Mosby's 2014 Nursing Drug Reference (392 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(thye′roid)
Armour Thyroid, Bio-Throid, Nature Thyroid, NP Thyroid
Func. class.:
Thyroid hormone
Chem. class.:
Active thyroid hormone in natural state and ratio
Increases metabolic rates, increases cardiac output, O
2
consumption, body temp, blood volume; growth, development at cellular level
Hypothyroidism, cretinism (juvenile hypothyroidism), myxedema
Adrenal insufficiency, MI, thyrotoxicosis, porcine protein hypersensitivity
Black Box Warning:
Obesity treatment
Precautions:
Pregnancy (A), breastfeeding, geriatric patients, angina pectoris, hypertension, ischemia, cardiac disease
Calculator
• Adult:
PO
60 mg/day, increased by 30 mg/mo until desired response; maintenance dose 60-120 mg/day
• Geriatric:
PO
7.5-15 mg/day, increase dose q6-8wk until desired response
• Child:
PO
15 mg/day, then 30 mg/day after 2 wk, then 60 mg/day after another 2 wk; maintenance dose 60-180 mg/day
• Adult:
PO
15 mg/day, double dose q2wk, maintenance 60-180 mg/day
Available forms:
Tabs 16, 32, 60, 65, 98, 130, 195, 260, 325 mg; enteric-coated tabs 32, 65, 130 mg; sugarcoated tabs 32, 65, 130, 195 mg; caps 65, 130, 195, 325 mg
•
In
AM
if possible as single dose to decrease sleeplessness; separate iron, calcium products by 4 hr
•
At same time each day to maintain product level
•
Only for hormone imbalances; not to be used for obesity, male infertility, menstrual disorders, lethargy
•
Lowest dose that relieves symptoms
CNS:
Insomnia, tremors
, headache,
thyroid storm
CV:
Tachycardia, palpitations, angina, dysrhythmias
, hypertension,
cardiac arrest
GI:
Nausea, diarrhea, increased or decreased appetite, cramps
MISC:
Menstrual irregularities, weight loss, sweating, heat intolerance, fever
PO:
Peak 12-48 hr, half-life 6-7 days
Increase:
effects of anticoagulants, sympathomimetics, tricyclics, catecholamines
Decrease:
thyroid absorption—bile acid sequestrants, aluminum, magnesium, calcium
Decrease:
thyroid effects—estrogens
Decrease:
thyroid effect—soy
Increase:
CPK, LDH, AST, PBI, blood glucose
Decrease:
thyroid function tests
Black Box Warning:
Obesity treatment:
use can lead to serious or life-threatening toxicity
•
B/P, pulse before each dose
•
I&O ratio
•
Weight daily in same clothing, using same scale, at same time of day
•
Height, growth rate of child
•
T
3
, T
4
, which are decreased; radioimmunoassay of TSH, which is increased; radio uptake, which is decreased if dosage is too low
•
PT may require decreased anticoagulant; check for bleeding, bruising
•
Hyperthyroidism:
increased nervousness, excitability, irritability; may indicate too high of a dose of medication, usually after 1-3 wk of treatment
•
Hypothyroidism:
lethargy, cold intolerance, weight gain, constipation, muscle cramps; may indicate too low of a dose
•
Cardiac status: angina, palpitation, chest pain, change in VS
•
Removal of medication 4 wk before RAIU test
•
Therapeutic response: absence of depression; increased weight loss, diuresis, pulse, appetite; absence of constipation, peripheral edema, cold intolerance; pale, cool, dry skin; brittle nails, alopecia, coarse hair, menorrhagia, night blindness, paresthesias, syncope, stupor, coma, rosy cheeks
•
That hair loss will occur in child, is temporary
•
To report excitability, irritability, anxiety; indicates overdose
•
Not to switch brands unless directed by prescriber
•
That strong odor is normal
•
That hypothyroid child will show almost immediate behavior/personality change
•
That treatment product is not to be taken to reduce weight
•
To avoid OTC preparations with iodine; to read labels
•
To separate iron, calcium products by 4 hr
•
To avoid iodine food, iodized salt, soybeans, tofu, turnips, some seafood, some bread
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tie-ah-ga′been)
Gabitril
Func. class.:
Anticonvulsant
Do not confuse:
tiaGABine
/tiZANidine
Inhibits reuptake and metabolism of GABA, may increase seizure threshold; structurally similar to GABA; tiaGABine binding sites in neocortex, hippocampus
Adjunct treatment of partial seizures in adults and children ≥12 yr
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children <12 yr, geriatric patients, renal/hepatic disease, suicidal thoughts/behaviors, status epilepticus, mania, bipolar disorder, abrupt discontinuation, depression
Calculator
When not given with a CYP3A4 enzyme, effect of tiaGABine is doubled; lower doses are indicated
• Adult (those receiving an enzyme-inducing antiepileptic product):
PO
4 mg/day in divided doses, may increase by 4-8 mg/wk until desired response, max 56 mg/day
• Child 12-18 yr:
PO
4 mg/day, may increase by 4 mg at beginning of wk 2; may increase by 4-8 mg/wk until desired response; max 32 mg/day
• Adult:
PO
reduce dose or increase dosing interval
Available forms:
Tabs 2, 4, 12, 16 mg
•
With food
CNS:
Dizziness, anxiety
, somnolence, ataxia, confusion,
asthenia
, unsteady gait, depression,
suicidal ideation, seizures
CV:
Vasodilation
GI:
Nausea, vomiting, diarrhea, increased appetite
INTEG:
Pruritus, rash,
Stevens-Johnson syndrome
RESP:
Pharyngitis, coughing
Absorption >95%; peak 45 min; protein binding 96%; metabolized in the liver via CYP3A4; half-life 7-9 hr without enzyme inducers, 2-5 hr with enzyme inducers
•
Lower doses may be needed when used with valproate
Increase:
CNS depression—CNS depressants, alcohol
Decrease:
tiaGABine effect—sevelamer
Decrease:
effect—carBAMazepine, PHENobarbital, phenytoin, primidone
Decrease:
rate of absorption—high-fat meal
•
Renal studies: urinalysis, BUN, urine creatinine q3mo
•
Hepatic studies: ALT, AST, bilirubin
•
Seizures:
location, duration, presence of aura; assess for weakness
•
Withdraw gradually to prevent seizures
•
May cause status epilepticus and unexplained death
Mental status: mood, sensorium, affect, behavioral changes, suicidal thoughts/behaviors; if mental status
changes, notify prescriber, hypomania may be present before suicide attempt
•
Storage at room temp, away from heat and light
•
Assistance with ambulation during early part of treatment; dizziness occurs
•
Seizure precautions: padded side rails; move objects that may harm patient
•
Therapeutic response: decreased seizure activity; document on patient’s chart
•
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
•
Not to discontinue medication quickly after long-term use
•
To take with food
•
To notify prescriber if pregnancy is planned or suspected, avoid breastfeeding
Lavage, VS
