Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (376 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(sul-fa-sal′a-zeen)
Azulfidine, Azulfidine EN-tabs, Salazopyrin
Func. class.:
GI antiinflammatory, antirheumatic (DMARD)
Chem. class.:
Sulfonamide
Do not confuse:
sulfaSALAzine
/sulfiSOXAZOLE
Prodrug to deliver sulfapyridine and 5-aminosalicylic acid to colon; antiinflammatory in connective tissue also
Ulcerative colitis; RA; juvenile RA (Azulfidine EN-tabs)
Unlabeled uses:
Crohn’s disease
Pregnancy at term, children <2 yr; hypersensitivity to sulfonamides or salicylates; intestinal, urinary obstruction; porphyria
Precautions:
Pregnancy (B), breastfeeding, impaired renal/hepatic function, severe allergy, bronchial asthma, megaloblastic anemia
Calculator
• Adult:
PO
3-4 g/day in divided doses; maintenance 2 g/day in divided doses q6hr
• Child ≥6 yr:
PO
40-60 mg/kg/day in 4-6 divided doses then 30 mg/kg/day in 4 doses, max 2 g/day
• Adult:
PO
0.5-1 g/day then increase daily dose by 500 mg/wk to 2 g/day in 2-3 divided doses
• Child ≥6 yr:
PO
30-50 mg/kg/24 hr in 2 divided doses
•
Modify dose based on renal impairment, response
• Adult:
PO
1 g/15 kg, max 5 g/day
Available forms:
Tabs 500 mg; oral susp 250 mg/5 ml; del rel tabs 500 mg
•
Do not break, crush, chew del rel tabs
•
With full glass of water to maintain adequate hydration; increase fluids to 2 L/day to decrease crystallization in kidneys
•
Total daily dose in evenly spaced doses and after meals to help minimize GI intolerance
CNS:
Headache, confusion, insomnia, hallucinations, depression, vertigo, fatigue, anxiety,
seizures,
product fever, chills
CV:
Allergic myocarditis
GI:
Nausea, vomiting, abdominal pain
, stomatitis,
hepatitis,
glossitis, pancreatitis, diarrhea
GU:
Renal failure, toxic nephrosis,
increased BUN, creatinine, crystalluria
HEMA:
Leukopenia, neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia
INTEG:
Rash, dermatitis, urticaria,
Stevens-Johnson syndrome,
erythema, photosensitivity
SYST:
Anaphylaxis
PO:
Partially absorbed; peak 1½-6 hr; duration 6-12 hr; half-life 6 hr; excreted in urine as sulfaSALAzine (15%), sulfapyridine (60%), 5-aminosalicylic acid, metabolites (20%-33%); excreted in breast milk; crosses placenta
Increase:
leukopenia risk—thiopurines (azaTHIOprine, mercaptopurine)
Increase:
hypoglycemic response—oral hypoglycemics
Increase:
anticoagulant effects—oral anticoagulants
Decrease:
effect of cycloSPORINE, digoxin, folic acid
Decrease:
renal excretion of methotrexate
Decrease:
iron/folic acid absorption
False positive:
rinary glucose test
•
Renal studies: BUN, creatinine, urinalysis (long-term therapy)
Blood dyscrasias:
skin rash, fever, sore throat, bruising, bleeding, fatigue, joint pain; monitor CBC before therapy and q3mo
Allergic reaction:
rash, dermatitis, urticaria, pruritus, dyspnea, bronchospasm
•
Ulcerative colitis, proctitis, other inflammatory bowel disease:
character, amount consistency of stools; abdominal pain, cramping, blood, mucous
•
Rheumatoid arthritis:
assess mobility, joint swelling, pain, ability to complete activities of daily living
•
Storage in tight, light-resistant container at room temp
•
Therapeutic response: absence of fever, mucus in stools, pain in joints
•
To take each oral dose with full glass of water to prevent crystalluria
•
That contact lenses, urine, skin may be yellow-orange
•
To avoid sunlight or use sunscreen to prevent burns
•
To notify prescriber of skin rash, sore throat, fever, mouth sores, unusual bruising, bleeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(soo-ma-trip′tan)
ALSUMA Auto-injector, Imitrex, Sumavel DosePro
Func. class.:
Antimigraine agent
Chem. class.:
5-HT
1
B/D receptor agonist, abortive agent, triptan
Do not confuse:
SUMAtriptan
/somatropin
Binds selectively to the vascular 5-HT
1
B/D receptor subtype, exerts antimigraine effect; causes vasoconstriction in cranial arteries
Acute treatment of migraine with/without aura and cluster headache
Angina pectoris, history of MI, documented silent ischemia, Prinzmetal’s angina, ischemic heart disease, IV use, concurrent ergotamine-containing preparations, uncontrolled hypertension, hypersensitivity, basilar or hemiplegic migraine
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, postmenopausal women, men >40 yr, risk factors for CAD, hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function, overuse
Calculator
• Adult:
SUBCUT
≤6 mg; may repeat in 1 hr; max 12 mg/24 hr;
PO
25 mg with fluids, if no relief in 2 hr, give another dose, max 200 mg/day;
NASAL
single dose of 5, 10, or 20 mg in 1 nostril, may repeat in 2 hr, max 40 mg/24 hr; 1 puff each nostril q2hr
• Adult:
PO
25 mg; if no response after 2 hr, give ≤50 mg
Available forms:
Inj 4, 6 mg/0.5 ml; tabs 25, 50, 100 mg; nasal spray 5 mg/100 mcl-U; dose spray device 20 mg/100 mcl-U
•
Swallow tabs whole; do not break, crush, or chew
•
Take tabs with fluids as soon as symptoms appear; may take a 2nd dose >4 hr; max 200 mg/24 hr
SUBCUT only just below the skin; avoid IM or IV administration; use only for actual migraine attack
•
Give 1st dose supervised by medical staff to patients with coronary artery disease or those at risk for CAD
•
May give as 2 sprays of 5 mg in 1 nostril or 1 spray in each nostril (10 mg)
CNS:
Tingling, hot sensation, burning, feeling of pressure, tightness, numbness, dizziness, sedation
, headache, anxiety, fatigue, cold sensation
CV:
Flushing
,
MI,
hypo/hypertension
EENT:
Throat, mouth, nasal discomfort; vision changes
GI:
Abdominal discomfort
INTEG:
Inj site reaction, sweating
MS:
Weakness, neck stiffness
, myalgia
RESP:
Chest tightness, pressure
Onset of pain relief 10 min-2 hr, peak 10-20 min; 10%-20% plasma protein binding; metabolized in liver (metabolite); excreted in urine, feces; nasal spray half-life 2 hr
Increase:
vasospastic effects: ergot, ergot derivatives
Increase:
serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists, sibutramine
Increase:
SUMAtriptan effect—MAOIs
•
Serotonin syndrome: SAM-e, St. John’s wort
•
Migraine:
type of pain, aura; alleviating, aggravating factors; sensitivity to light, noise
Serotonin syndrome:
delirium, coma, agitation, diaphoresis, hypertension, fever, tremors; may resemble neuroleptic malignant syndrome in patients taking SSRIs, SNRIs
•
B/P; signs, symptoms of coronary vasospasms, ECG
•
Tingling, hot sensation, burning, feeling of pressure, numbness, flushing, inj site reaction
•
Stress level, activity, recreation, coping mechanisms
•
Neurologic status: LOC, blurring vision, nausea, vomiting, tingling in extremities preceding headache
•
Ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artificial sweeteners, chocolate, caffeine, which may precipitate these types of headaches
•
Renal function, urinary output
•
Quiet, calm environment with decreased stimuli: noise, bright light, excessive talking
•
Therapeutic response: decrease in frequency, severity of migraine
•
To report chest pain, tightness; sudden, severe abdominal pain; swelling of eyelids, face, lips; skin rash to prescriber immediately
•
To notify prescriber if pregnancy is planned or suspected; to use contraception while taking product
•
Nasal spray:
to use 1 spray in 1 nostril, may repeat if headache returns; not to repeat if pain continues after 1st dose
•
To have a dark, quiet environment
•
To avoid hazardous activities if dizziness, drowsiness occur
•
To avoid alcohol; may increase headache
•
To use SUBCUT inj technique, nasal route if prescribed
•
That product does not reduce number of migraines; to be used for acute migraine; to use as symptoms occur
