prednisoLONE F
pred-niss-oh-lone
(AK-Pred, AK-Tate J, Cotolone, Depo-Predate, Hydeltrasol, Inflamase Forte, Inflamase Mild, Key-Pred, Key-Pred SP, Minims-Prednisolone J, Novo-Prednisolone J, Orapred, Pediapred, Predacort 50, Predaject-50, Predate-50, Pred Forte, Pred-Ject-50, Pred Mild, Prednisolone Acetate, Prelone)
Do not confuse prednisolone with prednisone or primidone.
FIXED-COMBINATION(S)
Blephamide: prednisolone/sulfacetamide (an anti-infective): 0.2%/10%. Vasocidin: prednisolone/sulfacetamide: 0.25%/10%.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Adrenal corticosteroid. CLINICAL: Glucocorticoid.
ACTION
An adrenocortical steroid that inhibits accumulation of inflammatory cells at inflammation sites, phagocytosis, lysosomal enzyme release and synthesis, and release of mediators of inflammation. Therapeutic Effect: Prevents or suppresses cell-mediated immune reactions. Decreases or prevents tissue response to inflammatory process.
USES
Substitution Therapy in Deficiency States: Acute or chronic adrenal insufficiency, congenital adrenal hyperplasia, adrenal insufficiency secondary to pituitary insufficiency. Nonendocrine Disorders: Allergic, collagen, intestinal tract, hepatic, ocular, renal, skin diseases; bronchial asthma; arthritis; rheumatic carditis; cerebral edema; malignancies. Ophthalmic: Treatment conjunctivitis, corneal injury (from chemical or thermal burns, foreign body).
PRECAUTIONS
CONTRAINDICATIONS: Acute superficial herpes simplex keratitis, systemic fungal infections, varicella. CAUTIONS: Hyperthyroidism, cirrhosis, ocular herpes simplex, peptic ulcer disease, osteoporosis, myasthenia gravis, hypertension, CHF, ulcerative colitis, thromboembolic disorders. Pregnancy Category C. (D if used in first trimester).
INTERACTIONS
DRUG: Amphotericin: May increase hypokalemia. Digoxin: May increase the risk of digoxin toxicity caused by hypokalemia. Diuretics, insulin, oral hypoglycemics, potassium supplements: May decrease the effects of these drugs. Hepatic enzyme inducers: May decrease the effects of prednisolone. Live virus vaccines: May decrease the patient's antibody response to vaccine, increase vaccine side effects, and potentiate virus replication. HERBAL: None known. FOOD: None known. LAB VALUES: May increase blood glucose and serum lipid, amylase, and sodium levels. May decrease serum calcium, potassium, and thyroxine levels.
AVAILABILITY (Rx)
TABLETS: 5 mg. SYRUP: 5 mg/5 ml (Prelone), 15 mg/5 ml (Prednisolone Acetate, Prelone). ORAL LIQUID, SODIUM PHOSPHATE: 5 mg/5 ml (Orapred, Pediapred), 15 mg/5 ml (Orapred). INJECTABLE SOLUTION, SODIUM PHOSPHATE (HYDELTRASOL, KEY-PRED SP): 20 mg/ml. INJECTABLE SUSPENSION, ACETATE: 25 mg/ml (Cotolone, Key-Pred), 40 mg/ml (Depo-Predate), 50 mg/ml (Cotolone, Predacort 50, Predaject-50, Predate-50, Pred-Ject-50), 80 mg/ml (Depo-Predate). OPHTHALMIC SOLUTION, SODIUM PHOSPHATE: 0.125% (Inflamase Mild), 1% (AK-Pred, Inflamase Forte). OPHTHALMIC SUSPENSION, ACETATE: 0.12% (Pred Mild), 1% (Pred Forte).
ADMINISTRATION/HANDLING
IM, INTRA-ARTICULAR, INTRALESIONAL
N Do not administer prednisolone intravenously. N Shake well before using. N Inject into joint, lesion, or muscle as needed.
N Give without regard to meals; give with food if GI upset occurs.
OPHTHALMIC
N For ophthalmic solution, shake well before using. N Instill drops into conjunctival sac, as prescribed. N Avoid touching the applicator tip to the conjunctiva to avoid contamination.
IV INCOMPATIBILITIES
Do not mix with other medications.
INDICATIONS/ROUTES/DOSAGE
INTRA-ARTICULAR, INTRALESIONAL (ACETATE): ADULTS, ELDERLY: 4U100 mg, repeated as needed.
INTRA-ARTICULAR, INTRALESIONAL (SODIUM PHOSPHATE): ADULTS, ELDERLY: 2U30 mg, repeated at 3-day to 3-wk intervals, as needed.
IM (ACETATE, SODIUM PHOSPHATE): ADULTS, ELDERLY: 4U60 mg a day.
TREATMENT OF CONJUCTIVITIS AND CORNEAL INJURY
OPHTHALMIC: ADULTS, ELDERLY: 1U2 drops every hr during day and q2h during night. After response, decrease dosage to 1 drop q4h, then 1 drop 3U4 times a day.
SIDE EFFECTS
FREQUENT: Insomnia, heartburn, nervousness, abdominal distention, increased sweating, acne, mood swings, increased appetite, facial flushing, delayed wound healing, increased susceptibility to infection, diarrhea or constipation. OCCASIONAL: Headache, edema, change in skin color, frequent urination. RARE: Tachycardia, allergic reaction (such as rash and hives), psychological changes, hallucinations, depression. Ophthalmic: stinging or burning, posterior subcapsular cataracts.
ADVERSE REACTIONS/TOXIC EFFECTS
Long-term therapy may cause hypocalcemia, hypokalemia, muscle wasting (especially in the arms and legs), osteoporosis, spontaneous fractures, amenorrhea, cataracts, glaucoma, peptic ulcer disease, and CHF. Abruptly withdrawing the drug after long-term therapy may cause anorexia, nausea, fever, headache, severe or sudden joint pain, rebound inflammation, fatigue, weakness, lethargy, dizziness, and orthostatic hypotension. Suddenly discontinuing prednisolone may be fatal.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Obtain baselines for height, weight, BP, serum glucose, electrolytes. Check results of initial tests (e.g., tuberculosis (TB) skin test, x-rays, EKG). Never give live virus vaccine (e.g., smallpox).
INTERVENTION/EVALUATION
Monitor BP, weight, serum electrolytes, glucose, height, weight in children. Be alert to infection (sore throat, fever, vague symptoms); assess oral cavity daily for signs of candida infection (white patches, painful tongue or mucous membranes).
PATIENT/FAMILY TEACHING
N Notify physician of fever, sore throat, muscle aches, sudden weight gain/swelling. N Avoid alcohol, minimize use of caffeine. N Do not abruptly discontinue without physician's approval. N Avoid exposure to chickenpox, measles.
oseltamivir
ah-suhl-tahm-ah-veer
(Tamiflu)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Neuraminidase inhibitor. CLINICAL: Antiviral.
ACTION
A selective inhibitor of influenza virus neuraminidase, an enzyme essential for viral replication. Acts against both influenza A and B viruses. Therapeutic Effect: Suppresses the spread of infection within the respiratory system and reduces the duration of clinical symptoms.
PHARMACOKINETICS
Readily absorbed. Protein binding: 3%. Extensively converted to active drug in the liver. Primarily excreted in urine. Half-life: 6U10 hr.
USES
Symptomatic treatment of uncomplicated acute illness caused by influenza A or B virus in adults and children 1 yr and older who are symptomatic no longer than 2 days. Prevention of influenza in adults, children 1 yr and older.
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Renal impairment.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if excreted in breast milk. Pregnancy Category C. Children: Safety and efficacy not established in those younger than 1 yr. Elderly: No age-related precautions noted.
INTERACTIONS
DRUG: Probenecid: Increases oseltamivir concentration. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
CAPSULES: 75 mg. ORAL SUSPENSION: 12 mg/ml.
ADMINISTRATION/HANDLING
N Give without regard to food.
INDICATIONS/ROUTES/DOSAGE
INFLUENZA
PREVENTION OF INFLUENZA
DOSAGE IN RENAL IMPAIRMENT
SIDE EFFECTS
FREQUENT (10%U7%): Nausea, vomiting, diarrhea. RARE (2%U1%): Abdominal pain, bronchitis, dizziness, headache, cough, insomnia, fatigue, vertigo.
ADVERSE REACTIONS/TOXIC EFFECTS
Colitis, pneumonia, tympanic membrane disorder, and pyrexia occur rarely.
NURSING CONSIDERATION
INTERVENTION/EVALUATION
Monitor serum glucose, renal function, in patients with diabetes.
PATIENT/FAMILY TEACHING
N Begin as soon as possible from first appearance of flu symptoms. N Avoid contact with those who are at high risk for influenza. N Not a substitute for flu shot.
oxaliplatin A
ox-ale-ee-plah-tin
(Eloxatin)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Platinum-containing complex. CLINICAL: Antineoplastic.
ACTION
A platinum-containing complex that cross-links with DNA strands, preventing cell division. Cell cycleUphase nonspecific. Therapeutic Effect: Inhibits DNA replication.
PHARMACOKINETICS
Rapidly distributed. Protein binding: 90%. Undergoes rapid, extensive nonenzymatic biotransformation. Excreted in urine. Half-life: 70 hr.
USES
Combination treatment of metastatic carcinoma of the colon or rectum with 5-fluorouracil (5-FU)/leucovorin in patients whose disease has recurred or progressed during or within 6 mo of completion of first-line therapy with bolus 5-FU/leucovorin and irinotecan. OFF-LABEL: Treatment of germ cell cancer, ovarian cancer, pancreatic cancer, renal cell cancer, solid tumors.
PRECAUTIONS
CONTRAINDICATIONS: History of allergy to other platinum compounds. CAUTIONS: Previous therapy with other antineoplastic agents, radiation, renal impairment, infection, pregnancy, immunosuppression, presence or history of peripheral neuropathy.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: If possible, avoid use during pregnancy, especially first trimester. May cause fetal harm. Breast-feeding not recommended. Pregnancy Category D. Children: Safety and efficacy not established. Elderly: Increased incidence of diarrhea, dehydration, hypokalemia, fatigue.
INTERACTIONS
DRUG: Live virus vaccines: May potentiate virus replication, increase vaccine side effects, and decrease the patient's antibody response to the vaccine. Nephrotic medications: May decrease the clearance of oxaliplatin. HERBAL: None known. FOOD: None known. LAB VALUES: May alter serum bilirubin, AST, and ALT levels. May decrease blood Hgb and Hct levels and platelet count.
AVAILABILITY (Rx)
INJECTION SOLUTION: 50-mg, 100-mg vials 5 mg/ml.
ADMINISTRATION/HANDLING
O ALERT P Pretreat the patient with antiemetics (5-HT3 antagonists), if ordered. Know that repeat courses should not be given more frequently than every 2 wk.
O ALERT P Wear protective gloves during handling of oxaliplatin. If solution comes in contact with skin, wash skin immediately with soap, water. Do not use aluminum needles or administration sets that may come in contact with drug; may cause degradation of platinum compounds.
O ALERT P Patient to avoid ice or drinking, touching cold objects during infusion (can exacerbate acute neuropathy).
L IV
Rate of administration N Administer differing infusion rates as a 2-hr or 22-hr rate, according to protocol orders.
IV INCOMPATIBILITIES
Don't infuse oxaliplatin with alkaline medications.
INDICATIONS/ROUTES/DOSAGE
METASTATIC COLON
IV: ADULTS: Day 1: Oxaliplatin 85 mg/m2 in 250U500 ml D5W and leucovorin 200 mg/m2, both given simultaneously over more than 2 hr in separate bags using a Y-line, followed by 5-FU 400 mg/m2 IV bolus given over 2U4 min, followed by 5-FU 600 mg/m2 in 500 ml D5W as a 22-hr continuous IV infusion. Day 2: Leucovorin 200 mg/m2 IV infusion given over more than 2 hr, followed by 5-FU 400 mg/m2 IV bolus given over 2U4 min, followed by 5-FU 600 mg/m2 in 500 ml D5W as a 22-hr continuous IV infusion.
OVARIAN CANCER
IV: ADULTS: Cisplatin 100 mg/m2 and oxaliplatin 130 mg/m2 q3wk.
SIDE EFFECTS
FREQUENT (76%U20%): Peripheral or sensory neuropathy (usually occurs in hands, feet, perioral area, and throat but may present as jaw spasm, abnormal tongue sensation, eye pain, chest pressure, or difficulty walking, swallowing, or writing), nausea (64%), fatigue, diarrhea, vomiting, constipation, abdominal pain, fever, anorexia. OCCASIONAL (14%U10%): Stomatitis, earache, insomnia, cough, difficulty breathing, backache, edema. RARE (7%U3%): Dyspepsia, dizziness, rhinitis, flushing, alopecia.
ADVERSE REACTIONS/TOXIC EFFECTS
Peripheral or sensory neuropathy can occur, sometimes precipitated or exacerbated by drinking or holding a glass of cold liquid during the IV infusion. Pulmonary fibrosis, characterized by a nonproductive cough, dyspnea, crackles, and radiologic pulmonary infiltrates, may require drug discontinuation. Hypersensitivity reaction (rash, urticaria, pruritus) occurs rarely.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Patient to avoid ice or drinking, holding a glass of cold liquid during IV infusion; can precipitate/exacerbate neurotoxicity (occurs within hours or 1U2 days of dosing, lasts up to 14 days). Assess baseline BUN, serum creatinine, WBC, platelet count.
INTERVENTION/EVALUATION
Monitor for decrease in WBC or platelets (myelosuppression is minimal). Monitor for diarrhea, GI bleeding (bright red or tarry stool). Maintain strict I&O. Assess oral mucosa for stomatitis.
PATIENT/FAMILY TEACHING
N Promptly report fever, sore throat, signs of local infection, unusual bruising or bleeding from any site. N Do not have immunizations without physician's approval (lowers body's resistance). N Avoid contact with those who have recently taken oral polio vaccine. N Avoid cold drinks, ice, cold objects (may produce neuropathy).
oxcarbazepine
ox-car-bah-zeh-peen
(Trileptal)
CLASSIFICATION
CLINICAL: Anticonvulsant.
ACTION
An anticonvulsant that blocks sodium channels, resulting in stabilization of hyperexcited neural membranes, inhibition of repetitive neuronal firing, and diminishing synaptic impulses. Therapeutic Effect: Prevents seizures.
PHARMACOKINETICS
Completely absorbed from GI tract and extensively metabolized in the liver to active metabolite. Protein binding: 40%. Primarily excreted in urine. Half-life: 2 hr; metabolite, 6U10 hr.
USES
Monotherapy and adjunctive therapy in adults, children 2 yr of age and older for treatment of partial seizures. OFF-LABEL: Atypical panic disorder, bipolar disorders, neuralgia/neuropathy.
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Renal impairment, sensitivity to carbamazepine.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Crosses placenta. Distributed in breast milk. Pregnancy Category C. Children: No age-related precautions in those older than 4 yr. Elderly: Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Carbamazepine, phenobarbital, phenytoin, valproic acid, verapamil: May decrease the blood concentration and effects of oxcarbazepine. Felodipine, oral contraceptives: May decrease the effectiveness of these drugs. Phenobarbital, phenytoin: May increase the blood concentration and risk of toxicity of these drugs. HERBAL: None known. FOOD: None known. LAB VALUES: May increase GGT level and other hepatic function test results. May increase or decrease blood glucose level. May decrease serum calcium, potassium, and sodium levels.
AVAILABILITY (Rx)
ORAL SUSPENSION: 300 mg/5 ml. TABLETS: 150 mg, 300 mg, 600 mg.
ADMINISTRATION/HANDLING
N Give without regard to food.
INDICATIONS/ROUTES/DOSAGE
ADJUNCTIVE TREATMENT OF SEIZURES
CONVERSION TO MONOTHERAPY
INITIATION OF MONOTHERAPY
DOSAGE IN RENAL IMPAIRMENT
For patients with creatinine clearance less than 30 ml/min, give 50% of normal starting dose, then titrate slowly to desired dose.
SIDE EFFECTS
FREQUENT (22%U13%): Dizziness, nausea, headache. OCCASIONAL (7%U5%): Vomiting, diarrhea, ataxia, nervousness, heartburn, indigestion, epigastric pain, constipation. RARE (4%): Tremor, rash, back pain, epistaxis, sinusitis, diplopia.
ADVERSE REACTIONS/TOXIC EFFECTS
Clinically significant hyponatremia may occur.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Review history of seizure disorder (type, onset, intensity, frequency, duration, level of consciousness [LOC]), drug history (especially other anticonvulsants). Provide safety precautions; quiet, dark environment.
INTERVENTION/EVALUATION
Assist with ambulation if dizziness, ataxia occurs. Assess for visual abnormalities, headache. Monitor serum sodium levels. Assess for signs of hyponatremia (nausea, malaise, headache, lethargy, confusion). Assess for clinical improvement (decrease in intensity and frequency of seizures).
PATIENT/FAMILY TEACHING
N Do not abruptly stop taking medication (may increase seizure activity). N Inform physician if rash, nausea, headache, dizziness occurs. N May need periodic blood tests.
oxybutynin
ox-i-byoo-ti-nin
(Ditropan, Ditropan XL, Oxytrol, Urotrol)
Do not confuse oxybutynin with OxyContin, or Ditropan with diazepam.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Anticholinergic. CLINICAL: Antispasmodic.
ACTION
An anticholinergic that exerts antispasmodic (papaverine-like) and antimuscarinic (atropine-like) action on the detrusor smooth muscle of the bladder. Therapeutic Effect: Increases bladder capacity and delays desire to void.
PHARMACOKINETICS
Route Onset Peak Duration
Rapidly absorbed from the GI tract. Metabolized in the liver. Primarily excreted in urine. Unknown if removed by hemodialysis. Half-life: 1U2.3 hr.
USES
Relief of symptoms (urgency, incontinence, frequency, nocturia, urge incontinence) associated with uninhibited neurogenic bladder, reflex neurogenic bladder.
PRECAUTIONS
CONTRAINDICATIONS: GI or GU obstruction, glaucoma, myasthenia gravis, toxic megacolon, ulcerative colitis. CAUTIONS: Renal or hepatic impairment, cardiovascular disease, hyperthyroidism, reflux esophagitis, hypertension, prostatic hypertrophy, neuropathy.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category B. Children: No age-related precautions noted in those older than 5 yr. Elderly: May be more sensitive to anticholinergic effects (e.g., dry mouth, urinary retention).
INTERACTIONS
DRUG: Medications with anticholinergic effects (such as antihistamines): May increase the anticholinergic effects of oxybutynin. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
SYRUP (DITROPAN): 5 mg/5 ml. TABLETS (DITROPAN, UROTROL): 5 mg. TABLETS (EXTENDED-RELEASE [DITRO-PAN XL]): 5 mg, 10 mg, 15 mg. TRANSDERMAL (OXYTROL): 3.9 mg.
ADMINISTRATION/HANDLING
N Give without regard to meals.
TRANSDERMAL
N Apply patch to dry, intact skin on the abdomen, hip, or buttock. N Use a new application site for each new patch; avoid reapplication to the same site within 7 days.
INDICATIONS/ROUTES/DOSAGE
NEUROGENIC BLADDER
TRANSDERMAL: ADULTS: 3.9 mg applied twice a week. Apply every 3U4 days.
SIDE EFFECTS
FREQUENT: Constipation, dry mouth, somnolence, decreased perspiration. OCCASIONAL: Decreased lacrimation or salivation, impotence, urinary hesitancy and retention, suppressed lactation, blurred vision, mydriasis, nausea or vomiting, insomnia.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdose produces CNS excitation (including nervousness, restlessness, hallucinations, and irritability), hypotension or hypertension, confusion, tachycardia, facial flushing, and respiratory depression.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Assess dysuria, urgency, frequency, incontinence.
INTERVENTION/EVALUATION
Monitor for symptomatic relief. Monitor I&O; palpate bladder for retention. Monitor pattern of bowel activity and stool consistency.
PATIENT/FAMILY TEACHING
N Avoid alcohol. N May cause dry mouth. N Avoid tasks that require alertness, motor skills until response to drug is established (may cause drowsiness).
oxycodone A
ox-ee-koe-done
(M-Oxy, OxyContin, Oxydose, OxyFast, OxyIR, Percolone, Roxicodone, Roxicodone Intensol, Supeudol J)
Do not confuse oxycodone with oxybutynin.
FIXED-COMBINATION(S)
Combunox: oxycodone/ibuprofen (an NSAID): 5 mg/400 mg. Percocet, Roxicet, Tylox: oxycodone/acetaminophen (a non-narcotic analgesic): 5 mg/500 mg. Percocet: oxycodone/acetaminophen: 2.5 mg/325 mg; 5 mg/325 mg; 5 mg/500 mg; 7.5 mg/325 mg; 7.5 mg/500 mg; 10 mg/325 mg; 10 mg/650 mg. Percodan: oxycodone/aspirin (a non-narcotic analgesic): 2.25 mg/325 mg; 4.5 mg/325 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Opioid analgesic (Schedule II). CLINICAL: Narcotic analgesic.
ACTION
An opioid analgesic that binds with opioid receptors in the CNS. Therapeutic Effect: Alters the perception of and emotional response to pain.
PHARMACOKINETICS
Moderately absorbed from the GI tract. Protein binding: 38%U45%. Widely distributed. Metabolized in the liver. Excreted in urine. Unknown if removed by hemodialysis. Half-life: 2U3 hr (3.2 hr controlled-release).
USES
Relief of mild to moderately severe pain.
PRECAUTIONS
CONTRAINDICATIONS: Acute bronchial asthma or hypercarbia, paralytic ileus, respiratory depression. EXTREME CAUTION: CNS depression, anoxia, hypercapnia, respiratory depression, seizures, acute alcoholism, shock, untreated myxedema, respiratory dysfunction. CAUTIONS: Increased intracranial pressure (ICP), hepatic impairment, acute abdominal conditions, hypothyroidism, prostatic hypertrophy, Addison 's disease, urethral stricture, chronic obstructive pulmonary disease (COPD).
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Readily crosses placenta. Distributed in breast milk. Respiratory depression may occur in neonate if mother received opiates during labor. Regular use of opiates during pregnancy may produce withdrawal symptoms in neonate (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, seizures. Pregnancy Category B (D if used for prolonged periods or at high dosages at term). Children: Paradoxical excitement may occur. Those younger than 2 yr are more susceptible to respiratory depressant effects. Elderly: Age-related renal impairment may increase risk of urinary retention. May be more susceptible to respiratory depressant effects.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS or respiratory depression and hypotension. MAOIs: May produce a severe, sometimes fatal reaction; expect to administer ¼ of usual oxycodone dose. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum amylase and lipase levels.
AVAILABILITY (Rx)
CAPSULES (IMMEDIATE-RELEASE [OXYIR]): 5 mg. ORAL CONCENTRATE (OXYDOSE, OXYFAST, ROXICODONE INTENSOL): 20 mg/ml. ORAL SOLUTION (ROXICODONE): 5 mg/5 ml. TABLETS (M-OXY, PERCOLONE, ROXICODONE): 5 mg, 15 mg, 30 mg. TABLETS (EXTENDED-RELEASE [OXY-CONTIN]): 10 mg, 20 mg, 40 mg, 80 mg, 160 mg.
ADMINISTRATION/HANDLING
N Give without regard to meals. N Tablets may be crushed. N Controlled-release: Swallow whole; do not crush, break, chew.
INDICATIONS/ROUTES/DOSAGE
ANALGESIA
SIDE EFFECTS
FREQUENT: Somnolence, dizziness, hypotension (including orthostatic hypotension), anorexia. OCCASIONAL: Confusion, diaphoresis, facial flushing, urine retention, constipation, dry mouth, nausea, vomiting, headache. RARE: Allergic reaction, depression, paradoxical CNS hyperactivity or nervousness in children, paradoxical excitement and restlessness in elderly or debilitated patients.
ADVERSE REACTIONS/TOXIC EFFECTS
Overdose results in respiratory depression, skeletal muscle flaccidity, cold or clammy skin, cyanosis, and extreme somnolence progressing to seizures, stupor, and coma. Hepatotoxicity may occur with overdose of the acetaminophen component of fixed-combination products. The patient who uses oxycodone repeatedly may develop a tolerance to the drug's analgesic effect and physical dependence.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Assess onset, type, location, duration of pain. Effect of medication is reduced if full pain recurs before next dose. Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician.
INTERVENTION/EVALUATION
Palpate bladder for urinary retention. Monitor pattern of daily bowel activity and stool consistency. Initiate deep breathing, coughing exercises, particularly in patients with pulmonary impairment. Monitor pain relief, respiratory rate, mental status, BP.
PATIENT/FAMILY TEACHING
N May cause dry mouth, drowsiness. N Avoid tasks that require alertness, motor skills until response to drug is established. N Avoid alcohol. N May be habit forming. N Do not crush, chew, break controlled-release tablets.
oxytocin
ox-ee-toe-sin
(Pitocin, Syntocinon)
Do not confuse Pitocin with Pitressin.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Uterine smooth muscle stimulant. CLINICAL: Oxytocic.
ACTION
An oxytocic that affects uterine myofibril activity and stimulates mammary smooth muscle. Therapeutic Effect: Contracts uterine smooth muscle. Enhances lactation.
PHARMACOKINETICS
Route Onset Peak Duration
IV Immediate N/A 1 hr
IM 3U5 min N/A 2U3 hr
Rapidly absorbed through nasal mucous membranes. Protein binding: 30%. Distributed in extracellular fluid. Metabolized in the liver and kidney. Primarily excreted in urine. Half-life: 1U6 min.
USES
Induction of labor at term, control postpartum bleeding. Adjunct in management of abortion.
PRECAUTIONS
CONTRAINDICATIONS: Adequate uterine activity that fails to progress, cephalopelvic disproportion, fetal distress without imminent delivery, grand multiparity, hyperactive or hypertonic uterus, obstetric emergencies that favor surgical intervention, prematurity, unengaged fetal head, unfavorable fetal position or presentation, when vaginal delivery is contraindicated, such as active genital herpes infection, placenta previa, or cord presentation. CAUTIONS: Induction of labor should be for medical, not elective, reasons.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Used as indicated, not expected to present risk of fetal abnormalities. Small amounts in breast milk; breast-feeding not recommended. Pregnancy Category X. Children/Elderly: Not used in these patient populations.
INTERACTIONS
DRUG: Caudal block anesthetics, vasopressors: May increase pressor effects. Other oxytocics: May cause cervical lacerations, uterine hypertonus, or uterine rupture. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
INJECTION (PITOCIN): 10 units/ml. NASAL SPRAY (SYNTOCINON): 40 units/ml.
ADMINISTRATION/HANDLING
L IV
Reconstitution N Dilute 10U40 units (1U4 ml) in 1,000 ml of 0.9% NaCl, lactated Ringer's, or D5W to provide a concentration of 10U40 milliunits/ml solution.
Rate of administration N Give by IV infusion (use infusion device to carefully control rate of flow as ordered by physician).
Storage N Store at room temperature.
INTRANASAL
N Store at room temperature. N Use before breast-feeding or pumping of breasts. N Insert the spray tip into the patient's nostril, pointing toward the nasal passages, away from the nasal septum. N Spray oxytocin into the nostril while holding the patient's other nostril closed and at the same time, have the patient inhale through nose to deliver the medication as high into the nasal passages as possible.
IV INCOMPATIBILITIES
No known incompatibilities via Y-site administration.
IV COMPATIBILITIES
Heparin, insulin, multivitamins, potassium chloride.
INDICATIONS/ROUTES/DOSAGE
INDUCTION OR STIMULATION OF LABOR
IV: ADULTS: 0.5U1 milliunit/min. May gradually increase in increments of 1U2 milliunit/min. Rates of 9U10 milliunit/min are rarely required.
ABORTION
IV: ADULTS: 10U20 milliunit/min. Maximum: 30 unit/12h dose.
CONTROL OF POSTPARTUM BLEEDING
IV INFUSION: ADULTS: 10U40 units in 1,000 ml IV fluid at a rate sufficient to control uterine atony.
IM: ADULTS: 10 units (total dose) after delivery.
LACTATION STIMULANT
INTRANASAL: ADULTS: One spray into one or both nostrils 2U3 min before breast-feeding or pumping of the breasts.
SIDE EFFECTS
OCCASIONAL: Tachycardia, premature ventricular contractions, hypotension, nausea, vomiting. RARE: Nasal: Lacrimation or tearing, nasal irritation, rhinorrhea, unexpected uterine bleeding or contractions.
ADVERSE REACTIONS/TOXIC EFFECTS
Hypertonicity may occur with tearing of the uterus, increased bleeding, abruptio placentae (i.e., placental abruption), and cervical and vaginal lacerations. In the fetus, bradycardia, CNS or brain damage, trauma due to rapid propulsion, low Apgar score at 5 min, and retinal hemorrhage occur rarely. Prolonged IV infusion of oxytocin with excessive fluid volume has caused severe water intoxication with seizures, coma, and death.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Assess baselines for vital signs, BP, fetal heart rate. Determine frequency, duration, strength of contractions.
INTERVENTION/EVALUATION
Monitor BP, pulse, respirations, fetal heart rate, intrauterine pressure, contractions (duration, strength, frequency) q15min. Notify physician of contractions that last longer than 1 min, occur more frequently than every 2 min, or stop. Maintain careful I&O; be alert to potential water intoxication. Check for blood loss.
PATIENT/FAMILY TEACHING
N Keep patient, family informed of labor progress.
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