potassium acetate A
potassium bicarbonate/citrate A
(Effer K, Klor-Con EF, K-Lyte, K-Lyte DS)
potassium chloride H
(Apo-K J, Cena K, Ed K+10, K+Care, K-8, K-10, Kaochlor, Kaon-Cl, Kaon-CL 10, Kaon-CL 20%, Kato, Kay Ciel, KCl-20, KCl-40, K-Dur, K-Dur 10, K-Dur 20, K-Lor, K-Lor-Con M 15, Klor-Con, Klor-Con 8, Klor-Con 10, Klor-Con/25, Klor-Con M10, Klor-Con M15, Klor-Con M20, Klotrix, K-Norm, K-Sol, K-Tab, Micro-K, Micro-K 10, Rum-K)
potassium gluconate A
(Kaon)
poe-tah-see-um
Do not confuse K-dur with Cardura.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Electrolyte. CLINICAL: Potassium replenisher.
ACTION
An electrolyte that is necessary for multiple cellular metabolic processes. Primary action is intracellular. Therapeutic Effect: Needed for nerve impulse conduction and contraction of cardiac, skeletal, and smooth muscle; maintains normal renal function and acid-base balance.
PHARMACOKINETICS
Well absorbed from the GI tract. Enters cells by active transport from extracellular fluid. Primarily excreted in urine.
USES
Treatment of potassium deficiency found in severe vomiting, diarrhea, loss of GI fluid, malnutrition, prolonged diuresis, debilitated, poor GI absorption, metabolic alkalosis, prolonged parenteral alimentation. Prevention of hypokalemia in at-risk patients.
PRECAUTIONS
CONTRAINDICATIONS: Concurrent use of potassium-sparing diuretics, digitalis toxicity, heat cramps, hyperkalemia, postop oliguria, severe burns, severe renal impairment, shock with dehydration or hemolytic reaction, untreated Addison's disease. CAUTIONS: Cardiac disease, tartrazine sensitivity (mostly noted in those with aspirin hypersensitivity).
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category C (A for potassium chloride). Children: No age-related precautions noted. Elderly: May be at increased risk for hyperkalemia. Age-related ability to excrete potassium is reduced.
INTERACTIONS
DRUG: Angiotensin-converting enzyme (ACE) inhibitors, beta-adrenergic blockers, heparin, NSAIDs, potassium-containing medications, potassium-sparing diuretics, salt substitutes: May increase potassium blood concentration. Anticholinergics: May increase the risk of GI lesions. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (Rx)
POTASSIUM ACETATE
INJECTION: 2 mEq/ml.
POTASSIUM BICARBONATE AND POTASSIUM CITRATE
TABLETS FOR SOLUTION: 25 mEq (Klor-Con EF, Effer-K, K-Lyte), 50 mEq (K-Lyte DS). POTASSIUM CHLORIDE
CAPSULES (CONTROLLED-RELEASE [MICRO-K]): 8 mEq, 10 mEq. LIQUID: 20 mEq/15 ml (Kaochlor), 40 mEq/15 ml (Kaon-Cl). POWDER FOR ORAL SOLUTION (K-LOR): 20 mEq. POWDER FOR RECONSTITUTION (K+CARE): 20 mEq. INJECTION: 2 mEq/ml. TABLETS (EXTENDED-RELEASE): 8 mEq (K-8, Klor-Con, Klor-Con 8, Klor-Con M10, Micro-K, Micro-K10), 10 mEq (K-8, Kaon-CL, Kaon-CL 10, K-Dur, Klor-Con, Klor-Con 8, Klor-Con M10, Klotrix, K-Tab, Micro-K, Micro-K 10), 20 mEq (K-Dur).
POTASSIUM GLUCONATE
EIIXIR (KAON): 20 mEq/15 ml.
ADMINISTRATION/HANDLING
L IV
Reconstitution N For IV infusion only, must dilute before administration, mix well, infuse slowly. N Avoid adding potassium to hanging IV.
Rate of administration N Give at rate no more than 40 mEq/L; no faster than 20 mEq/hr. (Higher concentrations or faster rates may sometimes be necessary.) N Check IV site closely during infusion for evidence of phlebitis (heat, pain, red streaking of skin over vein, hardness to vein), extravasation (swelling, pain, cool skin, little or no blood return).
Storage N Store at room temperature.
N Take with or after meals and with full glass of water (decreases GI upset). N Liquids, powder, effervescent tablets: Mix, dissolve with juice, water before administering. N Do not chew, crush tablets; swallow whole.
IV INCOMPATIBILITIES
Amphotericin B complex (Abelcet, AmBisome, Amphotec), methylprednisolone (Solu-Medrol), phenytoin (Dilantin).
IV COMPATIBILITIES
Aminophylline, amiodarone (Cordarone), atropine, aztreonam (Azactam), calcium gluconate, cefepime (Maxipime), ciprofloxacin (Cipro), clindamycin (Cleocin), dexamethasone (Decadron), digoxin (Lanoxin), diltiazem (Cardizem), diphenhydramine (Benadryl), dobutamine (Dobutrex), dopamine (Intropin), enalapril (Vasotec), famotidine (Pepcid), fluconazole (Diflucan), furosemide (Lasix), granisetron (Kytril), heparin, hydrocortisone (Solu-Cortef), insulin, lidocaine, lorazepam (Ativan), magnesium sulfate, methylprednisolone (Solu-Medrol), metoclopramide (Reglan), midazolam (Versed), milrinone (Primacor), morphine, norepinephrine (Levophed), ondansetron (Zofran), oxytocin (Pitocin), piperacillin and tazobactam (Zosyn), procainamide (Pronestyl), propofol (Diprivan), propranolol (Inderal).
INDICATIONS/ROUTES/DOSAGE
PREVENTION OF HYPOKALEMIA (IN PATIENTS ON DIURETIC THERAPY)
TREATMENT OF HYPOKALEMIA
IV: ADULTS, ELDERLY: 5U10 mEq/hr. Maximum: 400 mEq/day. CHILDREN: 1 mEq/kg over 1U2 hr.
SIDE EFFECTS
OCCASIONAL: Nausea, vomiting, diarrhea, flatulence, abdominal discomfort with distention, phlebitis with IV administration (particularly when potassium concentration of greater than 40 mEq/L is infused). RARE: Rash.
ADVERSE REACTIONS/TOXIC EFFECTS
Hyperkalemia (more common in elderly patients and those with impaired renal function) may be manifested as paresthesia, feeling of heaviness in the lower extremities, cold skin, grayish pallor, hypotension, confusion, irritability, flaccid paralysis, and cardiac arrhythmias.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
INTERVENTION/EVALUATION
Monitor serum potassium level (particularly in renal impairment). If GI disturbance is noted, dilute preparation further or give with meals. Be alert to decrease in urinary output (may be indication of renal insufficiency). Monitor pattern of daily bowel activity and stool consistency. Assess I&O diligently during diuresis, IV site for extravasation, phlebitis. Be alert to evidence of hyperkalemia (skin pallor/coldness, complaints of paraesthesia, feeling of heaviness of lower extremities).
PATIENT/FAMILY TEACHING
N Foods rich in potassium include beef, veal, ham, chicken, turkey, fish, milk, bananas, dates, prunes, raisins, avocados, watermelon, cantaloupe, apricots, molasses, beans, yams, broccoli, Brussels sprouts, lentils, potatoes, spinach. N Report paraesthesia, feeling of heaviness of lower extremities.
ketorolac tromethamine
key-tore-oh-lack
(Acular, Acular LS, Acular PF, Toradol, Toradol IM, Toradol IV/IM)
Do not confuse Acular with Acthar or Ocular.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Nonsteroidal anti-inflammatory. CLINICAL: Analgesic, intraocular anti-inflammatory.
ACTION
An NSAID that inhibits prostaglandin synthesis and reduces prostaglandin levels in the aqueous humor. Therapeutic Effect: Relieves pain stimulus and reduces intraocular inflammation.
PHARMACOKINETICS
Route Onset Peak Duration
IV/IM 30 min 1U2 hr 4U6 hr
Readily absorbed from the GI tract, after IM administration. Protein binding: 99%. Largely metabolized in the liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 3.8U6.3 hr (increased with impaired renal function and in the elderly).
USES
Short-term relief of mild to moderate pain. Ophthalmic: Relief of ocular itching due to seasonal allergic conjunctivitis. Treatment postop for inflammation following cataract extraction, pain following incisional refractive surgery. OFF-LABEL: Prevention or treatment of ocular inflammation (ophthalmic form).
PRECAUTIONS
CONTRAINDICATIONS: Active peptic ulcer disease, chronic inflammation of GI tract, GI bleeding or ulceration, history of hypersensitivity to aspirin or NSAIDs. CAUTIONS: Renal or hepatic impairment, history of GI tract disease, predisposition to fluid retention.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug is excreted in breast milk. Avoid use during third trimester (may adversely affect fetal cardiovascular system: premature closure of ductus arteriosus). Pregnancy Category C (D if used in third trimester). Children: Safety and efficacy not established, but doses of 0.5 mg/kg have been used. Elderly: GI bleeding or ulceration more likely to cause serious adverse effects. Age-related renal impairment may increase risk of hepatic/renal toxicity; decreased dosage recommended.
INTERACTIONS
DRUG: Antihypertensives, diuretics: May decrease the effects of these drugs. Aspirin, other salicylates: May increase the risk of GI side effects such as bleeding. Bone marrow depressants: May increase the risk of hematologic reactions. Heparin, oral anticoagulants, thrombolytics: May increase the effects of these drugs. Lithium: May increase the blood concentration and risk of toxicity of lithium. Methotrexate: May increase the risk of methotrexate toxicity. Probenecid: May increase ketorolac blood concentration. HERBAL: Feverfew: May decrease the effects of feverfew. Ginkgo biloba: May increase the risk of bleeding. FOOD: None known. LAB VALUES: May prolong bleeding time. May increase liver function test results.
AVAILABILITY (Rx)
TABLETS (TORADOL): 10 mg. INJECTION (TORADOL, TORADOL IM, TORADOL IV/IM): 15 mg/ml, 30 mg/ml. OPHTHALMIC SOLUTION: 0.4% (Acular LS), 0.5% (Acular, Acular PF).
ADMINISTRATION/HANDLING
L IV
N Give undiluted as IV push. N Give over at least 15 sec.
IM
N Give deep IM slowly into large muscle mass.
N Give with food, milk, antacids if GI distress occurs.
OPHTHALMIC
N Place finger on lower eyelid, pull out until pocket is formed between eye and lower lid. Hold dropper above pocket, place prescribed number of drops in pocket. N Close eye gently. Apply digital pressure to lacrimal sac for 1U2 min (minimized drainage into nose and throat, reducing risk of systemic effects). N Remove excess solution with tissue.
IV INCOMPATIBILITY
Promethazine (Phenergan).
IV COMPATIBILITIES
Fentanyl (Sublimaze), hydromorphone (Dilaudid), morphine, nalbuphine (Nubain).
INDICATIONS/ROUTES/DOSAGE
SHORT-TERM RELIEF OF MILD TO MODERATE PAIN (MULTIPLE DOSES)
IV, IM: ADULTS YOUNGER THAN 65 YR: 30 mg q6h. Maximum: 120 mg/24 hr. ADULTS 65 YR AND OLDER, THOSE WITH RENAL IMPAIRMENT, THOSE WEIGHING LESS THAN 50 KG: 15 mg q6h. Maximum: 60 mg/24 hr. CHILDREN 2U16 YR: 0.5 mg/kg q6h.
SHORT-TERM RELIEF OF MILD TO MODERATE PAIN (SINGLE DOSE)
IV: ADULTS YOUNGER THAN 65 YR, CHILDREN 17 YR AND OLDER WEIGHING MORE THAN 50 KG: 30 mg. ADULTS 65 YR AND OLDER, WITH RENAL IMPAIRMENT, WEIGHING LESS THAN 50 KG: 15 mg. CHILDREN 2U16 YR: 0.5 mg/kg. Maximum: 15 mg.
IM: ADULTS YOUNGER THAN 65 YR, CHILDREN 17 YR AND OLDER, WEIGHING MORE THAN 50 KG: 60 mg. ADULTS 65 YR AND OLDER, WITH RENAL IMPAIRMENT, WEIGHING LESS THAN 50 KG: 30 mg. CHILDREN 2U16 YR: 1 mg/kg. Maximum: 15 kg.
ALLERGIC CONJUNCTIVITIS
OPHTHALMIC: ADULTS, ELDERLY, CHILDREN 3 YR AND OLDER: 1 drop 4 times a day.
CATARACT EXTRACTION
OPHTHALMIC: ADULTS, ELDERLY: 1 drop 4 times a day. Begin 24 hr after surgery and continue for 2 wk.
REFRACTIVE SURGERY
OPHTHALMIC: ADULTS, ELDERLY: 1 drop 4 times a day for 3 days.
SIDE EFFECTS
FREQUENT (17%U12%): Headache, nausea, abdominal cramps or pain, dyspepsia. OCCASIONAL (9%U3%): Diarrhea. Ophthalmic: Transient stinging and burning. RARE (3%U1%): Constipation, vomiting, flatulence, stomatitis, dizziness. Ophthalmic: Ocular irritation, allergic reactions, superficial ocular infection, keratitis.
ADVERSE REACTIONS/TOXIC EFFECTS
Rare reactions with long-term use include peptic ulcer disease, GI bleeding, gastritis, severe hepatic reactions (cholestasis, jaundice), nephrotoxicity (glomerular nephritis, interstitial nephritis, nephrotic syndrome), and an acute hypersensitivity reaction (including fever, chills, and joint pain).
NURSING CONSIDERATION
BASELINE ASSESSMENT
Assess onset, type, location, duration of pain.
INTERVENTION/EVALUATION
Monitor renal and liver function tests, occult blood loss, urine output. Evaluate for therapeutic response: relief of pain, stiffness, swelling; increased joint mobility, reduced joint tenderness, improved grip strength. Be alert to signs of bleeding (may also occur with ophthalmic route due to systemic absorption).
PATIENT/FAMILY TEACHING
N Avoid aspirin, alcohol during therapy with oral or ophthalmic ketorolac (increases tendency to bleed). N If GI upset occurs, take with food, milk. N Avoid tasks that require alertness, motor skills until response to drug is established. N Ophthalmic: Transient stinging, burning may occur upon instillation. N Do not administer while wearing soft contact lenses.
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