Mosby's 2014 Nursing Drug Reference (79 page)

BOOK: Mosby's 2014 Nursing Drug Reference
6.09Mb size Format: txt, pdf, ePub
captopril (Rx)

(kap′toe-pril)

Apo-Capto
, Capoten

Func. class.:
Antihypertensive

Chem. class.:
Angiotensin-converting enzyme (ACE) inhibitor

Do not confuse:
captopril
/Capitrol/carvedilol

ACTION:

Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II

USES:

Hypertension, CHF, left ventricular dysfunction after MI, diabetic nephropathy

Unlabeled uses:
Acute MI, hypertensive emergency/urgency, scleroderma renal crisis (SRC)

CONTRAINDICATIONS:

Breastfeeding, children, hypersensitivity, heart block, potassium-sparing diuretics, bilateral renal artery stenosis, angioedema

 

Black Box Warning:

Pregnancy (D)

Precautions:
Dialysis patients, hypovolemia, leukemia, scleroderma, SLE, blood dyscrasias, CHF, diabetes mellitus, thyroid/renal/hepatic disease, COPD, asthma

DOSAGE AND ROUTES
Calculator
Hypertension

• Adult:
PO
initial dose: 12.5-25 mg bid-tid; may increase to 50 mg bid-tid at 1-2 wk intervals; usual range: 25-150 mg bid-tid; max 450 mg/day

• Child:
PO
0.3-0.5 mg/kg/dose, titrate up to 6 mg/kg/day in 2-4 divided doses

• Neonate:
PO
0.01-0.1 mg/kg/dose, may increase as needed

CHF

• Adult:
PO
25 mg bid; may increase to 50 mg tid; after 14 days, may increase to 150 mg tid if needed

Diabetic nephropathy

• Adult:
PO
25 mg tid

Renal dose

• Adult:
PO
CCr >50 ml/min, no change; CCr 10-50 ml/min, decrease dose by 25%; CCr <10 ml/min, decrease dose by 50%

Acute MI (unlabeled) or Post-MI

• Adult:
PO
6.25-12.5 mg tid, increase to 25 mg tid gradually

Hypertensive emergency/urgency (unlabeled)

• Adult:
PO
25 mg, may repeat q30min

Available forms:
Tabs 12.5, 25, 50, 100 mg

Administer:

• 
1 hr before or 2 hr after meals

• 
Oral sol:
may crush tab, dissolve in water; give within 1/2 hr; make sure tab completely dissolved

SIDE EFFECTS

CNS:
Fever, chills

CV:
Hypotension
, postural hypotension,
tachycardia
, angina

GI:
Loss of taste, increased LFTs

GU:
Impotence, dysuria, nocturia, proteinuria,
nephrotic syndrome, acute reversible renal failure,
polyuria, oliguria, urinary frequency

HEMA:
Neutropenia, agranulocytosis, pancytopenia, thrombocytopenia,
anemia

INTEG:
Rash, pruritus

MISC:
Angioedema,
hyperkalemia

RESP:
Bronchospasm,
dyspnea, cough

PHARMACOKINETICS

Peak 1 hr; duration 2-6 hr; half-life <2 hr, increased in renal disease; metabolized by liver (metabolites); excreted in urine; crosses placenta; excreted in breast milk, small amounts; protein binding 25%-30%

INTERACTIONS

• 
Do not use with potassium-sparing diuretics, sympathomimetics, potassium supplements

Increase:
possible toxicity—lithium, digoxin

Increase:
hypoglycemia—insulin, oral antidiabetics

Increase:
hypotension—diuretics, other antihypertensives, phenothiazines, nitrates, acute alcohol ingestion

Decrease:
captopril effect—antacids, NSAIDs, salicylates

Drug/Herb

Increase:
antihypertensive effect—hawthorn

Decrease:
antihypertensive effect—ephedra

Drug/Food

Decrease:
absorption of captopril

Drug/Lab Test

Increase:
AST, ALT, alk phos, bilirubin, uric acid, potassium

Decrease:
platelets, WBC, RBC, Hgb/HcT

False positive:
urine acetone, ANA titer

NURSING CONSIDERATIONS
Assess:

• 
Blood dyscrasias:
blood studies: decreased platelets; WBC with differential at baseline and periodically q3mo; if neutrophils <1000/mm
3
, discontinue treatment (recommended with collagen-vascular or renal disease)

• 
Hypertension:
B/P, pulse rates at baseline, frequently

• 
Renal studies: protein, BUN, creatinine; watch for raised levels, may indicate nephrotic syndrome; increased LFTs, uric acid; glucose may be increased

• 
Allergic reaction:
rash, fever, pruritus, urticaria; discontinue product if antihistamines fail to help

• 
CHF:
edema, dyspnea, wet crackles, increased B/P, weight gain

Perform/provide:

• 
Storage in tight container at 86° F (30° C) or less

Evaluate:

• 
Therapeutic response: decrease in B/P with hypertension; edema, moist crackles (CHF)

Teach patient/family:

• 
To take 1 hr before or 2 hr after meals; not to discontinue product abruptly; if dose is missed, take as soon as remembered but not if almost time for next dose; not to double doses

• 
Not to use OTC products (cough, cold, or allergy) unless directed by prescriber; avoid salt substitutes, high-potassium or high-sodium foods

• 
To adhere to dosage schedule, even if feeling better

• 
To rise slowly to sitting or standing position to minimize orthostatic hypotension

• 
To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, signs of angioedema

• 
That excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P; to consult prescriber if these occur

• 
That dizziness, fainting, light-headedness may occur during first few days of therapy

• 
That skin rash or impaired perspiration may occur

• 
How to take B/P and when to notify prescriber

 

Black Box Warning:

To report if pregnancy is suspected or planned, pregnancy (D)

TREATMENT OF OVERDOSE:

0.9% NaCl IV/INF; hemodialysis

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

carbachol ophthalmic

 

carBAMazepine (Rx)

(kar-ba-maz′e-peen)

Carbatrol, Epitol, Equetro, Tegretol, Tegretol-XR

Func. class.:
Anticonvulsant

Chem. class.:
Iminostilbene derivative

Do not confuse:
TEGretol
/Toradol

ACTION:

Exact mechanism unknown; appears to decrease polysynaptic responses and block posttetanic potentiation

USES:

Tonic-clonic, complex-partial, mixed seizures; trigeminal neuralgia; bipolar disorder

Unlabeled uses:
Neurogenic pain, psychotic behavior with dementia, diabetic neuropathy, agitation, hiccups

CONTRAINDICATIONS:

Pregnancy (D), hypersensitivity to carBAMazepine or tricyclics, AV or bundle branch block

 

Black Box Warning:

Bone marrow depression

Precautions:
Breastfeeding, children <6 yr, glaucoma, cardiac/renal/hepatic disease, psychosis, alcoholism, hepatic porphyria

 

Black Box Warning:

Hematologic disease, Asian patients, agranulocytosis, leukopenia, neutropenia, thrombocytopenia

DOSAGE AND ROUTES
Calculator
Seizures

• Adult and child >12 yr:
PO
200 mg bid, may be increased by 200 mg/day in weekly intervals, give in divided doses q6-8hr; maintenance 800-1200 mg/day, max 1600 mg/day (adult); max child 12-15 yr 1000 mg/day; max child >15 yr 1200 mg/day; adjust to minimum dose to control seizures;
EXT REL
give bid; rectal administration of
ORAL SUSP
200 mg/10 ml or 6 mg/kg as a single dose

• Child 6-12 yr:
PO
tabs 100 mg bid or susp 50 mg qid; may increase by <100 mg q wk; max 1000 mg/day
EXT REL
tabs daily-bid

• Child <6 yr:
PO
10-20 mg/kg/day in 2-3 divided doses, may increase every wk

Trigeminal neuralgia

• Adult:
PO
100 mg bid with meals; may increase 100 mg q12hr until pain subsides, max 1200 mg/day; maintenance 200-400 mg bid

Diabetic neuropathy (unlabeled)

• Adult:
PO
100 mg bid or 50 mg qid, titrate to 600-800 mg/day

Bipolar disorder

• Adult:
PO
(Equetro only) 200 mg bid, may adjust dose by 200 mg/day to desired response, max 1600 mg/day

Agitation due to dementia (unlabeled)

• Adult:
PO
100 mg bid, may increase to 250-300 mg/day

Hiccups (unlabeled)

• Adult:
PO
200 mg tid

Available forms:
Chewable tabs 100, 200 mg; tabs 200 mg; ext rel tabs (XR) 100, 200, 400 mg; oral susp 100 mg/5 ml; ext rel caps 100, 200, 300 mg

Administer:
PO route

• 
Do not crush, chew ext rel tab; ext rel cap may be opened and beads sprinkled over food; patient should chew chewable tab, not swallow it whole

• 
With food, milk to decrease GI symptoms; shake oral susp before use

• 
Mix an equal amount of water, D
5
W, 0.9% NaCl when giving by NG tube; flush tube with 100 ml of above sol

SIDE EFFECTS

CNS:
Drowsiness
, dizziness, unsteadiness, confusion, fatigue,
paralysis,
headache, hallucinations,
worsening of seizures,
speech disturbance,
suicidal thoughts/behaviors

CV:
Hypertension, CHF, dysrhythmias, AV block,
hypotension, aggravation of cardiac artery disease

EENT:
Tinnitus, dry mouth, blurred vision, diplopia, nystagmus, conjunctivitis

ENDO:
SIADH (geriatric patients)

GI:
Nausea, constipation, diarrhea
, anorexia, vomiting, abdominal pain, stomatitis, glossitis, increased hepatic enzymes,
hepatitis, hepatic porphyria

GU:
Frequency, retention, albuminuria, glycosuria, impotence, increased BUN,
renal failure

HEMA:
Thrombocytopenia, leukopenia, agranulocytosis, leukocytosis, aplastic anemia, eosinophilia,
increased PT

INTEG:
Rash
,
Stevens-Johnson syndrome,
urticaria, photosensitivity,
toxic epidermal necrolysis

RESP:
Pulmonary hypersensitivity (fever, dyspnea, pneumonitis)

PHARMACOKINETICS

Onset slow; peak 4-5 hr; metabolized by liver; excreted in urine, feces; crosses placenta, blood-brain barrier; excreted in breast milk; half-life 18-65 hr then 8-29 hr after 1st month; protein binding 76%; metabolized by CYP3A4

INTERACTIONS

• 
CNS toxicity: lithium

 
Fatal reaction: MAOIs

Increase:
carBAMazepine levels—CYP3A inhibitors (cimetidine, clarithromycin, danazol, diltiazem, erythromycin, FLUoxetine, fluvoxamine, isoniazid, propoxyphene, valproic acid, verapamil, voriconazole)

Increase:
effects of desmopressin, lithium, lypressin, vasopressin

Decrease:
carBAMazepine effect—CYP1A2, CYP2C9 substrates

Decrease:
effect of CYP3A inducers

Decrease:
effects of benzodiazepines, doxycycline, felbamate, haloperidol, oral contraceptives, PHENobarbital, phenytoin, primidone, theophylline, thyroid hormones, warfarin

Decrease:
carBAMazepine levels—CYP3A4 inducers (CISplatin, darunavir, delavirdine, DOXOrubicin, felbamate, nefazodone, OXcarbazepine, PHENobarbital, phenytoin, primidone, rifampin, theophylline)

Drug/Herb

Decrease:
carBAMazepine metabolism, increased levels—echinacea

Decrease:
anticonvulsant effect—St. John’s wort

Drug/Food

Increase:
peak concentration of carBAMazepine—grapefruit juice

NURSING CONSIDERATIONS
Assess:

 

Black Box Warning:

Asian patients for serious skin reaction; genetic test before administration

• 
Seizures:
character, location, duration, intensity, frequency, presence of aura

• 
Trigeminal neuralgia:
facial pain including location, duration, intensity, character, activity that stimulates pain

• 
Renal studies: urinalysis, BUN, urine creatinine q3mo

 

Black Box Warning:

Bone marrow depression:
blood studies: RBC, Hct, Hgb, reticulocyte counts every wk for 4 wk then q3-6mo if on long-term therapy; if myelosuppression occurs, product should be discontinued; blood dyscrasias: fever, sore throat, bruising, rash, jaundice

• 
Hepatic studies: ALT, AST, bilirubin

• 
Product levels during initial treatment or when changing dose; should remain at 4-12 mcg/ml; anorexia may indicate increased blood levels

 
Mental status: mood, sensorium, affect, behavioral changes,
suicidal thoughts/behaviors;
if mental status changes, notify prescriber

• 
Eye problems: need for ophthalmic examinations before, during, after treatment (slit lamp, funduscopy, tonometry)

• 
Allergic reaction: purpura, red, raised rash; if these occur, product should be discontinued

 
Toxicity: bone marrow depression, nausea, vomiting, ataxia, diplopia, CV collapse, Stevens-Johnson syndrome

Perform/provide:

• 
Storage at room temp

• 
Hard candy, gum, frequent rinsing for dry mouth

Evaluate:

• 
Therapeutic response: decreased seizure activity; document on patient’s chart

Teach patient/family:

• 
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 usually for the first 3 days of treatment

• 
Not to discontinue medication quickly after long-term use

• 
To immediately report chills, rash, light-colored stools, dark urine, yellowing of skin and eyes, abdominal pain, sore throat, mouth ulcers, bruising, blurred vision, dizziness

• 
That urine may turn pink to brown

• 
To notify if pregnancy is planned or suspected, pregnancy (D), avoid breastfeeding

TREATMENT OF OVERDOSE:

Lavage, VS

Other books

The Terra-Cotta Dog by Andrea Camilleri
TRAPPED by ROSE, JACQUI
The Shadowboxer by Behn, Noel;
So Many Ways to Begin by Jon McGregor
A Perfect Likeness by Roger Gumbrell
The Fuller Memorandum by Stross, Charles
Dark Alpha's Embrace by Donna Grant