Mosby's 2014 Nursing Drug Reference (299 page)

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

olmesartan (Rx)

(ol-meh-sar′tan)

Benicar

Func. class.:
Antihypertensive

Chem. class.:
Angiotensin II receptor (type AT
1
) antagonist

ACTION:

Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT
1
receptor found in tissues

USES:

Hypertension, alone or in combination with other antihypertensives

CONTRAINDICATIONS:

Hypersensitivity, pregnancy 2nd/3rd trimesters (D)

Precautions:
Pregnancy (C) 1st trimester, breastfeeding, children, geriatric patients, hepatic disease, CHF

DOSAGE AND ROUTES
Calculator

• Adult:
PO
Single agent 20 mg/day initially in patients who are not volume depleted, may be increased to 40 mg/day if needed after 2 wk

• Child ≥6 yr/adolescents ≤16 yr weighing ≥35 kg:
PO
20 mg/day, may increase to max 40 mg/day after 2 wk

• Child ≥6 yr/adolescents ≤16 yr weighing 20-<35 kg:
PO
10 mg daily, may increase to max 20 mg/day after 2 wk

Available forms:
Tabs 5, 20, 40 mg

Administer:

• 
Without regard to meals, refrigerate susp and store up to 1 mo, shake susp before use

SIDE EFFECTS

CNS:
Dizziness
, fatigue, headache, insomnia

CV:
Chest pain, peripheral edema, tachycardia

EENT:
Sinusitis, rhinitis, pharyngitis

GI:
Diarrhea
, abdominal pain

MS:
Arthralgia, pain

RESP:
Upper respiratory infection
, bronchitis

SYST:
Angioedema

PHARMACOKINETICS

Peak 1-2 hr; excreted in urine, feces; half-life 13 hr; protein binding 99%

INTERACTIONS

Increase:
antihypertensive effects—other antihypertensives, diuretics

Increase:
hyperkalemia—potassium supplements, potassium-sparing diuretics

Increase:
effect of lithium, antioxidants

Decrease:
antihypertensive effect—NSAIDs, colesevelan

Drug/Herb

Increase:
antihypertensive effect—hawthorn

Decrease:
antihypertensive effect—ephedra

NURSING CONSIDERATIONS
Assess:

 

Black Box Warning:

Pregnancy;
product can cause fetal death when given during pregnancy (D) 2nd/3rd trimesters

• 
Response, adverse reactions, especially in renal disease

• 
Hypertension:
B/P, pulse q4hr; note rate, rhythm, quality; electrolytes: sodium, potassium, chloride; baselines for renal, hepatic studies before therapy begins

• 
Hypotension:
place supine, may occur with hyponatremia or those with volume depletion, more common in those taking a diuretic also

Evaluate:

• 
Therapeutic response: decreased B/P

Teach patient/family:

• 
To comply with dosage schedule, even if feeling better

• 
To notify prescriber of mouth sores, fever, swelling of hands or feet, irregular heartbeat, chest pain

• 
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur

• 
That product may cause dizziness, fainting, lightheadedness

• 
To rise slowly to sitting or standing position to minimize orthostatic hypotension

 

Black Box Warning:

To notify prescriber immediately if pregnant; not to use during breastfeeding

• 
To avoid all OTC medications unless approved by prescriber

• 
That blood glucose may increase and antidiabetic product may need dosage change

• 
To inform all health care providers of medication use

• 
To use proper technique for obtaining B/P, acceptable parameters

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

olopatadine nasal agent

 

olopatadine ophthalmic

 

olsalazine (Rx)

(ohl-sal′ah-zeen)

Dipentum

Func. class.:
Antiinflammatory

Chem. class.:
Salicylate derivative

Do not confuse:
olsalazine
/OLANZapine

ACTION:

Bioconverted to 5-aminosalicylic acid, which decreases inflammation

USES:

Maintenance of remission of ulcerative colitis in patients intolerant to sulfasalazine

CONTRAINDICATIONS:

Hypersensitivity to this product or salicylates

Precautions:
Pregnancy (C), breastfeeding, children <14 yr; impaired renal/hepatic function; severe allergy; bronchial asthma

DOSAGE AND ROUTES
Calculator

• Adult:
PO
500 mg bid, max 3 g/day

Available forms:
Caps 250 mg

Administer:

• 
Total daily dose evenly spaced to minimize GI intolerance, give with food

SIDE EFFECTS

CNS:
Headache, hallucinations, depression, vertigo, fatigue, dizziness

GI:
Nausea, vomiting, abdominal pain,
hepatitis,
diarrhea, bloating, pancreatitis

HEMA:
Leukopenia, neutropenia, thrombocytopenia, agranulocytosis, anemia

INTEG:
Rash, dermatitis, urticaria

PHARMACOKINETICS

Partially absorbed, peak 1½ hr, half-life 30-90 min (rectal), 2-15 hr (PO), excreted in urine as 5-aminosalicylic acid and metabolites, crosses placenta

INTERACTIONS

Increase:
azaTHIOprine toxicity—azaTHIOprine

Increase:
myelosuppression—mercaptopurine, thioguanine

Increase:
PT, INR—warfarin

Drug/Lab Test

Increase:
AST, ALT

NURSING CONSIDERATIONS
Assess:

• 
Colitis:
bowel pattern, number of stools, consistency, frequency, pain, mucus before treatment and periodically

 
Blood dyscrasias:
skin rash, fever, sore throat, bruising, bleeding, fatigue, joint pain (rare); CBC before treatment and periodically

• 
Allergic reaction:
rash, dermatitis, urticaria, pruritus, dyspnea, bronchospasm; allergy to salicylates

Perform/provide:

• 
Storage in tight, light-resistant container at room temp

Evaluate:

• 
Therapeutic response: absence of fever, mucus in stools, decreased diarrhea, abdominal pain

Teach patient/family:

• 
To report diarrhea, rash, bleeding, bruising, fever, hallucinations

• 
That product may cause dizziness; to avoid hazardous activities until reaction is known

• 
To take even if feeling better; to take as directed; to take missed dose when remembered; but not to double

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

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