Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (423 page)
PO-OTC
, Rx-IM)
Aquasol A, Vitamin A
Func. class.:
Vitamin, fat soluble
Chem. class.:
Retinol
Needed for normal bone, tooth development; visual dark adaptation; skin disease; mucosa tissue repair; assists with production of adrenal steroids, cholesterol, RNA
Vit A deficiency
Pregnancy (X) (IM), hypersensitivity to vit A, malabsorption syndrome, hypervitaminosis A, IV administration
Precautions:
Pregnancy (C) (PO), breastfeeding, impaired renal function, children, hepatic disease, infants, alcoholism, hepatitis
Calculator
• Adult and child >8 yr:
PO
100,000-500,000 international units/day × 3 days then 50,000/day × 2 wk; dose based on severity of deficiency; maintenance 10,000-20,000 international units for 2 mo
• Child 1-8 yr:
IM
5000-15,000 international units/day × 10 days
• Infant <1 yr:
IM
5000-15,000 international units × 10 days
• Child 4-8 yr:
IM
15,000 international units/day × 2 mo
• Child <4 yr:
IM
10,000 international units/day × 2 mo
Available forms:
Caps 10,000, 25,000, 50,000 international units; drops 5000 international units; inj 50,000 international units/ml; tabs 10,000, 25,000, 50,000 international units
•
With food (PO) for better absorption
•
Do not administer IV because of risk of anaphylactic shock; IM only
•
Oral preparations not indicated for vit A deficiency in those with malabsorption syndrome
•
Give deep in large muscle mass; do not use deltoid muscle for administration of >1 ml
CNS:
Headache,
increased intracranial pressure, intracranial hypertension,
lethargy, malaise
EENT:
Gingivitis, papilledema, exophthalmos, inflammation of tongue and lips
GI:
Nausea, vomiting, anorexia, abdominal pain,
jaundice
INTEG:
Drying of skin, pruritus, increased pigmentation, night sweats, alopecia
META:
Hypomenorrhea, hypercalcemia
MS:
Arthralgia, retarded growth, hard areas on bone
Stored in liver, kidneys, fat; excreted (metabolites) in urine, feces
Increase:
levels of vit A—corticosteroids, oral contraceptives
Decrease:
absorption of vit A—mineral oil, cholestyramine, colestipol
False increase:
bilirubin, serum cholesterol
•
Nutritional status: yellow and dark green vegetables, yellow/orange fruits, vit-A–fortified foods, liver, egg yolks
•
Vit A deficiency:
decreased growth; night blindness; dry, brittle nails; hair loss; urinary stones; increased infection; hyperkeratosis of skin; drying of cornea
•
Storage in tight, light-resistant container
•
Therapeutic response: increased growth rate, weight; absence of dry skin and mucous membranes, night blindness
•
That, if dose is missed, it should be omitted
•
That ophthalmic exams may be required periodically throughout therapy
•
Not to use mineral oil while taking this product
•
To notify prescriber of nausea, vomiting, lip cracking, loss of hair, headache
•
Not to take more than prescribed amount
Discontinue product
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
OTC
)
Aquasol E
Func. class.:
Vit E
Chem. class.:
Fat soluble
Needed for digestion and metabolism of polyunsaturated fats; decreases platelet aggregation, blood clot formation; promotes normal growth and development of muscle tissue, prostaglandin synthesis
Vit E deficiency, impaired fat absorption, hemolytic anemia in premature neonates, prevention of retrolental fibroplasia, sickle cell anemia, supplement for malabsorption syndrome
IV use in infants
Precautions:
Pregnancy (A), anemia, breastfeeding, hypoprothrombinemia
Calculator
• Adult:
PO
60-75 international units/day
• Child:
PO
1 international units/kg (malabsorption)
• Adult:
PO
30 international units/day;
TOP
apply to affected areas
• Infant:
PO
5 international units/day
Available forms:
Caps 100, 200, 400, 500, 600, 1000 international units; tabs 100, 200, 400 international units; drops 50 mg/ml; chew tabs 400 units; ointment; cream; lotion; oil
•
Administer with or after meals
•
Chew chewable tabs well
•
Sol may be dropped in mouth or mixed with food
•
To moisturize dry skin
CNS:
Headache, fatigue
CV:
Increased risk for thrombophlebitis
EENT:
Blurred vision
GI:
Nausea, cramps, diarrhea
GU:
Gonadal dysfunction
INTEG:
Sterile abscess, contact dermatitis
META:
Altered metabolism of hormones (thyroid, pituitary, adrenal), altered immunity
MS:
Weakness
PO:
Metabolized in liver, excreted in bile
Increase:
action of oral anticoagulants
Decrease:
absorption—cholestyramine, colestipol, mineral oil, sucralfate
•
Nutritional status: wheat germ; dark green, leafy vegetables; nuts; eggs; liver; vegetable oils; dairy products; cereals
•
Storage in tight, light-resistant container
•
Therapeutic response: absence of hemolytic anemia, adequate vit E levels, improvement in skin lesions, decreased edema
•
About the necessary foods for diet
•
To omit dose if missed
•
To avoid vitamin supplements unless directed by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(vohr-i-kahn′a-zol)
Vfend
Func. class.:
Antifungal, systemic
Chem. class.:
Triazole derivative
Inhibits fungal CYP 450-mediation demethylation; needed for biosynthesis; causes leakage from cell membrane
Invasive aspergillosis, serious fungal infections (
Candida
sp.,
Scedosporium apiospermum, Fusarium
sp.,
Monosporium, Apiospermum
)
Unlabeled uses:
Acremonium sp., Blastomyces dermatitidis, Coccidioides immitis, Cryptococcus neoformans
, febrile neutropenia, fungal keratitis,
Histoplasma capsulatum
, oropharyngeal candidiasis,
Rhodotorula sp., Scedosporium sp.
, cutaneous aspergillosis, candidemia (premature neonates), fungal infections in children ≥12 yr
Pregnancy (D), breastfeeding, children, hypersensitivity, severe bone marrow depression, severe hepatic disease
Precautions:
Renal disease (IV); patients of Asian/African descent; cardiomyopathy, cholestasis, chemotherapy, lactase deficiency, visual disturbances, renal failure, pancreatitis, QT prolongation, hypokalemia; ventricular dysrhythmias, torsades de pointes
Calculator
• Adult/geriatric/child ≥12 yr and ≥40 kg:
PO
200 mg q12hr; <40 kg, 100 mg q12hr
• Adult/geriatric/child ≥12 yr:
IV INF
Loading dose 6 mg/kg q12hr × 2 dose then 4 mg/kg q12hr; may switch to oral dosing
• Adult/child ≥12 yr:
IV
loading dose 6 mg/kg q12hr × 24 hr then 3-4 mg/kg q12hr × ≥14 days and ≥7 days after resolution of symptoms;
PO
after loading dose >
40 kg
200 mg q12hr × ≥14 days and ≥7 days after resolution of symptoms; <
40 kg
100 mg q12hr × ≥14 days and ≥7 days after resolution of symptoms
• Adults/adolescents:
IV
6 mg/kg q12hr (loading dose) then 4 mg/kg q12hr, may reduce to 3 mg/kg q12hr if intolerable
• Child ≥12 yr:
IV
6 mg/kg q12hr, then 4 mg/kg q12hr
• Adult:
PO
200-400 mg bid × at least 12 mo and until resolution of CSF abnormalities
• Adult:
PO
CCr <50 ml/min, use orally only
• Adult:
PO
6 mg/kg q12hr × 2 doses then 2 mg/kg q12hr or 100 mg q12hr if >40 kg; 50 mg q12hr if <40 kg
Available forms:
Tabs 50, 200 mg; powder for inj, lyophilized 200 mg voriconazole, powder for oral susp 45 g (40 mg/ml after reconstitution)
•
Oral susp: tap bottle; add 46 ml of water to bottle; shake well; remove cap; push bottle adaptor into neck of bottle; replace cap; write expiration date (14 days); shake well before each use; administer using only oral dispenser supplied, 1 hr before or after meals; tabs and susp may be interchanged
•
Product only after C&S confirms organism, product needed to treat condition; make sure product used in life-threatening infections
•
Reconstitute powder with 19 ml water for inj to 10 mg/ml, shake until dissolved; infuse over 1-2 hr at conc of ≤5 mg/ml; do not admix with other products, 4.2% sodium bicarbonate inf
•
Store at room temp (powder, tabs)
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B liposome, ampicillin, ampicillin/sulbactam, anidulafungin, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, bu
prenorphine, butorphanol, calcium acetate/chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, ifosfamide, imipenem/cilastatin, inamrinone, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methohexital, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, morphine, nafcillin, nalbuphine, naloxone, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, pamidronate, pancuronium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium chloride/phosphates, procainamide, promethazine, propranolol, quinupristin/dalfopristin, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tirofiban, tobramycin, topotecan, trimethobenzamide, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, zidovudine
CNS:
Headache
, paresthesias, peripheral neuropathy, hallucinations, psychosis, EPS, depression, Guillain-Barré syndrome, insomnia, suicidal ideation, dizziness
CV:
Tachycardia,
hypo/hypertension, vasodilation,
atrial arrhythmias, atrial fibrillation, AV block, bradycardia, CHF, MI, QT prolongation, torsades de pointes
EENT:
Blurred vision, eye hemorrhage
GI:
Nausea, vomiting, anorexia
, diarrhea, cramps,
hemorrhagic gastroenteritis, acute hepatic failure, hepatitis, intestinal perforation, pancreatitis
GU:
Hypokalemia
, azotemia,
renal tubular necrosis, permanent renal impairment, anuria, oliguria
HEMA:
Anemia,
eosinophilia,
hypomagnesemia,
thrombocytopenia, leukopenia, pancytopenia
INTEG:
Burning, irritation
, pain, necrosis at inj site with extravasation, dermatitis, rash, photosensitivity
MISC:
Respiratory disorder
SYST:
Stevens-Johnson syndrome, toxic epidermal necrolysis, sepsis;
melanoma (photosensitivity reactions)
By CYP3A4, CYP2C9 enzymes; max serum conc 1-2 hr after dosing; eliminated via hepatic metabolism; protein binding 58%; elimination half-life 6 hr (dose dependent)
Increase:
effects of benzodiazepines, calcium channel blockers, cycloSPORINE, ergots, HMG-CoA reductase inhibitors, pimozide, quiNIDine, prednisoLONE, sirolimus, sulfonylureas, tacrolimus, vinca alkaloids, warfarin, rifabutin, proton pump inhibitors, NNRTIs, protease inhibitors, phenytoin
Increase:
nephrotoxicity—other nephrotoxic antibiotics (aminoglycosides, CISplatin, vancomycin, cycloSPORINE, polymyxin B)
Increase:
hypokalemia—corticosteroids, digoxin, skeletal muscle relaxants, thiazides
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl; CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
•
Do not use with St. John’s wort
•
Avoid use with high-fat meals, take 1 hr before or after meal
Increase:
AST/ALT, alk phos, creatinine, bilirubin
Decrease:
Hgb/Hct, platelets, WBC
•
VS q15-30min during first inf; note changes in pulse, B/P
•
I&O ratio; watch for decreasing urinary output, change in specific gravity; discontinue product to prevent permanent damage to renal tubules
•
Blood studies: CBC, K, Na, Ca, Mg q2wk; BUN, creatinine weekly
•
Weight weekly; if weight increases >2 lb/wk, edema is present; renal damage should be considered
Renal toxicity:
increasing BUN, serum creatinine; if BUN is >40 mg/dl or if serum creatinine >3 mg/dl, product may be discontinued or dosage reduced
Hepatotoxicity:
increasing AST, ALT, alk phos, bilirubin, baseline and periodically
•
Allergic reaction:
dermatitis, rash; product should be discontinued, antihistamines (mild reaction) or epinephrine (severe reaction) administered
•
Hypokalemia:
anorexia, drowsiness, weakness, decreased reflexes, dizziness, increased urinary output, increased thirst, paresthesias
•
Ototoxicity:
tinnitus (ringing, roaring in ears), vertigo, loss of hearing (rare); visual disturbance
•
QT prolongation:
ECG, ejection fraction; assess for chest pain, palpitations, dyspnea
•
Therapeutic response: decreased fever, malaise, rash, negative C&S for infecting organism
•
That long-term therapy may be needed to clear infection (2 wk-3 mo, depending on type of infection)
•
To notify prescriber of bleeding, bruising, soft-tissue swelling, dark urine, persistent nausea or diarrhea, headache, rash, yellow skin/eyes
•
Take 1 hr before or after meal (PO)
•
Do not drive at night because of vision changes
•
Avoid strong, direct sunlight
•
Women of childbearing age should use effective contraceptive, pregnancy (D)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
