zalcitabine
zal-site-a-been
(Hivid)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Nucleoside reverse transcriptase inhibitor. CLINICAL: Antiretroviral.
ACTION
A nucleoside reverse transcriptase inhibitor that inhibits viral DNA synthesis. Therapeutic Effect: Prevents replication of HIV-1.
PHARMACOKINETICS
Readily absorbed from the GI tract (absorption decreased by food). Protein binding: less than 4%. Undergoes phosphorylation intracellularly to the active metabolite. Primarily excreted in urine. Removed by hemodialysis. Half-life: 1U3 hr; metabolite, 2.6U10 hr (increased in impaired renal function).
USES
Treatment of HIV infection in combination with other antiretroviral agents.
PRECAUTIONS
CONTRAINDICATIONS: Moderate or severe peripheral neuropathy. EXTREME CAUTION: Those with low CD4 cell counts (risk of peripheral neuropathy is greater), preexisting neuropathy. CAUTIONS: Preexisting peripheral neuropathy, diabetes, weight loss, history of hepatic disease, alcohol abuse, renal impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Avoid breast-feeding in HIV-positive women. Pregnancy Category C. Children: No age-related precautions in those younger than 6 mo, dosage not established. Elderly: Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Medications associated with peripheral neuropathy (including cisplatin, disulfiram, phenytoin, vincristine): May increase the risk of neuropathy. Medications causing pancreatitis (including IV pentamidine): May increase the risk of pancreatitis. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum alkaline phosphatase, amylase, bilirubin, lipase, AST, ALT, and triglyceride levels. May decrease serum calcium, magnesium, and phosphate levels. May alter blood glucose and sodium levels.
AVAILABILITY (Rx)
TABLETS: 0.375 mg, 0.75 mg.
ADMINISTRATION/HANDLING
N Best taken on empty stomach (food decreases absorption). N May take with food to decrease GI distress. N Space doses evenly around the clock.
INDICATIONS/ROUTES/DOSAGE
HIV INFECTION (IN COMBINATION WITH OTHER ANTIRETROVIRALS)
DOSAGE IN RENAL IMPAIRMENT
Dosage and frequency are modified based on creatinine clearance.
Creatinine Clearance Dose
10U40 ml/min 0.75 mg q12h
Less than 10 ml/min 0.75 mg q24h
SIDE EFFECTS
FREQUENT (28%U11%): Peripheral neuropathy, fever, fatigue, headache, rash. OCCASIONAL (10%U5%): Diarrhea, abdominal pain, oral ulcers, cough, pruritus, myalgia, weight loss, nausea, vomiting. RARE (4%U1%): Nasal discharge, dysphagia, depression, night sweats, confusion.
ADVERSE REACTIONS/TOXIC EFFECTS
Peripheral neuropathy (characterized by numbness, tingling, burning, and pain in the lower extremities) occurs in 17% to 31% of patients. These symptoms may be followed by sharp, shooting pain and progress to a severe, continuous, burning pain that may be irreversible if the drug is not discontinued in time. Pancreatitis, leukopenia, neutropenia, eosinophilia, and thrombocytopenia occur rarely.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Monitor CBC, serum triglycerides, amylase levels before and during therapy.
INTERVENTION/EVALUATION
Stop medication, notify physician immediately if signs or symptoms of peripheral neuropathy develop: numbness, tingling, burning, shooting pains of extremities; loss of vibratory sense or ankle reflex. Although rare, be alert to impending potentially fatal pancreatitis: increasing serum amylase, rising serum triglycerides, nausea, vomiting, abdominal pain (withhold medication, notify physician). Assess for therapeutic response: weight gain, increased energy, decreased fatigue. Assess CBC for evidence of blood dyscrasias. Offer emotional support to patient, family.
PATIENT/FAMILY TEACHING
zaleplon
zal-e-plon
(Sonata, Stamoc J)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Nonbenzodiazepine. CLINICAL: Hypnotic.
ACTION
A nonbenzodiazepine that enhances the action of the inhibitory neurotransmitter gamma-aminobutyric acid. Therapeutic Effect: Induces sleep.
PHARMACOKINETICS
Rapidly and almost completely absorbed following PO administration. Protein binding: 60%. Metabolized in liver. Primarily excreted in urine. Partially eliminated in feces. Half-life: 1 hr.
USES
Short-term treatment of insomnia (7U10 days). Decreases sleep onset time (no effect on number of nocturnal awakenings, total sleep time).
PRECAUTIONS
CONTRAINDICATIONS: Severe hepatic impairment. CAUTIONS: Mild to moderate hepatic function impairment in patients experiencing signs and symptoms of depression, those hypersensitive to aspirin (allergic-type reaction).
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta; is distributed is breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: May be more sensitive to zaleplon effects.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS depression. Cimetidine: May increase the effect of zaleplon. Rifampin: Decreases the zaleplon blood concentration. HERBAL: None known. FOOD: High-fat, heavy meals: May delay onset of sleep by approximately 2 hr. LAB VALUES: None known.
AVAILABILITY (Rx)
CAPSULES: 5 mg, 10 mg.
ADMINISTRATION/HANDLING
N Giving drug with or immediately after a high-fat meal results in slower absorption. N Capsules may be emptied and mixed with food.
INDICATIONS/ROUTES/DOSAGE
INSOMNIA
SIDE EFFECTS
EXPECTED: Somnolence, sedation, mild rebound insomnia (on first night after drug is discontinued). FREQUENT (28%U7%): Nausea, headache, myalgia, dizziness. OCCASIONAL (5%U3%): Abdominal pain, asthenia, dyspepsia, eye pain, paresthesia. RARE (2%): Tremors, amnesia, hyperacusis (acute sense of hearing), fever, dysmenorrhea.
ADVERSE REACTIONS/TOXIC EFFECTS
Zaleplon may produce altered concentration, behavior changes, and impaired memory. Taking the drug while up and about may result in adverse CNS effects, such as hallucinations, impaired coordination, dizziness, and light-headedness. Overdose results in somnolence, confusion, diminished reflexes, and coma.
NURING CONSIDERATION
BASELINE ASSESSMENT
Raise bed rails. Provide environment conducive to sleep (back rub, quiet environment, low lighting).
INTERVENTION/EVALUATION
Assess sleep pattern.
PATIENT/FAMILY TEACHING
N Take right before bedtime or when in bed and not falling asleep. N Avoid tasks that require alertness, motor skills until response to drug is established. N Do not exceed prescribed dosage. N Do not take with or immediately after a high-fat or heavy meal. N Rebound insomnia may occur when drug is discontinued after short-term therapy. N Avoid alcohol, other CNS depressants.
zidovudine
zye-dough-view-deen
(Apo-Zidovudine J, AZT, Novo-AZT J, Retrovir)
Do not confuse Retrovir with ritonavir.
FIXED-COMBINATION(S)
Combivir: zidovudine/lamivudine (an antiviral): 300 mg/150 mg. Trizivir: zidovudine/lamivudine/abacavir (an antiviral): 300 mg/150 mg/300 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Nucleoside reverse transcriptase inhibitors. CLINICAL: Antivirals.
ACTION
A nucleoside reverse transcriptase inhibitor that interferes with viral RNA-dependent DNA polymerase, an enzyme necessary for viral HIV replication. Therapeutic Effect: Interferes with HIV replication, slowing the progression of HIV infection.
PHARMACOKINETICS
Rapidly and completely absorbed from the GI tract. Protein binding: 25%U38%. Undergoes first-pass metabolism in the liver. Crosses the blood-brain barrier and is widely distributed, including to cerebrospinal fluid (CSF). Primarily excreted in urine. Minimal removal by hemodialysis. Half-life: 0.8U1.2 hr (increased in impaired renal function).
USES
Treatment of HIV infection in combination with other antiretroviral agents. OFF-LABEL: Prophylaxis in health care workers at risk of acquiring HIV after occupational exposure.
PRECAUTIONS
CONTRAINDICATIONS: Life-threatening allergic reactions to zidovudine or its components. CAUTIONS: Bone marrow compromise, renal or hepatic dysfunction, decreased hepatic blood flow.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Unknown if fetal harm or effects on fertility can occur. Pregnancy Category C. Children: No age-related precautions noted. Elderly: Information not available.
INTERACTIONS
DRUG: Bone marrow depressants, ganciclovir: May increase myelosuppression. Clarithromycin: May decrease zidovudine blood concentration. Probenecid: May increase zidovudine blood concentrations and the risk of zidovudine toxicity. HERBAL: None known. FOOD: None known. LAB VALUES: May increase mean corpuscular volume.
AVAILABILITY (Rx)
CAPSULES (RETROVIR): 100 mg. SYRUP (RETROVIR): 50 mg/5 ml. TABLETS (RETROVIR): 300 mg. INJECTION (RETROVIR): 10 mg/ml.
ADMINISTRATION/HANDLING
L IV
Reconstitution N Must dilute before administration. N Remove calculated dose from vial and add to D5W to provide a concentration no greater than 4 mg/ml.
Rate of administration N Infuse over 1 hr.
Storage N After dilution, IV solution is stable for 24 hr at room temperature; 48 hr if refrigerated. N Use within 8 hr if stored at room temperature; 24 hr if refrigerated. N Do not use if particulate matter is present or discoloration occurs.
N Keep capsules in cool, dry place. Protect from light. N Food, milk do not affect GI absorption. N Space doses evenly around the clock. N Patient should be in upright position when giving medication to prevent esophageal ulceration.
D IV INCOMPATIBILITIES
None known.
IV COMPATIBILITIES
Dexamethasone (Decadron), dobutamine (Dobutrex), dopamine (Intropin), heparin, lorazepam (Ativan), morphine, potassium chloride.
INDICATIONS/ROUTES/DOSAGE
HIV INFECTION
IV: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YR: 1U2 mg/kg/dose q4h. CHILDREN 12 YR AND YOUNGER: 120 mg/m2/dose q6h. NEONATES: 1.5 mg/kg/dose q6h.
SIDE EFFECTS
EXPECTED (46%U42%): Nausea, headache. FREQUENT (20%U16%): Abdominal pain, asthenia, rash, fever, acne. OCCASIONAL (12%U8%): Diarrhea, anorexia, malaise, myalgia, somnolence. RARE (6%U5%): Dizziness, paresthesia, vomiting, insomnia, dyspnea, altered taste.
ADVERSE REACTIONS/TOXIC EFFECTS
Serious reactions include anemia, which occurs most commonly after 4U6 wk of therapy, and granulocytopenia; both effects are more likely to occur in patients who have a low Hgb level or granulocyte count before beginning therapy. Neurotoxicity (as evidenced by ataxia, fatigue, lethargy, nystagmus, and seizures) may occur.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Avoid drugs that are nephrotoxic, cytotoxic, myelosuppressive—may increase risk of toxicity. Obtain specimens for viral diagnostic tests before starting therapy (therapy may begin before results are obtained). Check hematology reports for accurate baseline.
INTERVENTION/EVALUATION
Monitor CBC, Hgb, MCV, retriculocyte count, CD4 cell count, HIV RNA plasma levels. Check for bleeding. Assess for headache, dizziness. Determine pattern of bowel activity and stool consistency. Evaluate skin for acne, rash. Be alert to development of opportunistic infections (e.g., fever, chills, cough, myalgia). Monitor I&O, serum renal and liver function tests. Check for insomnia.
PATIENT/FAMILY TEACHING
N Doses should be evenly spaced around the clock. N Zidovudine does not cure AIDS or HIV disease, nor does it reduce risk of transmission to others, but acts to reduce symptoms and slows or arrests progress of disease. N Do not take any medications without physician approval. N Bleeding from gums, nose, rectum may occur and should be reported to physician immediately. N Blood counts are essential because of bleeding potential. N Dental work should be done before therapy or after blood counts return to normal (often weeks after therapy has stopped). N Inform physician if muscle weakness, difficulty breathing, headache, inability to sleep, unusual bleeding, rash, signs of infection occur.
ziprasidone
zye-pray-za-done
(Geodon)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Piperazine derivative. CLINICAL: Antipsychotic.
ACTION
A piperazine derivative that antagonizes alpha-adrenergic, dopamine, histamine, and serotonin receptors; also inhibits reuptake of serotonin and norepinephrine. Therapeutic Effect: Diminishes symptoms of schizophrenia and depression.
PHARMACOKINETICS
Well absorbed after PO administration. Food increases bioavailability. Protein binding: 99%. Extensively metabolized in the liver. Not removed by hemodialysis. Half-life: 7 hr.
USES
Treatment of schizophrenia, acute bipolar mania. OFF-LABEL: Tourette's syndrome.
PRECAUTIONS
CONTRAINDICATIONS: Conditions that prolong the QT interval, such as congenital long QT syndrome. CAUTIONS: Patients with bradycardia, hypokalemia, hypomagnesemia may be at greater risk for torsades de pointes (atypical ventricular tachycardia).
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS depression. Carbamazepine: May decrease ziprasidone blood concentration. Ketoconazole: May increase ziprasidone blood concentration. HERBAL: None known. FOOD: All foods: Enhance the bioavailability of ziprasidone. LAB VALUES: May prolong the QT interval.
AVAILABILITY (Rx)
CAPSULES: 20 mg, 40 mg, 60 mg, 80 mg. INJECTION: 20 mg/ml.
ADMINISTRATION/HANDLING
IM
N Store vials at room temperature, protect from light. N Reconstitute each vial with 1.2 ml sterile water for injection to provide a concentration of 20 mg/ml. N Reconstituted solution stable for 24 hr at room temperature or 7 days refrigerated.
N Give with food (increases bioavailability).
INDICATIONS/ROUTES/DOSAGE
SCHIZOPHRENIA
IM: ADULTS, ELDERLY: 10 mg q2h or 20 mg q4h. Maximum: 40 mg/day.
MANIA IN BIPOLAR DISORDER
SIDE EFFECTS
FREQUENT (30%U16%): Headache, somnolence, dizziness. OCCASIONAL: Rash, orthostatic hypotension, weight gain, restlessness, constipation, dyspepsia. RARE: Hyperglycemia, priapism.
ADVERSE REACTIONS/TOXIC EFFECTS
Prolongation of QT interval may produce torsades de pointes, a form of ventricular tachycardia. Patients with bradycardia, hypokalemia, or hypomagnesemia are at increased risk.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Assess patient's behavior, appearance, emotional status, response to environment, speech pattern, thought content. An EKG should be obtained to assess for QT prolongation before instituting medication. Blood chemistry for serum magnesium, potassium should be obtained before beginning therapy and routinely thereafter.
INTERVENTION/EVALUATION
Assess for therapeutic response (greater interest in surroundings, improved self-care, increased ability to concentrate, relaxed facial expression). Monitor weight.
PATIENT/FAMILY TEACHING
N Avoid tasks that require alertness, motor skills until response to drug is established.
zoledronic acid
zole-eh-drone-ick
(Zometa)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Bisphosphonate. CLINICAL: Calcium regulator, bone resorption inhibitor.
ACTION
A bisphosphonate that inhibits the resorption of mineralized bone and cartilage; inhibits increased osteoclastic activity and skeletal calcium release induced by stimulatory factors produced by tumors. Therapeutic Effect: Increases urinary calcium and phosphorus excretion; decreases serum calcium and phosphorus levels.
USES
Treatment of hypercalcemia, bone metastases of solid tumors. Treatment of multiple myeloma. OFF-LABEL: Prevention of bone metastases from breast, prostate cancer, treatment of bone diseases.
PRECAUTIONS
CONTRAINDICATIONS: Hypersensitivity to other bisphosphonates, including alendronate, etidronate, pamidronate, risedronate, and tiludronate. CAUTIONS: History of aspirin-sensitive asthma, renal impairment, hypoparathyroidism, risk of hypocalcemia.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Calcium-containing medications, vitamin D: May antagonize the effects of zoledronic acid in treatment of hypercalcemia. HERBAL: None known. FOOD: None known. LAB VALUES: May decrease serum magnesium, calcium, and phosphate levels.
AVAILABILITY (Rx)
INJECTION POWDER FOR RECONSTITUTION: 4 mg. INJECTION SOLUTION: 4 mg/5 ml.
ADMINISTRATION/HANDLING
O ALERT P Patient should be adequately rehydrated before administration of zoledronic acid.
L IV
Reconstitution N Reconstitute 4-mg vial with 5 ml sterile water for injection. Allow drug to dissolve before withdrawing. N Further dilute with 100 ml 0.9% NaCl or D5W.
Rate of administration N Adequate hydration is essential in conjunction with zoledronic acid. N Administer as an IV infusion over not less than 15 min (increases risk of deterioration in renal function).
Storage N Store at room temperature. N If not used immediately, reconstituted solution should be refrigerated; time from reconstitution to end of administration should not exceed 24 hr.
D IV INCOMPATIBILITIES
Do not mix with other medications.
INDICATIONS/ROUTES/DOSAGE
HYPERCALCEMIA
IV INFUSION: ADULTS, ELDERLY: 4 mg IV infusion given over no less than 15 min. Retreatment may be considered, but at least 7 days should elapse to allow for full response to initial dose.
MULTIPLE MYELOMA, BONE METASTASES OF SOLID TUMORS
IV: ADULTS, ELDERLY: 4 mg q3U4wk.
SIDE EFFECTS
FREQUENT (44%U26%): Fever, nausea, vomiting, constipation. OCCASIONAL (15%U10%): Hypotension, anxiety, insomnia, flu-like symptoms (fever, chills, bone pain, myalgia, and arthralgia). RARE: Conjunctivitis.
ADVERSE REACTIONS/TOXIC EFFECTS
Renal toxicity may occur if IV infusion is administered in less than 15 min.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Establish baseline serum electrolytes.
INTERVENTION/EVALUATION
Monitor serum renal function, CBC, Hgb, Hct. Assess vertebral bone mass (document stabilization and improvement). Monitor serum calcium, phosphate, magnesium, creatinine levels. Assess for fever. Monitor food intake, pattern of bowel activity and stool consistency. Check I&O, BUN, serum creatinine in patients with renal impairment.
zolmitriptan
zohl-mih-trip-tan
(Zomig, Zomig Rapimelt J, Zomig-ZMT)
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 but incompletely absorbed after PO administration. Protein binding: 15%. Undergoes first-pass metabolism in the liver to active metabolite. Eliminated primarily in urine (60%) and, to a lesser extent, in feces (30%). Half-life: 3 hr.
USES
Treatment of acute migraine attack with or without aura.
PRECAUTIONS
CONTRAINDICATIONS: Arrhythmias associated with conduction disorders, basilar or hemiplegic migraine, coronary artery disease, ischemic heart disease (including angina pectoris, history of MI, silent ischemia, and Prinzmetal's angina), uncontrolled hypertension, use within 24 hr of ergotamine-containing preparations or another serotonin receptor agonist, use within 14 days of MAOIs, Wolff-Parkinson-White syndrome. CAUTIONS: Mild to moderate renal or hepatic impairment, patient profile suggesting cardiovascular risks, controlled hypertension, history of cerebrovascular accident (CVA).
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug is distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy not established in those younger than 12 yr. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Ergotamine-containing medications: May produce a vasospastic reaction. Fluoxetine, fluvoxamine, paroxetine, sertraline: May produce hyperreflexia, incoordination, and weakness. MAOIs: May dramatically increase plasma concentration of zolmitriptan. Oral contraceptives: Decrease zolmitriptan clearance and volume of distribution. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
TABLETS (ZOMIG): 2.5 mg, 5 mg. TABLETS (ORALLY-DISINTEGRATING [ZOMIG-ZMT]): 2.5 mg, 5 mg. NASAL SPRAY (ZOMIG): 5 mg/0.1 ml.
ADMINISTRATION/HANDLING
N Give without regard to food.
NASAL
N Instruct the patient to gently blow nose to clear nasal passages. N With head upright, patient should close one nostril with index finger and breathe out gently through mouth. N Instruct patient to insert nozzle into open nostril about ½ inch, close mouth, and while taking a breath through nose, release spray dosage by firmly pressing the plunger. N Have patient remove nozzle from nose, gently breathe in through nose and out through mouth for 15U20 sec. Tell patient to avoid breathing in deeply.
INDICATIONS/ROUTES/DOSAGE
ACUTE MIGRAINE ATTACK
INTRANASAL: ADULTS, ELDERLY: 5 mg. May repeat in 2 hr. Maximum: 10 mg/24 hr.
SIDE EFFECTS
FREQUENT (8%U6%): Oral: Dizziness; tingling; neck, throat, or jaw pressure; somnolence. Nasal: Altered taste, paraesthesia. OCCASIONAL (5%U3%): Oral: Warm or hot sensation, asthenia, chest pressure. Nasal: Nausea, somnolence, nasal discomfort, dizziness, asthenia, dry mouth. RARE (2%U1%): Diaphoresis, myalgia, paresthesia.
ADVERSE REACTIONS/TOXIC EFFECTS
Cardiac reactions (including ischemia, coronary artery vasospasm, and MI) and noncardiac vasospasm-related reactions (such as hemorrhage and cerebrovascular accident [CVA]) occur rarely, particularly in patients with hypertension, diabetes, or a strong family history of coronary artery disease; obese patients; smokers; males older than 40 yr; and postmenopausal women.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Question for history of peripheral vascular disease or coronary artery disease, renal or hepatic impairment, use of MAOIs. Question patient regarding onset, location, duration of migraine, possible precipitating symptoms.
INTERVENTION/EVALUATION
Monitor for evidence of dizziness. Monitor BP, especially in patients with hepatic impairment. Assess for relief of migraine headache and migraine potential for photophobia, phonophobia (sound sensitivity, light sensitivity, nausea, vomiting).
PATIENT/FAMILY TEACHING
N Take a single dose as soon as symptoms of an actual migraine attack appear. N Medication is intended to relieve migraine, not to prevent or reduce number of attacks. N Lie down in quiet dark room for additional benefit after taking medication. N Avoid tasks that require alertness, motor skills until response to drug is established. N Report chest pain, palpitations, tightness in throat, edema of face, lips, or eyes, rash, easy bruising, blood in urine or stool, pain or numbness in arms or legs.
zolpidem tartrate H
zole-pi-dem
(Ambien, Ambien CR)
Do not confuse Ambien with Amen.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Nonbenzodiazepine. CLINICAL: Sedative-hypnotic (Schedule IV).
ACTION
A nonbenzodiazepine that enhances the action of the inhibitory neurotransmitter gamma-aminobutyric acid. Therapeutic Effect: Induces sleep and improves sleep quality.
PHARMACOKINETICS
Route Onset Peak Duration
Rapidly absorbed from the GI tract. Protein binding: 92%. Metabolized in the liver; excreted in urine. Not removed by hemodialysis. Half-life: 1.4U4.5 hr (increased in hepatic impairment).
USES
Short-term treatment of insomnia. Reduces sleep-induction time, number of nocturnal awakenings; increases length of sleep; improves sleep quality.
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Hepatic impairment, patients with depression, history of drug dependence.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category B. Children: Safety and efficacy not established. Elderly: More likely to experience falls or confusion; decreased initial doses recommended. Age-related hepatic impairment may require dosage adjustment.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS depression. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
TABLETS (AMBIEN): 5 mg, 10 mg. TABLETS (EXTENDED-RELEASE [AMBIEN CR]): 6.25 mg, 12.5 mg.
ADMINISTRATION/HANDLING
N For faster sleep onset, do not give with or immediately after a meal.
INDICATIONS/ROUTES/DOSAGE
INSOMNIA
SIDE EFFECTS
OCCASIONAL (7%): Headache. RARE (less than 2%): Dizziness, nausea, diarrhea, muscle pain.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdose may produce severe ataxia, bradycardia, altered vision (such as diplopia), severe drowsiness, nausea and vomiting, difficulty breathing, and unconsciousness.Abrupt withdrawal of the drug after long-term use may produce asthenia, facial flushing, diaphoresis, vomiting, and tremor.Drug tolerance or dependence may occur with prolonged, high-dose therapy.
NURSING CONSSIDERATION
BASELINE ASSESSMENT
Assess BP, pulse, respirations. Raise bed rails, provide call light. Provide environment conducive to sleep (back rub, quiet environment, low lighting).
INTERVENTION/EVALUATION
Assess sleep pattern of patient. Evaluate for therapeutic response to insomnia: decrease in number of nocturnal awakenings, increase in length of sleep.
PATIENT/FAMILY TEACHING
N Do not abruptly withdraw medication after long-term use. N Avoid alcohol, tasks that require alertness, motor skills until response to drug is established. N Tolerance or dependence may occur with prolonged use of high dosages.
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