Mosby's 2014 Nursing Drug Reference (50 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(a-toe′va-kwon)
Malarone
Func. class.:
Antiprotozoal
Chem. class.:
Aromatic diamide derivative
The constituents of Malarone, atovaquone, and proguanil hydrochloride interfere with 2 different pathways involved in DNA/RNA synthesis in protozoa
Malaria, malaria prophylaxis
Hypersensitivity to this product, malaria prophylaxis in patients with severe renal impairment
Precautions:
Pregnancy (C), breastfeeding, children, hepatic/GI/renal disease
Calculator
P. falciparum
malaria malarone adult strength tabs
• Adult/adolescent/child >40 kg: PO
4 adult strength tabs every day as a single dose × 3 consecutive days
• Child 31-40 kg: PO
3 adult strength tabs every day as a single dose × 3 consecutive days
• Child 21-30 kg: PO
2 adult strength tabs every day as a single dose × 3 consecutive days
• Infant/child 11-20 kg: PO
1 adult strength tab every day × 3 consecutive days
• Infant/child 11-20 kg: PO
4 pediatric tabs every day × 3 consecutive days
• Infant/child 9-10 kg: PO
3 pediatric tabs every day × 3 consecutive days
• Infant/child 5-8 kg: PO
2 pediatric tabs every day every 3 consecutive days
malaria prophylaxis, including chloroquine resistance areas
•
Each Malarone adult strength tab contains atovaquone 250 mg/proguanil 100 mg; Malarone Pediatric tablet contains atovaquone 62.5 mg/proguanil 25 mg
• Adult/adolescent/child >40 kg: PO
1 adult strength tab every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area
• Child 31-40 kg: PO
3 pediatric tabs every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area
• Child 21-30 kg: PO
2 pediatric tabs every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area
• Infant/child 11-20 kg: PO
1 pediatric tab every day; begin prophylaxis 1-2 days before entering the endemic area; continue daily during the stay and for 7 days after leaving the area
Available forms:
Tabs (adult) 250 mg atovaquone/proguanil 100 mg; tabs (pediatric) 62.5 atovaquone/proguanil 25 mg
•
Give with food or with milk or milk-based drink (nutritional supplement shake) to enhance oral absorption of atovaquone; food with high fat content is desired
•
Give dose at the same time each day, administer a repeat dose if vomiting occurs within 1 hour after dosing
•
Tabs may be crushed and mixed with condensed milk for children unable to swallow whole tablets
CNS:
Dizziness, headache, anxiety, insomnia
, asthenia, fever
CV:
Hypotension
GI:
Nausea, vomiting, diarrhea
, anorexia, increased AST/ALT,
acute pancreatitis,
constipation, abdominal pain
HEMA:
Anemia, neutropenia
INTEG:
Pruritus, urticaria,
rash
META:
Hyperkalemia, hypoglycemia, hyponatremia
OTHER:
Cough, dyspnea
Atovaquone excreted unchanged in feces (94%), highly protein bound (99%), Protaguanil 75% protein bound, 40%-60% excreted in urine, hepatic metabolism; half-life 2-3 days
Increase:
Level of indinavir
Decrease:
Effect of atovaquone-rifampin, rifabutin, tetracycline, metoclopramide
Increase:
AST, ALT, alk phos
Decrease:
Glucose, neutrophils, Hgb, sodium
•
Malaria:
Identify when the patient will be entering an area with malaria
•
Bowel pattern before, during treatment
•
Respiratory status: rate, character, wheezing, dyspnea; risk for respiratory infection
•
Allergies before treatment, reaction to each medication
•
CBC, LFTs, serum amylase, creatinine/BUN, sodium; increases in LFTs can persist for 4 wk after discontinuation of treatment
•
Resolution/prevention of malaria
•
To take with food to increase plasma concentrations
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
atracurium (Rx)
(a-tra-kyoor′ee-um)
Func. class.:
Neuromuscular blocker (nondepolarizing)
Facilitation of endotracheal intubation, skeletal muscle relaxation during mechanical ventilation, surgery, or general anesthesia
Hypersensitivity
Black Box Warning:
Respiratory insufficiency
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• Adult and child >2 yr: IV BOL
0.4-0.5 mg/kg then 0.08-0.1 mg/kg 20-45 min after 1st dose if needed for prolonged
procedures; give smaller doses with halothane
• Child 1 mo-2 yr: IV BOL
0.3-0.4 mg/kg
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTatropine (Rx)
(a′troe-peen)
Atreza, AtroPen, Sal-Tropine
Func. class.:
Antidysrhythmic, anticholinergic parasympatholytic, antimuscarinic
Chem. class.:
Belladonna alkaloid
Do not confuse:
atropine
/Akarpine
Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by blocking vagal stimulation in heart; dries secretions by blocking vagus
Bradycardia <40-50 bpm, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU, biliary surgery, bronchodilator, AV heart block
Unlabeled uses:
Cardiac arrest, CPR, diarrhea, pulseless electrical activity, ventricular asystole, asthma
Hypersensitivity to belladonna alkaloids, closed-angle glaucoma, GI obstructions, myasthenia gravis, thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia/tachydysrhythmias, asthma, acute hemorrhage, severe hepatic disease, myocardial ischemia, paralytic ileus
Precautions:
Pregnancy (C), breastfeeding, children <6 yr, geriatric patients, renal disease, CHF, hyperthyroidism, COPD, hypertension, intraabdominal infection, Down syndrome, spastic paralysis, gastric ulcer
Calculator
• Adult: IV BOL
0.5-1 mg given q3-5min, max 3 mg
• Child: IV BOL
0.01 mg/kg up to 0.4 mg or 0.3 mg/m
2
; may repeat q4-6hr; min dose 0.1 mg to avoid paradoxical reaction, max single dose 0.5 mg
• Adult and child: IM/IV
1-2 mg hourly until muscarinic symptoms disappear; may need 6 mg every hr
• Adult and child >90 lb, usually >10 yr: AtroPen
2 mg
• Child 40-90 lb, usually 4-10 yr: AtroPen
1 mg
• Child 15-40 lb: AtroPen
0.5 mg
• Infant <15 lb: IM/IV
0.05 mg/kg q5-20min as needed
• Adult and child >20 kg: SUBCUT/IM/IV
0.4-0.6 mg 30-60 min before anesthesia
• Child <20 kg: IM/SUBCUT
0.01 mg/kg up to 0.4 mg 1/2-1 hr preop, max 0.6 mg/dose
