Mosby's 2014 Nursing Drug Reference (331 page)

Black Box Warning:

Bone marrow failure, cardiac arrhythmias

• Adult:
IV
loading dose 20 mg/min; either ventricular tachycardia resolves or patient becomes hypotensive; QRS complex is widened by 50% of original width or total is 17 mg/kg (1.2 g for a 70-kg patient); may give up to 50 mg/min in urgent situations; maintenance: 1-4 mg/min
CONT IV INF; IM
50 mg/kg/day in divided doses q3-6hr

• Child:
IV
PALS 15 mg/kg over 30-60 min

• Adult:
IV
CCr 35-59 ml/min, give 70% maintenance dose; CCr 15-34 ml/min, give 40%-60% maintenance dose; CCr <15 ml/min, individualize dose

Y-site compatibilities:
Alfentanil, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, ascorbic acid, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, caspofungin, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, cefTRIAXone, cefuroxime, cephalothin, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, mezlocillin, miconazole, midazolam, mitoXANtrone, morphine, moxalactam, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, ritodrine, rocuronium, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine,
vinorelbine, vitamin B complex/C, voriconazole, zoledronic acid

Increase:
effects of neuromuscular blockers

Increase:
procainamide effects—cimetidine, quiNIDine, trimethoprim, β-blockers, ranitidine

Increase:
toxicity—other antidysrhythmics, thioridazine, quinolones

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

Black Box Warning:

Cardiac dysrhythmias:
ECG continuously if using IV to determine increased PR or QRS segments; discontinue immediately; watch for increased ventricular ectopic beats, maximum need to rebolus

• 
Therapeutic blood levels, 4-10 mcg/ml or NAPA levels 10-20 mcg/ml

Black Box Warning:

Bone marrow suppression:
CBC q2wk × 3 mo; leukocyte, neutrophil, platelet counts may be decreased, treatment may need to be discontinued

• 
I&O ratio; electrolytes (K, Na, Cl), weight weekly, report gain of >2 lb

 
Toxicity:
confusion, drowsiness, nausea, vomiting, tachydysrhythmias, oliguria

• 
ANA titer; during long-term treatment, watch for lupuslike symptoms

• 
Cardiac rate, rhythm, character, B/P continuously for fluctuations

• 
Respiratory status: rate, rhythm, character, lung fields; bilateral crackles may occur in CHF patient; watch for respiratory depression

 
CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued

• 
Therapeutic response: decreased dysrhythmias

• 
That wax matrix may appear in stools

• 
Not to discontinue without provider’s approval

Black Box Warning:

To notify prescriber immediately if lupuslike symptoms appear (joint pain, butterfly rash, fever, chills, dyspnea)

Black Box Warning:

To notify prescriber of leukopenia (sore mouth, gums, throat) or thrombocytopenia (bleeding, bruising)

• 
How to take pulse and when to report to prescriber

• 
To avoid driving, other hazardous activities until product effect is known