Mosby's 2014 Nursing Drug Reference (122 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(deh-sihr′uh-din)
Iprivask
Func. class.:
Anticoagulant
Chem. class.:
Thrombin inhibitor
Selectively inhibits free and clot-bound thrombin, prevents activation of clotting factors
Prevents DVT in hip-replacement surgery
Hypersensitivity to this product, mannitol (diluent), hirudin, active bleeding, coagulation disorders
Precautions:
Renal disease (CCr <60 ml/min), hepatic disease, GI/respiratory bleeding ≤3 mo, severe uncontrolled hypertension, spinal/epidural anesthesia, bacterial endocarditis children
Black Box Warning:
Epidural anesthesia
Calculator
•
Adult: SUBCUT
15 mg every 12 hr × 9-12 days; give first dose 5-15 min before surgery and after induction if a regional block is used
•
Adult: SUBCUT
CCr 31-60 ml/min 5 mg q12hr; CCr < 31 ml/min 1.7 mg q12hr
Available forms:
INJ 15 mg and mannitol 3% in water
•
Visually inspect particulate matter and discoloration prior to use, do not use sols that are cloudy or contain particles
•
Do not use IM
•
Do not mix with other injections, solvents, or parenteral fluids
•
Reconstitute
each vial with 0.5 ml of provided diluent, shake gently until the drug is fully reconstituted; the injection should be clear, colorless; once reconstituted, each 0.5 ml contains 15.75 mg desirudin; use immediately; however, it remains stable ≤24 hr at room temperature and protected from light. Discard any unused solution
•
Subcut injection:
Have patient sit or lie down; using a syringe with a 26- or 27-G needle, which is approximately 0.5-inch long, withdraw the entire reconstituted sol into the syringe; inject total volume subcut; alternate between the left and right anterolateral and left and right posterolateral thigh or abdominal wall; insert whole length of the needle in a skin fold held between the thumb and forefinger; the skin fold should be held throughout the injection; to minimize bruising, do not rub the site
CNS:
Dizziness, fever
CV:
Thrombosis, thrombophlebitis,
hypotension
EENT:
Nosebleeds
GI:
Hematemesis,
nausea, vomiting
GU:
Hematuria
HEMA:
Hemorrhage,
anemia
MISC:
Anaphylaxis,
impaired healing, edema
Onset ½ hr, 1-1½ hr, half-life 2 hr (12 hr in severe renal disease)
Increase:
bleeding risk—other anticoagulants, salicylates, NSAIDs, thrombolytics, glycoprotein IIb/IIIa antagonists, corticosteroids, dextran 40
Decrease:
Hct/Hgb
•
Gums, black tarry stools, hematuria, epistaxis, decreased Hct/Hgb, guiac-positive stools, bleeding from hip-replacement site, notify prescriber if these occur; observe for thrombosis, ecchymosis
•
Monitor aPTT daily in those with bleeding risk, CCr <60 ml/min, aPTT should not be >2× control
Black Box Warning:
Epidural/spinal anesthesia sites for hematomas; can result in irreversible paralysis
•
CCr baseline and qd if CCr >60 ml/min
•
Decreased occurrence of DVT in hip-replacement surgery
•
To report any signs of bleeding
•
To use a soft-bristle toothbrush to avoid bleeding gums, to use an electric razor
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(des′lor-at′ah-deen)
Clarinex, Clarinex RediTabs
Func. class.:
Antihistamine, 2nd generation
Chem. class.:
Selective histamine (H
1
)-receptor antagonist
Binds to peripheral histamine receptors, thus providing antihistamine action without sedation
Seasonal/perennial allergic rhinitis, chronic idiopathic urticaria, pruritus
Hypersensitivity, infants/neonates
Precautions:
Pregnancy (C), breastfeeding, child, asthma, renal/hepatic impairment
Calculator
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Adult and child ≥12 yr: PO
5 mg/day
•
Child 6-11 yr: PO
2.5 mg/day
•
Child 2-5 yr: PO
1.25 mg/day
•
Child 6-11 mo: PO
1 mg/day (urticaria, only)
•
Adult: PO
5 mg every other day
Available form:
Tabs 5 mg; orally disintegrating tabs 2.5, 5 mg (Reditabs); syr 0.5 mg/ml
•
Without regard to meals
•
Do not remove RediTabs from blister until ready to use
•
RediTabs directly on tongue; may take with or without water
CNS:
Sedation (more common with increased doses), headache, psychomotor hyperactivity,
seizures,
fatigue
GI:
Hepatitis,
nausea, dry mouth
MISC:
Flulike symptoms
Onset antihistamine effect 1 hr, relief as early as 1 day, duration up to 24 hr, peak 1½ hr, elimination half-life 8½-28 hr, metabolized in liver to active metabolites, excreted in urine
Increase:
CNS depression (rare)—alcohol, opiates, sedative/hypnotics, H
1
blockers, antipsychotics, tricyclic antidepressants, anxiolytics
Increase:
desloratadine—nilotinib, etravirine
•
Allergy:
hives, rash, rhinitis; monitor respiratory status; stop product 4 days before antigen skin test
•
Therapeutic response: absence of running or congested nose, other allergy symptoms
•
To avoid driving, other hazardous activities if drowsiness occurs; to use caution until product’s effects are known
•
That product may cause photosensitivity; to use sunscreen or stay out of the sun to prevent burns
•
Not to exceed max dose
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(des-moe-press′in)
DDAVP, Minirin, Octostim
, Stimate
Func. class.:
Pituitary hormone
Chem. class.:
Synthetic antidiuretic hormone
Promotes reabsorption of water by action on renal tubular epithelium; causes smooth muscle constriction, increase in plasma factor VIII levels, which increases platelet aggregation, thereby resulting in vasopressor effect; similar to vasopressin
Hemophilia A, von Willebrand’s disease type 1, nonnephrogenic diabetes insipidus, symptoms of polyuria/polydipsia caused by pituitary dysfunction, nocturnal enuresis
Unlabeled uses:
Cardiopulmonary bypass, sickle cell disease, uremic bleeding
Hypersensitivity, nephrogenic diabetes insipidus, severe renal disease
Precautions:
Pregnancy (B), breastfeeding, coronary artery disease, hypertension, cystic fibrosis, thrombus
Calculator
•
Adult and child ≥6 yr: PO
0.2 mg at bedtime, max 0.6 mg at bedtime; intranasal 0.2 ml at bedtime, half in each nostril
•
Adult: INTRANASAL
0.1-0.4 ml/day in divided doses (1-4 sprays with pump);
IV/SUBCUT
2-4 micromcg/day in 2 divided doses
• Child 3 mo to 12 yr: INTRANASAL
0.05-0.3 ml/day in divided doses
•
Adult and child >3 mo: IV
0.3 mcg/kg in 0.9% NaCl over 15-30 min; may repeat if needed
• Adult and child >3 mo: IV
0.3 mcg/kg
• Adult and child <50 kg: INTRANASAL
1 spray in 1 nostril
• Adult and child >50 kg:
1 spray in each nostril
•
Adult: IV
0.3 mcg/kg with aminocaproic acid given as a single postop dose
•
Adult: SUBCUT/IV
0.3 mcg/kg with a high fluid intake
•
Adult: SUBCUT/IV
0.3-0.4 mg/kg as a single inj
Available forms:
Inj 4, 15 mg/ml; Rhihal tube delivery 2.5 mg/vial (0.1 mg/ml); tabs 0.1, 0.2 mg; nasal spray pump 10 mcg/spray (0.1 mg/ml); nasal sol 1.5 mg/ml (150 mcg/dose)
•
Store at room temperature
•
Undiluted over 1 min for diabetes insipidus
•
Diluted single dose/50 ml of 0.9% NaCl (adult and child >10 kg), single dose/10 ml as IV inf over 15-30 min for von Willebrand’s disease or hemophilia A
•
Store in refrigerator
CNS:
Drowsiness, headache, lethargy, flushing,
seizures
CV:
Increased B/P, palpitations, tachycardia
EENT:
Nasal irritation, congestion, rhinitis
GI:
Nausea, heartburn, cramps
GU:
Vulval pain
META:
Hyponatremia, hyponatremia-induced seizures
SYST:
Anaphylaxis (IV)
PO:
Onset 1 hr, peak 4-7 hr
INTRANASAL:
Onset 1 hr; peak 1-4 hr; duration 8-20 hr; half-life 8 min, 76 min (terminal)
IV:
Onset 1 min, peak 1/2 hr, duration >3 hr
Increase:
antidiuretic action—carBAMazepine, chlorproPAMIDE, clofibrate
Increase:
pressor effect—pressor products
Decrease:
antidiuretic action—lithium, alcohol, demeclocycline, heparin, large doses of EPINEPHrine
•
Pulse, B/P when giving IV or SUBCUT
•
I&O ratio, weight daily; check for edema in extremities; if water retention severe, diuretic may be prescribed
•
Water intoxication:
lethargy, behavioral changes, disorientation, neuromuscular excitability
•
Intranasal use: nausea, congestion, cramps, headache; usually decreased with decreased dose; for nasal mucosa changes: congestion, edema, discharge, scarring (nasal route)
For severe allergic reaction, including
anaphylaxis (IV route)
•
Urine volume/osmolality and plasma osmolality (diabetes insipidus)
•
Factor VIII coagulant activity, bleeding time before using for hemostasis
•
Nocturnal enuresis:
frequency of enuresis before and during treatment
•
Therapeutic response: absence of severe thirst, decreased urine output, decreased osmolality
•
About the proper technique for nasal instillation: to insert tube into nostril to instill product
•
To avoid OTC products (cough, hay fever) because these preparations may contain EPINEPHrine, decrease product response; not to use with alcohol because adverse reactions may occur
•
To wear emergency ID specifying therapy
•
That, if dose is missed, to take when remembered up to 1 hr before next dose; not to double dose; to avoid fluids from 1 hr to up to 8 hr after PO dose
•
To report upper respiratory infection, nasal congestion to prescriber
