Mosby's 2014 Nursing Drug Reference (317 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pen-tox′ih-fill-in)
Trental
Func. class.:
Hemorheologic agent
Chem. class.:
Dimethylxanthine derivative
Decreases blood viscosity, stimulates prostacyclin formation, increases blood flow by increasing flexibility of RBCs; decreases RBC hyperaggregation; reduces platelet aggregation, decreases fibrinogen concentration
Intermittent claudication related to chronic occlusive vascular disease
Unlabeled uses:
Behçet’s syndrome, Kawasaki disease to reduce coronary artery lesions, diabetic neuropathies, sickle cell anemia
Hypersensitivity to this product or xanthines, retinal/cerebral hemorrhage
Precautions:
Pregnancy (C), breastfeeding, children, angina pectoris, impaired renal function, recent surgery, peptic ulceration, cardiac disease, bleeding disorders
Calculator
• Adult:
PO
400 mg tid with meals, may decrease to bid if side effects occur; must be taken for ≥8 wk for maximal effect
• Adult:
PO
300 mg bid × 2 wk then 300 mg/day
• Adult:
PO
400 mg tid
• Child:
PO
20 mg/kg/day in 3 divided doses with aspirin and IVIG
Available forms:
Cont rel tabs 400 mg; ext rel tabs 400 mg
•
Do not break, crush, or chew ext rel tabs
•
With meals to prevent GI upset
CNS:
Headache
, anxiety,
tremors
, confusion,
dizziness
GI:
Dyspepsia, nausea, vomiting
PO:
Peak 2-4 hr, half-life 1/2-1 hr, degradation in liver, excreted in urine
Increase:
bleeding risk—warfarin, abciximab, eptifibatide, tirofiban, ticlopidine, clopidogrel, thrombin inhibitor
Increase:
theophylline level—theophylline
Increase:
hypotension—antihypertensives, nitrates
Increase:
pentoxifylline—cimetidine, ciprofloxacin
•
B/P, respirations of patient also taking antihypertensives; intermittent claudication at baseline and throughout
•
PT, Hgb, Hct in patients at risk for hemorrhage
•
Serum creatinine/BUN
•
Therapeutic response: decreased pain, cramping, increased ambulation
•
That therapeutic response may take 2-4 wk, 8-12 wk to reach full benefit
•
To observe feet for arterial insufficiency
•
To wear cotton socks, well-fitted shoes; not to go barefoot
•
To watch for bleeding, bruises, petechiae, epistaxis
•
To avoid smoking to prevent blood vessel constriction
•
That there are many drug, herb interactions
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(per-in′doe-pril)
Aceon, Coversye
Func. class.:
Antihypertensive
Chem. class.:
Angiotensin-converting enzyme inhibitor
Selectively suppresses the renin-angiotensin-aldosterone system; inhibits ACE; prevents the conversion of angiotensin I to angiotensin II and the dilation of arterial and venous vessels
Hypertension, stable coronary artery disease
Unlabeled uses:
Heart failure
Hypersensitivity, history of angioedema
Black Box Warning:
Pregnancy (D)
Precautions:
Breastfeeding, renal disease, hyperkalemia, hepatic failure, dehydration, bilateral renal artery stenosis, cough, angioedema, severe CHF
Calculator
• Adult:
PO
4 mg/day, may increase or decrease to desired response, range 4-8 mg/day; may give in 2 divided doses or as single dose, max 16 mg/day
• Adult:
PO
2-4 mg/day in 1-2 divided doses, range 4-8 mg/day
• Adult:
PO
4 mg/day × 2 wk then increase as tolerated to 8 mg/day
• Adult:
PO
CCr 16-29 ml/min, 2 mg every other day; CCr 30-59 ml/min, 2 mg/day
Available forms:
Tabs scored 2, 4, 8 mg
•
As single dose or in 2 divided doses, without regard to meals
CNS:
Insomnia, dizziness
, paresthesias, headache, fatigue, anxiety, depression
CV:
Hypotension
, chest pain, tachycardia, dysrhythmias, syncope
EENT:
Tinnitus;
visual changes; sore throat; double vision; dry, burning eyes
GI:
Nausea, vomiting, colitis, cramps, diarrhea, constipation, flatulence, dry mouth, loss of taste
GU:
Proteinuria, renal failure,
increased frequency of polyuria or oliguria
HEMA:
Agranulocytosis, neutropenia
INTEG:
Rash, purpura, alopecia, hyperhidrosis
META:
Hyperkalemia
RESP:
Dyspnea,
dry cough
, crackles
SYST:
Angioedema
Bioavailability 75%; peak 1 hr parent product, 3-7 hr prodrug; protein binding 68%; metabolized by liver (active metabolite perindoprilat); half-life 0.8-10 hr; excreted in urine
Increase:
effects of neuromuscular blocking agents, antihypertensives, lithium
Increase:
antihypertensive effect—diuretics, NSAIDs
Increase:
hypersensitivity—allopurinol
Increase:
severe hypotension—diuretics, other antihypertensives
Increase:
hyperkalemia—salt substitutes, potassium-sparing diuretics, potassium supplements
Decrease:
effects of NSAIDs
Decrease:
antihypertensive effect—NSAIDs, salicylates
Increase:
antihypertensive effect—hawthorn
Decrease:
antihypertensive effect—ephedra
Interference:
glucose/insulin tolerance tests
•
Hypertension:
B/P, pulse q4hr; note rate, rhythm, quality
•
Electrolytes: K, Na, Cl during 1st 2 wk of therapy
•
Baselines of renal, hepatic studies before therapy begins, 1 wk into therapy
•
Skin turgor, dryness of mucous membranes for hydration status, dry mouth
•
CHF:
edema, dyspnea, wet crackles
•
Angioedema:
facial swelling, urticaria; product should be discontinued, may be more common in African Americans
•
Therapeutic response: decreased B/P
•
Not to use OTC (cough, cold, allergy) products unless directed by prescriber; to avoid salt substitutes
•
To avoid sunlight or to wear sunscreen for photosensitivity
•
To comply with dosage schedule, even if feeling better
•
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pains, signs of angioedema
•
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur
•
That product may cause dizziness, fainting; that lightheadedness may occur during 1st few days of therapy
•
That product may cause skin rash or impaired perspiration; that angioedema may occur and to discontinue product if it occurs
•
Not to discontinue product abruptly
•
To rise slowly to sitting or standing position to minimize orthostatic hypotension
Black Box Warning:
To notify prescriber if pregnancy is planned or suspected; pregnancy category (D)
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O
2
, diuretic for cardiac failure
