Mosby's 2014 Nursing Drug Reference (312 page)

• Adult:
IV BOL
0.04-0.1 mcg/kg (2.8-7 mcg) no more than every other day during dialysis; may increase by 2-4 mcg q2-4wk until target serum intact PTH (1.5−3× nonuremic upper limit of normal) achieved;
PO
1 mcg/day or 2 mcg 3×/wk (IPTH ≤500 pg/ml); 2 mcg/day or 4 mcg 3×/wk (IPTH >500 pg/ml)

Decrease:
paricalcitol effect—cholestyramine, colestipol, mineral oil, orlistat, corticosteroids, barbiturates, hydantoins, CYP3A4 enzymes (nevirapine, rifampin, bosentan)

Increase:
calcium levels—thiazide diuretics, calcium products, vit D supplements

Increase:
effect of cardiac glycosides

Altered:
paricalcitol effect—CYP3A4 inhibitors (amiodarone, protease inhibitors, systemic azole antifungals, chloramphenicol, clarithromycin, delavirdine, erythromycin)

• 
Hypocalcemia:
twitching, dysrhythmias, Chvostek’s/Trousseu’s signs, paresthesia, laryngospasm, prolonged QTc/ST interval

• 
Serum calcium, serum intact parathyroid hormone concentrations (iPTH), phosphate 2×/wk during initial therapy; after dose is established, take calcium and phosphorus monthly

• 
Decreased hypoparathyroidism with chronic renal disease, normal serum calcium, phosphate, iPTH

• 
To report weakness, lethargy, headache, anorexia, loss of weight

• 
To report nausea, vomiting, palpitations

• 
To adhere to dietary regimen of calcium supplementation/phosphorus restriction

• 
To avoid excessive use of aluminum compounds, antacids

• 
Not to breastfeed

• 
Not to take mineral oil, antacids (magnesium) while taking vit D

Black Box Warning:

Children, suicidal ideation

• Adult:
PO
20 mg/day in
AM
, range 20-50 mg/day

• Adult:
PO
20 mg/day, range 20-60 mg/day

• Adult:
PO
20 mg/day in
AM
; after 4 wk, if no clinical improvement is noted, dose may be increased by 10 mg/day each wk to desired response, max 50 mg/day or
CONT REL
25 mg/day, may increase by 12.5 mg/day/wk up to 62.5 mg/day

• Geriatric:
PO
10 mg/day, increase by 10 mg to desired dose, max 40 mg/day

• Adult:
PO
40 mg/day in
AM
, start with 20 mg/day, increase in 10-mg/day increments, max 60 mg/day

• Adult:
PO
Start with 10 mg/day, increase in 10-mg/day increments to 40 mg/day, max 60 mg/day or
CONT REL
12.5 mg/day, max 75 mg/day

• Adult:
CONT REL
12.5 mg/day in
AM

• Adult:
PO
CCr 30-60 ml/min, lower doses may be needed; CCr <30 ml/min, 10 mg/day initially, regular rel, max 40 mg/day;
CONT REL
12.5 mg/day initially, max 50 mg/day

• Adult:
PO
10 mg/day initially, max 40 mg
regular rel;
12.5 mg/day initially, max 50 mg/day
(CONT REL)

• Adult:
PO (CONT REL)
12.5 mg/day, may increase to 25 mg/day after 1 wk

• Adult:
PO
20 mg/day

• 
Do not substitute Pexeva with Paxil, Paxil CR, or generic PARoxetine

• 
Increased fluids, bulk in diet for constipation, urinary retention

• 
With food, milk for GI symptoms

• 
Crushed if patient is unable to swallow medication whole (regular rel only)

• 
Gum, hard candy, frequent sips of water for dry mouth

• 
Avoid use with other CNS depressants

• 
Oral susp:
shake, measure with oral syringe or calibrated measuring device

• 
Cont rel tab:
do not cut, chew, crush; do not give concurrently with antacids

Decrease:
level of digoxin

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

Increase:
PARoxetine plasma levels—cimetidine

Increase:
agitation—
L
-tryptophan

Increase:
side effects—highly protein-bound products

Increase:
theophylline levels—theophylline

Increase:
toxicity—CYP2D6 inhibitors (aprepitant, delavirdine, imatinib, nefazodone)

Decrease:
PARoxetine levels—PHENobarbital and phenytoin

• 
Avoid use with St. John’s wort, kava

• 
Possible serotonin syndrome: St. John’s wort

• 
Hypertensive crisis: ephedra

Black Box Warning:

Depression/OCD/anxiety/panic attacks:
mental status: mood, sensorium, affect, suicidal tendencies (especially in child/young adult), increase in psychiatric symptoms, decreasing obsessive thoughts, compulsive behaviors, restrict amount available

• 
Postural hypotension:
B/P (lying/standing), pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; take vital signs q4hr for patients with CV disease

• 
Hepatic/renal studies: AST, ALT, bilirubin, creatinine

• 
Weight weekly; appetite may decrease with product, constipation

• 
ECG for flattening of T wave, bundle branch or AV block, dysrhythmias in cardiac patients

• 
EPS, primarily in geriatric patients: rigidity, dystonia, akathisia

• 
Renal status:
BUN, creatinine, urinary retention

• 
Withdrawal symptoms:
headache, nausea, vomiting, muscle pain, weakness; not usual unless product discontinued abruptly, taper over 1-2 wk

• 
Alcohol intake; if alcohol is consumed, hold dose until morning

 
Serotonin, neuroleptic malignant syndrome:
hallucinations, coma, headache, agitation, shivering, sweating, tachycardia, diarrhea, tremor, hypertension, hyperthermia, rigidity, delirium, coma, myoclonus, agitation, nausea, vomiting

• 
Storage at room temp; do not freeze

• 
Therapeutic response: decreased depression

• 
That therapeutic effect may take 1-4 wk

• 
To use caution when driving, performing other activities requiring alertness because of drowsiness, dizziness, blurred vision

• 
Not to discontinue medication quickly after long-term use; may cause nausea, headache, malaise (abrupt withdrawal syndrome)

Black Box Warning:

That depression may worsen, suicidal thoughts/behaviors; children/adolescents, young adults, to notify prescriber

• 
To avoid alcohol ingestion, OTC products unless approved by prescriber

• 
To report bleeding, headache, nausea, anxiety, or if depression continues

• 
To discuss sexual side effects: impotence, possible male infertility while taking product