Mosby's 2014 Nursing Drug Reference (72 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(byoo-pre-nor′feen)
Buprenex, Butrans
Func. class.:
Opioid analgesic, partial agonist
Chem. class.:
Thebaine derivative
Do not confuse:
Buprenex
/Bumex
Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Moderate to severe pain, opiate agonist withdrawal
Unlabeled uses:
Cocaine withdrawal
Hypersensitivity, ileus
Black Box Warning:
Respiratory depression
Precautions:
Pregnancy (C), breastfeeding, substance abuse/alcoholism, increased intracranial pressure, MI (acute), severe heart disease, respiratory depression, renal/hepatic/pulmonary disease, hypothyroidism, Addison’s disease
Black Box Warning:
QT prolongation, use of heating pad, accidental exposure, potential for overdose/poisoning, substance abuse
Calculator
• Adult: IM/IV
0.3 mg q6hr prn, reduce dosage in geriatric patients, may repeat after 30-60 min;
EPIDURAL
(unlabeled) 4 mcg/kg or 2 mcg/kg (epidural inj);
TD
each patch is worn for 7 days (moderate-severe pain);
opioid-naive patients
(those taking <30 mg of oral morphine or equivalent before beginning treatment with TD buprenorphine), 5 mcg/hr q7days, overestimating dose can be fatal;
conversion from other opiate agonist therapy,
titrate from other opioids for up to 7 days to no more than 30 mg oral morphine or equivalent before beginning TD therapy, begin with 5 mcg/hr q7days; for those with daily dose of 30-80 mg oral morphine or equivalent, start with 10 mcg/hr q7days; for those taking >80 mg oral morphine or equivalent, start with 20 mcg/hr q7days
• Child 2-12 yr: IM/IV
2-6 mcg/kg q4-6hr
Available forms:
Inj 0.3 mg/ml (1-ml vials); SL tab 2, 8 mg as base; TD system 5, 10, 20 mcg/hr (weekly)
•
Do not chew, dissolve under tongue, take 2 or more at same time
•
Apply to clean, dry, intact skin; each patch should be worn for 7 days; do not apply direct heat source to patch, will increase absorption of product
•
Apply to upper outer arm, upper chest/back, or side of chest
•
In deep muscle mass
•
Give
undiluted over ≥2 min, titrate to patient response
•
With antiemetic if nausea, vomiting occur
•
When pain is beginning to return; determine dosage interval by patient response
Additive compatibilities:
Bupivacaine, glycopyrrolate, haloperidol
Syringe compatibilities:
Glycopyrrolate, haloperidol, heparin, midazolam
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, amphotericin B liposome (AmBisone), anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, butorphanol, calcium chloride/gluconate, CARBOplatin, cefamandole, ceFAZolin, cefepime, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, D
5
W-dextrose 5%, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin HCl, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, lactated Ringer’s injection, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins injection, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, 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, Ringer’s injection, ritodrine, riTUXimab, rocuronium, sodium acetate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA (3-in-1), tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole
CNS:
Drowsiness, dizziness, confusion, headache, sedation, euphoria
,
increased intracranial pressure,
amnesia
CV:
Palpitations, bradycardia, change in B/P, tachycardia
EENT:
Tinnitus, blurred vision,
miosis
, diplopia
GI:
Nausea
, vomiting, anorexia, constipation, cramps, dry mouth
GU:
Dysuria, urinary retention
INTEG:
Rash
, urticaria, bruising, flushing, diaphoresis, pruritus
RESP:
Respiratory depression,
dyspnea, hypo/hyperventilation
Metabolized in liver by CYP3A4, excreted by kidneys and in feces, crosses placenta, excreted in breast milk, half-life 2½-3½ hr, 96% bound to plasma proteins
IM:
Onset 15 min, peak 1/2 hr, duration 6 hr
SL:
Onset, peak, duration unknown, half-life 37 hr
IV:
Onset 1 min, peak 5 min, duration 6 hr, half-life 2.2 hr
Increase:
effect with other CNS depressants—alcohol, opioids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants, MAOIs
Increase:
buprenorphine effect—CYP3A4 inhibitors (erythromycin, indinavir, ketoconazole, ritonavir, saquinavir)
Increase:
QT prolongation—class IA, III antidysrhythmics
Decrease:
buprenorphine effect—CYP3A4 inducers (carBAMazepine, PHENobarbital, phenytoin, rifampin)
Increase:
CNS depression—St. John’s wort
•
Pain:
intensity, location, type before treatment, after 5 min (IV); need for pain medication, tolerance
•
I&O ratio; check for decreasing output; may indicate urinary retention
•
Bowel pattern; severe constipation can occur
•
CNS changes, dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction; withdrawal in opioid-dependent persons; if dependence occurs, within 2 wk of discontinuing product
withdrawal symptoms
will occur
•
Allergic reactions: rash, urticaria
•
Respiratory dysfunction: respiratory depression, character, rate, rhythm; notify prescriber if respirations are <12/min
Black Box Warning:
Potential for overdose may occur from chewing, swallowing, snorting, or injecting extracted product from TD formulation
Black Box Warning:
QT prolongation:
in those taking class Ia, III antidysrhythmics; patients with hypokalemia, cardiac instability (TD), max TD 20 mcg/hr q7day
•
Therapeutic response: decrease in pain, absence of grimacing
•
To report any symptoms of CNS changes, allergic reactions
Black Box Warning:
That psychologic dependence leading to substance abuse may result when used for extended periods; that long-term use not recommended
•
To avoid hazardous activities such as driving unless reaction known
Naloxone 0.4 mg ampule diluted in 10 ml 0.9% NaCl given by direct IV push 0.02 mg q2min (adult)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(byoo-proe′pee-on)
Aplenzin, Budeprion SR, Budeprion XL, Buproban, Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban
Func. class.:
Antidepressant—miscellaneous smoking deterrent
Chem. class.:
Aminoketone
Do not confuse:
buPROPion
/busPIRone
Zyban
/Diovan/Zagam
Inhibits reuptake of DOPamine, norepinephrine, serotonin
Depression (Wellbutrin), smoking cessation (Zyban); seasonal affective disorder
Unlabeled uses:
Neuropathic pain, enhancement of weight loss, ADHD (attention-deficit/hyperactivity disorder)
Hypersensitivity, eating disorders, seizure disorders
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, renal/hepatic disease, recent MI, cranial trauma, seizure disorder
Black Box Warning:
Children <18 yr, suicidal thinking/behavior (young adults)
Calculator
• Adult: PO
100 mg bid initially then increase after 3 days to 100 mg tid if needed, max 150 mg single dose;
ER/SR
initially 150 mg
AM
, increase to 300 mg/day if initial dose is tolerated, after no less than 4 days; after several wk, titrate to 200 mg bid; Aplenzin 174 mg q
AM
, may increase to 348 mg q
AM
on day 4, may increase to 522 mg after several weeks if needed
• Geriatric: PO
50-100 mg/day, may increase by 50-100 mg q3-4days
• Adult: SR
150 mg q day × 3 days then 150 mg bid for remainder of treatment, initiate 1-2 wk before targeted “quit day,” continue for 7-12 wk; in combination with nicotine TD, 150 mg q day × 3 days then 150 mg bid for remainder of treatment, give ≥8 hr apart, max 300 mg/day, initiate 1-2 wk before targeted “quit day,” continue for 7-12 wk, may be continued for 8-20 wk
• Adult: PO
100 mg bid, after ≥3 days titrate to 100 mg tid; SR 300 mg/day, 200 mg 8
AM
, 100 mg 4
PM
• Adult: PO
SR 150-300 mg/day
Available forms:
Tabs 75, 100 mg; sus rel tabs (SR) 150; ext rel tab (XL) 100, 150, 300 mg; (SR-12 hr, XL-24 hr); tab ext rel (Aplenzin) 174, 348, 522 mg
When switching to Aplenzin from Wellbutrin, Wellbutrin SR or XL, use these equivalents: 174 mg buPROPion HBr = 150 mg buPROPion HCl; 348 mg buPROPion HBr = 300 mg buPROPion HCl; 522 mg buPROPion HBr = 450 mg buPROPion HCl
•
Wellbutrin immediate rel,
separate by ≥6 hr, give in 3 divided doses;
Wellbutrin SR,
if multiple doses are used, separate by ≥8 hr;
Wellbutrin XL,
give daily in
AM
;
Zyban SR,
give in 2 divided doses, ≥8 hr apart;
Aplenzin ER,
give daily in
AM
, a larger dose of Aplenzin is needed because these products are not equivalent
•
Do not break, crush, chew sus rel, ext rel tab
•
At evenly spaced times to prevent seizures; seizure risk increases with high doses
•
Increase fluids, bulk in diet if constipation occurs
•
With food, milk for GI symptoms
•
Sugarless gum, hard candy, frequent sips of water for dry mouth
•
Avoid giving at night to prevent insomnia
CNS:
Headache, agitation, dizziness, akinesia, bradykinesia, confusion
,
seizures,
delusions,
insomnia, sedation, tremors
,
suicidal ideation
CV:
Dysrhythmias, hypertension
, palpitations,
tachycardia
, hypotension,
complete AV block; QRS prolongation (overdose)
EENT:
Blurred vision, auditory disturbance
GI:
Nausea, vomiting
, anorexia, diarrhea,
dry mouth
, increased appetite,
constipation
, altered taste
GU:
Impotence, urinary frequency, retention,
menstrual irregularities
INTEG:
Rash
, pruritus,
sweating
,
Stevens-Johnson syndrome
MISC:
Weight loss or gain
Onset 2-4 wk, half-life 14 hr, extensively metabolized by liver, some conversion to active metabolites, steady state 5-8 days, protein binding 84%, excreted in urine and feces
Increase:
adverse reactions, seizures —levodopa, MAOIs, phenothiazines, antidepressants, benzodiazepines, alcohol, theophylline, systemic steroids
Increase:
buPROPion toxicity—ritonavir
Increase:
buPROPion level—cimetidine
Increase:
buPROPion effect—CYP2D6/CYP2B6 inhibitors
Decrease:
effect of tamoxifen
Decrease:
buPROPion effect—carBAMazepine, cimetidine, PHENobarbital, phenytoin or other products (CYP2D6); CYP2B6 inducers
Increase:
CNS depression—kava, valerian
•
Hepatic/renal function in patients with hepatic, kidney impairment
•
For increased risk of seizures; if patient has excessively used CNS depressants and OTC stimulants, dosage of buPROPion should not be exceeded
•
For smoking cessation after 7-12 wk; if progress has not been made, product should be discontinued
Black Box Warning:
Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms
•
Assistance with ambulation during beginning therapy because sedation occurs
•
Safety measures, primarily for geriatric patients
•
Therapeutic response: decreased depression, ability to perform daily activities, ability to sleep throughout the night, smoking cessation
•
That therapeutic effects may take 2-4 wk; not to increase dose without prescriber’s approval; that treatment for smoking cessation lasts 7-12 wk
•
To use caution when driving, performing other activities that require alertness; sedation, blurred vision may occur
•
To avoid alcohol, other CNS depressants; alcohol may increase risk of seizures
•
Not to use with nicotine patches unless directed by prescriber; may increase B/P
•
To notify prescriber immediately if urinary retention occurs
•
That risk of seizures increased when dose exceeded, if patient has seizure disorder
Black Box Warning:
That suicidal ideas, behaviors, hostility, depression may occur in children or young adults
•
To notify prescriber if pregnancy is suspected, planned
ECG monitoring; lavage, activated charcoal; administer anticonvulsant
