Mosby's 2014 Nursing Drug Reference (46 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Ascendin
/Afrin
Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation
Mild to moderate pain or fever including RA, osteoarthritis, thromboembolic disorders; TIAs, rheumatic fever, post-MI, prophylaxis of MI, ischemic stroke, angina, acute MI
Unlabeled uses:
Prevention of cataracts (long-term use), prevention of pregnancy loss in women with clotting disorders, bone pain, claudication, colorectal cancer prophylaxis, Kawasaki disease, PCI, preeclampsia/thrombosis prophylaxis, vernal keratoconjunctivitis, pericarditis
Pregnancy (D) 3rd trimester, breastfeeding, children <12 yr, children with flulike symptoms, hypersensitivity to salicylates, tartrazine (FDC yellow dye #5), GI bleeding, bleeding disorders, vit K deficiency, peptic ulcer, acute bronchospasm, agranulocytosis, increased intracranial pressure, intracranial bleeding, nasal polyps, urticaria
Precautions:
Abrupt discontinuation, acetaminophen/NSAIDs hypersensitivity, acid/base imbalance, alcoholism, ascites, asthma, bone marrow suppression in elderly patients, dehydration, G6PD deficiency, gout, heart failure, anemia, renal/hepatic disease, pre/postoperatively, gastritis, pregnancy (C) 1st trimester
Calculator
• Adult: PO
3 g/day in divided doses q4-6hr
• Child >25 kg (55 lb): PO/RECT
90-130 mg/kg/day in divided doses
• Adult: PO/RECT
325-650 mg q4hr prn, max 4 g/day
• Child 2-11 yr: PO
10-15 mg/kg/dose q4hr, max 4 g/day
• Adult: PO
325-650 mg/day or bid
• Adult: PO
50-325 mg/day (grade 1A)
• Adult: PO
160-325 mg nonenteric, chewed and swallowed immediately, maintenance 75-162 mg daily
• Adult: PO
50-325 mg/day
• Adult: PO
75-162 mg/day
• Adult: PO
75-325 mg/day starting 6 hr postprocedure, continue for 1 yr
• Adult: PO
325 mg 2 hr before surgery
• Adult: PO
160-325 mg nonenteric, chewed and swallowed immediately
• Adult: PO
800 mg tid-qid × 7-10 days with gradual tapering to 800 mg/day q wk for an additional 2-3 wk
• Adult: PO
325 mg every other day
• Child: PO
80-100 mg/kg/day in 4 divided doses, maintenance 3-5 mg/kg/day
Tabs 81, 325, 500, 650, 800 mg; chewable tabs 81 mg; supp 300, 600 mg; gum 227 mg; enteric-coated tabs 81, 325, 500, 975 mg; ext rel tabs 800 mg; del rel tabs 325, 500 mg; suppository 300, 600 mg
•
Do not break, crush, or chew enteric product
•
Crushed or whole; chewable tablets may be chewed
•
1/2 hr before planned exercise
•
With food or milk to decrease gastric symptoms; separate by 2 hr from enteric products
•
With 8 oz of water; sit upright for 1/2 hr after dose to facilitate product passing into stomach
•
Place suppository in refrigerator for at least 30 minutes before removing wrapper
CNS:
Stimulation, drowsiness, dizziness, confusion,
seizures,
headache, flushing, hallucinations,
coma
CV:
Rapid pulse, pulmonary edema
EENT:
Tinnitus, hearing loss
ENDO:
Hypoglycemia, hyponatremia, hypokalemia
GI:
Nausea, vomiting
,
GI bleeding,
diarrhea, heartburn, anorexia,
hepatitis,
GI ulcer
HEMA:
Thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia,
increased PT, aPTT, bleeding time
INTEG:
Rash
, urticaria, bruising
RESP:
Wheezing, hyperpnea,
bronchospasm
SYST:
Reye’s syndrome (children), anaphylaxis, laryngeal edema
Enteric metabolized by liver; inactive metabolites excreted by kidneys; crosses placenta; excreted in breast milk; half-life 15-20 min, up to 9 hr in large dose; rectal products may be erratic, protein binding 90%
PO:
Onset 15-30 min, peak 1-2 hr, duration 4-6 hr, well absorbed
RECT:
Onset slow, duration 4-6 hr
Increase:
gastric ulcer risk—corticosteroids, antiinflammatories, NSAIDs, alcohol
Increase:
bleeding—alcohol, plicamycin, cefamandole, thrombolytics, ticlopidine, clopidogrel, tirofiban, eptifibatide, anticoagulants
Increase:
effects of warfarin, insulin, methotrexate, thrombolytic agents, peni
cillins, phenytoin, valproic acid, oral hypoglycemics, sulfonamides
Increase:
salicylate levels—urinary acidifiers, ammonium chloride, nizatidine
Increase:
hypotension—nitroglycerin
Decrease:
effects of aspirin—antacids (high doses), urinary alkalizers, corticosteroids
Decrease:
antihypertensive effect—ACE inhibitors
Decrease:
effects of probenecid, spironolactone, sulfinpyrazone, sulfonylamides, NSAIDs, β-blockers, loop diuretics
Increase:
risk of bleeding—feverfew, garlic, ginger, ginkgo, ginseng
(Panax)
, horse chestnut
Increase:
risk of bleeding—fish oil (omega-3 fatty acids)
•
Foods that acidify urine may increase aspirin level
Increase:
coagulation studies, LFTs, serum uric acid, amylase, CO
2
, urinary protein
Decrease:
serum potassium, cholesterol
Interference:
VMA, 5-HIAA, xylose tolerance test, TSH, pregnancy test
•
Pain:
character, location, intensity; ROM before and 1 hr after administration
•
Fever:
temp before and 1 hr after administration
•
Hepatic studies: AST, ALT, bilirubin, creatinine if patient is receiving long-term therapy
•
Renal studies: BUN, urine creatinine; I&O ratio; decreasing output may indicate renal failure (long-term therapy)
•
Blood studies: CBC, Hct, Hgb, PT if patient is receiving long-term therapy
Hepatotoxicity:
dark urine, clay-colored stools, yellowing of skin, sclera, itching, abdominal pain, fever, diarrhea if patient is receiving long-term therapy
•
Allergic reactions:
rash, urticaria; if these occur, product may have to be discontinued; patients with asthma, nasal polyps, allergies: severe allergic reaction may occur
•
Ototoxicity:
tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
•
Salicylate level:
therapeutic level 150-300 mcg/ml for chronic inflammation
•
Edema in feet, ankles, legs
•
Product history; many product interactions
•
Therapeutic response: decreased pain, inflammation, fever
•
To report any symptoms of hepatotoxicity, renal toxicity, visual changes, ototoxicity, allergic reactions, bleeding (long-term therapy)
•
To avoid if allergic to tartrazine
•
Not to exceed recommended dosage; acute poisoning may result
•
To read labels on other OTC products because many contain aspirin, salicylates
•
That the therapeutic response takes 2 wk (arthritis)
•
To report tinnitus, confusion, diarrhea, sweating, hyperventilation
•
To avoid alcohol ingestion; GI bleeding may occur
•
That patients who have allergies, nasal polyps, asthma may develop allergic reactions
•
To discard tabs if vinegar-like smell is detected
•
That medication is not to be given to children or teens with flulike symptoms or chickenpox because Reye’s syndrome may develop
•
To take with a full glass of water
•
Not to use during 3rd trimester of pregnancy (D)
Lavage, activated charcoal, monitor electrolytes, VS
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(at-a-za-na′veer)
Reyataz
Func. class.:
Antiretroviral
Chem. class.:
Protease inhibitor
Inhibits human immunodeficiency virus (HIV-1) protease, which prevents maturation of the infectious virus
HIV-1 infection in combination with other antiretroviral agents
Hypersensitivity
Pregnancy (B), breastfeeding, children, geriatric patients, hepatic disease, alcoholism, drug resistance, AV block, diabetes, dialysis, elderly, females, hemophilia, hypercholesterolemia, immune reconstitution syndrome, lactic acidosis, pancreatitis
