f-i drug handbook

8/12/2019 F-I Drug Handbook

1/55

fentanyl(fen' ta nil)Actiq; Duragesic 25, 50, 75, 100;Sublimaze

Pregnancy Category CControlled Substance C-II

Drug classOpioid agonist analgesic

Theraeutic acti!nsActs at specific opioid receptors, causinganalgesia, respiratory depression, physicaldepression, euphoria.

"n#icati!ns

Analgesic action of short duration

during anesthesia and immediatepostoperative period

Analgesic supplement in general or

regional anesthesia

Administration with a neuroleptic as

an anesthetic premedication, forinduction of anesthesia, and as anadjunct in maintenance of general

and regional anesthesia For use as an anesthetic agent with

oxygen in selected high-ris patients

!ransdermal system" #anagement

of chronic pain in patients re$uiringopioid analgesia over an extendedperiod of time who cannot %emanaged %y other means and whoare already receiving opioid therapy

Actiq" !reatment of %reathrough

pain in cancer patients %eing treated

with and tolerant to opioids

$!ntrain#icati!ns an# cauti!ns

&ontraindicated with hypersensitivity

to opioids, diarrhea caused %ypoisoning, acute %ronchial asthma,upper airway o%struction, pregnancy.

'se cautiously with %radycardia,

history of seiures, lactation, renaldysfunction history of drugaddiction.

A%ailable f!rms*oenge on a stic (Actiq)+, , /,0, 1,, 1,/ mcg transdermal+1.2,2, 2, 32, 1 mcg4hr injection+2mcg4m*

Dosages5ndividualie dosage monitor vital signs.AD&TS6arenteral

Premedication:271 mcg 5# 87

/ min %efore surgery. Adjunct to general anesthesia:!otal

dosage is mcg4g. #aintenancedose, 7 mcg 59 or 5# whenchanges in vital signs indicatesurgical stress or lightening ofanalgesia.

With oxygen for anesthesia:!otal

high dose is 72 mcg4g 59.

Adjunct to regional anesthesia:27

1 mcg 5# or slowly 59 over 17

min. Postoperatively:271 mcg 5# for

the control of pain, tachypnea, oremergence delirium repeat in 17 hrif needed.

!ransdermal5nitiate therapy with 2 mcg4hr system adjustdose as needed and tolerated. Apply tononirritated and nonirradiated sin on a flatsurface of the upper torso may re$uirereplacement in 3 hr if pain has not

su%sided do not use torn or damagedsystems, serious overdose can occur.*oenges6laceActiqunit in mouth %etween chee andlower gum. :tart with initial dose of mcg.'ntil appropriate dose is reached, anadditional dose can %e used to treat anepisode of %reathrough pain. ;edosing may

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start 12 min after the previous loenge has%een completed.


3/55

=o not administer an #AO5 within 1

days of fentanyl (increased &


4/55

;eport severe nausea, vomiting,

palpitations, shortness of %reath, ordifficulty %reathing.

Adverse effects in Italicare most common

those in 8!l# are life-threatening.

fe!fena#ine hy#r!chl!ri#e(fecs oh fen'a deen)Allegra

Pregnancy Category C

Drug classAntihistamine (nonsedating type)

Theraeutic acti!ns&ompetitively %locs the effects of histamineat peripheral B1-receptor sites has noanticholinergic (atropine-lie) or sedatingeffects.

"n#icati!ns

:ymptomatic relief of symptoms

associated with seasonal allergicrhinitis in adults and children E / yr

&hronic idiopathic urticaria in adults

and children E / yr


&ontraindicated with allergy to any

antihistamines, pregnancy, lactation.

'se cautiously with hepatic or renal

impairment, in geriatric patients.

A%ailable f!rms!a%lets+8, /, 10 mg capsules+/ mg

DosagesAD&TS A+D (AT")+TS 9 12 -*

Allergic rhinitis:/ mg 6O %id or

10 mg once4day.

$hronic idiopathic urticaria:/ mg

6O %id.()D"AT*"$ (AT")+TS :11 -*

Allergic rhinitis and chroninc

idiopathic urticaria:8 mg 6O %id.3)*"AT*"$ (AT")+TS 4* (AT")+TS"T6 *)+A "/(A"*/)+TFor geriatric patients or adults with renal

impairment, use / mg 6O daily. For children/711 yr with renal impairment, use 8 mg 6Odaily.

(harmac!.inetics

;oute Onset 6ea

Oral ;apid ./ hr

/etab!lism Bepatic !14" 1. hrDistributi!n &rosses placenta may enter%reast mil

)creti!n Feces, urine

A#%erse effects

$+S Fatigue, drowsiness

3"


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dryness %ecome %othersomeencourage ade$uate intae of fluids.

6rovide supportive care if flulie

symptoms occur.

!eaching "oints Avoid excessive dosage tae only

the dosage prescri%ed.

=o not tae at the same time as

antacids.

Dou may experience these side

effects" =iiness, sedation,drowsiness (use caution if driving orperforming tass that re$uirealertness) thicening of %ronchialsecretions, dryness of nasal mucosa

(use of a humidifier may help)menstrual irregularities fluliesymptoms (medication may %ehelpful).

;eport difficulty %reathing, severe

nausea, fever.

Adverse effects in Italicare most commonthose in 8!l# are life-threatening.

finasteri#e

(fin as'teh ride)(r!ecia, (r!scar

Pregnancy Category #

Drug classAndrogen hormone inhi%itor

Theraeutic acti!ns5nhi%its the intracellular enyme that convertstestosterone into a potent androgen (=B!)

does not affect androgen receptors in the%ody the prostate gland depends on =B! forits development and maintenance.

"n#icati!ns

Proscar: !reatment of symptomatic

@6B most effective with long-termuse reduces the need for prostate

surgery and reduces the ris ofurinary retention with doxaosin, toreduce the ris of progression of@6B symptoms

Propecia:6revention of male pattern

%aldness in patients with familyhistory or early signs of loss

'nla%eled uses" Adjuvant

monotherapy following radicalprostatectomy prevention of theprogression of first-stage prostatecancer hirsutism male chronicpelvic pain syndrome


&ontraindicated with allergy to

finasteride or any component of theproduct, pregnancy, lactation.

'se cautiously with hepatic

impairment.

A%ailable f!rms!a%lets+1 mg (Propecia), 2 mg (Proscar)

DosagesAD&TS

%P&:2 mg daily 6O with or without

meals may tae /71 mo forresponse.

'ale pattern (aldness:1 mg4day

6O.()D"AT*"$ (AT")+TS:afety and efficacy not esta%lished.3)*"AT*"$ (AT")+TS 4* (AT")+TS"T6 *)+A "+S&"$")+$-


6/55

3" A%dominal upset

3& Impotence, decreased li(ido,

decreased volume of ejaculation

4ther >ynecomastia

"nteracti!nsDrug-lab test

=ecreased 6:A levels when

measured false decrease does notmean patient is free of ris ofprostate cancer

Nursing considerationsAssessment

6ist!ry Allergy to finasteride or any

component, hepatic impairment,

pregnancy, lactation (hysical *iver evaluation,

a%dominal examination renalfunction tests, normal urine output,prostate examination

Interentions

&onfirm that pro%lem is @6B, and

other disorders (prostate cancer,infection, strictures, hypotonic%ladder) have %een ruled out.

Administer without regard to meals

protect container from light.

Arrange for regular follow-up,

including prostate examination, 6:Alevels, and evaluation of urine flow.

#onitor urine flow and output

increase in urine flow may not occurin all situations.

A*+"+3 =o not allow pregnant

women to handle crushed or %roen

ta%lets %ecause of ris of inadvertenta%sorption, adversely affecting thefetus.

Alert patient that li%ido may %e

decreased as well as the volume ofejaculate usually reversi%le whenthe drug is stopped.

!eaching "oints

!ae this drug once a day without

regard to meals protect from light.

Bave regular medical follow-up to

evaluate your response. Dour health

care provider will monitor your liverand idney function as well asprostate-specific antigen (6:A)levels.

!his drug has serious adverse

effects on un%orn %a%ies. =o notallow a pregnant woman to handlethe ta%let if it is crushed or %roen.


effects" *oss of li%ido, impotence,decreased amount of ejaculate

(usually reversi%le when the drug isstopped) %reast enlargement,tenderness.

;eport ina%ility to void, groin pain,

sore throat, fever, weaness.

Adverse effects in Italic are most commonthose in 8!l# are life-threatening.

fluc!naz!le(floo .!n'a ole)

Diflucan


Drug classAntifungal

Theraeutic acti!ns@inds to sterols in the fungal cell mem%rane,changing mem%rane permea%ility fungicidalor fungistatic depending on concentration

and organism.

"n#icati!ns

!reatment of oropharyngeal,

esophageal, vaginal, and systemiccandidiasis

!reatment of cryptococcal meningitis

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6rophylaxis of candidiasis in %one

marrow transplants



to fluconaole, lactation. 'se cautiously with renal or hepatic

impairment.

A%ailable f!rms!a%lets+2, 1, 12, mg powder fororal suspension+1, mg4m* injection+ mg4m*

Dosages5ndividualie dosage same for oral or 59

routes %ecause of rapid and almost completea%sorption.AD&TS

)ropharyngeal candidiasis: mg

6O or 59 on the first day, followed %y1 mg daily. &ontinue treatment forat least w to decrease lielihoodof relapse.

*sophageal candidiasis: mg 6O

or 59 on the first day, followed %y1 mg daily. =osage up to

mg4day may %e used in severecases. !reat for a minimum of 8 wat least w after resolution.

Systemic candidiasis: mg 6O or

59 on the first day, followed %y mg daily. !reat for a minimum of w at least w after resolution.

Vaginal candidiasis:12 mg 6O as a

single dose.

$ryptococcal meningitis: mg 6O

or 59 on the first day, followed %y mg daily. mg daily may %eneeded. &ontinue treatment for 171 w after cultures of &:F %ecomenegative.

Suppression of cryptococcal

meningitis in AI+S patients: mgdaily 6O or 59.

Prevention of candidiasis in (one

marro transplants: mg 6O dailyfor several days %efore and 3 daysafter neutropenia.

()D"AT*"$ (AT")+TS

)ropharyngeal candidiasis:/ mg4g6O or 59 on the first day, followed %y8 mg4g once daily for at least w.

*sophageal candidiasis:/ mg4g 6O

or 59 on the first day, followed %y8 mg4g once daily. !reat for aminimum of 8 w at least w afterresolution.

Systemic &andida infections:=aily

doses of /71 mg4g4day 6O or 59.

$ryptococcal meningitis:1 mg4g

6O or 59 on the first day, followed %y/ mg4g once daily. &ontinuetreatment for 171 w after culturesof &:F %ecome negative.

Suppression of cryptococcal

meningitis in children ith AI+S:/ mg4g daily 6O or 59.

(AT")+TS "T6 *)+A "/(A"*/)+T5nitial dose of 27 mg 6O or 59. 5fcreatinine clearance E 2 m*4min, use 1recommended dose for creatinine clearance172 m*4min, use 2 of therecommended dose for creatinine clearance117 m*4min, use 2 of recommendeddose for patients on hemodialysis, use onedose after each dialysis.

(harmac!.inetics

;oute Onset 6ea =uration

Oral :low 17 hr 7 days

59 ;apid 1 hr 7 days

/etab!lism Bepatic !14" 8 hrDistributi!n &rosses placenta may enter%reast mil)creti!n'rine

IV facts(rearati!n=o not remove overwrap untilready for use. 5nner %ag maintains sterility of

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product. =o not use plastic containers inseries connections. !ear overwrap down sideat slit, and remove solution container. :omeopacity of plastic may occur chec forminute leas, s$ueeing %ag firmly. =iscard

solution if any leas are found."nfusi!n5nfuse at a maximum rate of mg4hr given as a continuous infusion."nc!matibilities=o not add anysupplementary medications.

A#%erse effects

$+S &eadache

3" #ausea, vomiting, diarrhea,

a(dominal painA:!4A*! elevations

4ther;ash

"nteracti!nsDrug-drug

5ncreased serum levels and

therefore therapeutic and toxiceffects of cyclosporine, phenytoin,%enodiaepines, oralhypoglycemics, warfarinanticoagulants, idovudine

=ecreased serum levels with

rifampin, theophylline, tacrolimus


6ist!ry Bypersensitivity to

fluconaole, renal impairment,lactation, pregnancy

(hysical :in color, lesions !

injection site orientation, reflexes,affect %owel sounds *F!s, renalfunction tests &@& and differentialculture of area involved

Interentions

&ulture infection %efore therapy

%egin treatment %efore la% resultsare returned.

=ecrease dosage in cases of renal

failure.

5nfuse 59 only not intended for 5# or

su%cutaneous use.

=o not add supplement medication

to fluconaole.

Administer through sterile e$uipment

at a maximum rate of mg4hrgiven as a continuous infusion.

A*+"+3#onitor renal function

tests weely, discontinue ordecrease dosage of drug at any signof increased renal toxicity. #onitor*F!s monthly during therapy.

!eaching "oints

=rug may %e given orally or 59 as

needed. !he drug will need to %e

taen for the full course and mayneed to %e taen long term.

'se hygiene measures to prevent

reinfection or spread of infection.

Arrange for fre$uent follow-up while

you are taing this drug. @e sure toeep all appointments, includingthose for %lood tests.


effects"


9/55

Theraeutic acti!ns;e$uired for nucleoprotein synthesis andmaintenence of normal erythropoiesis.

"n#icati!ns !reatment of mego%lastic anemias

due to sprue, nutritional deficiency,pregnancy, infancy, and childhood


&ontraindicated with allergy to folic

acid preparations pernicious,aplastic, normocytic anemias.

'se cautiously during lactation.

A%ailable f!rms!a%lets+., .0, 1 mg injection+2 mg4m*

DosagesAdminister orally unless patient has severeintestinal mala%sorption.AD&TS

-herapeutic dose:'p to 1 mg4day

6O, 5#, 59, or su%cutaneously.*arger doses may %e needed insevere cases.

'aintenance dose:. mg4day. Pregnancy and lactation:.0 mg4day.

()D"AT*"$ (AT")+TS

'aintenance dose:

Infants:.1 mg4day.. / yr:'p to .8 mg4day.0 / yr:. mg4day.

(harmac!.inetics

;oute Onset 6ea

Oral, 5#, :&, or59

9aries 87/ min

/etab!lism Bepatic !14" 'nnownDistributi!n &rosses placenta enters%reast mil)creti!n'rine

IV facts(rearati!n:olution is yellow to yellow-orange may %e added to hyperalimentationsolution or dextrose solutions."nfusi!n5nfuse at rate of 2 mg4min %y direct

59 injection may %e diluted inhyperalimentation for continuous infusion.

A#%erse effects

6yersensiti%ityAllergic reactions

!cal Pain and discomfort at

injection site


=ecrease in serum phenytoin and

increase in seiure activity with folicacid preparations

=ecreased a%sorption with

sulfasalaine, aminosalicyclic acid

Nursing considerations$"+"$A A)*TName confusion has been re"ortedbetween folinic acid $leucoorin% and folicacid; use extreme caution.

Assessment 6ist!ry Allergy to folic acid

preparations pernicious, aplastic,normocytic anemias lactation

(hysical :in lesions, color ;,

adventitious sounds &@&, Bg%, Bct,serum folate levels, serum vitamin@1levels, :chilling test

Interentions

Administer orally if at all possi%le.

?ith severe >5 mala%sorption orvery severe disease, give 5#, 59, orsu%cutaneously.

!est using :chilling test and serum

vitamin @1levels to rule outpernicious anemia. !herapy maymas signs of pernicious anemia

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while the neurologic deteriorationcontinues.

A*+"+3'se caution when giving

the parenteral preparations topremature infants. !hese

preparations contain %enyl alcoholand may produce a fatal gaspingsyndrome in premature infants.

A*+"+3#onitor patient for

hypersensitivity reactions, especiallyif drug previously taen. Ceepsupportive e$uipment andemergency drugs readily availa%le incase of serious allergic response.

!eaching "oints

?hen the cause of megalo%lasticanemia is treated or passes (infancy,pregnancy), there may %e no needfor folic acid %ecause it normallyexists in sufficient $uantities in thediet.

;eport rash, difficulty %reathing, pain

or discomfort at injection site.


f!rm!ter!l fumarate(for m!h'te rol)!ra#il Aer!lizer


Drug classes@etaagonistAntasthmatic

Theraeutic acti!ns*ong-acting agonist that %inds to %etareceptors in the lungs causing%ronchodilation may also inhi%it the releaseof inflammatory mediators in the lung,%locing swelling and inflammation.

"n#icati!ns

*ong-term maintenance treatment of

asthma in adults and children E 2 yr

6revention of exercise-induced

%ronchospasm in adults and childrenE 1 yr when used on an occasional,

as-needed %asis *ong-term maintenance treatment of

%ronchoconstriction in patients with&O6=



to adrenergics, amines, or toformoterol, acute asthma attac,acute airway o%struction.

'se cautiously in the elderly, with

pregnancy, lactation.

A%ailable f!rms5nhalation powder in capsules+1 mcg

DosagesAD&TS

'aintenance treatment of $)P+:

Oral inhalation of contents of 1capsule (1 mcg) usingAeroli!erInhaler $ 1 hr. =o not exceed a totaldaily dose of mcg.

AD&TS A+D ()D"AT*"$ (AT")+TS 9 12-*

Prevention of exercise"induced

(ronchospasm:Oral inhalation ofcontents of one capsule (1 mcg)using theAeroli!er Inhaler12 min%efore exercise. 'se on anoccasional, as-needed %asis.

AD&TS A+D ()D"AT*"$ (AT")+TS 9 5-*

'aintenance treatment of asthma:

Oral inhalation of contents of 1capsule (1 mcg) using theAeroli!erInhalerevery 1 hr. =o not exceed 1capsule every 1 hr.

(harmac!.inetics

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5nhalation 178 min 178 hr 07 hr

/etab!lism Bepatic !14" 171 hrDistributi!n &rosses placenta may enter

%reast mil)creti!nFeces, urine

A#%erse effects

$+S !remor, diiness, insomnia,

dysphonia, headache, nervousness

$Bypertension, tachycardia, chest

pain

3"


12/55

;eport severe headache, irregular

heart%eat, worsening of asthma,difficulty %reathing.



f!sin!ril s!#ium(foh sin'oh pril)/!n!rilPregnancy Category C $first trimester%Pregnancy Category D $second and thirdtrimesters%

Drug classesAntihypertensive

A& inhi%itor

Theraeutic acti!ns;enin, synthesied %y the idneys, isreleased into the circulation where it acts ona plasma precursor to produce angiotensin 5,which is converted %y A& to angiotensin 55,a potent vasoconstrictor that also causesrelease of aldosterone from the adrenalsfosinopril %locs the conversion ofangiotensin 5 to angiotensin 55, leading to

decreased @6, decreased aldosteronesecretion, an increase in serum potassiumlevels, and sodium and fluid loss increasedprostaglandin synthesis may %e involved inthe antihypertensive action.

"n#icati!ns

!reatment of hypertension, alone or

in com%ination with thiaide-typediuretics

#anagement of &BF as adjunctive

therapy



fosinopril or other A& inhi%itorspregnancy.

'se cautiously with impaired renal

function, hyperalemia, salt orvolume depletion, lactation.

A%ailable f!rms

!a%lets+1, , mg

DosagesAD&TS5nitial dose, 1 mg 6O daily. #aintenancedose, 7 mg4day 6O as a single dose ortwo divided doses. 5n patients receivingdiuretic therapy, %egin fosinopril therapy with1 mg. =o not exceed maximum dose of0 mg.()D"AT*"$ (AT")+TS

:afety and efficacy not esta%lished.

(harmac!.inetics


Oral 1 hr 8 hr hr

/etab!lism Bepatic !14" 1 hrDistributi!n &rosses placenta enters%reast mil)creti!n Feces, urine

A#%erse effects $Angina pectoris, orthostatic

hypotension in salt- or volume-depleted patients, palpitations

Dermat!l!gic ;ash, pruritus,

diaphoresis, flushing

3" #ausea,a%dominal pain,

vomiting, diarrhea

*esirat!ry $ough,asthma,

%ronchitis, dyspnea, sinusitis

4ther Angioedema, asthenia,

myalgia, arthralgia, hyperalemia


=ecreased effectiveness if com%ined

with indomethacin or other


13/55

;is of lithium toxicity if com%ined

with A& inhi%itors

;is of increased potassium levels if

taen with potassium-sparingdiuretics

=ecreased a%sorption when givenwith antacids separate %y at least hr.

Nursing considerations$"+"$A A)*TName confusion has occurred betweenfosino"ril and lisino"ril; use caution.

Assessment

6ist!ry Allergy to fosinopril and

other A& inhi%itors, impaired renalor hepatic function, hyperalemia,salt or volume depletion, lactation,pregnancy

(hysical :in color, lesions, turgor

! 6, @6, peripheral perfusionmucous mem%ranes, %owel sounds,liver evaluation urinalysis, *F!s,renal function tests, &@&, anddifferential

Interentions A*+"+3Alert surgeon and mar

patientHs chart with notice thatfosinopril is %eing taen theangiotensin 55 formation su%se$uentto compensatory renin releaseduring surgery will %e %locedhypotension may %e reversed withvolume expansion.

Arrange to switch to a different drug

if pregnancy occurs suggest using%arrier contraceptives.

#onitor patient closely for a fall in @6

secondary to reduction in fluidvolume (excessive perspiration anddehydration, vomiting, diarrhea)%ecause excessive hypotension mayoccur.

!eaching "oints

=o not stop taing the medication

without consulting your prescri%er.

Avoid pregnancy while taing this

drug using %arrier contraceptives isadvised.

@e careful in any situation that may

lead to a drop in %lood pressure(diarrhea, sweating, vomiting,dehydration) if light-headedness ordiiness occurs, consult your careprovider.


effects" >5 upset, loss of appetite(these may %e transient) light-

headedness (transient changeposition slowly and limit activities tothose that do not re$uire alertnessand precision) dry cough (notharmful).

;eport mouth sores sore throat,

fever, chills swelling of the hands,feet irregular heart%eat, chest painsswelling of the face, eyes, lips,tongue, difficulty %reathing,persistent cough.


fur!semi#e(fur !h'se mide)A!>ur!semi#e


14/55

"n#icati!ns

Oral, 59" dema associated with

&BF, cirrhosis, renal disease

59" Acute pulmonary edema

Oral" Bypertension



furosemide, sulfonamides allergy totartraine (in oral solution) anuria,severe renal failure hepatic comapregnancy lactation.

'se cautiously with :*, gout,

dia%etes mellitus.

A%ailable f!rms

!a%lets+, , 0 mg oral solution+1 mg4m*, mg42 m* injection+1 mg4m*

DosagesAD&TS

*dema:5nitially, 70 mg4day 6O

as a single dose. 5f needed, asecond dose may %e given in /70 hr.5f response is unsatisfactory, dosemay %e increased in - to -mgincrements at /- to 0-hr intervals. 'pto / mg4day may %e given.5ntermittent dosage schedule (7consecutive days4w) is preferred formaintenance, or7 mg 5# or 59(slow 59 injection over 17 min). #ayincrease dose in increments of mg in hr. Bigh-dose therapyshould %e given as infusion at ratenot exceeding mg4min.

Acute pulmonary edema: mg 59

over 17 min. #ay %e increased to0 mg 59 given over 17 min ifresponse is unsatisfactory after 1 hr.

&ypertension: mg %id 6O. 5f

needed, additional antihypertensiveagents may %e added.

()D"AT*"$ (AT")+TS

Avoid use in premature infants" stimulatesprostaglandin synthesis and may increaseincidence of patent ductus arteriosus andcomplicate respiratory distress syndrome.

*dema:5nitially, mg4g4day 6O. 5f

needed, increase %y 17 mg4g in /70 hr. D! n!t ecee# : mg?.g@Adjustmaintenance dose to lowest effectivelevel.

Pulmonary edema:1 mg4g 59 or 5#.

#ay increase %y 1 mg4g in hr untilthe desired effect is seen. D! n!tecee# : mg?.g@

(AT")+TS "T6 *)+A "/(A"*/)+T'p to g4day has %een tolerated. 59 %olusinjection should not exceed 1 g4day given

over 8 min.

(harmac!.inetics


Oral / min /71min

/70 hr

59, 5# 2 min 8 min hr

/etab!lism Bepatic !14" 87/ minDistributi!n &rosses placenta enters%reast mil

)creti!n Feces, urine

IV facts(rearati!n:tore at room temperatureexposure to light may slightly discolorsolution."nfusi!n5nject directly or into tu%ing ofactively running 59 inject slowly over 17min."nc!matibilities=o not mix with acidicsolutions. 5sotonic saline, lactated ;ingerHs

injection, and 2 dextrose injection may %eused after pB has %een adjusted (ifnecessary) precipitates form withgentamicin, netilimicin, milrinone in 2dextrose, .I sodium chloride.

A#%erse effects

195


15/55

$+S +i!!iness, vertigo,

paresthesias, xanthopsia,ea2ness,headache, drowsiness,fatigue, %lurred vision, tinnitus,irreversi%le hearing loss

$)rthostatic hypotension,volumedepletion, cardiac arrhythmias,throm(ophle(itis

Dermat!l!gic Photosensitivity,

rash, pruritus, urticaria,purpura,exfoliative dermatitis, erythemamultiforme

3" #ausea, anorexia, vomiting, oral

and gastric irritation, constipation,diarrhea, acute pancreatitis, jaundice

3& 6olyuria, nocturia, glycosuria,

urinary (ladder spasm 6emat!l!gic 3eu2openia, anemia,

throm(ocytopenia,fluid andelectrolyte im%alances,hyperglycemia, hyperuricemia

4ther 'uscle cramps and muscle

spasms


5ncreased ris of cardiac arrhythmias

with digitalis glycosides (due toelectrolyte im%alance)

5ncreased ris of ototoxicity with

aminoglycoside anti%iotics, cisplatin

=ecreased a%sorption of furosemide

with phenytoin

=ecreased natriuretic and

antihypertensive effects withindomethacin, i%uprofen, other5 a%sorption withcharcoal

#ay reduce effect of insulin or oral

antidia%etic agents %ecause %loodglucose levels can %ecome elevated

Nursing considerations

$"+"$A A)*TName confusion has occurred betweenfurosemide and torsemide; use extremecaution.

Assessment 6ist!ry Allergy to furosemide,

sulfonamides, tartraine electrolytedepletion anuria, severe failurehepatic coma :* gout dia%etesmellitus lactation, pregnancy

(hysical :in color, lesions,

edema orientation, reflexes,hearing pulses, %aseline &>, @6,orthostatic @6, perfusion ;, pattern,adventitious sounds liver evaluation,

%owel sounds urinary outputpatterns &@&, serum electrolytes(including calcium), %lood sugar,*F!s, renal function tests, uric acid,urinalysis, weight

Interentions

Administer with food or mil to

prevent >5 upset.

;educe dosage if given with other

antihypertensives readjust dosage

gradually as @6 responds. >ive early in the day so that

increased urination will not distur%sleep.

Avoid 59 use if oral use is at all

possi%le.

A*+"+3=o not mix parenteral

solution with highly acidic solutionswith pB %elow 8.2.

=o not expose to light, may discolor

ta%lets or solution do not usediscolored drug or solutions.

=iscard diluted solution after hr.

;efrigerate oral solution.

#easure and record weight to

monitor fluid changes.

196


16/55

Arrange to monitor serum

electrolytes, hydration, liver andrenal function.

Arrange for potassium-rich diet or

supplemental potassium as needed.

!eaching "oints

;ecord intermittent therapy on a

calendar or dated envelopes. ?henpossi%le, tae the drug early soincreased urination will not distur%sleep. !ae with food or meals toprevent >5 upset.

?eigh yourself on a regular %asis, at

the same time and in the sameclothing, and record the weight on

your calendar. @lood glucose levels may %ecome

temporarily elevated in patients withdia%etes after starting this drug.


effects" 5ncreased volume andfre$uency of urination diiness,feeling faint on arising, drowsiness(avoid rapid position changeshaardous activities, lie driving andconsumption of alcohol) sensitivityto sunlight (use sunglasses, wearprotective clothing, or use asunscreen) increased thirst (suc onsugarless loenges use fre$uentmouth care) loss of %ody potassium(a potassium-rich diet or potassiumsupplement will %e needed).

;eport loss or gain of more than 8

pounds in 1 day, swelling in youranles or fingers, unusual %leedingor %ruising, diiness, trem%ling,num%ness, fatigue, muscleweaness or cramps.


gabaentin(ga% ah en'tin)+eur!ntin


Drug classAntiepileptic

Theraeutic acti!ns#echanism of action not understoodantiepileptic activity may %e related to itsa%ility to inhi%it polysynaptic responses and%loc posttetanic potentiation.

"n#icati!ns

Adjunctive therapy in the treatmentof partial seiures with and withoutsecondary generaliation in adultsand children 871 yr with epilepsy

Orphan drug use" !reatment of

amyotrophic lateral sclerosis

#anagement of postherpetic

neuralgia or pain in the area affected%y herpes oster after the diseasehas %een treated

'nla%eled uses"!remors of #:,

neuropathic pain, %ipolar disorder,migraine prophylaxis



to ga%apentin.

'se cautiously with pregnancy,

lactation.

A%ailable f!rms&apsules+1, 8, mg ta%lets+/,

0 mg oral solution+2 mg42 m*

DosagesAD&TS

*pilepsy::tarting dose is 8 mg

6O tid, then titrated up as needed.'aintenance:I71,0 mg4day 6Oin divided doses tid maximum

197


17/55

interval %etween doses should notexceed 1 hr. 'p to ,78,/ mg4day has %een used.

Postherpetic neuralgia:5nitial dose of

8 mg4day 6O 8 mg %id 6O on

day 8 mg tid 6O on day 8.()D"AT*"$ (AT")+TS 12 -*5nitially, 1712 mg4g4day 6O in three divideddoses adjust upward over a%out 8 days to2782 mg4g daily in three divided doses inchildren E 2 yr, and up to mg4g4day inthree divided doses in children 87 yr.3)*"AT*"$ (AT")+TS 4* (AT")+TS"T6 *)+A "/(A"*/)+T

&reatinine clearance(m*4min)

=osage (mg4day)

E / I78,/ in threedivided doses

E 872I 71, in twodivided doses

E 127I 73 in onedose

J 12 178 in onedose

6ostdialysis supplemental dosing, 12782 mg 6O following each hr of dialysis.

(harmac!.inetics;oute Onset =uration

Oral 9aries /70 hr

/etab!lismBepatic !14" 273 hrDistributi!n&rosses placenta enters%reast mil)creti!n'rine, unchanged

A#%erse effects

$+S +i!!iness, insomnia,

nervousness, fatigue, somnolence,ataxia,diplopia, tremor

Dermat!l!gic 6ruritus, a%rasion

3"=yspepsia, vomiting, nausea,

constipation, dry mouth

*esirat!ry ;hinitis, pharyngitis

4ther?eight gain, facial edema,

cancer, impotence


=ecreased serum levels withantacids

Drug-lab test

False positives may occur with

Ames #"'ultistix S4dipstic test forprotein in the urine


6ist!ryBypersensitivity to

ga%apentin lactation, pregnancy

(hysical ?eight ! sin color,lesions orientation, affect, reflexes6 ;, adventitious sounds %owelsounds, normal output

Interentions

>ive drug with food to prevent >5

upset.

Arrange for consultation with support

groups for people with epilepsy.

A*+"+35f overdose occurs,

hemodialysis may %e an option.

!eaching "oints

!ae this drug exactly as prescri%ed

do not discontinue a%ruptly orchange dosage, except on theadvice of your health care provider.

?ear a medical alert 5= at all times

so that any emergency medicalpersonnel will now that you have

epilepsy and are taing antiepilepticmedication.


effects" =iiness, %lurred vision(avoid driving or performing othertass re$uiring alertness or visualacuity) >5 upset (tae drug with foodor mil, eat fre$uent small meals)

198


18/55

headache, nervousness, insomniafatigue (periodic rest periods mayhelp).

;eport severe headache,

sleepwaling, rash, severe vomiting,

chills, fever, difficulty %reathing.


gemfibr!zil(jem fi'%roe il)A!>3emfibr!zil 3emfibr!zil3emfibr!zil


19/55

4ther6ainful extremities, %ac

pain, arthralgia, muscle cramps,myalgia, swollen joints

"nteracti!ns

Drug-drug ;is of rha%domyolysis from 8 w to

several mo after therapy whencom%ined with B#>-&oA inhi%itors(eg lovastatin, simvastatin)

;is of increased %leeding when

com%ined with anticoagulantsmonitor patient closely

;is of hypoglycemia if com%ined

with sulfonylureas and repaglinidemonitor closely


6ist!ry Allergy to gemfi%roil,

hepatic or renal dysfunction, primary%iliary cirrhosis, gall%ladder disease,pregnancy, lactation

(hysical :in lesions, color, ! gait,

range of motion orientation, affect,reflexes %owel sounds, normaloutput, liver evaluation lipid studies,&@&, *F!s, renal function tests,%lood glucose

Interentions

Administer drug with meals or mil if

>5 upset occurs.

Arrange for regular follow-up visits,

including %lood tests for lipids, liverfunction, &@&, %lood glucose duringlong-term therapy.

!eaching "oints

!ae the drug with meals or with mil

if >5 upset occurs changes in dietwill %e needed.

Bave regular follow-up visits to your

doctor for %lood tests to evaluatedrug effectiveness.


effects" =iarrhea, loss of appetite,flatulence (eat fre$uent small meals)muscular aches and pains, %one andjoint discomfort diiness, faintness,

%lurred vision (use caution if drivingor operating dangerous e$uipment).

;eport severe stomach pain with

nausea and vomiting, fever and chillsor sore throat, severe headache,vision changes.


gentamicin sulfate

(jen ta mye'sin)Parenteral( intrathecal)Alc!micin


20/55

aeruginosa, Proteusspecies,*scherichia coli, 5le(siella"*ntero(acter"Serratiaspecies,$itro(acter, Staphylococcusspecies

:erious infections when causative

organisms are not nown (often inconjunction with a penicillin orcephalosporin)

'nla%eled use"?ith clindamycin as

alternative regimen in 65=5ntrathecal

>ram-negative infections

:erious &entamicin-impregnated 6#AA %eads onsurgical wire


chronic osteomyelitis ofposttraumatic, postoperative, orhematogenous origin

>entamicin liposome injection


disseminated 'yo(acterium avium"intracellulare infection


&ontraindicated withallergy to any

aminoglycosides.

'se cautiously with renal or hepatic

disease preexisting hearing lossactive infection with herpes, vaccinia,varicella, fungal infections,

myo%acterial infections (ophthalmicpreparations) myasthenia gravisparinsonism infant %otulism %urnpatients lactation pregnancy.

A%ailable f!rms5njection+1, mg4m* ophthalmic solution+8 mg4m* ophthalmic ointment+8 mg4gtopical ointment+.1 topical cream+.1 ointment+1 mg cream+1 mg

Dosages6arenteralAD&TS8 mg4g4day in three e$ual doses $ 0 hr 5#or 59. 'p to 2 mg4g4day in three to four

e$ual doses in severe infections. For 59 use,a loading dose of 17 mg4g may %e infusedover 87/ min, followed %y a maintenancedose, usually for 371 days.

PI+: mg4g 59 followed %y

1.2 mg4g tid plus clindamycin/ mg 59 $id. &ontinue for at least days and at least 0 hr afterpatient improves, then continueclindamycin 2 mg orally $id for171 days total therapy.

Surgical prophylaxis regimens::everal complex, multidrugprophylaxis regimens are availa%lefor preoperative use consultmanufacturerHs instructions.

()D"AT*"$ (AT")+TS7.2 mg4g $ 0 hr 5# or 59.Infants and neonates:.2 mg4g $ 0 hr.Premature or full"term neonates:.2 mg4g $1 hr.3)*"AT*"$ (AT")+TS 4* (AT")+TS

"T6 *)+A A"&*);educe dosage or extend time dosageintervals, and carefully monitor serum druglevels and renal function tests.Ophthalmic solutionAD&TS A+D ()D"AT*"$ (AT")+TS17 drops into affected eye or eyes $ hruse up to drops hourly in severe infections.

201


21/55

Ophthalmic ointmentAD&TS A+D ()D"AT*"$ (AT")+TSApply small amount to affected eye %id7tid.=ermatologic preparationsAD&TS A+D ()D"AT*"$ (AT")+TS

Apply tid to $id. &over with sterile %andage ifneeded.

(harmac!.inetics

;oute Onset 6ea

5#, 59 ;apid 87I min

/etab!lismBepatic !14" 78 hrDistributi!n&rosses placenta enters%reast mil)creti!n 'rine

IV facts(rearati!n=ilute single dose in 27m* of sterile isotonic saline or =2?. =o notmix in solution with any other drugs."nfusi!n5nfuse over 871 min."nc!matibilities=o not mix in solution withany other drugs.

A#%erse effects

$+S Ototoxicity+tinnitus,

di!!iness,vertigo, deafness (partiallyreversi%le to irreversi%le), vesti%ularparalysis, confusion, disorientation,depression, lethargy, nystagmus,visual distur%ances, headache,num(ness, tingling,tremor,paresthesias, muscle twitching,seiures, muscular weaness,neuromuscular %locade

$ 6alpitations, hypotension,

hypertension

3"Bepatic toxicity, nausea,vomiting, anorexia,weight loss,stomatitis, increased salivation

3& +ehr!t!icity

6emat!l!gic 3eu2emoid reaction,

agranulocytosis, granulocytosis,leuopenia, leuocytosis,throm%ocytopenia, eosinophilia,

pancytopenia, anemia, hemolyticanemia, increased or decreasedreticulocyte count, electrolytedistur%ances

6yersensiti%ity Purpura, rash,

urticaria, exfoliative dermatitis,itching

!cal Pain, irritation, arachnoiditis

at I' injection sites

4therFever, apnea, splenomegaly,

joint pain, superinfectionsOphthalmic preparations

!cal -ransient irritation, (urning,

stinging, itching,angioneuroticedema, urticaria, vesicular andmaculopapular dermatitis

!opical dermatologic preparations !cal Photosensiti!ation,

superinfections


5ncreased ototoxic, nephrotoxic,

neurotoxic effects with otheraminoglycosides, cephalothin, potentdiuretics, cephalosporins,vancomycin, methoxyflurane,enflurane

5ncreased neuromuscular %locade

and muscular paralysis withanesthetics, nondepolariingneuromuscular %locing drugs,succinylcholine, citrate-anticoagulated %lood

6otential inactivation of %oth drugs if

mixed with %eta-lactam7typeanti%iotics (space doses withconcomitant therapy)

5ncreased %actericidal effect with

penicillins, cephalosporins (to treatsome gram-negative organisms andenterococci), car%enicillin, ticarcillin(to treat Pseudomonas infections)


202


22/55

Assessment

6ist!ry Allergy to any

aminoglycosides renal or hepaticdisease preexisting hearing lossactive infection with herpes, vaccinia,

varicella, fungal infections,myo%acterial infections (ophthalmicpreparations) myasthenia gravisparinsonism infant %otulismlactation, pregnancy

(hysical :ite of infection sin

color, lesions orientation, reflexes,eighth cranial nerve function 6, @6;, adventitious sounds %owelsounds, liver evaluation urinalysis,@'ive %y 5# route if at all possi%le

give %y deep 5# injection.

&ulture infected area %efore therapy.

'se mg4m* intrathecal preparation

without preservatives, for intrathecaluse.

Avoid long-term therapies %ecause

of increased ris of toxicities.;eduction in dose may %e clinicallyindicated.

6atients with edema or ascites may

have lower pea concentrations dueto expanded extracellular fluidvolume.

&leanse area %efore application of

dermatologic preparations.

nsure ade$uate hydration of patient

%efore and during therapy.

A*+"+3#onitor renal functiontests, &@&s, serum drug levelsduring long-term therapy. &onsultwith prescri%er to adjust dosage.

!eaching "oints

Apply ophthalmic preparations %y

tilting head %ac place medications

into conjunctival sac and close eyeapply light pressure on lacrimal sacfor 1 minute. &leanse area %eforeapplying dermatologic preparationsarea may %e covered if necessary.

Dou may experience these sideeffects" ;inging in the ears,headache, diiness (reversi%le usesafety measures if severe) nausea,vomiting, loss of appetite (eatfre$uent small meals, performfre$uent mouth care) %urning,%lurring of vision with ophthalmicpreparations (avoid driving orperforming dangerous activities ifvisual effects occur)

photosensitiation with dermatologicpreparations (wear sunscreen andprotective clothing).

;eport pain at injection site, severe

headache, diiness, loss of hearing,changes in urine pattern, difficulty%reathing, rash or sin lesionsitching or irritation (ophthalmicpreparations) worsening of thecondition, rash, irritation(dermatologic preparation).


glimeiri#e(glye meh'per ide)Amaryl


Drug classes

Antidia%etic:ulfonylurea (second generation)

Theraeutic acti!ns:timulates insulin release from functioning%eta cells in the pancreas may improve%inding %etween insulin and insulin receptorsor increase the num%er of insulin receptors

203


23/55

thought to %e more potent in effect than first-generation sulfonylureas.

"n#icati!ns

As an adjunct to diet to lower %lood

glucose in patients with type (non7insulin-dependent) dia%etes mellituswhose hypoglycemia cannot %econtrolled %y diet and exercise alone

5n com%ination with metformin or

insulin to %etter control glucose asan adjunct to diet and exercise inpatients with type dia%etes mellitus



sulfonylureas dia%etes complicated%y fever, severe infections, severetrauma, major surgery, etosis,acidosis, coma (insulin is indicated inthese conditions) type 1 (insulin-dependent) dia%etes, serious hepaticor renal impairment, uremia, thyroidor endocrine impairment, glycosuria,hyperglycemia associated withprimary renal disease la%or anddelivery+if glimepiride is used

during pregnancy, discontinue drugat least 1 mo %efore deliverylactation, safety not esta%lished.

'se cautiously with pregnancy.

A%ailable f!rms!a%lets+1, , mg

DosagesAD&TS'sual starting dose is 17 mg 6O once daily

with %reafast or first meal of the day usualmaintenance dose is 17 mg 6O once daily,depending on patient response and glucoselevels. =o not exceed 0 mg4day.

$om(ination ith insulin therapy:

0 mg 6O daily with first meal of theday with low-dose insulin.

-ransfer from other hypoglycemic

agents:


24/55

salts, #AO5s, methyldopa,oxyphen%utaone, phenyl%utaone,pro%enecid, salicylates,sulfinpyraone, sulfonamides, !&As,urinary acidifiers

=ecreased effectiveness of %othglimepiride and diaoxide if taenconcurrently

5ncreased ris of hyperglycemia with

rifampin, thiaides

;is of hypoglycemia and

hyperglycemia with ethanolGdisulfiram reactionG has also %eenreported

6ossi%le decreased hypoglycemic

effect with %eta %locers, calcium

channel %locers, cholestyramine,corticosteroids, diaoxide, estrogens,hydantoins, hormonalcontraceptives, isoniaid, nicotinicacid, phenothiaines, rifampin,sympathomimetics, thiaidediuretics, thyroid agents, urinaryalaliniers

Drug-alternatie thera"y

5ncreased ris of hypoglycemia if

taen with juniper %erries, ginseng,

garlic, fenugree, coriander,dandelion root, celery


6ist!ry Allergy to sulfonylureas

dia%etes complicated %y fever,severe infections, severe trauma,major surgery, etosis, acidosis,coma (insulin is indicated in theseconditions) type 1 dia%etes, serious

hepatic or renal impairment, uremia,thyroid or endocrine impairment,glycosuria, hyperglycemiaassociated with primary renaldisease pregnancy


orientation, reflexes, peripheralsensation ;, adventitious sounds

liver evaluation, %owel soundsurinalysis, @'


25/55


gliizi#e(gli'i ide)

3luc!tr!l, 3luc!tr!l B


Drug classesAntidia%etic:ulfonylurea (second generation)

Theraeutic acti!ns:timulates insulin release from functioning%eta cells in the pancreas may improve

%inding %etween insulin and insulin receptorsor increase the num%er of insulin receptorsmore potent in effect than first-generationsulfonylureas.

"n#icati!ns

Adjunct to diet and exercise to lower

%lood glucose with type (non7insulin-dependent) dia%etes mellitus

Adjunct to insulin therapy in the

sta%iliation of certain cases of type

1 (insulin-dependent) dia%etes,reducing the insulin re$uirement anddecreasing the chance ofhypoglycemic reactions



sulfonylureas dia%etes withetoacidosis, sole therapy of type 1dia%etes or dia%etes complicated %ypregnancy, dia%etes complicated %y

fever, severe infections, severetrauma, major surgery, etosis,acidosis, coma (insulin is indicated)type 1 dia%etes, serious hepaticimpairment, serious renalimpairment.

'se cautiously with uremia, thyroid

or endocrine impairment, glycosuria,

hyperglycemia associated withprimary renal disease la%or anddelivery (if glipiide is used duringpregnancy, discontinue drug at least1 mo %efore delivery) lactation

pregnancy.

A%ailable f!rms!a%lets+2, 1 mg ; ta%lets+.2, 2, 1 mg

Dosages>ive approximately 8 min %efore %reafastto achieve greatest reduction in postprandialhyperglycemia.AD&TS

Initial therapy:2 mg 6O %efore

%reafast. Adjust dosage inincrements of .272 mg asdetermined %y %lood glucoseresponse. At least several daysshould elapse %etween adjustments.#aximum once-daily dose shouldnot exceed 12 mg a%ove 12 mg,divide dose, and administer %eforemeals. =o not exceed mg4day.; ta%lets" 2 mg4day. Adjust dosagein 2-mg increments every 8 mo

maximum dose+ mg4day. 'aintenance therapy:!otal daily

doses a%ove 12 mg 6O should %edivided total daily doses a%ove8 mg are given in divided doses%id.

*xtended release:2 mg4day with

%reafast, may %e increased to1 mg4day after 8 mo if indicated.

()D"AT*"$ (AT")+TS:afety and efficacy not esta%lished.

3)*"AT*"$ (AT")+TS>eriatric patients tend to %e more sensitiveto the drug. :tart with initial dose of.2 mg4day 6O. #onitor for hr andgradually increase dose after several days asneeded.

(harmac!.inetics

206


26/55


Oral 171.2 hr 178 hr 17 hr

/etab!lismBepatic !14" 7 hrDistributi!n&rosses placenta enters

%reast mil)creti!n@ile, urine

A#%erse effects

$+S=rowsiness, asthenia,

nervousness, tremor, insomnia,tinnitus, fatigue

$ "ncrease# ris. !f $ m!rtality

)n#!crine &ypoglycemia, :5A=B

3"Anorexia, nausea,vomiting,

epigastric discomfort, heart(urn,

diarrhea 6emat!l!gic *euopenia,

throm%ocytopenia, anemia

6yersensiti%ityAllergic s2in

reactions,ecema, pruritus,erythema, urticaria, photosensitivity,fever, eosinophilia, jaundice

4ther?eight gain

"nteracti!ns

Drug-drug 5ncreased ris of hypoglycemia with

sulfonamides, chloramphenicol,oxyphen%utaone, phenyl%utaone,salicylates, clofi%rate

=ecreased effectiveness of glipiide

and diaoxide if taen concurrently


rifampin, thiaides


hyperglycemia with ethanol

Gdisulfiram reactionG also has %eenreported



taen with juniper %erries, ginseng,garlic, fenugree, coriander,dandelion root, celery


6ist!ry Allergy to sulfonylureas

dia%etes with complications type 1dia%etes, serious hepatic or renal

impairment, uremia, thyroid orendocrine impairment, glycosuria,hyperglycemia associated withprimary renal disease pregnancy


orientation, reflexes, peripheralsensation ;, adventitious soundsliver evaluation, %owel soundsurinalysis, @'ive drug 8 min %efore %reafast if

severe >5 upset occurs or more than12 mg4day is re$uired, dose may %edivided and given %efore meals.

#onitor urine or serum glucose

levels fre$uently to determine drugeffectiveness and dosage.

A*+"+3!ransfer to insulin

therapy during periods of high stress(eg, infections, surgery, trauma).

A*+"+3'se 59 glucose if severehypoglycemia occurs as a result ofoverdose.

!eaching "oints

!ae this drug 8 minutes %efore

%reafast for %est results.

=o not discontinue this drug without

consulting your health care provider.

#onitor urine or %lood for glucose

and etones. =o not use this drug during

pregnancy consult health careprovider.

Avoid alcohol while using this drug.

;eport fever, sore throat, unusual

%leeding or %ruising, rash, darurine, light-colored stools,

207


27/55

hypoglycemic or hyperglycemicreactions.


glyburi#e(glye'%yoor ide)Dia8eta, )ugluc!n 3lybe


28/55

d

/etab!lismBepatic !14" hrDistributi!n&rosses placenta enters%reast mil

)creti!n @ile, urine

A#%erse effects

$+S=rowsiness, tinnitus, fatigue,

asthenia, nervousness, tremor,insomnia

$ "ncrease# ris. !f $ m!rtality

)n#!crine &ypoglycemia

3"Anorexia, nausea,vomiting,

epigastric discomfort, heart(urn,diarrhea, eight gain

6emat!l!gic *euopenia,throm%ocytopenia, anemia

6yersensiti%ityAllergic s2in

reactions,ecema, pruritus,erythema, urticaria, photosensitivity,fever, eosinophilia, jaundice


5ncreased ris of hypoglycemia with

sulfonamides, chloramphenicol,oxyphen%utaone, phenyl%utaone,salicylates, clofi%rate

=ecreased effectiveness of gly%uride

and diaoxide if taen concurrently


rifampin, thiaides


hyperglycemia with ethanolGdisulfiram reactionG has %eenreported

Drug-alternatie thera"y 5ncreased ris of hypoglycemia if

taen with juniper %erries, ginseng,garlic, fenugree, coriander,dandelion root, celery


$"+"$A A)*TName confusion has occurred betweenDia/eta $glyburide% and 0ebeta$biso"rolol%; use caution.

Assessment 6ist!ry Allergy to sulfonylureas

dia%etes with complications type 1dia%etes, serious hepatic or renalimpairment, uremia, thyroid orendocrine impairment, glycosuria,hyperglycemia associated withprimary renal disease, pregnancy


orientation, reflexes, peripheralsensation ;, adventitious sounds

liver evaluation, %owel soundsurinalysis, @'ive drug %efore %reafast. 5f severe

>5 upset occurs, dose may %edivided and given %efore meals.


levels fre$uently to determine drugeffectiveness and dosage.

#onitor dosage carefully if switchingto or from 4lynase1

A*+"+3!ransfer to insulin

therapy during periods of high stress(eg, infections, surgery, trauma).

A*+"+3'se 59 glucose if severe

hypoglycemia occurs as a result ofoverdose.

!eaching "oints

=o not discontinue this medication

without consulting your health careprovider.

#onitor urine or %lood for glucose

and etones.

=o not use this drug during

pregnancy consult health careprovider.

209


29/55

Avoid alcohol while using this drug.

;eport fever, sore throat, unusual

%leeding or %ruising, rash, darurine, light-colored stools,hypoglycemic or hyperglycemic

reactions.


guaifenesin(gwye fen'e sin)Allfen; A/8" 1000, 1200; Diabetic Tussin;6ytuss; 6ytuss 2B; iquibi#; /ucine;/uc!>en; 4rgani#in +*; *!bitussin,Sc!t>Tussin )ect!rant; Siltussin SA


Drug classxpectorant

Theraeutic acti!nsnhances the output of respiratory tract fluid%y reducing adhesiveness and surfacetension, facilitating the removal of viscousmucus.

"n#icati!ns

:ymptomatic relief of respiratory

conditions characteried %y dry,nonproductive cough when there ismucus in the respiratory tract.



guaifenesin.


lactation, and persistent coughs.

A%ailable f!rms:yrup+1 mg42 m* li$uid+1, mg42m* capsules+ mg ta%lets+1, , mg ; ta%lets+/ mg

Dosages

AD&TS A+D ()D"AT*"$ (AT")+TS 9 12-*7 mg 6O $ hr. =o not exceed .g4day.()D"AT*"$ (AT")+TS :12 -*

17 mg 6O $ hr. =o not exceed 1.g4day.()D"AT*"$ (AT")+TS 2: -*271 mg 6O $ hr. =o not exceed/ mg4day.

(harmac!.inetics

;oute Onset =uration

Oral 8 min 7/ hr

/etab!lism5 discomfort

"nteracti!nsDrug-lab test

&olor interference and false results

of 2-B5AA and 9#A urinarydeterminations

Nursing considerations$"+"$A A)*TName confusion has been re"ortedbetween ,ucinex $guaifenesin% and,ucomyst $acetylcysteine%; use caution.Assessment

6ist!ry Allergy to guaifenesin

persistent cough due to smoing,

asthma, or emphysema veryproductive cough pregnancy

(hysical :in lesions, color !

orientation, affect ;, adventitioussounds

Interentions

210


30/55

A*+"+3#onitor reaction to drug

persistent cough for more than 1 w,fever, rash, or persistent headachemay indicate a more seriouscondition.

!eaching "oints

:ome extended-release formulations

may %e cut in half %ut cannot %ecrushed or chewed. 'ucinexcannot%e crushed, chewed, or cut.

=o not tae for longer than 1 wee if

fever, rash, or headache occur,consult your health care provider.


effects"


31/55

.278 times control+or a6!! L 1.278 timescontrol value. !he following are guidelines todosage"AD&TS:u%cutaneous (deep su%cutaneous injection)

6or general anticoagulation:59loading dose of 2, units and then1,7, units su%cutaneouslyfollowed %y 0,71, units $ 0hr or 12,7, units $ 1 hr.

Prophylaxis of postoperative

throm(oem(olism:2, units %ydeep su%cutaneous injection hr%efore surgery and $ 071 hrthereafter for 3 days or until patientis fully am%ulatory.

59 Intermittent IV: 5nitial dose of

1, units and then 2,71, units $ 7/ hr.

$ontinuous IV infusion:*oading

dose of 2, units and then,7, units4day.

Surgery of heart and (lood vessels

for patients undergoing total (odyperfusion:


32/55

Drug-drug

5ncreased %leeding tendencies with

oral anticoagulants, salicylates,penicillins, cephalosporins low-moleculer-weight heparins

=ecreased anticoagulation effects iftaen concurrently with nitroglycerin

Drug-lab test

5ncreased A:!, A*! levels

5ncreased thyroid function tests

Altered %lood gas analyses,

especially levels of car%on dioxide,%icar%onate concentration, and %aseexcess


5ncreased ris of %leeding if

com%ined with chamomile, garlic,ginger, gingo, and ginseng therapyhigh-dose vitamin


6ist!ry ;ecent surgery or injury

sensitivity to heparin hyperlipidemiapregnancy

(hysical 6eripheral perfusion, ;,

stool guaiac test, 6!! or other testsof %lood coagulation, platelet count,renal function tests

Interentions

Adjust dose according to coagulation

test results performed just %eforeinjection (8 min %efore eachintermittent dose or $ 7/ hr ifcontinuous 59 dose). !herapeuticrange a6!!" 1.27.2 times control.

Always chec compata%ilities withother 59 solutions.

'se heparin loc needle to avoid

repeated injections.

>ive deep su%cutaneous injections

do not give heparin %y 5# injection.

=o not give 5# injections to patients

on heparin therapy (heparin

predisposes to hematomaformation).

A*+"+3Apply pressure to all

injection sites after needle iswithdrawn inspect injection sites for

signs of hematoma do not massageinjection sites.

#ix well when adding heparin to 59

infusion.

=o not add heparin to infusion lines

of other drugs, and do not piggy%acother drugs into heparin line. 5f thismust %e done, ensure drugcompati%ility.

6rovide for safety measures (electric

raor, soft tooth%rush) to prevent

injury from %leeding. &hec for signs of %leeding monitor

%lood tests.

Alert all health care providers of

heparin use.

A*+"+3Bave protamine sulfate

(heparin antidote) readily availa%le incase of overdose each mgneutralies 1 units of heparin.

A*+"+3!reatment of overdose"

6rotamine sulfate (1 solution).ach mg of protamine neutralies1 ':6 heparin units. >ive veryslowly 59 over 1 min, not to exceed2 mg. sta%lish dose %ased on%lood coagulation studies.

!eaching "oints

!his drug must %e given %y a

parenteral route (cannot %e taenorally).

Fre$uent %lood tests are necessaryto determine %lood clotting time iswithin the correct range.

@e careful to avoid injury" 'se an

electric raor, avoid contact sportsand other activities that might lead toinjury.

Dou may experience loss of hair.

213


33/55

;eport nose %leed, %leeding of the

gums, unusual %ruising, %lac ortarry stools, cloudy or dar urine,a%dominal or lower %ac pain,severe headache.


hy#r!chl!r!thiazi#e(hye droe lor oh thye'a ide)A!>6y#r!


34/55

Dermat!l!gic 6hotosensitivity,

rash, purpura, exfoliative dermatitis,hives, alopecia

3" #ausea, anorexia, vomiting, dry

mouth, diarrhea, constipation,

jaundice, hepatitis, pancreatitis 3& Polyuria, nocturia,impotence,

loss of li%ido

6emat!l!gic *euopenia,

throm%ocytopenia, agranulocytosis,aplastic anemia, neutropenia

4ther #uscle cramps and muscle

spasms, fever, gouty attacs,flushing, weight loss, rhinorrhea,electrolyte im%alances,hyperglycemia


Altered electrolytes with loop

diueretics, amphotericin @,corticosteroids

5ncreased neuromuscular %locing

effects and respiratory depressionwith nondepolariing musclerelaxants

=ecreased a%sorption with

cholestyramine, colestipol

5ncreased ris of cardiac glycoside

toxicity if hypoalemia occurs

5ncreased ris of lithium toxicity

=ecreased effectiveness of

antidia%etic drugsDrug-lab test

=ecreased 6@5 levels without clinical

signs of thyroid distur%ance


6ist!ry Allergy to thiaides,

sulfonamides fluid or electrolyteim%alance renal or liver diseasegout :* glucose tolerancea%normalities, dia%etes mellitushyperparathyroidism manic-

depressive disorders lactation,pregnancy

(hysical :in color, lesions,

edema orientation, reflexes, musclestrength pulses, %aseline &>, @6,

orthostatic @6, perfusion ;, pattern,adventitious sounds liver evaluation,%owel sounds, urinary outputpatterns &@&, serum electrolytes,%lood glucose, *F!s, renal functiontests, serum uric acid, urinalysis

Interentions

>ive with food or mil if >5 upset

occurs.

#ar calendars or provide other

reminders of drug for alternate dayor 872 days4w therapy.

;educe dosage of other

antihypertensives %y at least 2 ifgiven with thiaides readjustdosages gradually as @6 responds.

Administer early in the day so

increased urination will not distur%sleep.

#easure and record weights to

monitor fluid changes.

!eaching "oints

;ecord intermittent therapy on a

calendar, or use prepared, datedenvelopes. !ae drug early soincreased urination will not distur%sleep. =rug may %e taen with foodor meals if >5 upset occurs.

?eigh yourself on a regular %asis, at

the same time and in the sameclothing record weight on yourcalendar.


effects" 5ncreased volume andfre$uency of urination diiness,feeling faint on arising, drowsiness(avoid rapid position changeshaardous activities, lie driving and

215


35/55

alcohol) sensitivity to sunlight (usesunglasses, wear protective clothing,or use a sunscreen) decrease insexual function increased thirst(sucing on sugarless loenges and

fre$uent mouth care may help) goutattac (report any sudden joint pain).

;eport weight change of more than 8

pounds in 1 day, swelling in youranles or fingers, unusual %leedingor %ruising, diiness, trem%ling,num%ness, fatigue, muscleweaness or cramps.


hy#r!c!rtis!ne(hye droe .!r' ti one)

hy#r!c!rtis!ne acetateDermatologic cream( ointment)$!rtai# Fith Al!e, $!rtef eminine "tch,$!rticaine, 3ynec!rt emale $reme,anac!rt>5, anac!rt>10, /aimumStrength $al#ec!rt, /aimum Strength$!rtai#

hy#r!c!rtis!ne butyrateDermatologic ointment and cream)!c!i#

hy#r!c!rtis!ne cyi!nate*ral sus"ension)$!rtate $!rtef

hy#r!c!rtis!ne %alerateDermatologic cream( ointment( lotion)

estc!rt


Drug classes

&orticosteroid, short acting>lucocorticoidAdrenal cortical steroidBormone

Theraeutic acti!nsnters target cells and %inds to cytoplasmicreceptors initiates many complex reactionsthat are responsi%le for its anti-inflammatory,immunosuppressive (glucocorticoid), andsalt-retaining (mineralocorticoid) actions.

:ome actions may %e undesira%le,depending on drug use.

"n#icati!ns

;eplacement therapy in adrenal

cortical insufficiency

Allergic states+severe or

incapacitating allergic conditions

Bypercalcemia associated with

cancer

:hort-term inflammatory and allergic

disorders, such as rheumatoidarthritis, collagen diseases (:*),dermatologic diseases (pemphigus),status asthmaticus, and autoimmunedisorders

Bematologic disorders+

throm%ocytopenic purpura,erythro%lastopenia

!richinosis with neurologic or

myocardial involvement

'lcerative colitis, acute

exacer%ations of #:, and palliationin some leuemias and lymphomas

5ntra-articular or soft-tissue

administration" Arthritis, psoriaticpla$ues

;etention enema" For ulcerative

colitis, proctitis

216


36/55

=ermatologic preparations" !o

relieve inflammatory and pruriticmanifestations of dermatoses thatare steroid responsive

Anorectal cream, suppositories" !o

relieve discomfort of hemorrhoidsand perianal itching or irritation

$!ntrain#icati!ns an# cauti!ns:ystemic administration

&ontraindicated with fungal

infections, ame%iasis, hepatitis @,vaccinia, or varicella, and anti%iotic-resistant infections.

'se cautiously with idney disease

(ris to edema) liver disease,

cirrhosis, hypothyroidism ulcerativecolitis with impending perforationdiverticulitis recent >5 surgeryactive or latent peptic ulcerinflammatory %owel disease (rissexacer%ations or %owel perforation)hypertension, &BFthrom%oem%olitic tendencies,throm%ophle%itis, osteoporosis,seiure disorders, metastaticcarcinoma, dia%etes mellitus !@

lactation.;etention enemas, intrarectal foam

&ontraindicated with systemic fungal

infections, recent intestinal surgery,extensive fistulas.

'se cautiously with pregnancy.

!opical dermatologic administration

&ontraindicated with fungal,

tu%ercular, herpes simplex sininfections vaccinia, varicella earapplication when eardrum isperforated.


lactation.

A%ailable f!rms!a%lets+2, 1, mg oral suspension+1 mg42 m*, 2, 2 mg4m* injection+2, 2

mg4m*, 1, 2, 2, 1, mg4vial topicallotion+.2, .2, 1, , .2 topicalli$uid+1 topical oil+1 topical solution+1 topical spray+1 cream+.,.2, 1, .2 ointment+.2, 1, .2

topical gel+1,

DosagesAD&TS5ndividualie dosage, %ased on severity andresponse. >ive daily dose %efore I A# tominimie adrenal suppression. 5f long-termtherapy is needed, alternate-day therapyshould %e considered. After long-termtherapy, withdraw drug slowly to avoidadrenal insufficiency. For maintenance

therapy, reduce initial dose in smallincrements at intervals until lowest clinicallysatisfactory dose is reached.5#, 59 (hydrocortisone sodium succinate)172 mg initially and $ 71 hr, %ased oncondition and response.

Acute adrenal insufficiency

;hydrocortisone sodium phosphate


37/55

1 applicator daily or %id for w and everysecond day thereafter.5ntra-articular, intralesional (hydrocortisoneacetate)272 mg, depending on joint or soft-tissue

injection site.!opical dermatologic preparationsApply sparingly to affected area %id7$id.

(harmac!.inetics


Oral 17 hr 17 hr 171.2days

5# ;apid 70 hr 171.2days

59 5mmediate 'nnown 171.2

days6; :low 872 days 7/ days

/etab!lism Bepatic !14" 071 minDistributi!n &rosses placenta enters%reast mil)creti!n'rine

IV facts(rearati!n >ive directly or dilute in normalsaline or =2?. Administer within hr of

diluting"nfusi!n 5nject slowly, directly or dilute, andinfuse hydrocortisone phosphate at a rate of2 mg4min hydrocortisone sodium succinateat rate of each 2 mg over 87/ sec."nc!matibilities =o not mix or inject at D-site with amo%ar%ital, ampicillin, %leomycin,dimenhydrinate, doxapram, doxoru%icin,ephedrine, ergotamine, heparin, hydralaine,metaraminol, methicillin, nafcillin,pento%ar%ital, pheno%ar%ital, phenytoin,

prochloperaine, promethaine, seco%ar%ital,tetracyclines.

A#%erse effects:ystemic

$+S Vertigo, headache,

paresthesias, insomnia, seiures,psychosis

$ &ypotension, shoc2,

hypertension and &BF secondary tofluid retention, throm%oem%olism,throm%ophle%itis, fat em%olism,cardiac arrhythmias secondary to

electrolyte distur%ances Dermat!l!gic -hin, fragile s2in

petechiae ecchymosespurpurastriae su%cutaneous fat atrophy

))+T &ataracts, glaucoma (long-

term therapy), increased 5O6

)n#!crineAmenorrhea, irregular

menses,growth retardation,decreased car%ohydrate toleranceand dia%etes mellitus, cushingoidstate (long-term therapy), B6A

suppression systemic with therapylonger than 2 days

3" Peptic or esophageal ulcer,

pancreatitis,a%dominal distention,nausea, vomiting, increased appetiteand weight gain (long-term therapy)

6emat!l!gic #a>and fluid

retention, hypo2alemia,hypocalcemia, increased %loodsugar, increased serum cholesterol,decreased serum !8and !levels

6yersensiti%ity Anaphylactoid or

hypersensitivity reactions

/uscul!s.eletal 'uscle

ea2ness,steroid myopathy andloss of muscle mass, osteoporosis,spontaneous fractures (long-termtherapy)

4ther Immunosuppression,

aggravation or mas2ing of infections,impaired ound healing

Adverse effects related to specific routes ofadministration

"/ re!sit!ry inCecti!ns Atrophy at

injection site

"ntra>articular Osteonecrosis,

tendon rupture, infection

"ntralesi!nal theray, hea# an#

nec. @lindness (rare)

218


38/55

"ntrasinal #eningitis, adhesive

arachnoiditis, conus medullarissyndrome

"ntrathecal a#ministrati!n

Arachnoiditis

*etenti!n enema *ocal pain,%urning rectal %leeding systemica%sorption and adverse effects (see:ystemic Adverse ffects)

T!ical #ermat!l!gic !intments,

creams, srays *ocal %urning,irritation, acneiform lesions, striae,sin atrophy


5ncreased steroid %lood levels withhormonal contraceptives,troleandomycin, etoconaole,estrogen

=ecreased steroid %lood levels with

phenytoin, pheno%ar%ital, rifampin,cholestyramine

=ecreased serum level of salicylates

=ecreased effectiveness of

anticholinesterases (am%enonium,

edrophonium, neostigmine,pyridostigmine), etoconaole,estrogen

Drug-lab test

False-negative nitro%lue-tetraolium

test for %acterial infection (withsystemic a%sorption)

:uppression of sin test reactions

#ay decrease serum potassium

levels, !8, and !levels


6ist!ry 5nfections idney disease

liver disease, hypothyroidismulcerative colitis with impendingperforation diverticulitis recent >5surgery active or latent peptic ulcerinflammatory %owel disease

hypertension, &BFthrom%oem%olitic tendencies,throm%ophle%itis, osteoporosis,seiure disorders, metastaticcarcinoma, dia%etes mellitus

lactation. =etention enemas,intrarectal foam: :ystemic fungalinfections recent intestinal surgery,extensive fistulas. -opicaldermatologic administration: Fungal,tu%ercular, herpes simplex sininfections vaccinia, varicella earapplication when eardrum isperforated

(hysical Systemic administration:

?eight, ! reflexes, affect, %ilateral

grip strength, ophthalmologicexamination @6, 6, auscultation,peripheral perfusion, discoloration,pain or prominence of superficialvessels ;, adventitious sounds,chest x-ray upper >5 x-ray (historyor symptoms of peptic ulcer), liverpalpation &@&, serum electrolytes,-hr postprandial %lood glucose,urinalysis, thyroid function tests,serum cholesterol. -opical,

dermatologic preparations:Affectedarea, integrity of sin

Interentions:ystemic administration

A*+"+3>ive daily %efore I A#

to mimic normal pea diurnalcorticosteroid levels and minimieB6A suppression.

:pace multiple doses evenly

throughout the day.

=o not give 5# injections if patienthas throm%ocytopenic purpura.

;otate sites of 5# repository

injections to avoid local atrophy.

'se minimal doses for minimal

duration to minimie adverse effects.

!aper doses when discontinuing

high-dose or long-term therapy.

219


39/55

Arrange for increased dosage when

patient is su%ject to unusual stress.

nsure that ade$uate amount of

&aMis taen if prolongedadministration of steroids.

'se alternate-day maintenancetherapy with short-actingcorticosteroids whenever possi%le.

A*+"+3=o not give live virus

vaccines with immunosuppressivedoses of hydrocortisone.

6rovide antacids %etween meals to

help avoid peptic ulcer.!opical dermatologic administration

'se caution with occlusive

dressings tight or plastic diapersover affected area can increasesystemic a%sorption.

Avoid prolonged use, especially near

eyes, in genital and rectal areas, onface, and in sin creases.

!eaching "oints:ystemic administration

!ae this drug exactly as prescri%ed.

=o not stop taing this drug without

notifying your health care providerslowly taper dosage to avoidpro%lems.

=osage reductions may create

adrenal insufficiency. ;eport anyfatigue, muscle and joint pains,anorexia, nausea, vomiting, diarrhea,weight loss, weaness, diiness, orlow %lood sugar (if you monitor %loodsugar).

!ae with meals or snacs if >5

upset occurs. !ae single daily or alternate-day

doses %efore I A# mar calendar oruse other measures as reminder oftreatment days.

=o not overuse joint after intra-

articular injections, even if pain isgone.

Fre$uent follow-up visits to your

health care provider are needed tomonitor drug response and adjustdosage.

?ear a medical alert 5= (long-term

therapy) so that any emergencymedical personnel will now that youare taing this drug.


effects" 5ncrease in appetite, weightgain (some of gain may %e fluidretention monitor intae) heart%urn,indigestion (eat fre$uent smallmeals use of antacids may help)increased suscepti%ility to infection(avoid crowds during pea cold or flu

seasons, and avoid anyone with anown infection) poor woundhealing (if injured or wounded,consult health care provider) muscleweaness, fatigue (fre$uent restperiods may help).

;eport unusual weight gain, swelling

of lower extremities, muscleweaness, %lac or tarry stools,vomiting of %lood, epigastric %urning,puffing of face, menstrual

irregularities, fever, prolonged sorethroat, cold or other infection,worsening of symptoms.

5ntra-articular, intralesional administration

=o not overuse the injected joint

even if the pain is gone. Adhere torules of proper rest and exercise.

!opical dermatologic administration

Apply sparingly, and ru% in lightly

Avoid contacting your eye with the

medication.

;eport %urning, irritation, or infection

of the site, worsening of thecondition.

Avoid prolonged use.

Anorectal preparations

220


40/55

#aintain normal %owel function with

proper diet, ade$uate fluid intae,and regular exercise.

'se stool softeners or %ul laxatives

if needed.

6y#r!yzine 6y#r!yzine


41/55

:tart patients on 5# therapy when indicateduse oral therapy for maintenance. Adjustdosage to patientHs response.AD&TSOral

Symptomatic relief of anxiety:271 mg $id.

'anagement of pruritus:2 mg tid7

$id.

Sedative ;preoperative and

postoperativeive 5# injections deep into a large

muscle. 5n adults, use upper outer$uadrant of %uttocs or midlateralthigh in children use midlateral thighmuscles use deltoid area only if well

developed.

!eaching "oints

!ae this drug as prescri%ed. Avoid

excessive dosage.


effects" =iiness, sedation,drowsiness (use caution if driving or

222


42/55

performing tass that re$uirealertness) avoid alcohol, sedatives,sleep aids (serious overdosagecould result) dry mouth (fre$uentmouth care, sucing on sugarless

loenges may help). ;eport difficulty %reathing, tremors,

loss of coordination, sore muscles,or muscle spasms.


ibur!fen(eye by!!'proe fen)A#%il, A#%il iqui>3els, A#%il /igraine,

A!>"bur!fen (r!fen


43/55

6ever ; mo897 yr5 upset occurs.

Arrange for periodic ophthalmologic

examination during long-termtherapy.

=iscontinue drug if eye changes,

symptoms of liver dysfunction, orrenal impairment occur.

A*+"+35nstitute emergency

procedures if overdose occurs"

224


44/55

>astric lavage, induction of emesis,supportive therapy.

!eaching "oints

'se drug only as suggested avoid

overdose. !ae the drug with food orafter meals if >5 upset occurs. =onot exceed the prescri%ed dosage.

Avoid over-the-counter drugs. #any

of these drugs contain similarmedications, and seriousoverdosage can occur.


effects" 5 upset, dyspepsia(tae drug with food) diarrhea orconstipation drowsiness, diiness,

vertigo, insomnia (use caution whendriving or operating dangerousmachinery).

;eport sore throat, fever, rash,

itching, weight gain, swelling inanles or fingers, changes in vision,%lac or tarry stools.


ibutili#e fumarate(eye byu'ti lyed)$!r%ert


Drug classAntiarrhythmic (predominately class 555)

Theraeutic acti!ns6rolongs cardiac action potential, increases

atrial and ventricular refractoriness producesmild slowing of sinus rate and A9 conduction.

"n#icati!ns

;apid conversion of atrial fi%rillation

or flutter of recent onset to sinusrhythm most effective in arrhythmiasof J I daysH duration


&ontraindicated withhypersensitivity

to i%utilide second- or third-degreeA9 heart %loc, prolonged N!c

intervals. 'se cautiously with ventricular

arrhythmias, pregnancy, lactation,renal and hepatic impairment.

A%ailable f!rms:olution+.1 mg4m*

DosagesAD&TS 9 :0 H3


45/55

"nc!matibilities =o not mix in solution withany other drugs.

A#%erse effects

$+S Beadache, light-headedness,

diiness, tingling in arms,num%ness

$ entricular arrhythmias,

hypotension, hypertension

3" #ausea


5ncreased ris of serious to life-

threatening arrhythmias withdisopyramide, $uinidine,

procainamide, amiodarone, sotaloldo not give together

5ncreased ris of proarrhythmias with

phenothiaines, !&As,antihistamines

'se cautiously with digoxin %ecause

i%utilide may mas digoxincardiotoxicity


6ist!ry Bypersensitivity to i%utilide

second- or third-degree A9 heart%loc, time of onset of atrialarrhythmia prolonged N!c intervalspregnancy, lactation ventriculararrhythmias

(hysical Orientation @6, 6,

auscultation, &> ;, adventitioussounds

Interentions

=etermine time of onset of

arrhythmia and potential %enefit%efore %eginning therapy.&onversion is more liely in patientswith arrhythmias of short (J I daysH)duration.

A*+"+3nsure that patient is

ade$uately anticoagulated, generallyfor at least w, if atrial fi%rillationlasts E 78 days.

#onitor &> continually during and

for at least hr after administration.@e alert for possi%le arrhythmias,including 69&s, sinus tachycardia,sinus %radycardia, varying degreesof %loc at time of conversion.

A*+"+3Ceep emergency

e$uipment readily availa%le duringand for at least hr afteradministration.

6rovide appointments for continued

follow-up, including &> monitoring

tendency to revert to atrialarrhythmia after conversionincreases with length of time patientwas in a%normal rhythm.

!eaching "oints

!his drug can only %e given %y 59

infusion. Dou will needelectrocardiogram monitoring duringand for hours after administration.

Arrange for follow-up medical

evaluation, including anelectrocardiogram, which isimportant to monitor the effect of thedrug on your heart.


effects" ;apid or irregular heart%eat(usually passes shortly), headache.

;eport chest pain, difficulty

%reathing, num%ness or tingling.


insulin(in'su lin)Insulin inection)

226


46/55

6umulin *, 6umulin * *egular &>500, ente "lentin "", +!%!lin gelente


47/55

'se cautiously with pregnancy (eep

patients under close supervisionrigid control is desired followingdelivery, re$uirements may drop for73 hr, rising to normal levels

during next / w) lactation (monitormother carefully insulinre$uirements may decrease duringlactation).

A%ailable f!rms5njection+1 units4m*, 2 units4m*(concentrated) prefilled cartridges and pens+1 units4m*DosagesAD&TS A+D ()D"AT*"$ (AT")+TS

>eneral guidelines, .271 unit4g4day. !henum%er and sie of daily doses, times ofadministration, and type of insulinpreparation are determined after closemedical scrutiny of the patientHs %lood andurine glucose, diet, exercise, and intercurrentinfections and other stresses. 'sually givensu%cutaneously. ;egular insulin may %egiven 59 or 5# in dia%etic coma oretoacidosis. 5nsulin injection concentratedmay %e given su%cutaneoulsy or 5#, %ut do

not administer 59.AD&TS "T6 T-() 2 D"A8)T)S*)M&"*"+3 8ASA "+S&"+ $4+T*41 units4day su%cutaneously, given at thesame time each day. ;ange, 71 units4day(3antus) or .17. units4g su%cutaneouslyin the evening or 1 units once or twice a day(3evemir).

(harmac!.inetics

!ype Onset 6ea =uration

;egular 87/min 78 hr /71 hr

:emilente 171.2hr

271hr

171/ hr


48/55

/etab!licBypoglycemia

etoacidosis

InteractionsDrug-drug

5ncreased hypoglycemic effects ofinsulin with #AO5s, %eta %locers,salicylates, or alcohol

=elayed recovery from hypoglycemic

episodes and mased signs andsymptoms of hypoglycemia if taenwith %eta-adrenergic %locing drugs



taen with juniper %erries, ginseng,garlic, fenugree, coriander,

dandelion root, celery

Nursing considerations$"+"$A A)*TName confusion may occur betweenantus and ente insulin; use etremecaution.

Assessment

6ist!ry Allergy to por products

pregnancy lactation

(hysical :in color, lesions eye%allturgor orientation, reflexes,peripheral sensation 6, @6,adventitious sounds ; urinalysis,%lood glucose

Interentions

nsure uniform dispersion of insulin

suspensions %y rolling the vial gently%etween hands avoid vigorousshaing.

>ive maintenance doses

su%cutaneously, rotating injectionsites regularly to decrease incidenceof lipodystrophy give regular insulin59 or 5# in severe etoacidosis ordia%etic coma.

#onitor patients receiving insulin 59

carefully plastic 59 infusion setshave %een reported to remove 70 of the insulin dosage deliveredto the patient will vary.

=o not give insulin injectionconcentrated 59 severe anaphylacticreactions can occur.

'se caution when mixing two types

of insulin always draw the regularinsulin into the syringe first if mixingwith insulin lispro, draw the lisprofirst use mixtures of regular and


49/55


levels fre$uently to determineeffectiveness of drug and dosage.6atients can learn to adjust insulindosage on a sliding scale %ased on

test results. #onitor insulin needs during times of

trauma or severe stress dosageadjustments may %e needed.

A*+"+3Ceep life support

e$uipment and glucose readilyavaila%le to deal with etoacidosis orhypoglycemic reactions.

!eaching "oints

'se the same type and %rand of

syringe use the same type and%rand of insulin to avoid dosageerrors.

=o not change the order of mixing

insulins. ;otate injection sitesregularly (eep a chart of sites used)to prevent %readown at injectionsites.

=osage may vary with activities,

stress, diet. #onitor %lood or urineglucose levels, and consult physicianif pro%lems arise.

:tore drug in the refrigerator or in a

cool place out of direct sunlight donot freee insulin.

5f refrigeration is not possi%le, drug is

sta%le at controlled roomtemperature and out of directsunlight for up to 1 month.

#onitor your urine or %lood for

glucose and etones as prescri%ed.

?ear a medical alert tag stating thatyou have dia%etes and are tainginsulin so that emergency medicalpersonnel will tae proper care ofyou.

Avoid alcohol serious reactions can

occur.

;eport fever, sore throat, vomiting,

hypoglycemic or hyperglycemicreactions, rash.



iratr!ium br!mi#e(i pra tr!e'pee um)A!>"ra%ent "rami#e


50/55

A%ailable f!rmsAerosol+10 mcg4actuation solution forinhalation+. (2 mcg4vial) nasal spray+.8 (1 mcg4spray), ./( mcg4spray)

DosagesAerosolAD&TS A+D ()D"AT*"$ (AT")+TS 9 12-*!he usual dosage is inhalations (8/ mcg)$id. 6atients may tae additional inhalationsas re$uired. =o not exceed 1 inhalations4hr.:olution for inhalationAD&TS A+D ()D"AT*"$ (AT")+TS 9 12

-*2 mcg tid7$id with doses /70 hr apart.11 -* sprays ./ per nostril tid for relief withcommon cold.AD&TS A+D ()D"AT*"$ (AT

f-i drug handbook

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