IM or IV

SIDE EFFECTS

CNS:
Anxiety, hypertonia, tremor, vertigo
, speech disorder,
agitation
, confusion, flushing

CV:
Migraine, palpitations, syncope, tachycardia, vasodilation
, chest pain, hypertension

EENT:
Ear pain, blurred vision

GI:
Nausea, vomiting, diarrhea, anorexia, gastroenteritis

GU:
Urinary urgency, dysmenorrhea, vaginal moniliasis

HEMA:
Ecchymosis, lymphadenopathy

INTEG:
Pruritus, rash, sweating, urticaria, erythema
, inj site reaction

META:
Edema, weight gain

MS:
Arthralgia, back pain, neck pain
, increased muscle tone

RESP:
Bronchitis, dyspnea, laryngismus, rhinitis

PHARMACOKINETICS

May be hydrolyzed locally, may reach regional lymph nodes

NURSING CONSIDERATIONS
Assess:

• 
CNS symptoms: anxiety, confusion, vertigo

• 
GI status: diarrhea, vomiting, abdominal pain, gastroenteritis

• 
Cardiac status: tachycardia, palpitations, vasodilation, chest pain

Evaluate:

• 
Therapeutic response: decreased symptoms of MS

Teach patient/family:

• 
With written, detailed instructions about product; provide initial and return demonstrations on inj procedure; give information about use and disposal of product, inj site reaction (hives, rash, irritation, severe pain, flushing, chest pain)

• 
To notify prescribers of allergic reactions including itching, trouble breathing; chest pain, dizziness, sweating

• 
That irregular menses, dysmenorrhea, metrorrhagia, breast pain may occur; to use contraception during treatment

• 
That if pregnancy is suspected or if nursing to notify prescriber

• 
Not to change dosing or stop taking product without advice of prescriber

• 
About
immediate postinjection reaction:
flushing, chest pain, palpitations, anxiety, dyspnea, laryngeal constriction, urticaria; does not usually require treatment, may occur months after beginning treatment

• 
To take as directed, not to stop product or change schedule; teach on self-injection technique

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