valacyclovir
val-a-sye-kloe-ver
(Valtrex)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Antiviral. CLINICAL: Antiherpetic agent.
ACTION
A virustatic antiviral that is converted to acyclovir triphosphate, becoming part of the viral DNA chain. Therapeutic Effect: Interferes with DNA synthesis and replication of herpes simplex virus and varicella-zoster virus.
PHARMACOKINETICS
Rapidly absorbed after PO administration. Protein binding: 13%U18%. Rapidly converted by hydrolysis to the active compound acyclovir. Widely distributed to tissues and body fluids (including cerebrospinal fluid [CSF]). Primarily eliminated in urine. Removed by hemodialysis. Half-life: 2.5U3.3 hr (increased in impaired renal function).
USES
Treatment of herpes zoster (shingles) in immunocompetent adults. Episodic treatment of recurrent genital herpes in immunocompetent adults. Prevention of recurrent genital herpes. Treatment of initial genital herpes. Treatment of cold sores. OFF-LABEL: To reduce the risk of heterosexual transmission of genital herpes.
PRECAUTIONS
CONTRAINDICATIONS: Hypersensitivity to or intolerance of acyclovir, valacyclovir, or their components. CAUTIONS: Bone marrow or renal transplantation, advanced HIV infections, renal or hepatic impairment, dehydration, fluid or electrolyte imbalance, concurrent use of nephrotoxic agents, neurologic abnormalities.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: May cross placenta. May be distributed in breast milk. Pregnancy Category B. Children: Safety and efficacy not established. Elderly: Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Cimetidine, probenecid: May increase acyclovir blood concentration. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
CAPLETS: 500 mg, 1000 mg.
ADMINISTRATION/HANDLING
N Give without regard to meals. N Do not crush, break caplets.
INDICATIONS/ROUTES/DOSAGE
HERPES ZOSTER (SHINGLES)
HERPES SIMPLEX (COLD SORES)
INITIAL EPISODE OF GENITAL HERPES
RECURRENT EPISODES OF GENITAL HERPES
PREVENTION OF GENITAL HERPES
DOSAGE IN RENAL IMPAIRMENT
Dosage and frequency are modified based on creatinine clearance.
SIDE EFFECTS
FREQUENT: Herpes zoster (17%U10%): Nausea, headache. Genital herpes (17%): Headache. OCCASIONAL: Herpes zoster (7%U3%): Vomiting, diarrhea, constipation (50 yr or older), asthenia, dizziness (50 yr and older). Genital herpes (8%U3%): Nausea, diarrhea, dizziness. RARE: Herpes zoster (3%U1%): Abdominal pain, anorexia. Genital herpes (3%U1%): Asthenia, abdominal pain.
ADVERSE REACTIONS/TOXIC EFFECTS
Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) has occurred in patients with advanced HIV disease and also in allogenic bone marrow transplant and renal transplant recipients taking valacyclovir at doses of 8 g/day.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Question for history of allergies, particularly to valacyclovir, acyclovir. Tissue cultures for herpes zoster, herpes simplex should be done before giving first dose (therapy may proceed before results are known). Assess medical history, especially advanced HIV infection, bone marrow or renal transplantation, hepatic or renal impairment.
INTERVENTION/EVALUATION
Evaluate cutaneous lesions. Monitor serum renal and liver function tests, CBC, urinalysis. Manage herpes zoster with strict isolation. Provide analgesics, comfort measures for herpes zoster (especially exhausting to elderly). Encourage fluids. Keep patient's fingernails short, hands clean.
PATIENT/FAMILY TEACHING
N Drink adequate fluids. N Do not touch lesions with fingers to avoid spreading infection to new site. N Genital Herpes: Continue therapy for full length of treatment. N Space doses evenly. N Avoid sexual intercourse during duration of lesions to prevent infecting partner. N Valacyclovir does not cure herpes. N Notify physician if lesions recur or do not improve. N Pap smears should be done at least annually due to increased risk of cervical cancer in women with genital herpes. N Initiate treatment at first sign of a recurrent episode of genital herpes or herpes zoster (early treatment within first 24U48 hr is imperative for therapeutic results).
valproic acid
val-pro-ick
(Depakene)
valproate sodium
(Depakene syrup)
divalproex sodium
(Depacon, Depakote, Depakote ER, Depakote Sprinkle)
CLASSIFICATION
CLINICAL: Anticonvulsant, antimanic, antimigraine.
ACTION
An anticonvulsant, antimanic, and antimigraine agent that directly increases concentration of the inhibitory neurotransmitter gamma-aminobutyric acid. Therapeutic Effect: Reduces seizure activity.
PHARMACOKINETICS
Well absorbed from the GI tract. Protein binding: 80%U90%. Metabolized in the liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 6U16 hr (may be increased in hepatic impairment, the elderly, and children younger than 18 mo).
USES
Prophylaxis of absence seizures (petit mal), myoclonic, tonic-clonic seizure control. Used principally as adjunct with other anticonvulsant agents. Treatment of manic episodes with bipolar disorders, complex partial seizures. Prophylaxis of migraine headaches. OFF-LABEL: Prevention of migraine; treatment of behavior disorders in Alzheimer's disease; bipolar disorder; chorea, myoclonic, simple partial, and tonic-clonic seizures; organic brain syndrome; schizophrenia; status epilepticus; tardive dyskinesia.
PRECAUTIONS
CONTRAINDICATIONS: Active hepatic disease, urea cycle disorders. CAUTIONS: History of hepatic disease, bleeding abnormalities.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Drug crosses placenta; is distributed in breast milk. Pregnancy Category D. Children: Increased risk of hepatotoxicity in those younger than 2 yr. Elderly: No age-related precautions, but lower dosages recommended.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS depressant effects. Amitriptyline, primidone: May increase the blood concentration of these drugs. Anticoagulants, heparin, platelet aggregation inhibitors, thrombolytics: May increase the risk of bleeding. Carbamazepine: May decrease valproic acid blood concentration. Hepatotoxic medications: May increase the risk of hepatotoxicity. Phenytoin: May increase the risk of phenytoin toxicity and decrease the effects of valproic acid. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum LDH, bilirubin, AST, and ALT levels. Therapeutic serum level is 50U100 mcg/ml; toxic serum level is greater than 100 mcg/ml.
AVAILABILITY (Rx)
CAPSULES (DEPAKENE): 250 mg. SYRUP (DEPAKENE): 250 mg/5 ml. TABLETS (DELAYED-RELEASE [DEPAKOTE]): 125 mg, 250 mg, 500 mg. TABLETS (EXTENDED-RELEASE [DEPAKOTE ER]): 250 mg, 500 mg. CAPSULES SPRINKLES (DEPAKOTE SPRINKLE): 125 mg. INJECTION (DEPACON): 100 mg/ml.
ADMINISTRATION/HANDLING
L IV
Reconstitution N Dilute each single dose with at least 50 ml D5W, 0.9% NaCl, or lactated Ringer's.
Rate of administration N Infuse over 5U10 min. N Do not exceed rate of 3 mg/kg/min (5-min infusion) or 1.5 mg/kg/min (10-min infusion). Too rapid infusion increases side effects.
Storage N Store vials at room temperature. N Diluted solutions stable for 24 hr. N Discard unused portion.
N May give with or without regard to food. Do not administer with carbonated drinks. N May sprinkle capsule contents on applesauce and give immediately (do not break, crush sprinkle beads). N Delayed-release and extended-release tablets to be given whole.
D IV INCOMPATIBILITIES
Do not mix valproic acid with any other medications.
INDICATIONS/ROUTES/DOSAGE
SEIZURES
IV: ADULTS, ELDERLY, CHILDREN: Same as oral dose but given q6h.
MANIC EPISODES
PREVENTION OF MIGRAINE HEADACHES
SIDE EFFECTS
FREQUENT: Epilepsy: Abdominal pain, irregular menses, diarrhea, transient alopecia, indigestion, nausea, vomiting, tremors, weight gain or loss. Mania (22%U19%): Nausea, somnolence. OCCASIONAL: Epilepsy: Constipation, dizziness, drowsiness, headache, skin rash, unusual excitement, restlessness. Mania (12%U6%): Asthenia, abdominal pain, dyspepsia (heartburn, indigestion, epigastric distress), rash. RARE: Epilepsy: Mood changes, diplopia, nystagmus, spots before eyes, unusual bleeding or ecchymosis.
ADVERSE REACTIONS/TOXIC EFFECTS
Blood dyscrasias may occur.
O ALERT P Hepatotoxicity may occur, particularly in the first 6 mo of valproic acid therapy. It may be preceded by loss of seizure control, malaise, weakness, lethargy, anorexia, and vomiting rather than abnormal serum liver function test results.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Anticonvulsant: Review history of seizure disorder (intensity, frequency, duration, level of consciousness [LOC]). Initiate safety measures, quiet dark environment. CBC, platelet count should be performed before and 2 wk after therapy begins, then 2 wk following maintenance dose. Antimanic: Assess behavior, appearance, emotional status, response to environment, speech pattern, thought content. Antimigraine: Question patient regarding onset, location, duration of migraine, possible precipitating symptoms.
INTERVENTION/EVALUATION
Monitor serum liver function tests, bilirubin, ammonia, CBC, platelets. Anticonvulsant: Observe frequently for recurrence of seizure activity. Monitor serum liver function tests, CBC, platelet count. Assess skin for ecchymoses, petechiae. Monitor for clinical improvement (decrease in intensity/frequency of seizures). Antimanic: Assess for therapeutic response (interest in surroundings, increased ability to concentrate, relaxed facial expression). Antimigraine: Evaluate for relief of migraine headache and resulting photophobia, phonophobia, nausea, vomiting. Therapeutic serum level: 50U100 mcg/ml; toxic serum level: over 100 mcg/ml.
PATIENT/FAMILY TEACHING
N Do not abruptly withdraw medication after long-term use (may precipitate seizures). N Strict maintenance of drug therapy is essential for seizure control. N Drowsiness usually disappears during continued therapy. N Avoid tasks that require alertness, motor skills until response to drug is established. N Avoid alcohol. N Carry identification card or bracelet to note anticonvulsant therapy. N Inform physician if nausea, vomiting, lethargy, altered mental status, weakness, loss of appetite, abdominal pain, yellowing of skin, unusual bruising or bleeding occurs.
valsartan
val-sar-tan
(Diovan)
Do not confuse valsartan with Valstan.
FIXED-COMBINATION(S)
Diovan HCT: valsartan/hydrochlorothiazide (a diuretic): 80 mg/12.5 mg; 160 mg/12.5 mg; 160 mg/25 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Angiotensin II receptor antagonist. CLINICAL: Antihypertensive.
ACTION
An angiotensin II receptor, type AT1, antagonist that blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II, inhibiting the binding of angiotensin II to the AT1 receptors. Therapeutic Effect: Causes vasodilation, decreases peripheral resistance, and decreases BP.
PHARMACOKINETICS
Poorly absorbed after PO administration. Food decreases peak plasma concentration. Protein binding: 95%. Metabolized in the liver. Recovered primarily in feces and, to a lesser extent, in urine. Unknown if removed by hemodialysis. Half-life: 6 hr.
USES
Treatment of hypertension alone or in combination with other antihypertensives. Treatment of heart failure. Reduce cardiovascular deaths in high risk patients (left ventricular failure, dysfunction) after heart attack. OFF-LABEL: Diabetic nephropathy.
PRECAUTIONS
CONTRAINDICATIONS: Bilateral renal artery stenosis, biliary cirrhosis or obstruction, hypoaldosteronism, severe hepatic impairment. CAUTIONS: Concurrent use of potassium-sparing diuretics or potassium supplements, mild to moderate hepatic impairment, CHF, unilateral renal artery stenosis, coronary artery disease.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: May cause fetal harm. Unknown if distributed in breast milk. Pregnancy Category C (D if used in second or third trimester). Children: Safety and efficacy not established. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Diuretics: Produce additive hypotensive effects. HERBAL: None known. FOOD: All foods: Decrease peak plasma concentration of valsartan. LAB VALUES: May increase AST, ALT, and serum bilirubin, creatinine, and potassium levels. May decrease blood Hgb and Hct levels.
AVAILABILITY (Rx)
TABLETS: 40 mg, 80 mg, 160 mg, 320 mg.
ADMINISTRATION/HANDLING
N Give without regard to meals.
INDICATIONS/ROUTES/DOSAGE
HYPERTENSION
CHF
POST HEART ATTACK
SIDE EFFECTS
RARE (2%U1%): Insomnia, fatigue, heartburn, abdominal pain, dizziness, headache, diarrhea, nausea, vomiting, arthralgia, edema.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdosage may manifest as hypotension and tachycardia. Bradycardia occurs less often. Viral infection and upper respiratory tract infection (cough, pharyngitis, sinusitis, rhinitis) occur rarely.
NURISNG CONSIDERATION
BASELINE ASSESSMENT
Obtain BP, apical pulse immediately before each dose, in addition to regular monitoring (be alert to fluctuations). If excessive reduction in BP occurs, place patient in supine position, feet slightly elevated. Question for possibility of pregnancy. Assess medication history (especially diuretic). Question for history of hepatic or renal impairment, renal artery stenosis, history of severe CHF. Obtain BUN, AST, ALT, serum creatinine, alkaline phosphatase, bilirubin, Hgb, Hct.
INTERVENTION/EVALUATION
Maintain hydration (offer fluids frequently). Assess for evidence of upper respiratory infection. Monitor serum electrolytes, renal and liver function tests, urinalysis, BP, pulse. Observe for symptoms of hypotension.
PATIENT/FAMILY TEACHING
N Inform female patient regarding consequences of second- and third-trimester exposure to valsartan. N Report pregnancy to physician as soon as possible. N Report any sign of infection (sore throat, fever). N Do not stop taking medication. N Caution against exercising during hot weather (risk of dehydration, hypotension).
vancomycin hydrochloride
van-koe-mye-sin
(Lyphocin, Vancocin, Vancocin HCl Pulvules)
CLASSIFICATION
CLINICAL: Tricyclic glycopeptide antibiotic.
ACTION
A tricyclic glycopeptide antibiotic that binds to bacterial cell walls, altering cell membrane permeability and inhibiting RNA synthesis. Therapeutic Effect: Bactericidal.
PHARMACOKINETICS
USES
Systemic: Treatment of infections caused by staphylococcal and streptococcal species. PO : Treatment of antibiotic colitis, pseudomembranous colitis, antibiotic-associated diarrhea, staphylococcal enterocolitis. OFF-LABEL: Treatment of brain abscess, perioperative infections, staphylococcal or streptococcal meningitis.
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Renal dysfunction, preexisting hearing impairment, concurrent therapy with other ototoxic or nephrotoxic medications.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Drug crosses placenta. Unknown if distributed in breast milk. Pregnancy Category B. Children: Close monitoring of serum levels recommended in premature neonates and young infants. Elderly: Age-related renal impairment may increase risk of ototoxicity and nephrotoxicity; dosage adjustment recommended.
INTERACTIONS
DRUG: Aminoglycosides, amphotericin B, aspirin, bumetanide, carmustine, cisplatin, cyclosporine, ethacrynic acid, furosemide, streptozocin: May increase the risk of ototoxicity and nephrotoxicity of parenteral vancomycin. Cholestyramine, colestipol: May decrease the effects of oral vancomycin. HERBAL: None known. FOOD: None known. LAB VALUES: May increase BUN level. Therapeutic peak serum level is 20U40 mcg/ml; therapeutic trough serum level is 5U15 mcg/ml. Toxic peak serum level is greater than 40 mcg/ml; toxic trough serum level is greater than 15 mcg/ml.
AVAILABILITY (Rx)
CAPSULES (VANCOCIN HCL PULVULES): 125 mg, 250 mg. POWDER FOR ORAL SUSPENSION (VANCOCIN): 1 g (provides 250 mg/5 ml after mixing). POWDER FOR INJECTION (LYPHOCIN, VANCOCIN HCl): 500 mg, 1 g, 5 g, 10 g. INFUSION (PREMIX [VANCOCIN HCl]): 500 mg/100 ml, 1 g/200 ml.
ADMINISTRATION/HANDLING
L IV
O ALERT P Give by intermittent IV infusion (piggyback) or continuous IV infusion. Do not give IV push (may result in exaggerated hypotension).
Reconstitution N For intermittent IV infusion (piggyback), reconstitute each 500-mg vial with 10 ml sterile water for injection (20 ml for 1-g vial) to provide concentration of 50 mg/ml. N Further dilute to a final concentration not to exceed 5 mg/ml.
Rate of administration N Administer over 60 min or longer. N Monitor BP closely during IV infusion. N ADD-Vantage vials should not be used in neonates, infants, children requiring less than 500-mg dose.
Storage N After reconstitution, refrigerate and use within 14 days. N Discard if precipitate forms.
N Generally not given for systemic infections because of poor absorption from GI tract; however, some patients with colitis may have effective absorption. N Powder for oral solution may be reconstituted, given by mouth or NG tube. N Oral solution is stable for 2 wk if refrigerated. N Do not use powder for oral solution for IV administration.
D IV INCOMPATIBILITIES
Albumin, amphotericin B complex (Abelcet, AmBisome, Amphotec), aztreonam (Azactam), cefazolin (Ancef), cefepime (Maxipime), cefotaxime (Claforan), cefotetan (Cefotan), cefoxitin (Mefoxin), ceftazidime (Fortaz), ceftriaxone (Rocephin), cefuroxime (Zinacef), foscarnet (Foscavir), heparin, idarubicin (Idamycin), nafcillin (Nafcil), piperacillin and tazobactam (Zosyn), ticarcillin and clavulanate (Timentin).
IV COMPATIBILITIES
Amiodarone (Cordarone), calcium gluconate, diltiazem (Cardizem), hydromorphone (Dilaudid), insulin, lorazepam (Ativan), magnesium sulfate, midazolam (Versed), morphine, potassium chloride, propofol (Diprivan), total parenteral nutrition (TPN).
INDICATIONS/ROUTES/DOSAGE
TREATMENT OF BONE, RESPIRATORY TRACT, SKIN AND SOFT-TISSUE INFECTIONS, ENDOCARDITIS, PERITONITIS, AND SEPTICEMIA; PREVENTION OF BACTERIAL ENDOCARDITIS IN THOSE AT RISK (IF PENICILLIN IS CONTRAINDICATED) WHEN UNDERGOING BILIARY, DENTAL, GI, GU, OR RESPIRATORY SURGERY OR INVASIVE PROCEDURES
IV: ADULTS, ELDERLY: 500 mg q6h or 1 g q12h. CHILDREN OLDER THAN 1 MO: 40 mg/kg/day in divided doses q6U8h. Maximum: 3U4 g/day. NEONATES: Initially, 15 mg/kg, then 10 mg/kg q8U12h.
STAPHYLOCOCCAL ENTEROCOLITIS, ANTIBIOTIC-ASSOCIATED PSEUDOMEMBRANOUS COLITIS CAUSED BY CLOSTRIDIUM DIFFICILE
DOSAGE IN RENAL IMPAIRMENT
After a loading dose, subsequent dosages and frequency are modified based on creatinine clearance, the severity of the infection, and the serum concentration of the drug.
SIDE EFFECTS
FREQUENT: PO : Bitter or unpleasant taste, nausea, vomiting, mouth irritation (with oral solution). RARE: Parenteral: Phlebitis, thrombophlebitis, or pain at peripheral IV site; dizziness; vertigo; tinnitus; chills; fever; rash; necrosis with extravasation. PO : Rash.
ADVERSE REACTIONS/TOXIC EFFECTS
Nephrotoxicity and ototoxicity may occur. “Red-neck” syndrome (redness on face, neck, arms, and back; chills; fever; tachycardia; nausea or vomiting; pruritus; rash; unpleasant taste) may result from too-rapid injection.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Avoid other ototoxic, nephrotoxic medications if possible. Obtain culture, sensitivity test before giving first dose (therapy may begin before results are known).
INTERVENTION/EVALUATION
Monitor serum renal function tests, I&O. Assess skin for rash. Check hearing acuity, balance. Monitor BP carefully during infusion. Evaluate IV site for phlebitis (heat, pain, red streaking over vein). Therapeutic serum level: Peak: 20U40 mcg/ml; trough: 5U15 mcg/ml. Toxic serum level: Peak: over 40 mcg/ml; trough: over 15 mcg/ml.
PATIENT/FAMILY TEACHING
N Continue therapy for full length of treatment. N Doses should be evenly spaced. N Notify physician in event of tinnitus, rash, signs and symptoms of nephrotoxicity. N Lab tests are important part of total thera
venlafaxine
–––––––––––––––––––––––––––––––––––––––––––––
ven-la-fax een
(Effexor, Effexor XR)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Phenethylamine derivative. CLINICAL: Antidepressant.
ACTION
A phenethylamine derivative that potentiates CNS neurotransmitter activity by inhibiting the reuptake of serotonin, norepinephrine and, to a lesser degree, dopamine. Therapeutic Effect: Relieves depression.
PHARMACOKINETICS
Well absorbed from the GI tract. Protein binding: 25%U30%. Metabolized in the liver to active metabolite. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 3U7 hr; metabolite, 9U13 hr (increased in hepatic or renal impairment.
USES
Treatment of depression exhibited as persistent, prominent dysphoria (occurring nearly every day for at least 2 wk) manifested by 4 of 8 symptoms: change in appetite, change in sleep pattern, increased fatigue, impaired concentration, feelings of guilt or worthlessness, loss of interest in usual activities, psychomotor agitation or retardation, or suicidal tendencies. Psychotherapy augments therapeutic result. Treatment of generalized anxiety disorder (GAD), social anxiety disorder (SAD). Treatment of panic disorder, with or without agoraphobia. OFF-LABEL: Prevention of relapses of depression; treatment of attention-deficit hyperactivity disorder, autism, chronic fatigue syndrome, obsessive-compulsive disorder.
PRECAUTIONS
CONTRAINDICATIONS: Use within 14 days of MAOIs. CAUTIONS: Seizure disorder, renal/hepatic impairment, suicidal patients, recent MI, mania, volume-depleted patients, narrow-angle glaucoma, CHF, hyperthyroidism, abnormal platelet function.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if excreted in breast milk. Pregnancy Category C. Children: Children and adolescents are at increased risk of suicidal ideation and behavior or worsening depression, especially during the first few months of therapy. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: MAOIs: May cause neuroleptic malignant syndrome, autonomic instability (including rapid fluctuations of vital signs), extreme agitation, hyperthermia, mental status changes, myoclonus, rigidity, and coma. HERBAL: St. John's
AVAILABILITY (Rx)
CAPSULES (EXTENDED-RELEASE [EFFEXOR XL]): 37.5 mg, 75 mg, 150 mg. TABLETS (EFFEXOR): 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg.
ADMINISTRATION/HANDLING
N Give without regard to food. Give with food, milk if GI distress occurs. N Scored tablet may be crushed. N Do not crush, chew, or place in water extended-release capsules. N May open, sprinkle on applesauce.
INDICATIONS/ROUTES/DOSAGE
DEPRESSION
SOCIAL ANXIETY DISORDER, GENERALIZED ANXIETY DISORDER
PANIC DISORDER
DOSAGE IN RENAL AND HEPATIC IMPAIRMENT
Expect to decrease venlafaxine dosage by 50% in patients with moderate hepatic impairment, 25% in patients with mild to moderate renal impairment, and 50% in patients on dialysis (withhold dose until completion of dialysis).
SIDE EFFECTS
FREQUENT (greater than 20%): Nausea, somnolence, headache, dry mouth. OCCASIONAL (20%U10%): Dizziness, insomnia, constipation, diaphoresis, nervousness, asthenia, ejaculatory disturbance, anorexia. RARE (less than 10%): Anxiety, blurred vision, diarrhea, vomiting, tremor, abnormal dreams, impotence.
ADVERSE REACTIONS/TOXIC EFFECTS
A sustained increase in diastolic BP of 10U15 mm Hg occurs occasionally.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Obtain initial weight, BP. Assess appearance, behavior, speech pattern, level of interest, mood.
INTERVENTION/EVALUATION
Monitor signs/symptoms of depression, BP, weight. Assess sleep pattern for evidence of insomnia. Check during waking hours for somnolence or dizziness, anxiety; provide assistance as necessary. Supervise suicidal-risk patient closely during early therapy (as depression lessens, energy level improves, increasing suicide potential). Assess appearance, behavior, speech pattern, level of interest, mood for therapeutic response.
PATIENT/FAMILY TEACHING
N Take with food to minimize GI distress. N Do not increase, decrease, or suddenly stop medication. N Avoid tasks that require alertness, motor skills until response to drug is established. N Inform physician if breast-feeding, pregnant, or planning to become pregnant. N Avoid alcohol.
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