Mosby's 2014 Nursing Drug Reference (316 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Withdraw product; maintain airway; administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pen-tam′i-deen)
Nebupent, Pentam 300
Func. class.:
Antiprotozoal
Chem. class.:
Aromatic diamide derivative
Interferes with DNA/RNA synthesis in protozoa
Treatment/prevention of
Pneumocystis jiroveci
infections
Unlabeled uses:
Leishmania/Trypanosoma
infections
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, blood dyscrasias, cardiac/renal/hepatic disease, diabetes mellitus, hypocalcemia, hypo/hypertension, anemia
Calculator
• Adult and child
≥
4 mo:
IV/IM
4 mg/kg/day × 2-3 wk;
NEB
300 mg via specific nebulizer given q4wk for prevention
Available forms:
Inj, aerosol 300 mg/vial; sol for aerosol 60 mg/vial
•
Through nebulizer, using Raspirgard II jet nebulizer; mix contents in 6 ml of sterile water; do not use low pressure (<20 psi); flow rate should be 5-7 L/min (40-50 psi) air or O
2
source over 30-45 min until chamber is empty
•
300 mg diluted in 3 ml sterile water; give deep IM by
Z
-track; if painful by this route, rotate inj site
•
Reconstitute 300 mg/3-5 ml of sterile water for inj, D
5
W, withdraw dose and further dilute in 50-250 ml D
5
W, give over 1-2 hr with patient lying down; check B/P often
Y-site compatibilities:
Alfentanil, atracurium, atropine, benztropine, buprenorphine, calcium gluconate, CARBOplatin, caspofungin, chlorproMAZINE, cimetidine, CISplatin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, diltiazem, gatifloxacin, zidovudine
CNS:
Disorientation, hallucinations,
dizziness
, confusion, drowsiness
CV:
Hypotension, ventricular tachycardia,
QT prolongation, dysrhythmias
GI:
Nausea, vomiting, anorexia;
increased AST, ALT;
acute pancreatitis,
metallic taste
GU:
Acute renal failure, increased serum creatinine, renal toxicity,
decreased urination
HEMA:
Anemia,
leukopenia, thrombocytopenia
INTEG:
Sterile abscess, pain at inj site, pruritus, urticaria,
rash
META:
Hyperkalemia
, hypocalcemia, hypoglycemia, hypomagnesemia
MISC:
Fatigue, fever, chills, night sweats,
anaphylaxis, Stevens-Johnson syndrome
RESP:
Cough, SOB,
bronchospasm
(with aerosol), sore throat
IV:
Peak 1 hr
IM:
Peak 30 min
Excreted unchanged in urine (66%); half-life 9-12 hr (IM), 6 hr (IV)
•
Nephrotoxicity: aminoglycosides, amphotericin B, CISplatin, NSAIDs, vancomycin
Fatal dysrhythmias: erythromycin IV
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin, arsenic trioxide, levomethadyl); CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
Increase:
myelosuppression—antineoplastics, radiation
Decrease:
WBC, platelets, Hbg, Hct
Increase:
BUN, creatitine
•
Blood tests, blood glucose, CBC, platelets, calcium, magnesium
•
I&O ratio; report hematuria, oliguria
•
ECG for cardiac dysrhythmias; patient should be lying down when receiving product; severe hypotension may develop; monitor B/P during administration and until B/P stable
•
Hepatic studies: AST, ALT
•
Renal studies: urinalysis, BUN, creatinine; nephrotoxicity may occur; any patient with compromised renal system; product is excreted slowly with poor renal system function; toxicity may occur rapidly
•
Signs of infection, anemia
•
Bowel pattern before, during treatment
•
Sterile abscess, pain at inj site
•
Respiratory status: rate, character, wheezing, dyspnea
•
Dizziness, confusion, hallucination
•
Allergies before treatment, reaction of each medication; place allergies on chart in bright red letters; notify all people giving products
•
Diabetic patients, hypoglycemia may occur, then hyperglycemia with prolonged therapy
•
Storage in refrigerator protected from light
•
Therapeutic response: resolution of AIDS-related PCP
•
To report sore throat, fever, fatigue (may indicate superinfection)
•
To maintain adequate fluid intake
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERT(pen-taz′oh-seen)
Talwin, Talwin NX
Func. class.:
Opiate analgesic, antagonist
Chem. class.:
Synthetic benzomorphan
Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception
Moderate to severe pain
Hypersensitivity to this product or sulfites; addiction (opiate)
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, addictive personality, increased intracranial pressure, MI (acute), severe heart disease, respiratory depression, renal/hepatic disease, seizure disorder, head trauma, bowel impaction, geriatric patients
Calculator
• Adult:
IV/IM/SUBCUT
30 mg q3-4hr prn, max 360 mg/day
• Adult:
IM
30 mg as a single dose;
IV
20 mg q2-3hr when contractions are regular, max 2-3 times
• Adult:
CCr 10-50 ml/min, reduce dose by 25%; CCr <10 ml/min, reduce dose by 50%
Available forms:
Inj 30 mg/ml
•
With antiemetic if nausea, vomiting occur
•
When pain is beginning to return; determine dosage interval by patient response
•
Give IM deeply into large muscle mass, rotate sites; SUBCUT may cause necrosis with repeated inj
•
Undiluted or diluted in 5 mg/ml of sterile water for inj; give ≤5 mg over 1 min
Syringe compatibilities:
Atropine, benzquinamide, butorphanol, chlorproMAZINE, cimetidine, dimenhyDRINATE, diphenhydrAMINE, droperidol, fentaNYL, HYDROmorphone, hydrOXYzine, meperidine, metoclopramide, morphine, perphenazine, prochlorperazine, promazine, promethazine, ranitidine, scopolamine
Y-site compatibilities:
Heparin, hydrocortisone, potassium chloride, vit B/C
CNS:
Drowsiness, dizziness, confusion, headache, sedation, euphoria
, hallucinations, dreaming, insomnia, lightheadedness
CV:
Palpitations, bradycardia, change in B/P, tachycardia, increased B/P (high doses), hypotension, syncope, flushing
EENT:
Tinnitus, blurred vision, miosis, diplopia
GI:
Nausea
, vomiting, anorexia, constipation,
cramps
, dry mouth
GU:
Increased urinary output, dysuria, urinary retention
HEMA:
Eosinophilia, decreased WBC
INTEG:
Rash
, urticaria, bruising, flushing, diaphoresis, pruritus, severe irritation at inj sites,
Stevens-Johnson syndrome
RESP:
Respiratory depression
Metabolized by liver, excreted by kidneys, crosses placenta, half-life 2-3 hr, extensive first-pass metabolism with <20% entering circulation
IM/SUBCUT:
Onset 15-30 min, peak 1-2 hr, duration 2-4 hr
IV:
Onset 2-3 min, duration 4-6 hr
Unpredictable reactions: MAOIs
Increase:
effects—CNS depressants; alcohol, sedative/hypnotics, antipsychotics, skeletal muscle relaxants
Decrease:
effects—opiates
Increase:
amylase
•
Pain:
intensity, duration, location prior to and 1 hr after SUBCUT/IM dose or 30 min after IV dose
•
I&O ratio; check for decreasing output; may indicate urinary retention
•
Bowel status: constipation; may need stimulant laxatives/stool softeners
•
Withdrawal symptoms
in opiate-dependent patients
•
Abscesses, ulcerations, WBC count
•
CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
•
Allergic reactions: rash, urticaria
•
Respiratory depression:
character, rate, rhythm; notify prescriber if respirations are <10/min
•
Need for pain medication, physical dependence
•
Storage in light-resistant area at room temp
•
Assistance with ambulation
•
Safety measures: nightlight, call bell within easy reach
•
Therapeutic response: decrease in pain
•
To report any symptoms of CNS changes, allergic reactions
•
That physical dependency may result from extended use
•
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia
•
To avoid CNS depressants, alcohol
•
To avoid driving, operating machinery if drowsiness occurs
•
To use good oral hygiene, frequent rinsing of mouth to decrease dry mouth; to avoid gum, candy if drowsy
Naloxone (Narcan) 0.2-0.8 mg IV, O
2
, IV fluids, vasopressors
