Mosby's 2014 Nursing Drug Reference (295 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(nor-ep-i-nef′rin)
Levophed
Func. class.:
Adrenergic
Chem. class.:
Catecholamine
Do not confuse:
norepinephrine
/EPINEPHrine
Causes increased contractility and heart rate by acting on β-receptors in heart; also acts on α-receptors, thereby causing vasoconstriction in blood vessels; B/P is elevated, coronary blood flow improves, and cardiac output increases
Acute hypotension, shock
Hypersensitivity to this product or cyclopropane/halothane anesthesia, sulfites; ventricular fibrillation, tachydysrhythmias, pheochromocytoma, hypotension, hypovolemia
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, arterial embolism, peripheral vascular disease, hy-pertension, hyperthyroidism, cardiac disease
Black Box Warning:
Extravasation
Calculator
• Adult:
IV INF
0.5-1 mcg/min titrated to B/P; maintenance 2-4 mcg/min; max 30 mcg/min
• Child:
IV INF
0.1-0.2 mcg/kg/min titrated to B/P; max 2 mcg/kg/min
Available forms:
Inj 1 mg/ml
•
Plasma expanders for hypovolemia
•
Dilute with 500-1000 ml D
5
W or D
5
/0.9% NaCl; average dilution 4 mg/1000 ml diluent (4 mcg base/ml); give as inf 2-3 ml/min; titrate to response
Y-site compatibilities:
Alfentanil, amikacin, amiodarone, anidulafungin, argatroban, ascorbic acid, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, cephalothin, chloramphenicol, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cloNIDine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DAPTOmycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, meropenem, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, micafungin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins injection, mycophenolate, nafcillin, nalbuphine, naloxone, netilmicin, niCARdipine, nitroglycerin, nitroprusside, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, ritodrine, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid
CNS:
Headache
, anxiety, dizziness, insomnia, restlessness, tremor,
cerebral hemorrhage
CV:
Palpitations, tachycardia, hypertension, ectopic beats, angina
GI:
Nausea, vomiting
GU:
Decreased urine output
INTEG:
Necrosis, tissue sloughing with extravasation, gangrene
RESP:
Dyspnea
SYST:
Anaphylaxis
IV:
Onset 1-2 min; metabolized in liver; excreted in urine (inactive metabolites); crosses placenta
Increase:
dysrhythmias—general anesthetics
•
Incompatible with alkaline solutions: sodium, bicarbonate
•
Severe hypertension: guanethidine
Do not use within 2 wk of MAOIs, antihistamines, ergots, methyldopa, oxytocics, tricyclics, guanethidine because hypertensive crisis may result
Increase:
B/P—oxytocics
Increase:
pressor effect—tricyclics, MAOIs
Decrease:
norepinephrine action—α-blockers
•
I&O ratio; notify prescriber if output <30 ml/hr
•
B/P, pulse q2-3min after parenteral route, ECG during administration continuously; if B/P increases, product is decreased, CVP or PWP during inf if possible
•
Paresthesias and coldness of extremities; peripheral blood flow may decrease
Black Box Warning:
Extravasation:
inj site: tissue sloughing
•
Sulfite sensitivity, which may be life-threatening
•
Storage of reconstituted sol in refrigerator ≤24 hr, protect from light, store unopened product at room temp, do not use discolored sol
•
Therapeutic response: increased B/P with stabilization, adequate tissue perfusion
•
About the reason for product administration; to report dyspnea, dizziness, chest pain
Administer fluids, electrolyte replacement
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(nor-eth-in′drone)
Aygestin, Camila, Errin
, Heather, Jolivette, Micronor, Nora-BE, Nor-QD, Ortho Micronor
Func. class.:
Progestogen
Inhibits the secretion of pituitary gonadotropins, which prevents follicular maturation and ovulation; stimulates growth of mammary tissue; antineoplastic action against endometrial cancer
Uterine bleeding (abnormal), amenorrhea, endometriosis, contraception
Pregnancy (X), breast cancer, hypersensitivity, thromboembolic disorders, reproductive cancer, genital bleeding (abnormal, undiagnosed), liver tumors, hepatic disease
Precautions:
Breastfeeding, hypertension, asthma, blood dyscrasias, CHF, diabetes mellitus, depression, migraine headache, seizure disorders, bone/gallbladder/renal/hepatic disease, family history of breast or reproductive tract cancer, smoking, HIV
Calculator
• Adult:
PO
2.5-10 mg/day on days 5-25 of menstrual cycle
• Adult:
PO
5 mg/day × 2 wk then increased by 2.5 mg/day × 2 wk up to 15 mg/day, may continue for 6-9 mo
• Adult:
PO
0.35 mg on 1st day of menses then 0.35 mg/day
Available forms:
Tabs (Aygestin) 5 mg; tabs 0.35 mg
•
Titrated dose; use lowest effective dose
•
One dose in
AM
; do not interrupt between pill packs, give at roughly same time of day
•
Without regard to meals
CNS:
Dizziness, headache
, migraines, depression, fatigue
CV:
Hypotension,
thrombophlebitis,
edema,
thromboembolism, CVA, stroke, PE, MI
EENT:
Diplopia
GI:
Nausea
, vomiting, anorexia, cramps, increased weight,
cholestatic jaundice
GU:
Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea, vaginal candidiasis, breast changes, (gynecomastia, testicular atrophy, impotence), endometriosis,
spontaneous abortion,
breast tenderness
INTEG:
Rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma
META:
Hyperglycemia
Duration 24 hr, excreted in urine, feces; metabolized in liver
Decrease:
progestin effect—barbiturates, carBAMazepine, fosphenytoin, phenytoin, rifampin
Decrease:
contraception—St. John’s wort
Increase:
caffeine level—caffeine
Increase:
LDL
Decrease:
GTT, HDL, alk phos
•
Weight daily: notify prescriber of weekly weight gain >5 lb
•
B/P at beginning of treatment and periodically
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
Hepatic studies: ALT, AST, bilirubin periodically during long-term therapy
•
Edema, hypertension, cardiac symptoms, jaundice, thromboembolism
•
Mental status: affect, mood, behavioral changes, depression
•
Hypercalcemia
•
Breast exam, pap smear
•
Storage in dark area
•
Therapeutic response: decreased abnormal uterine bleeding, absence of amenorrhea
•
About cushingoid symptoms
To report breast lumps, vaginal bleeding, amenorrhea, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, numbness or stiffness in legs, chest pain; impotence or gynecomastia (men)
•
To take at same time of day; not to interrupt between pill packs
•
To report suspected pregnancy immediately, to wait ≥3 mo after stopping product to become pregnant, (X), use backup contraception methods for 48 hr, if treatment is not begun on the first day of menstruation
•
To avoid smoking; CV reactions may occur
•
That product does not protect against HIV, STDs
•
That product may mask onset of menopause
