Mosby's 2014 Nursing Drug Reference (252 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(mah-rav′er-rock)
Selzentry
Func. class.:
Antiretroviral
Chem. class.:
Fusion inhibitor, CCR5-receptor antagonist
Interferes with entry into HIV-1 by inhibiting the fusion of the virus and the cell membrane
CCR5-tropic HIV in combination with other antiretroviral agents for treating experienced patients
Hypersensitivity, dialysis, renal impairment
Precautions:
Pregnancy (B), Asian patients, breastfeeding, renal/hepatic/cardiac disease, electrolyte imbalance, dehydration, immune reconstitution syndrome, infection, MI, orthostatic hypotension, children, geriatric patients, Graves’ disease, Guillain-Barré syndrome, polymyositis
Black Box Warning:
Hepatitis, fever, serious rash
Calculator
• Adult/adolescent ≥16 yr:
PO
300 mg bid
• Adult/adolescent ≥16 yr:
PO
150 mg bid
• Adult/adolescent ≥16 yr:
PO
600 mg bid
• Adult:
PO
≤30 ml/min, reduce dose to 150 mg bid
Available forms:
Tabs 150, 300 mg
•
May give without regard to meals, with 8 oz water; swallow whole, do not crush, chew, break
CV:
MI, cardiac ischemia, orthostatic hypotension
CNS:
Dizziness, depression,
viral meningitis,
disturbances in consciousness, peripheral neuropathy, paresthesia, dysesthesia, fever
EENT:
Gingival hyperplasia
GI:
Diarrhea, constipation, dyspepsia,
pseudomembranous colitis, hepatotoxicity
INTEG:
Rash, urticaria, pruritus, folliculitis
MS:
Joint pain, leg pain, muscle cramps
RESP:
Cough, upper respiratory tract infection, sinusitis, bronchitis, pneumonia,
bronchospasm, obstruction
SYST:
Herpes virus
Metabolized by P450 system; CYP3A metabolism; excreted 20% urine, 76% feces; protein binding 76%; terminal half-life 14-18 hr
Increase:
maraviroc levels—CYP3A inhibitors (amiodarone, aprepitant, chloramphenicol, clarithromycin, conivaptan, cycloSPORINE, dalfopristin, danazol, diltiazem, erythromycin, estradiol, fluconazole, fluvoxaMINE, imatinib, isoniazid, itraconazole, ketoconazole, miconazole, nefazodone, niCARdipine, propoxyphene, RU-486, tamoxifen, telithromycin, troleandomycin, verapamil, voriconazole, zafirlukast); reduce dose
Decrease:
maraviroc levels—CYP3A4 inducers (efavirenz, aminoglutethimide, barbiturates, bexaroten, bosentan, carBAMazepine, dexamethasone, griseofulvin, modafinil, nafcillin, OXcarbazepine, phenytoin, fosphenytoin, rifabutin, rifampin, rifapentine, topiramate, tipranavir); increase dose
•
Decreased maraviroc effect: St. John’s wort
•
High-fat meal decreases absorption 33%
•
HIV:
CD
4
, T-cell count, plasma HIV RNA, CCR5-tropic HIV-1; assess for changes in symptoms, other infections during treatment
•
Renal studies: serum creatinine
•
Bowel pattern before, during treatment
•
Allergies:
skin eruptions: rash, urticaria, itching; discontinue product
Black Box Warning:
Hepatitis:
dark urine; abdominal pain, vomiting; yellowing of skin, eyes; hepatomegaly; discontinue product; monitor liver function tests
•
Storage at room temp
•
Therapeutic response: improvement in CD4, viral load, T-cell count
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose; that product does not cure condition, should not be shared with others
•
That product does not cure infection, just controls symptoms and does not prevent infecting others
To report sore throat, fever, fatigue
(may indicate superinfection);
yellow skin/eyes, abdominal pain, vomiting
(hepatitis);
itching, SOB
(allergic reaction)
•
That product must be taken in equal intervals around the clock to maintain blood levels for duration of therapy
•
To avoid all OTC products unless approved by prescriber
•
To avoid driving, other hazardous activities until reaction is known; that dizziness may occur
•
To make position changes slowly to prevent postural hypotension
•
To notify prescriber if pregnancy is planned or suspected,
not to breastfeed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(me-ben′da-zole)
Func. class.:
Anthelmintic
Chem. Class.:
Carbamate
Inhibits glucose uptake, degeneration of cytoplasmic microtubules in the cell; interferes with absorption, secretory function
Pinworms, roundworms, hookworms, whipworms, thread-worms, pork tapeworms, dwarf tapeworms, beef tapeworms, hydatid cyst
Hypersensitivity
Precautions:
Pregnancy (C) (1st trimester), breastfeeding, children <2yr, Crohn’s disease, hepatic disease, inflammatory bowel disease, ulcerative colitis
Calculator
• Adult and child >2 yr:
PO
100 mg as a single dose (pinworms) or bid ×3 days (whipworms, roundworms, or hookworms); course may be repeated in 3 wk if needed, max 200 mg/day
Available forms:
Chew tabs 100 mg
•
May be crushed, chewed, swallowed whole, mixed with food
•
PO after meals to avoid GI symptoms
•
Second course after 3 wk if needed; usually recommended
CNS:
Dizziness, fever, headache,
seizures (rare)
GI:
Transient diarrhea, abdominal pain, nausea, vomiting, constipation, hepatitis
INTEG:
Rash
Peak ½-7 hr; excreted in feces primarily (metabolites), small amount in urine (unchanged); highly bound to plasma proteins 95%
Decrease:
mebendazole effect—carBAMazepine, hydantoins
Increase:
absorption—high-fat meal
•
Stools during entire treatment; specimens must be sent to lab while still warm, also 1-3 wk after treatment is completed
•
For allergic reaction: rash (rare)
•
For diarrhea during expulsion of worms; avoid self-contamination with patient’s feces
•
For infection in other family members, since infection from person to person is common
•
Blood studies: AST, ALT, alk phos, BUN, CBC during treatment
•
Storage in tight container
•
Therapeutic response: expulsion of worms and 3 negative stool cultures after completion of treatment
•
Proper hygiene after BM, including hand-washing technique; tell patient to avoid putting fingers in mouth; clean fingernails
•
That infected person should sleep alone; do not shake bed linen, change bed linen daily, wash in hot water, change and wash undergarments daily
•
To clean toilet daily with disinfectant (green soap solution)
•
The need for compliance with dosage schedule, duration of treatment
•
To wear shoes, wash all fruits and vegetables well before eating; use commercial fruit/vegetable cleaner
•
That all members of the family should be treated (pinworms)
•
To report jaundice, liver pain
