Mosby's 2014 Nursing Drug Reference (190 page)

• Adult:
IM
500 mg as 2, 5-ml injections on days 1, 15, 29 and monthly thereafter

Increase:
LFTs

• 
For anticoagulant use

• 
For side effects; report to prescriber

• 
Liquid diet, if needed, including cola, gelatin; dry toast or crackers may be added if patient is not nauseated or vomiting

• 
Store in refrigerator, protect from light

• 
Therapeutic response: decreased tumor size, spread of malignancy

• 
To report any complaints, side effects to prescriber

• 
To report vaginal bleeding immediately

• 
That tumor flare (increase in size of tumor, increased bone pain) may occur, will subside rapidly; that analgesics may be taken for pain

• 
That premenopausal women must use mechanical birth control because ovulation may be induced; not to breastfeed

• 
To use contraception to prevent pregnancy; pregnancy category (D)

• Adult:
PO
20-80 mg/day in
AM
; may give another dose after 6 hr up to 600 mg/day;
IM/IV
20-40 mg; increase by 20 mg q2hr until desired response

• Child:
PO/IM/IV
2 mg/kg; may increase by 1-2 mg/kg q6-8hr up to 6 mg/kg

• Adult:
IV
40 mg given over several min, repeated after 1 hr; increase to 80 mg if needed

• Child:
IV/IM
1-2 mg/kg q6-12hr, max 6 mg/kg/dose

• Premature neonate >32 wk postconceptional age:
IV/IM
1-2 mg/kg q12-24hr

• Premature neonate ≤32 wk postconceptional age:
IV/IM
max 1 mg/kg initially

• Adult:
IM/IV
80-100 mg q1-4hr or
PO
120 mg/day or divided bid

• Child:
IM/IV
25-50 mg, repeat q4hr if needed

• Adult:
PO
80 mg/day, increase by 80-120 mg/day to desired response;
IV
100-200 mg, max 600-800 mg

• Adult:
IV
40-80 mg

• Adult:
IV
40 mg injected slowly then 80 mg injected slowly after 2 hr if needed

• Child:
IM/IV
1-2 mg/kg q6-12hr

• Premature neonate >32 wk postconceptional age:
IM/IV
1-2 mg/kg q12-24hr

• Premature neonate ≤32 wk postconceptional age:
IM/IV
Max 1 mg/kg, give no more frequently than q24hr

• 
In
AM
to avoid interference with sleep if using product as diuretic

• 
Potassium replacement if potassium <3 mg/dl

Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, alprostadil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B cholesteryl/lipid complex/liposome, anidulafungin, argatroban, ascorbic acid, atenolol, atropine, azaTHIOprine, aztreonam, bivalirudin, bleomycin, bumetanide, calcium chloride/gluconate, CARBOplatin, cefamandole, ceFAZolin, cefepime, cefme-tazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, CISplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, DOCEtaxel, doripenem, doxacurium, DOXOrubicin liposome, enalaprilat, ePHEDrine, EPINEPHrine, etoposide, fentaNYL, fludarabine, fluorouracil, folic acid, foscarnet, gallium nitrate, ganciclovir, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem-cilastatin, indomethacin, insulin (regular), isosorbide, kanamycin, leucovorin, lidocaine, linezolid, LORazepam, LR, mannitol, mechlorethamine, melphalan, meropenem, methicillin, methotrexate, methylPREDNISolone, metoprolol, metroNIDAZOLE, mezlocillin, micafungin, miconazole, mitoMYcin, moxalactam, multiple vitamin injection, nafcillin, naloxone, nitroprusside, octreotide, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pantoprazole, PEMEtrexed, penicillin G, PENTobarbital, PHENobarbital, phytonadione, piperacillin, piperacillin-tazobactam, potassium chloride, procainamide,
propofol, propranolol, ranitidine, remifentanil, Ringer’s, ritodrine, sargramostim, sodium acetate/bicarbonate, succinylcholine, SUFentanil, temocillin, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, urokinase, vit B/C, voriconazole, zoledronic acid

Increase:
toxicity—lithium, nondepolarizing skeletal muscle relaxants, digoxin

Increase:
hypotensive action of antihypertensives, nitrates

Increase:
ototoxicity—aminoglycosides, CISplatin, vancomycin

Increase:
effects of anticoagulants, salicylates

Decrease:
furosemide effect—probenecid

Interference:
GTT

Increase:
LDL

• 
CHF:
weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily

• 
Hypertension:
B/P lying, standing; postural hypotension may occur

• 
Metabolic alkalosis: drowsiness, restlessness

• 
Hypokalemia:
postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness

• 
Rashes, temp elevation daily

• 
Confusion, especially in geriatric patients; take safety precautions if needed

• 
Hearing,
including tinnitus and hearing loss, when giving high doses for extended periods

• 
Rate, depth, rhythm of respiration, effect of exertion, lung sounds

• 
Electrolytes (potassium, sodium, chloride); include BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid

• 
Glucose in urine if patient diabetic

• 
Allergies to sulfonamides, thiazides

• 
Increased fluid intake 2-3 L/day unless contraindicated

• 
Therapeutic response: improvement in edema of feet, legs, sacral area (CHF); increase urine output, decreased B/P; decreased calcium levels (hypercalcemia)

• 
To discuss the need for a high-potassium diet or potassium replacement with prescriber

• 
To rise slowly from lying or sitting position because orthostatic hypotension may occur

• 
To recognize adverse reactions that may occur: muscle cramps, weakness, nausea, dizziness

• 
About the entire treatment regimen, including exercise, diet, stress relief for hypertension

• 
To take with food or milk for GI symptoms

• 
To use sunscreen or protective clothing to prevent photosensitivity

• 
To take early in the day to prevent sleeplessness

• 
To avoid OTC medications unless directed by prescriber