Mosby's 2014 Nursing Drug Reference (84 page)

• 
Visually inspect for particulate matter, discoloration if sol or container permits

• 
Reconstitute:
add 20 ml of sterile water to 400- or 600-mg vial (20 ml/ml for 400 mg; 30 mg/ml for 600 mg), mix gently until dissolved;
dilute
in 250 ml of 0.9% NaCl, 0.45% NaCl, LR, D
₅
, D2.5,
give
over 1 hr, do not admix, use within 6 hr at room temp or 24 hr refrigerated

Black Box Warning:

GI bleeding/perforation, peptic ulcer disease, MI, stroke

• Adult:
PO
400 mg initially, then 200 mg if needed on 1st day, then 200 mg bid prn on subsequent days; start with 1/2 dose for poor CYP2C9 metabolizers

• Adult:
PO
200 mg/day as a single dose or 100 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers

• Geriatric:
PO
use lowest possible dose

• Adult:
PO
100-200 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers

• Adult:
PO
200 mg/day or in divided doses (bid); start with 1/2 dose for poor CYP2C9 metabolizers

• Adolescent and child ≥2 yr (>25 kg):
PO
100 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers

• Child ≥2 yr (10-25 kg):
PO
50 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers

• Adult:
PO
(Child-Pugh B) reduce dose by 50%

• Adult:
PO
400 mg bid × 6 mo

• 
Do not break, crush, chew, or dissolve caps with a full glass of water to enhance absorption; caps may be opened into applesauce or soft food, ingest immediately with water

• 
With food, milk to decrease gastric symptoms (with higher doses [400 mg bid]); do not increase dose

Increase:
bleeding risk—anticoagulants, SSRIs, antiplatelets, thrombolytics, salicylates, alcohol

Increase:
adverse reactions—glucocorticoids, NSAIDs, aspirin

Increase:
toxicity—lithium, antineoplastics, bisphosphonates

Increase:
celecoxib blood level—fluconazole

Decrease:
effect of aspirin, ACE inhibitors, thiazide diuretics, furosemide

Decrease:
effect of feverfew

Increase:
bleeding risk—garlic, ginger, ginkgo

Increase:
ALT, AST, BUN, cholesterol, glucose, potassium, sodium

Decrease:
glucose, sodium, WBC, platelets

• 
Pain
of rheumatoid arthritis, osteoarthritis; check ROM, inflammation of joints, characteristics of pain

Black Box Warning:

For cardiac disease that may be worse after taking product; MI, stroke; do not use with coronary artery bypass graft (CABG)

• 
CBC during therapy; watch for decreasing platelets; if low, therapy may need to be discontinued, restarted after hematologic recovery; LFTs, serum creatinine/BUN, stool guaiac

Black Box Warning:

For blood dyscrasias (thrombocytopenia): bruising, fatigue, bleeding, poor healing

• 
GI toxicity:
black, tarry stools; abdominal pain

 
Serious skin disorders:
Stevens-Johnson syndrome, toxic epidermal necrolysis; may be fatal

• 
Therapeutic response: decreased pain, inflammation in arthritic conditions; decreased number of polyps

Black Box Warning:

Not to exceed recommended dose; to notify prescriber immediately of chest pain, skin eruptions; to stop product if these occur

• 
To check with prescriber to determine when product should be discontinued prior to surgery

• 
That product must be continued for prescribed time to be effective; to avoid other NSAIDs, aspirin, sulfonamides

Black Box Warning:

To notify prescriber of GI symptoms: black, tarry stools; cramping or rash; edema of extremities; weight gain

Black Box Warning:

To report bleeding, bruising, fatigue, malaise because blood abnormalities do occur

• 
To report possible respiratory infection: fever, SOB, coughing, painful swallowing

• 
To report if pregnancy is planned or suspected, pregnancy (C) before 3 wk, (D) after 30 wk

cefadroxil:
Gram-negative bacilli:
Escherichia coli, Proteus mirabilis, Klebsiella
(UTI only); gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
upper, lower respiratory tract, urinary tract, skin infections; otitis media; tonsillitis; UTIs

ceFAZolin:
Gram-negative bacilli:
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella;
gram-positive organisms:
Staphylococcus aureus;
upper, lower respiratory tract, urinary tract, skin infections; bone, joint, biliary, genital infections; endocarditis, surgical prophylaxis, septicemia

cephalexin:
Gram-negative bacilli:
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella;
gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
upper, lower respiratory tract, urinary tract, skin, bone infections; otitis media

• Adult:
PO
1-2 g/day or divided q12hr; loading dose of 1 g initially

• Child:
PO
30 mg/kg/day in divided doses bid, max 2 g/day

• Adult:
PO
CCr 25-50 ml/min, 500 mg q12hr; CCr 10-24 ml/min, 500 mg q24hr; CCr <10 ml/min, 500 mg q36hr

• Adult:
IM/IV
1-2 g q6-8hr; max 12 g/day

• Child >1 mo:
IM/IV
75-100 mg/kg in 3-4 divided doses; max 6 g/day

• Adult:
IM/IV
250 mg-1 g q8hr, max 12 g/day

• Child >1 mo:
IM/IV
25-50 mg/kg in 3-4 equal doses, max 6 g/day, or 2 g as a single dose

• Adult:
IM/IV
after loading dose, CCr 35-54 ml/min, dose q8hr; CCr 10-34 ml/min, 50% of dose q12hr; CCr <10 ml/min, 50% of dose q18-24hr

• Child:
IM/IV
CCr >70 ml/min, no dosage adjustment; CCr 40-70 ml/min after loading dose, reduce dose to 7.5-30 mg/kg q12hr; CCr 20-39 ml/min, give 3.125-12.5 mg/kg after loading dose q12hr; CCr 5-19 ml/min, 2.5-10 mg/kg after loading dose q24hr

• Adult:
PO
250-500 mg q6hr, max 4 g/day

• Child:
PO
25-50 mg/kg/day in 4 equal doses, max 4 g/day

• Adult:
PO
500 mg q12hr

• 
2 g 1 hr before procedure

• Adult:
PO
500 mg-1 g q6hr

• Child:
PO
50-100 mg/kg/day in 4 equal doses, max 4 g/day

• Adult:
PO
CCr 10-40 ml/min, 250-500 mg then 250-500 mg q8-12hr; CCr <10 ml/min, 250-500 mg then 250-500 mg q12-24hr

• 
Check for irritation, extravasation often; dilute in 10 ml sterile water for inj, run over 3-5 min; may be further diluted with 50-100 ml of NS, D
₅
W sol, run over 1/2-1 hr by
Y
-tube or 3-way stopcock

• 
For 10-14 days to ensure organism death, prevent superinfection

• 
After C&S completed

Syringe compatibilities:
DimenhyDRINATE, heparin, vit B complex

Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, alprostadil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B liposome, anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, cefamandole, cefmetazole, cefonicid, cefoperazone, cefoTEtan, cefOXitin, cefpirome, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, cimetidine, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, DOCEtaxel, doxacurium, doxapram, DOXOrubicin liposomal, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, esmolol, etoposide, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid (as sodium salt), foscarnet, furosemide, gallium, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, lidocaine, linezolid, LORazepam, LR’s injection, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, morphine, moxalactam, multiple vitamins injection, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, penicillin G potassium/sodium, peritoneal dialysis solution, perphenazine, PHENobarbital, phenylephrine, phytonadione, piperacillin, Plasma-Lyte M in dextrose 5%, polymyxin B, potassium chloride, procainamide, propofol, propranolol, ranitidine, remifentanil, Ringer’s injection, ritodrine, riTUXimab, sargramostim, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil,
tacrolimus, teniposide, tenoxicam, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tolazoline, trastuzumab, trimetaphan, urokinase, vasopressin, vecuronium, verapamil, vinCRIStine, vitamin B complex with C, voriconazole, warfarin

Increase:
prothrombin time—anticoagulants; use cautiously

Increase:
toxicity—aminoglycosides, loop diuretics, probenecid

Increase:
AST, ALT, alk phos, LDH, BUN, creatinine, bilirubin

Interference:
cross-matching

• 
Sensitivity to penicillin and other cephalosporins

 
Nephrotoxicity
: increased BUN, creatinine; urine output: if decreasing, notify prescriber

• 
I&O daily

• 
Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phos, Coombs’ test monthly if patient is on long-term therapy

• 
Electrolytes: potassium, sodium, chlorine monthly if patient is on long-term therapy

• 
Pseudomembranous colitis:
bowel pattern daily; if severe diarrhea occurs, product should be discontinued

 
Anaphylaxis:
rash, urticaria, pruritus, chills, fever, joint pain; angioedema; may occur a few days after therapy begins; discontinue product, notify prescriber immediately, keep emergency equipment nearby

• 
Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac daily

 
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

• 
Therapeutic response: decreased symptoms of infection, negative C&S

• 
To use yogurt or buttermilk to maintain intestinal flora, decrease diarrhea

• 
To take all medication prescribed for length of time ordered

 
To report sore throat, bruising, bleeding, joint pain (may indicate
blood dyscrasias
[rare]); diarrhea with mucus, blood (may indicate
pseudomembranous colitis
)