Mosby's 2014 Nursing Drug Reference (42 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
argatroban
/Aggrastat
Direct inhibitor of thrombin, it reversibly binds to thrombin active site
Anticoagulation prevention/treatment of thrombosis in heparin-induced thrombocytopenia; adjunct to percutaneous coronary intervention (PCI) in those with history of HIT
Unlabeled uses:
Acute MI, DIC, use in infants/children/adolescents
Hypersensitivity, overt major bleeding
Precautions:
Pregnancy (B), breastfeeding, children, intracranial bleeding, renal function impairment, hepatic disease, severe hypertension, after lumbar puncture, spinal anesthesia, major surgery, congenital/acquired bleeding, GI ulcers
• Adult: CONT IV INF
2 mcg/kg/min; adjust dose until steady-state aPTT is 1.5-
3× initial baseline, max 100 sec, max dose 10 mcg/kg/min
• Infant/child/adolescent (unlabeled):
CONT IV INF
0.75 mcg/kg/min, monitor aPTT q2hr until stable then at least daily
• Adult: CONT INF
0.5 mcg/kg/min, adjust rate based on aPTT
• Adult: IV INF
25 mcg/kg/min and bolus of 350 mcg/kg given over 3-5 min, check ACT 5-10 min after bolus completed, proceed if ACT >300 sec; if ACT <300 sec, give another 150 mcg/kg
BOL,
increase inf rate to 30 mcg/kg/min, recheck ACT in 5-10 min; if ACT >450 sec, decrease inf rate to 15 mcg/kg/min, recheck ACT in 5-10 min; when ACT is therapeutic, continue for duration of procedure
• Adult: IV
loading dose of 1000 mcg/kg over 1 min, then 1-3 mcg/kg/min
• Adult: CONT IV
0.7 mcg/kg/min
Inj 100 mg/ml (2.5 ml; must dilute 100-fold)
•
Avoid all IM inj that may cause bleeding
•
For PCI:
350 mg/kg bol and continuous inf of 25 mcg/kg/min; check ACT 5-10 min after bolus
•
Dilute
in 0.9% NaCl, D
5
, LR to a final conc of 1 mg/ml;
dilute
each 2.5-ml vial 100-fold by mixing with 250 ml of diluent, mix by repeated inversion of the diluent bag for 1 min; may briefly be slightly hazy
•
Dosage adjustment may be made after review of aPTT, max 10 mcg/kg/min
CNS:
Fever
,
intracranial bleeding,
headache
CV:
Atrial fibrillation, coronary thrombosis, MI, myocardial ischemia, coronary occlusion, ventricular tachycardia, bradycardia,
chest pain, hypotension
GI:
Nausea, vomiting, abdominal pain, diarrhea
,
GI bleeding
GU:
Hematuria,
abnormal kidney function, UTI
HEMA:
Hemorrhage
MISC:
Back pain, headache
, infection
RESP:
Pneumonia, dyspnea, coughing, hemoptysis
SYST:
Sepsis
Metabolized in liver by P450 CYP3A 4/5, distributed to extracellular fluid, 54% plasma protein binding, half-life 39-51 min, excreted in feces, steady state 1-3 hr
Increase:
bleeding risk—antiplatelets, NSAIDs, salicylates, dipyridamole, clopidogrel, ticlopidine, heparin, warfarin, glycoprotein IIb/IIIa antagonists (abciximab, tirofiban, eptifibatide), thrombolytics (alteplase, reteplase, urokinase, tenecteplase), other anticoagulants
•
Baseline aPTT before treatment; do not start treatment if aPTT ratio is ≥2.5, then check aPTT 2 hr after initiation of treatment and at least daily thereafter
•
aPTT, which should be 1.5-3 × control, draw blood for ACT every 20-30 min during long PCI
Bleeding
gums: petechiae; ecchymosis; black, tarry stools; hematuria/epistaxis; B/P; vaginal bleeding, possible hemorrhage
Anaphylaxis:
dyspnea, rash during treatment
•
Fever, skin rash, urticaria
•
Therapeutic response: absence or decrease of thrombosis
•
To use a soft-bristle toothbrush to avoid bleeding gums; avoid contact sports; use electric razor; avoid IM inj
•
To report any signs of bleeding: gums, under skin, urine, stools; trouble breathing wheezing, skin rash
•
To notify prescriber if planning to become pregnant, breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a-rip-ip-pra′zol)
Abilify, Abilify Discmelt
Func. class.:
Antipsychotic
Chem. class.:
Quinolinone
Exact mechanism unknown; may be mediated through both DOPamine type 2 (D
2
, D
3
) and serotonin type 2 (5-HT
1A
, 5-HT
2A
) antagonism
Schizophrenia and bipolar disorder (adults and adolescents), agitation, mania, major depressive disorder, short-term mania or mixed episodes of bipolar disorder; irritability in patients with autism
Psychosis in patients with dementia
Breastfeeding, hypersensitivity, seizure disorders
Precautions:
Pregnancy (C), geriatric patients, renal/hepatic/cardiac disease
Black Box Warning:
Children, dementia, suicidal ideation
• Adult: PO
2-5 mg/day as an adjunct to other antidepressant treatment; adjust by 5 mg at ≥1 wk (range, 2-15 mg/day)
• Adult: PO
10-15 mg/day; if needed, dosage may be increased to 30 mg/day after 2 wk; maintenance 15 mg/day; periodically reassess
• Adolescent 13-17 yr: PO
2 mg/day, may increase to 5 mg after 2 days, then 10 mg after 2 more days, max 30 mg/day
• Adult: PO
15 mg/day, may increase to 30 mg if needed (monotherapy); adjunctive to lithium or valproate PO 10-15 mg qd, may increase to 30 mg if needed
• Child >10 yr, adolescents: PO
2 mg, titrate to 5 mg/day after 2 days to target of 10 mg/day after another 2 days
• Adult: IM
9.75 mg as a single dose, may start with a lower dose, max 30 mg/day
• Child
≥
6 yr, adolescents: PO
2 mg/day, increase to 5 mg/day after 1 wk, may increase to 10-15 mg/day if needed; dose changes should not occur more frequently than q1wk
• Adult: PO
Reduce to 50% of usual dose, increase dose when CYP2D6, CYP3A4 inhibitor withdrawn
• Adult: PO
reduce to 25% of usual dose
• Adults: PO
15 mg/day, may increase to 20-30 mg/day after 3 wk
Tabs 2, 5, 10, 15, 20, 30 mg; inj 9.75 mg/1.3 ml; orally disintegrating tab 10, 15 mg; oral sol 1 mg/ml
•
May be given without regard to meals
•
Orally disintegrating tabs; do not open blister until ready to use, do not push tab through foil; place on tongue, allow to dissolve, swallow, do not divide
•
Oral liquid: use calibrated measuring device
•
Oral solution: can be substituted for tablet on a mg-per-mg, up to 25 mg dose. Patients receiving 30-mg tablets should receive 25 mg of solution
•
Give IM only; inject slowly, deeply into muscle mass; discard unused portion
CNS:
Drowsiness, insomnia, agitation, anxiety, headache
,
seizures, neuroleptic malignant syndrome,
light-headedness, akathisia, asthenia, tremor
,
stroke, suicidal ideation,
dystonia
CV:
Orthostatic hypotension,
tachycardia
EENT:
Blurred vision, rhinitis
GI:
Constipation, nausea, vomiting
, jaundice,
weight gain
