Mosby's 2014 Nursing Drug Reference (329 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pre-gab′a-lin)
Lyrica
Func. class.:
Anticonvulsant
Chem. class.:
γ-Aminobutyric acid (GABA) analog
Binds to high-voltage–gated calcium channels in CNS tissues; this may lead to anticonvulsant action similar to the inhibitory neurotransmitter GABA; anxiolytic, analgesics, and antiepileptic properties
Neuropathic pain associated with spinal cord injury/diabetic peripheral neuropathy, partial-onset seizures, postherpetic neuralgia, fibromyalgia
Unlabeled uses:
Moderate pain, social anxiety disorder
Hypersensitivity, abrupt discontinuation
Precautions:
Pregnancy (C), breastfeeding, children <12 yr, geriatric pa
tients, renal disease, PR interval prolongation, creatine kinase elevations, CHF (class III, IV), decreased platelets, substance abuse, dependence, glaucoma, myopathy, angioedema history, suicidal behavior
Calculator
• Adult:
PO
50 mg tid, may increase to 300 mg/day (max) within 1 wk, adjust in patients with renal disease
• Adult:
PO
75 mg bid or 50 mg tid; may increase to 600 mg/day (max)
• Adult:
PO
150 mg/day in 2-3 divided doses, may increase to 300 mg/day in 2-3 divided doses; if higher dose is required after 2-4 wk, may increase to 600 mg/day in 2-3 divided doses
• Adult:
PO
75 mg bid, may increase to 150 mg bid within 1 wk and 225 mg bid after 1 wk
• Adult:
PO
CCr 30-60 ml/min, 75-300 mg/day in 2-3 divided doses; CCr 15-30 ml/min, 25-150 mg/day in 1-2 divided doses; CCr <15 ml/min, 25-75 mg/day as a single dose
• Adult:
PO
150-600 mg/day in 3 divided doses
Available forms:
Caps 25, 50, 75, 100, 150, 200, 225, 300 mg; oral sol 20 mg/ml
•
Do not crush or chew caps; caps may be opened and contents put in applesauce or dissolved in juice
•
Give without regard to meals
•
Gradually withdraw over 7 days; abrupt withdrawal may precipitate seizures
CNS:
Dizziness, fatigue, confusion, euphoria, incoordination, nervousness, neuropathy, tremor, vertigo, somnolence, ataxia, amnesia, abnormal thinking,
suicidal ideation
EENT:
Dry mouth, blurred vision, nystagmus, amblyopia, sinusitis
GI:
Constipation, flatulence, abdominal pain, weight gain
GU:
Gynecomastia
HEMA:
Ecchymosis,
thrombocytopenia
MS:
Back pain,
rhabdomyolysis,
myopathy
OTHER:
Pruritus, orgasm/erectile dysfunction, peripheral edema,
angioedema
RESP:
Dyspnea
Well absorbed, absorption decreased with food; peak 1.5 hr; 90% recovered in urine unchanged; negligible metabolism; not bound to plasma proteins; half-life 6 hr
Increase:
weight gain/fluid retention—thiazolidinedione; avoid use if possible
Increase:
CNS depression—anxiolytics, sedatives, hypnotics, barbiturates, general anesthetics, opiate agonists, phenothiazines, sedating H
1
blockers, thiazolidinediones, tricyclics, alcohol
Increase:
creatine kinase
Decrease:
platelets
•
Seizures:
aura, location, duration, activity at onset, use seizure precaution
•
Pain:
location, duration, characteristics if using for diabetic neuropathy
•
Renal studies: urinalysis, BUN, urine creatinine q3mo, creatine kinase; if markedly increased, discontinue product
Mental status: mood, sensorium, affect, behavioral changes, suicidal thoughts/behaviors; if mental status changes, notify prescriber
•
Angioedema/hypersensitivity:
monitor for blisters, hives, rash, dyspnea, wheezing; angioedema; if these occur, discontinue; cross-hypersensitivity with this product and gabapentin may occur
•
Rhabdomyolysis and creatinine kinase elevations:
monitor for muscle pain, tenderness, weakness accompanied by malaise or fever; product should be discontinued
•
Therapeutic response: decreased seizure activity; decrease in neuropathic pain
•
To carry emergency ID stating patient’s name, products taken, condition, prescriber’s name and phone number
•
To avoid driving, other activities that require alertness because dizziness, drowsiness may occur
•
Not to discontinue medication quickly after long-term use, to taper over ≥1 wk; that withdrawal-precipitated seizures may occur; not to double doses if dose is missed, to take if 2 hr or more before next dose
•
To notify prescriber if pregnancy planned or suspected; to avoid breastfeeding
•
To report muscle pain, tenderness, weakness when accompanied by fever, malaise, suicidal thoughts/behaviors
•
To avoid alcohol
Lavage, VS, hemodialysis
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(prim′a-kween)
Func. class.:
Antimalarial
Chem. class.:
Synthetic 8-aminoquinolone
Unknown; thought to destroy exoerythrocytic forms by gametocidal action
Malaria caused by
Plasmodium vivax;
in combination with clindamycin for
Pneumocystis jiroveci
pneumonia
Lupus erythematosus, rheumatoid arthritis; hypersensitivity to this product or idoquinol
Precautions:
Pregnancy (C), breastfeeding, methemoglobin reductase deficiency
Black Box Warning:
Bone marrow suppression, hemolytic anemia, G6PD deficiency
Calculator
• Adult:
PO
15-30 mg (base)/day × 2 wk or 45 mg (base)/day × 8 wk; 26.3-mg tab is 15-mg base
• Child:
PO
0.5 mg/kg (0.3 mg/base/day) daily × 2 wk
Available forms:
Tabs 26.3 mg
•
Before or after meals at same time each day to maintain product level; take with food to decrease GI upset
CNS:
Headache, dizziness
CV:
Hypertension, dysrhythmias
EENT:
Blurred vision, difficulty focusing
GI:
Nausea, vomiting, anorexia
, cramps
HEMA:
Agranulocytosis, granulocytopenia, leukopenia, hemolytic anemia, leukocytosis,
mild anemia,
methemoglobinemia
INTEG:
Pruritus, skin eruptions, pallor, weakness
PO:
Metabolized by liver (metabolites), half-life 3.7-9.6 hr
•
Toxicity: quinacrine
Decrease:
effect of carBAMazepine, PHENobarbital, phenytoins, rifamycins, nafcillin
Increase:
primaquine effect—food
Decrease:
primaquine effect—grapefruit juice
Increase:
WBC
Decrease:
WBC, RBC, Hgb
•
Ophthalmic test if patient receiving long-term treatment or product dosage of >150 mg/day
•
Hepatic studies weekly: AST, ALT, bilirubin if patient receiving long-term therapy
•
Blood studies: CBC; blood dyscrasias occur
•
Allergic reactions: pruritus, rash, urticaria
•
Blood dyscrasias: malaise, fever, bruising, bleeding (rare)
•
Renal status: dark urine, hematuria, decreased output
Hemolytic reaction:
chills, fever, chest pain, cyanosis; product should be discontinued immediately; hemolytic anemia may be severe in patients of Asian, Mediterranean descent
•
Therapeutic response: decreased symptoms of malaria
•
To report visual problems, fever, fatigue, dark urine, bruising, bleeding; may indicate blood dyscrasias
•
To complete full course of therapy
•
That an eye exam will be needed q4-6mo if using product for an extended period of time
