somatrem
soe-ma-trem
(Protopin)
somatropin
soe-mah-troe-pin
(Genotropin, Genotropin Miniquick, Humatrope, Norditropin, Norditropin Cartridge, Nutropin, Nutropin AQ, Nutropin Depot, Saizen, Serostim, Zorbitive)
Do not confuse Protopin with Proloprim, Protamine, or Protopam or somatropin with sumatriptan.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Polypeptide hormone. CLINICAL: Growth hormone.
ACTION
A polypeptide hormone that stimulates cartilaginous growth areas of long bones, increases the number and size of skeletal muscle cells, influences the size of organs, and increases RBC mass by stimulating erythropoietin. Influences the metabolism of carbohydrates (decreases insulin sensitivity), fats (mobilizes fatty acids), minerals (retains phosphorus, sodium, potassium by promotion of cell growth), and proteins (increases protein synthesis). Therapeutic Effect: Stimulates growth.
PHARMACOKINETICS
Well absorbed after subcutaneous or IM administration. Localized primarily in the kidneys and liver. Half-life: IV, 20U30 min; subcutaneous, IM, 3U5 hr.
USES
Somatrem, somatropin: Long-term treatment of growth failure in children caused by pituitary growth hormone (GH) deficiency. Somatropin: Treatment of growth failure in adults caused by GH deficiency, treatment of growth failure in children caused by chronic renal insufficiency, long-term treatment of short stature associated with Turner's syndrome, treatment of AIDS-related cachexia, weight loss, treatment of short bowel syndrome.
PRECAUTIONS
CONTRAINDICATIONS: Active neoplasia (either newly diagnosed or recurrent), critical illness, hypersensitivity to growth hormone. CAUTIONS: Diabetes mellitus, untreated hypothyroidism, malignancy.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug is distributed in breast milk. Pregnancy Category B (Genotropin, Genotropin Miniquick, Saizen, Serostim, Zorbitive); C (Humatrope, Norditropin, NorditropinCartridge, Nutropin, Nutropin AQ, Nutropin Depot, Protopin). Children, Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Corticosteroids: May inhibit growth response. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum alkaline phosphatase, inorganic phosphorus, and parathyroid hormone levels. May decrease glucose tolerance. May slightly decrease thyroid function.
AVAILABILITY (Rx)
INJECTION POWDER FOR RECONSTITUTION (SOMATREM [PROTOPIN]): 5 mg. INJECTION POWDER FOR RECONSTITUTION (SOMATROPIN): 0.4 mg (Genotropin Miniquick), 0.6 mg (Genotropin Miniquick), 0.8 mg (Genotropin Miniquick), 1 mg (Genotropin Miniquick), 1.2 mg (Genotropin Miniquick), 1.4 mg (Genotropin Miniquick), 1.5 mg (Genotropin, Genotropin Miniquick), 1.6 mg (Genotropin Miniquick), 1.8 mg (Genotropin Miniquick), 2 mg (Genotropin Miniquick), 4 mg (Norditropin, Serostim, Zorbitive) 5 mg (Humatrope, Nutropin, Saizen, Serostim, Zorbitive), 5.8 mg (Genotropin), 6 mg (Humatrope, Serostim, Zorbitive), 8 mg (Norditropin), 8.8 mg (Saizen, Zorbitive), 10 mg (Nutropin), 12 mg (Humatrope), 13.5 mg (Nutropin Depot), 18 mg (Nutropin Depot), 22.5 mg (Nutropin Depot), 24 mg (Humatrope). SOLUTION FOR INJECTION (SOMATROPIN [NORDITROPIN CARTRIDGE]): 15 mg/1.5 ml. INJECTION SOLUTION (SOMATROPIN [NUTROPIN AQ]): 5 mg/ml.
ADMINISTRATION/HANDLING
SOMATREM
O ALERT P Neonate: Benzyl alcohol as a preservative has been associated with fatal toxicity, e.g., gasping syndrome, in premature infants. Reconstitute with sterile water for injection only. Use only 1 dose per vial. Discard unused portion.
IM, SUBCUTANEOUS
Reconstitution N Reconstitute each 5 mg vial with 1U5 ml bacteriostatic water for injection (benzyl alcohol preserved) or each 10 mg vial with 1U10 ml bacteriostatic water for injection (benzyl alcohol preserved only). N Aim the stream of diluent against glass wall of the vial. N Swirl contents with a gentle rotary motion until completely dissolved. Do not shake (results in a cloudy solution). The solution should be clear immediately after reconstitution. If the solution is cloudy immediately after reconstitution or refrigeration, contents must not be injected.
Storage N Store in refrigeraton. N Use reconstituted vials within 14 days. N Do not freeze. N Do not use if solution is cloudy.
SOMATROPIN
O ALERT P Neonate: Benzyl alcohol as a preservative has been associated with fatal toxicity, e.g., gasping syndrome, in premature infants. Reconstitute with sterile water for injection only. Use only 1 dose per vial. Discard unused portion.
Reconstitution Humatrope: Vial: N Reconstitute with 1.5U5 ml diluent for Humatrope. N Diluent should be injected into vial by aiming stream of liquid against glass wall. N Swirl vial with a gently rotary motion until contents are completely dissolved. Do not shake. Cartridge N Reconstitute cartridge using only the diluent syringe and diluent connector. N Do not reconstitute with diluent for Humatrope provided with Humatrope vials.
Nutropin N Reconstitute each 5 mg vial with 1U5 ml bacteriostatic water for injection (benzyl alcohol preserved), or each 10 mg vial with 1U10 ml bacteriostatic water for injection (benzyl alcohol preserved only). N Aim the stream of diluent against glass wall of the vial. N Swirl contents with a gentle rotary motion until completely dissolved. Do not shake (results in a cloudy solution). The solution should be clear immediately after reconstitution. If the solution is cloudy immediately after reconstitution or refrigeration, contents must not be injected.
Storage: Humatrope: Refrigerate vials. N Do not freeze. N Reconstituted solution is stable for 14 days if reconstituted with bacteriostatic water for injection and stored in refrigerator. Reconstituted solution is stable for 24 hr if reconstituted with sterile water for injection and stored in refrigerator. If reconstituted solution is cloudy or contains precipitate, discard.
Nutropin N Refrigerate vials. N Do not freeze. N Reconstituted solution is stable for 14 days if reconstituted with bacteriostatic water for injection and stored in refrigerator. If reconstituted solution is cloudy or contains precipitate, discard.
INDICATIONS/ROUTES/DOSAGE
GROWTH HORMONE DEFICIENCY
SUBCUTANEOUS (HUMATROPE): ADULTS: 0.006 mg/kg once daily. CHILDREN: 0.18U0.3 mg/kg weekly divided into alternate-day doses or 6 doses/wk.
SUBCUTANEOUS (NUTROPIN): ADULTS: 0.006 mg/kg once daily. CHILDREN: 0.3U0.7 mg/kg weekly divided into daily doses.
SUBCUTANEOUS (NUTROPIN AQ): ADULTS: 0.006 mg/kg once daily.
SUBCUTANEOUS (GENOTROPIN): ADULTS: 0.04U0.08 mg/kg weekly divided into 6U7 equal doses/wk. CHILDREN: 0.16U0.24 mg/kg weekly divided into daily doses.
SUBCUTANEOUS (PROTOPIN): CHILDREN: 0.3 mg/kg weekly divided into daily doses.
SUBCUTANEOUS (NORDITROPIN): CHILDREN: 0.024U0.036 mg/kg/dose 6U7 times a week.
SUBCUTANEOUS (SAIZEN): CHILDREN: 0.06 mg/kg 3 times a week.
SUBCUTANEOUS ONLY (NUTROPIN DEPOT): CHILDREN: 0.75 mg/kg twice monthly or 1.5 mg/kg once monthly.
CHRONIC RENAL INSUFFICIENCY
SUBCUTANEOUS (NUTROPIN, NUTROPIN AQ): CHILDREN: 0.35 mg/kg weekly divided into daily doses.
TURNER SYNDROME
SUBCUTANEOUS (HUMATROPE, NUTROPIN, NUTROPIN AQ): CHILDREN: 0.375 mg/kg weekly divided into equal doses 3U7 times a week.
AIDS-RELATED WASTING
SUBCUTANEOUS: ADULTS WEIGHING MORE THAN 55 KG: 6 mg once a day at bedtime. ADULTS WEIGHING 45U55 KG: 5 mg once a day at bedtime. ADULTS WEIGHING 35U44 KG: 4 mg once a day at bedtime. ADULTS WEIGHING LESS THAN 35 KG: 0.1 mg/kg once a day at bedtime.
SHORT BOWEL SYNDROME
SUBCUTANEOUS (ZORBITIVE): ADULTS: 0.1 mg/kg/day. Maximum: 8 mg/day.
SIDE EFFECTS
FREQUENT: Otitis media, other ear disorders (with Turner's syndrome). OCCASIONAL: Carpal tunnel syndrome; gynecomastia; myalgia; swelling of hands, feet, or legs; fatigue; asthenia. RARE: Rash, pruritus, altered vision, headache, nausea, vomiting, injection site pain and swelling, abdominal pain, hip or knee pain.
ADVERSE REACTIONS/TOXIC EFFECTS
Glucose intolerance can occur with overdosage. Long-term overdosage with growth hormone could result in signs and symptoms of acromegaly.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Obtain baseline thyroid function, blood glucose level.
INTERVENTION/EVALUATION
Monitor bone growth, growth rate in relation to the patient's age. Monitor serum calcium, glucose, phosphorus levels, renal and parathyroid and thyroid function. Observe for decreased muscle wasting in AIDS patients.
PATIENT/FAMILY TEACHING
N Teach correct procedure to reconstitute drug for administration, safe handling and disposal of needles. N Inform patient of need for regular follow-up with physician. N Report development of severe headache, visual changes, pain in hip or knee, limping.
salmeterol
sal-met-er-all
(Serevent Diskus)
Do not confuse Serevent with Serentil.
FIXED-COMBINATION(S)
Advair: salmeterol/fluticasone (a corticosteroid): 50 mcg/100 mcg; 50 mcg/250 mcg; 50 mcg/500 mcg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Sympathomimetic (adrenergic agonist). CLINICAL: Bronchodilator.
ACTION
An adrenergic agonist that stimulates beta2-adrenergic receptors in the lungs, resulting in relaxation of bronchial smooth muscle. Therapeutic Effect: Relieves bronchospasm and reduces airway resistance.
PHARMACOKINETICS
Route Onset Peak Duration
Inhalation 10U20 min 3 hr 12 hr
Low systemic absorption; acts primarily in the lungs. Protein binding: 95%. Metabolized by hydroxylation. Primarily eliminated in feces. Half-life: 3U4 hr.
USES
Maintenance of asthma; prevention of exercise-induced bronchospasm, bronchospasm in patients with reversible obstructive airway disease. Long-term maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including emphysema, chronic bronchitis.
PRECAUTIONS
CONTRAINDICATIONS: History of hypersensitivity to sympathomimetics. CAUTIONS: Not for acute symptoms. May cause paradoxical bronchospasm, severe asthma. Patients with cardiovascular disorders (e.g., coronary insufficiency, arrhythmias, hypertension), seizure disorders, thyrotoxicosis.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if excreted in breast milk. Pregnancy Category C. Children: No age-related precautions in those older than 4 yr. Elderly: Lower dosages may be needed due to increased sympathetic sensitivity (may be more susceptible to tachycardia or tremors).
INTERACTIONS
DRUG: Beta blockers: May decrease the effects of beta blockers. MAOIs, tricyclic antidepressants: May increase the effects of salmeterol. HERBAL: None known. FOOD: None known. LAB VALUES: May decrease serum potassium level.
AVAILABILITY (Rx)
POWDER FOR ORAL INHALATION: 50 mcg.
ADMINISTRATION/HANDLING
INHALATION
N Shake container well. Instruct the patient to exhale completely through mouth; place mouthpiece into mouth and close lips, holding inhaler upright. N Have the patient inhale deeply through mouth while fully depressing the top of canister. Hold breath as long as possible before exhaling slowly. N Wait 2 min before second dose (allows for deeper bronchial penetration). N Rinse mouth with water immediately after inhalation (prevents mouth/throat dryness).
INDICATIONS/ROUTES/DOSAGE
PREVENTION AND MAINTENANCE TREATMENT OF ASTHMA
INHALATION (DISKUS): ADULTS, ELDERLY, CHILDREN 4 YR AND OLDER: 1 inhalation (50 mcg) q12h.
PREVENTION OF EXERCISE-INDUCED BRONCHOSPASM
INHALATION (DISKUS): ADULTS, ELDERLY, CHILDREN 4 YR AND OLDER: 1 inhalation at least 30 min before exercise.
COPD
INHALATION (DISKUS): ADULTS, ELDERLY: 1 inhalation q12h.
SIDE EFFECTS
FREQUENT (28%): Headache. OCCASIONAL (7%U3%): Cough, tremor, dizziness, vertigo, throat dryness or irritation, pharyngitis. RARE (3%): Palpitations, tachycardia, nausea, heartburn, GI distress, diarrhea.
ADVERSE REACTIONS/TOXIC EFFECTS
Salmeterol may prolong the QT interval, which may precipitate ventricular arrhythmias. Hypokalemia and hyperglycemia may occur.
NURSING CONSIDERATION
INTERVENTION/EVALUATION
Monitor rate, depth, rhythm, type of respiration; quality and rate of pulse, BP. Assess lungs for wheezing, rales, rhonchi. Periodically evaluate serum potassium levels.
PATIENT/FAMILY TEACHING
N Not for relief of acute episodes. N Keep canister at room temperature (cold decreases effects). N Do not stop medication or exceed recommended dosage. N Notify physician promptly of chest pain, dizziness. N Wait at least 1 full min before second inhalation. N Administer dose 30U60 min before exercise when used to prevent exercise-induced bronchospasm. N Avoid excessive use of caffeine derivatives: coffee, tea, colas, chocolate.
saquinavir
sa-kwin-a-veer
(Invirase)
Do not confuse saquinavir with Sinequan.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Protease inhibitor. CLINICAL: Antiretroviral.
ACTION
Inhibits HIV protease, rendering the enzyme incapable of processing the polyprotein precursors needed to generate functional proteins in HIV-infected cells. Therapeutic Effect: Interferes with HIV replication, slowing the progression of HIV infection.
PHARMACOKINETICS
Poorly absorbed after PO administration (absorption increased with high-calorie and high-fat meals). Protein binding: 99%. Metabolized in the liver to inactive metabolite. Primarily eliminated in feces. Unknown if removed by hemodialysis. Half-life: 13 hr.
USES
Treatment of HIV infection in combination with other antiretroviral agents.
PRECAUTIONS
CONTRAINDICATIONS: Concurrent use with ergot medications, lovastatin, midazolam, simvastatin, or triazolam. CAUTIONS: Diabetes mellitus, hepatic impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Breast-feeding not recommended (possibility of HIV transmission). Pregnancy Category B. Children: Safety and efficacy not established. Elderly: Information not available.
INTERACTIONS
DRUG: Calcium channel blockers, clindamycin, dapsone, quinidine, triazolam: May increase the plasma concentrations of these drugs. Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin: May reduce saquinavir plasma concentration. Ketoconazole: Increases saquinavir plasma concentration. HERBAL: Garlic, St. John's
AVAILABILITY (Rx)
CAPSULES (INVIRASE): 200 mg. TABLETS (INVIRASE): 500 mg.
ADMINISTRATION/HANDLING
N Give within 2 hr after a full meal (if taken without food in stomach, may result in no antiviral activity).
INDICATIONS/ROUTES/DOSAGE
HIV INFECTION IN COMBINATION WITH OTHER ANTIRETROVIRALS
DOSAGE ADJUSTMENTS WHEN GIVEN IN COMBINATION THERAPY
Delavirdine: Fortovase 800 mg 3 times a day. Lopinavir/ritonavir: Fortovase 800 mg twice a day. Nelfinavir: Fortovase 800 mg 3 times a day or 1,200 mg twice a day. Ritonavir: Fortovase or Invirase 1,000 mg twice a day.
SIDE EFFECTS
OCCASIONAL: Diarrhea, abdominal discomfort and pain, nausea, photosensitivity, stomatitis. RARE: Confusion, ataxia, asthenia, headache, rash.
ADVERSE REACTIONS/TOXIC EFFECTS
Ketoacidosis occurs rarely.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Obtain baseline laboratory testing, especially liver function tests, before beginning saquinavir therapy and at periodic intervals during therapy. Offer emotional support. Obtain medication history.
INTERVENTION/EVALUATION
Monitor serum liver function tests, triglycerides, glucose, CD4 cell count, HIV RNA levels. Closely monitor for evidence of GI discomfort. Monitor pattern of bowel activity and stool consistency. Inspect mouth for signs of mucosal ulceration. Monitor serum chemistry tests for marked laboratory abnormalities. If serious or severe toxicities occur, interrupt therapy, contact physician.
PATIENT/FAMILY TEACHING
N Report persistent abdominal pain, nausea, vomiting. N Avoid exposure to sunlight, artificial light sources. N Continue therapy for full length of treatment. N Doses should be evenly spaced. N Saquinavir is not a cure for HIV infection, nor does it reduce risk of transmission to others. N Patients may continue to acquire illnesses associated with advanced HIV infection. N Take within 2 hr after a full meal. N Avoid coadministration with grapefruit products.
somatrem
soe-ma-trem
(Protopin)
somatropin
soe-mah-troe-pin
(Genotropin, Genotropin Miniquick, Humatrope, Norditropin, Norditropin Cartridge, Nutropin, Nutropin AQ, Nutropin Depot, Saizen, Serostim, Zorbitive)
Do not confuse Protopin with Proloprim, Protamine, or Protopam or somatropin with sumatriptan.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Polypeptide hormone. CLINICAL: Growth hormone.
ACTION
A polypeptide hormone that stimulates cartilaginous growth areas of long bones, increases the number and size of skeletal muscle cells, influences the size of organs, and increases RBC mass by stimulating erythropoietin. Influences the metabolism of carbohydrates (decreases insulin sensitivity), fats (mobilizes fatty acids), minerals (retains phosphorus, sodium, potassium by promotion of cell growth), and proteins (increases protein synthesis). Therapeutic Effect: Stimulates growth.
PHARMACOKINETICS
Well absorbed after subcutaneous or IM administration. Localized primarily in the kidneys and liver. Half-life: IV, 20U30 min; subcutaneous, IM, 3U5 hr.
USES
Somatrem, somatropin: Long-term treatment of growth failure in children caused by pituitary growth hormone (GH) deficiency. Somatropin: Treatment of growth failure in adults caused by GH deficiency, treatment of growth failure in children caused by chronic renal insufficiency, long-term treatment of short stature associated with Turner's syndrome, treatment of AIDS-related cachexia, weight loss, treatment of short bowel syndrome.
PRECAUTIONS
CONTRAINDICATIONS: Active neoplasia (either newly diagnosed or recurrent), critical illness, hypersensitivity to growth hormone. CAUTIONS: Diabetes mellitus, untreated hypothyroidism, malignancy.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug is distributed in breast milk. Pregnancy Category B (Genotropin, Genotropin Miniquick, Saizen, Serostim, Zorbitive); C (Humatrope, Norditropin, NorditropinCartridge, Nutropin, Nutropin AQ, Nutropin Depot, Protopin). Children, Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Corticosteroids: May inhibit growth response. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum alkaline phosphatase, inorganic phosphorus, and parathyroid hormone levels. May decrease glucose tolerance. May slightly decrease thyroid function.
AVAILABILITY (Rx)
INJECTION POWDER FOR RECONSTITUTION (SOMATREM [PROTOPIN]): 5 mg. INJECTION POWDER FOR RECONSTITUTION (SOMATROPIN): 0.4 mg (Genotropin Miniquick), 0.6 mg (Genotropin Miniquick), 0.8 mg (Genotropin Miniquick), 1 mg (Genotropin Miniquick), 1.2 mg (Genotropin Miniquick), 1.4 mg (Genotropin Miniquick), 1.5 mg (Genotropin, Genotropin Miniquick), 1.6 mg (Genotropin Miniquick), 1.8 mg (Genotropin Miniquick), 2 mg (Genotropin Miniquick), 4 mg (Norditropin, Serostim, Zorbitive) 5 mg (Humatrope, Nutropin, Saizen, Serostim, Zorbitive), 5.8 mg (Genotropin), 6 mg (Humatrope, Serostim, Zorbitive), 8 mg (Norditropin), 8.8 mg (Saizen, Zorbitive), 10 mg (Nutropin), 12 mg (Humatrope), 13.5 mg (Nutropin Depot), 18 mg (Nutropin Depot), 22.5 mg (Nutropin Depot), 24 mg (Humatrope). SOLUTION FOR INJECTION (SOMATROPIN [NORDITROPIN CARTRIDGE]): 15 mg/1.5 ml. INJECTION SOLUTION (SOMATROPIN [NUTROPIN AQ]): 5 mg/ml.
ADMINISTRATION/HANDLING
SOMATREM
O ALERT P Neonate: Benzyl alcohol as a preservative has been associated with fatal toxicity, e.g., gasping syndrome, in premature infants. Reconstitute with sterile water for injection only. Use only 1 dose per vial. Discard unused portion.
IM, SUBCUTANEOUS
Reconstitution N Reconstitute each 5 mg vial with 1U5 ml bacteriostatic water for injection (benzyl alcohol preserved) or each 10 mg vial with 1U10 ml bacteriostatic water for injection (benzyl alcohol preserved only). N Aim the stream of diluent against glass wall of the vial. N Swirl contents with a gentle rotary motion until completely dissolved. Do not shake (results in a cloudy solution). The solution should be clear immediately after reconstitution. If the solution is cloudy immediately after reconstitution or refrigeration, contents must not be injected.
Storage N Store in refrigeraton. N Use reconstituted vials within 14 days. N Do not freeze. N Do not use if solution is cloudy.
SOMATROPIN
O ALERT P Neonate: Benzyl alcohol as a preservative has been associated with fatal toxicity, e.g., gasping syndrome, in premature infants. Reconstitute with sterile water for injection only. Use only 1 dose per vial. Discard unused portion.
Reconstitution Humatrope: Vial: N Reconstitute with 1.5U5 ml diluent for Humatrope. N Diluent should be injected into vial by aiming stream of liquid against glass wall. N Swirl vial with a gently rotary motion until contents are completely dissolved. Do not shake. Cartridge N Reconstitute cartridge using only the diluent syringe and diluent connector. N Do not reconstitute with diluent for Humatrope provided with Humatrope vials.
Nutropin N Reconstitute each 5 mg vial with 1U5 ml bacteriostatic water for injection (benzyl alcohol preserved), or each 10 mg vial with 1U10 ml bacteriostatic water for injection (benzyl alcohol preserved only). N Aim the stream of diluent against glass wall of the vial. N Swirl contents with a gentle rotary motion until completely dissolved. Do not shake (results in a cloudy solution). The solution should be clear immediately after reconstitution. If the solution is cloudy immediately after reconstitution or refrigeration, contents must not be injected.
Storage: Humatrope: Refrigerate vials. N Do not freeze. N Reconstituted solution is stable for 14 days if reconstituted with bacteriostatic water for injection and stored in refrigerator. Reconstituted solution is stable for 24 hr if reconstituted with sterile water for injection and stored in refrigerator. If reconstituted solution is cloudy or contains precipitate, discard.
Nutropin N Refrigerate vials. N Do not freeze. N Reconstituted solution is stable for 14 days if reconstituted with bacteriostatic water for injection and stored in refrigerator. If reconstituted solution is cloudy or contains precipitate, discard.
INDICATIONS/ROUTES/DOSAGE
GROWTH HORMONE DEFICIENCY
SUBCUTANEOUS (HUMATROPE): ADULTS: 0.006 mg/kg once daily. CHILDREN: 0.18U0.3 mg/kg weekly divided into alternate-day doses or 6 doses/wk.
SUBCUTANEOUS (NUTROPIN): ADULTS: 0.006 mg/kg once daily. CHILDREN: 0.3U0.7 mg/kg weekly divided into daily doses.
SUBCUTANEOUS (NUTROPIN AQ): ADULTS: 0.006 mg/kg once daily.
SUBCUTANEOUS (GENOTROPIN): ADULTS: 0.04U0.08 mg/kg weekly divided into 6U7 equal doses/wk. CHILDREN: 0.16U0.24 mg/kg weekly divided into daily doses.
SUBCUTANEOUS (PROTOPIN): CHILDREN: 0.3 mg/kg weekly divided into daily doses.
SUBCUTANEOUS (NORDITROPIN): CHILDREN: 0.024U0.036 mg/kg/dose 6U7 times a week.
SUBCUTANEOUS (SAIZEN): CHILDREN: 0.06 mg/kg 3 times a week.
SUBCUTANEOUS ONLY (NUTROPIN DEPOT): CHILDREN: 0.75 mg/kg twice monthly or 1.5 mg/kg once monthly.
CHRONIC RENAL INSUFFICIENCY
SUBCUTANEOUS (NUTROPIN, NUTROPIN AQ): CHILDREN: 0.35 mg/kg weekly divided into daily doses.
TURNER SYNDROME
SUBCUTANEOUS (HUMATROPE, NUTROPIN, NUTROPIN AQ): CHILDREN: 0.375 mg/kg weekly divided into equal doses 3U7 times a week.
AIDS-RELATED WASTING
SUBCUTANEOUS: ADULTS WEIGHING MORE THAN 55 KG: 6 mg once a day at bedtime. ADULTS WEIGHING 45U55 KG: 5 mg once a day at bedtime. ADULTS WEIGHING 35U44 KG: 4 mg once a day at bedtime. ADULTS WEIGHING LESS THAN 35 KG: 0.1 mg/kg once a day at bedtime.
SHORT BOWEL SYNDROME
SUBCUTANEOUS (ZORBITIVE): ADULTS: 0.1 mg/kg/day. Maximum: 8 mg/day.
SIDE EFFECTS
FREQUENT: Otitis media, other ear disorders (with Turner's syndrome). OCCASIONAL: Carpal tunnel syndrome; gynecomastia; myalgia; swelling of hands, feet, or legs; fatigue; asthenia. RARE: Rash, pruritus, altered vision, headache, nausea, vomiting, injection site pain and swelling, abdominal pain, hip or knee pain.
ADVERSE REACTIONS/TOXIC EFFECTS
Glucose intolerance can occur with overdosage. Long-term overdosage with growth hormone could result in signs and symptoms of acromegaly.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Obtain baseline thyroid function, blood glucose level.
INTERVENTION/EVALUATION
Monitor bone growth, growth rate in relation to the patient's age. Monitor serum calcium, glucose, phosphorus levels, renal and parathyroid and thyroid function. Observe for decreased muscle wasting in AIDS patients.
PATIENT/FAMILY TEACHING
N Teach correct procedure to reconstitute drug for administration, safe handling and disposal of needles. N Inform patient of need for regular follow-up with physician. N Report development of severe headache, visual changes, pain in hip or knee, limping.
stavudine (d4T)
stay-view-deen
(Zerit)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Nucleoside reverse transcriptase inhibitor. CLINICAL: Antiviral.
ACTION
Inhibits HIV reverse transcriptase by terminating the viral DNA chain. Also inhibits RNA- and DNA-dependent DNA polymerase, an enzyme necessary for HIV replication. Therapeutic Effect: Impedes HIV replication, slowing the progression of HIV infection.
PHARMACOKINETICS
Rapidly and completely absorbed after PO administration. Undergoes minimal metabolism. Excreted in urine. Half-life: 1.5 hr (increased in renal impairment).
USES
Treatment of HIV infection, in combination with other agents.
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: History of peripheral neuropathy, renal or hepatic impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Breast-feeding not recommended (possibility of HIV transmission). Pregnancy Category C. Children: No age-related precautions noted. Elderly: Information not available.
INTERACTIONS
DRUG: Didanosine, ethambutol, isoniazid, lithium, phenytoin, zalcitabine: May increase the risk of peripheral neuropathy development. Didanosine, hydroxyurea: May increase the risk of hepatotoxicity. Zidovudine: May have antagonistic antiviral effect. HERBAL: None known. FOOD: None known. LAB VALUES: Commonly increases AST and ALT levels. May decrease neutrophil count.
AVAILABILITY (Rx)
CAPSULES: 15 mg, 20 mg, 30 mg, 40 mg. ORAL SOLUTION: 1 mg/ml.
ADMINISTRATION/HANDLING
N Give without regard to meals.
INDICATIONS/ROUTES/DOSAGE
HIV INFECTION
DOSAGE IN RENAL IMPAIRMENT
Dosage and frequency are modified based on creatinine clearance and patient weight.
SIDE EFFECTS
FREQUENT: Headache (55%), diarrhea (50%), chills and fever (38%), nausea and vomiting, myalgia (35%), rash (33%), asthenia (28%), insomnia, abdominal pain (26%), anxiety (22%), arthralgia (18%), back pain (20%), diaphoresis (19%), malaise (17%), depression (14%). OCCASIONAL: Anorexia, weight loss, nervousness, dizziness, conjunctivitis, dyspepsia, dyspnea. RARE: Constipation, vasodilation, confusion, migraine, urticaria, abnormal vision.
ADVERSE REACTIONS/TOXIC EFFECTS
Peripheral neuropathy, (numbness, tingling, or pain in the hands and feet) occurs in 15%U21% of patients. Ulcerative stomatitis (erythema or ulcers of oral mucosa, glossitis, gingivitis), pneumonia, and benign skin neoplasms occur occasionally. Pancreatitis, hepatomegaly, and lactic acidosis have been reported.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Obtain baseline laboratory testing, especially serum liver function tests, before beginning stavudine therapy and at periodic intervals during therapy. Offer emotional support to patient and family. Question for previous history of peripheral neuropathy.
INTERVENTION/EVALUATION
Monitor for peripheral neuropathy (characterized by paraesthesia in extremities). Symptoms resolve promptly if therapy is discontinued (symptoms may worsen temporarily after drug is withdrawn). If symptoms resolve completely, reduced dosage may be resumed. Assess for headache, nausea, vomiting, myalgia. Monitor skin for evidence of rash, signs of fever. Determine pattern of bowel activity and stool consistency. Assess for myalgia, arthralgia, dizziness. Monitor sleep patterns. Assess eating pattern; monitor for weight loss. Check eyes for signs of conjunctivitis. Monitor CBC, Hgb, serum liver and renal function, CD4 cell count, HIV RNA levels.
PATIENT/FAMILY TEACHING
N Continue therapy for full length of treatment. N Doses should be evenly spaced. N Do not take any medications, including OTC drugs, without consulting physician. N Stavudine is not a cure for HIV infection, nor does it reduce risk of transmission to others. N Patient may continue to experience illnesses, including opportunistic infections. N Report tingling, burning, pain, numbness, abdominal discomfort, nausea, vomiting, fatigue, dyspnea, weakness.
sumatriptan
soo-ma-trip-tan
(Imitrex, Imitrex Nasal, Imitrex Statdose, Imitrex Statdose Refill)
Do not confuse sumatriptan with somatropin.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Serotonin receptor agonist. CLINICAL: Antimigraine.
ACTION
A serotonin receptor agonist that binds selectively to vascular receptors, producing a vasoconstrictive effect on cranial blood vessels. Therapeutic Effect: Relieves migraine headache.
PHARMACOKINETICS
Rapidly absorbed after subcutaneous administration. Absorption after PO administration is incomplete, with significant amounts undergoing hepatic metabolism, resulting in low bioavailability (about 14%). Protein binding: 10%U21%. Widely distributed. Undergoes first-pass metabolism in the liver. Excreted in urine. Half-life: 2 hr.
USES
Acute treatment of migraine headache with or without aura; treatment of cluster headaches.
PRECAUTIONS
CONTRAINDICATIONS: Cerebrovascular accident (CVA), ischemic heart disease (including angina pectoris, history of MI, silent ischemia, and Prinzmetal's angina), severe hepatic impairment, transient ischemic attack, uncontrolled hypertension, use within 14 days of MAOIs, use within 24 hr of ergotamine preparations. CAUTIONS: Hepatic or renal impairment, epilepsy, hypersensitivity to sulfonamides.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Ergotamine-containing medications: May produce vasospastic reaction.MAOIs: May increase sumatriptan blood concentration and half-life. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
TABLETS (IMITREX): 25 mg, 50 mg, 100 mg. INJECTION (IMITREX, IMITREX STATDOSE): 6 mg/0.5 ml, 4 mg prefilled cartridge. NASAL SPRAY (IMITREX NASAL): 5 mg, 20 mg.
ADMINISTRATION/HANDLING
SUBCUTANEOUS
N Follow patient instructions provided by manufacturer using autoinjection device.
N Swallow tablets whole. N Take with full glass of water.
NASAL
N Unit contains only one spray—do not test before use. N Instruct the patient to gently blow nose to clear nasal passages. N With head upright, have the patient close one nostril with index finger and breathe out gently through mouth. N Insert nozzle into open nostril about ½ inch. N Instruct the patient to close mouth, and while taking a breath through nose, release spray dosage by firmly pressing the blue plunger. N Remove nozzle from nose and instruct the patient to gently breathe in through nose and out through mouth for 10U20 sec. Advise the patient not to breathe in deeply.
INDICATIONS/ROUTES/DOSAGE
ACUTE MIGRAINE ATTACK
SUBCUTANEOUS: ADULTS, ELDERLY: 6 mg. Maximum: Two 6-mg injections/24 hr (separated by at least 1 hr).
INTRANASAL: ADULTS, ELDERLY: 5U20 mg; may repeat in 2 hr. Maximum: 40 mg/24 hr.
SIDE EFFECTS
FREQUENT: Oral (10%U5%): Tingling, nasal discomfort. Subcutaneous (greater than 10%): Injection site reactions, tingling, warm or hot sensation, dizziness, vertigo. Nasal (greater than 10%): Bad or unusual taste, nausea, vomiting. OCCASIONAL: Oral (5%U1%): Flushing , asthenia, visual disturbances. Subcutaneous (10%U2%): Burning sensation, numbness, chest discomfort, drowsiness, asthenia. Nasal (5%U1%): Nasopharyngeal discomfort, dizziness. RARE: Oral (less than 1%): Agitation, eye irritation, dysuria. Subcutaneous (less than 2%): Anxiety, fatigue, diaphoresis, muscle cramps, myalgia. Nasal (less than 1%): Burning sensation.
ADVERSE REACTIONS/TOXIC EFFECTS
Excessive dosage may produce tremor, red extremities, reduced respirations, cyanosis, seizures, and paralysis. Serious arrhythmias occur rarely, especially in patients with hypertension, diabetes, or a strong family history of coronary artery disease; obese patients; and smokers.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Question for history of peripheral vascular disease, renal or hepatic impairment, possibility of pregnancy. Question regarding onset, location, duration of migraine and possible precipitating symptoms.
INTERVENTION/EVALUATION
Evaluate for relief of migraine headache and resulting photophobia, phonophobia (sound sensitivity), nausea, vomiting.
PATIENT/FAMILY TEACHING
N Teach patient proper loading of autoinjector, injection technique, and discarding of syringe. N Do not use more than 2 injections during any 24Uhr period and allow at least 1 hr between injections. N If wheezing, palpitations, skin rash, facial swelling, pain or tightness in chest or throat occurs, contact physician immediately.
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