Mosby's 2014 Nursing Drug Reference (207 page)

• Adult:
PO
80 mg/kg as a single dose q3days or 20-30 mg/kg as a single dose daily

• Adult:
PO
80 mg/kg as a single dose q3days

• Adult:
PO
WBC >100,000/mm
³
, 50-75 mg/kg/day; WBC <100,000/mm
³
, 10-30 mg/kg/day; adjust for WBCs

• Child:
PO
10-20 mg/kg/day, adjust to hematologic response

• Adult:
PO
15 mg/kg/day, may increase by 5 mg/kg/day q12wk, max 35 mg/kg/day

• Adult:
CCr <59 ml/min use 50% of dose

• 
Gloves should be worn when handling bottles or caps, including by caregivers, wash hands immediately and thoroughly

• 
Do not crush or chew caps; caps can be opened and contents mixed with water

• 
Antiemetic 30-60 min before product and prn

Increase:
pancreatitis/hepatotoxicity—didanosine, stavudine

Increase:
toxicity—radiation or other antineoplastics

Increase:
bleeding risk—NSAIDs, anticoagulants, thrombolytics, salicylates, platelet inhibitors

Increase:
uric acid levels—probenecid, sulfinpyrazone

Increase:
BUN, creatinine, LFTs, uric acid

False increase:
urea, uric acid, lactic acid

Decrease:
Hgb, WBC, platelets

• 
Bone marrow suppression:
determine the hemoglobin concentration, total leukocyte count, and platelet count at least once a week during entire course; if the WBC is ≤2500/mm
³
or platelets are ≤100,000/mm
³
, interrupt Hydrea until the values rise significantly toward normal concentrations; if severe anemia occurs, manage it without interrupting Hydrea receipt; for Droxia, monitor blood counts q2wk and interrupt drug receipt if neutrophils are <2000/mm
³
, platelets are <80,000/mm
³
, hemoglobin is <4.5 g/dl, or reticulocytes are <80,000/mm
³
when the hemoglobin concentration is <9 g/dl; after recovery, Droxia may be resumed at lower dosage; Droxia therapy requires an experienced clinician knowledgeable in the use of this medication for the treatment of sickle cell anemia

• 
Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy

• 
Tumor lysis syndrome;
hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; uric acid nephropathy, acute renal failure, metabolic acidosis can also occur; aggressive alkalinization of urine, allopurinol can prevent this

• 
I&O ratio; report fall in urine output to <30 ml/hr

• 
Monitor temp; fever may indicate beginning infection

• 
Hepatic studies before, during therapy: bilirubin, alk phos, AST, ALT, LDH; prn or q mo

• 
Cutaneous vasculitic toxicity and gangrene:
more common in those who are receiving interferon

• 
Bleeding:
hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr

• 
Buccal cavity for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia

• 
Pulmonary reactions:
assess for pulmonary fibrosis, fever, dyspnea, diffuse pulmonary infiltrates

• 
Symptoms indicating severe allergic reaction:
rash, urticaria, itching, flushing

• 
Neurotoxicity:
headaches, hallucinations, seizures, dizziness

• 
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss

• 
Therapeutic response: decreased tumor size, spread of malignancy

• 
To report signs of infection: elevated temp, sore throat, flulike symptoms

• 
To report signs of anemia: fatigue, headache, faintness, SOB, irritability

• 
To report bleeding: to avoid use of razors, commercial mouthwash

• 
To avoid use of aspirin products, ibuprofen (thrombocytopenia)

• 
To avoid foods with citric acid, hot or rough texture if stomatitis is present

• 
To report stomatitis: any bleeding, white spots, ulcerations in the mouth; to examine mouth daily, report symptoms

• 
To notify prescriber if pregnancy is planned or suspected, pregnancy (D)

• 
To notify prescriber of fever, chills, sore throat, nausea, vomiting, anorexia, diarrhea, bleeding, bruising; may indicate blood dyscrasias; mental status changes

• Adult:
PO
50-100 mg qid, max 600 mg/day;
IM
50-100 mg q4-6hr

• Geriatric:
PO
max 50 mg/day

• Child
>
6 yr:
PO
50-100 mg/day in divided doses

• Child
<
6 yr:
PO
50 mg/day in divided doses

• Adult:
IM
50-100 mg q4-6hr

• Adult:
IM
25-100 mg q4-6hr

• Child:
IM
1.1 mg/kg as a single dose

• Adult:
PO
25 mg tid-qid;
IM
50-100 mg then q4-6hr prn, switch to
PO
as soon as feasible

• Child
≥
6 yr:
PO
50-100 mg/day in divided doses;
IM
0.5-1 mg/kg/dose q4-6hr prn, use
PO
when possible

• Child
<
6 yr:
PO
50 mg/day in divided doses

• Adult:
PO
50-100 mg 30-60 min before bedtime;
IM
50 mg 30-60 min before bedtime

• Adult:
PO
CCr <50 ml/min, give 50% of dose

Additive compatibilities:
CISplatin, cyclophosphamide, cytarabine, dimenhyDRINATE, etoposide, lidocaine, mesna, methotrexate, nafcillin

Syringe compatibilities:
Atropine, butorphanol, chlorproMAZINE, cimetidine, codeine, diphenhydrAMINE, doxapram, droperidol, fentaNYL, fluPHENAZine, glycopyrrolate, HYDROmorphone, lidocaine, meperidine, metoclopramide, midazolam, morphine, nalbuphine, oxymorphone, pentazocine, perphenazine, procaine, prochlorperazine, scopolamine, SUFentanil

Increase:
CNS depressant effect—barbiturates, opioids, analgesics, alcohol, sedative/hypnotics, other CNS depressants

Increase:
anticholinergic effects—phenothiazines, quiNIDine, disopyramide, antihistamines, antidepressants, atropine, haloperidol, MAOIs

False negative:
skin allergy testing

False increase:
17-hydroxycorticosteroids

• 
Anticholinergic effects: dry mouth, dizziness, confusion, hypotension, increased sedation; monitor B/P

• 
Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs

• 
Therapeutic response: decreased anxiety

• 
To avoid OTC preparations (cold, cough, hay fever) unless approved by prescriber

• 
To avoid driving, activities that require alertness

• 
To avoid alcohol, psychotropic medications

• 
Not to discontinue medication quickly after long-term use

• 
To rise slowly because fainting may occur