haloperidol
hal-oh-pear-ih-dawl
(Apo-Haloperidol J, Haldol, Haldol Decanoate, Novoperidol J, Peridol J)
Do not confuse Haldol with Halcion, Halog, or Stadol.
CLASSIFICATION
CLINICAL: Antipsychotic, antiemetic, antidyskinetic.
ACTION
An antipsychotic, antiemetic, and antidyskinetic agent that competitively blocks postsynaptic dopamine receptors, interrupts nerve impulse movement, and increases turnover of dopamine in the brain. Has strong extrapyramidal and antiemetic effects; weak anticholinergic and sedative effects. Therapeutic Effect: Produces tranquilizing effect.
PHARMACOKINETICS
Readily absorbed from the GI tract. Protein binding: 92%. Extensively metabolized in the liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 12U37 hr PO; 10U19 hr IV; 17U25 hr IM.
USES
Treatment of psychoses, Tourette's disorder, severe behavioral problems in children, emergency sedation of severely agitated/psychotic patients. OFF-LABEL: Treatment of Huntington's chorea, infantile autism, nausea or vomiting associated with cancer chemotherapy.
PRECAUTIONS
CONTRAINDICATIONS: Angle-closure glaucoma, CNS depression, myelosuppression, Parkinson's disease, severe cardiac or hepatic disease. CAUTIONS: Renal or hepatic impairment, cardiovascular disease, history of seizures.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Crosses placenta. Distributed in breast milk. Pregnancy Category C. Children: More susceptible to dystonias; not recommended in those younger than 3 yr. Elderly: More susceptible to orthostatic hypotension, anticholinergic effects and sedation, increased risk for extrapyramidal effects. Decreased dosage recommended.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS depression. Epinephrine: May block alpha-adrenergic effects. Extrapyramidal symptom-producing medications: May increase extrapyramidal symptoms. Lithium: May increase neurologic toxicity. HERBAL: None known. FOOD: None known. LAB VALUES: None known. Therapeutic serum level is 0.2-1 mcg/ml; toxic serum level is greater than 1 mcg/ml.
AVAILABILITY (Rx)
ORAL CONCENTRATE: 1 mg/ml, 2 mg/ml. TABLETS (HALDOL): 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg. INJECTION (LACTATE [HALDOL]): 5 mg/ml. INJECTION (DECANOATE [HALDOL DECANOATE]): 50 mg/ml, 100 mg/ml.
ADMINISTRATION/HANDLING
L IV
O ALERT P Only haloperidol lactate is given IV.
Reconstitution N May give undiluted. N Flush with at least 2 ml 0.9% NaCl before and after administration. N May add to 30U50 ml most solutions (D5W preferred).
Rate of administration N Give IV push at rate of 5 mg/min. N Infuse IV piggyback over 30 min. N For IV infusion, up to 25 mg/hr has been used (titrated to patient response).
Storage N Discard if precipitate forms, discoloration occurs. N Store at room temperature. N Protect from light, do not freeze.
IM
Parenteral administration: Patient should remain recumbent for 30U60 min in head-low position with legs raised to minimize hypotensive effect. N Prepare Decanoate IM injection using 21-gauge needle. N Do not exceed maximum volume of 3 ml per IM injection site. N Inject slow, deep IM into upper outer quadrant of gluteus maximus.
PO
N Give without regard to meals. N Scored tablets may be crushed.
IV INCOMPATIBILITIES
Allopurinol (Aloprim), amphotericin B complex (Abelcet, AmBisome, Amphotec), cefepime (Maxipime), fluconazole (Diflucan), foscarnet (Foscavir), heparin, nitroprusside (Nipride), piperacillin and tazobactam (Zosyn).
IV COMPATIBILITIES
Dobutamine (Dobutrex), dopamine (Intropin), fentanyl (Sublimaze), hydromorphone (Dilaudid), lidocaine, lorazepam (Ativan), midazolam (Versed), morphine, nitroglycerin, norepinephrine (Levophed), propofol (Diprivan).
INDICATIONS/ROUTES/DOSAGE
ACUTE PSYCHOSIS, DELIRIUM
IV: ADULTS, ELDERLY: 0.5U50 mg at a rate of 5 mg/min. May repeat as needed.
PSYCHOTIC DISORDER
PO: ADULTS, ELDERLY: Initially, 0.5U5 mg 2U3 times a day. Maximum: 100 mg/day.
SEVERE BEHAVIORAL PROBLEMS
PO: CHILDREN 3U12 YR, WEIGHING 15U40 KG: 0.05U0.075 mg/kg/day. Initially, 0.5 mg/day. May increase by 0.5 mg/day q5U7days divided into 2U3 doses a day.
TOURETTE'S DISORDER
PO: ADULTS, ELDERLY: 6U15 mg/day. May increase by 2 mg increments as needed. Maintenance: 9 mg/day. CHILDREN 3U12 YR, WEIGHING 15U40 KG: 0.05U0.075 mg/kg/day. Initially, 0.5 mg/day. May increase by 0.5 mg/day q5U7days divided into 2U3 doses a day.
SIDE EFFECTS
FREQUENT: Blurred vision, constipation, orthostatic hypotension, dry mouth, swelling or soreness of female breasts, peripheral edema. OCCASIONAL: Allergic reaction, difficulty urinating, decreased thirst, dizziness, decreased sexual function, drowsiness, nausea, vomiting, photosensitivity, lethargy.
ADVERSE REACTIONS/TOXIC EFFECTS
Extrapyramidal symptoms appear to be dose-related and typically occur in the first few days of therapy. Marked drowsiness and lethargy, excessive salivation, and fixed stare occur frequently. Less common reactions include severe akathisia (motor restlessness) and acute dystonias (such as torticollis, opisthotonos, and oculogyric crisis).Tardive dyskinesia (tongue protrusion, puffing of the cheeks, chewing or puckering of the mouth) may occur during long-term therapy or after discontinuing the drug and may be irreversible. Elderly female patients have a greater risk of developing this reaction.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Assess behavior, appearance, emotional status, response to environment, speech pattern, thought content.
INTERVENTION/EVALUATION
Supervise suicidal-risk patient closely during early therapy (as depression lessens, energy level improves, causing increased suicide potential). Monitor for rigidity, tremor, mask-like facial expression, fine tongue movement. Assess for therapeutic response (interest in surroundings, improvement in self-care, increased ability to concentrate, relaxed facial expression). Therapeutic serum level: 0.2U1 mcg/ml. Toxic serum level: greater than 1 mcg/ml.
PATIENT/FAMILY TEACHING
N Full therapeutic effect may take up to 6 wk. N Do not abruptly withdraw from long-term drug therapy. N Sugarless gum, sips of tepid water may relieve dry mouth. N Drowsiness generally subsides during continued therapy. N Avoid tasks that require alertness, motor skills until response to drug is established. N Avoid alcohol. N Report muscle stiffness. N Avoid exposure to sunlight, overheating, dehydration (increased risk of heat stroke).
hydrocodone bitartrate A
high-drough-koe'-doan
(Hycodan J, Robidone J)
FIXED-COMBINATION(S)
Anexsia: hydrocodone/acetaminophen (a non-narcotic analgesic): 5 mg/500 mg; 7.5 mg/650 mg; 10 mg/650 mg. Duocet: hydrocodone/acetaminophen: 5 mg/500 mg. Hycet: hydrocodone/acetaminophen: 7.5 mg/325 mg per 15 ml. Hycodan: hydrocodone/homatropine (an anticholinergic): 5mg/1.5 mg. Hycotuss, Vitussin: hydrocodone/guaifenesin (an expectorant): 5mg/100mg. Lorcet: hydrocodone/acetaminophen: 7.5 mg/650 mg; 10 mg/650 mg. Lortab Elixer: hydrocodone/acetaminophen: 2.5 mg/167 mg per 5 ml. Lortab with ASA: hydrocodone/aspirin: 5 mg/500 mg. Lortab: hydrocodone/acetaminophen: 2.5 mg/500 mg; 5 mg/500 mg; 7.5 mg/500 mg; 10 mg/500 mg. Norco: hydrocodone/acetaminophen: 10 mg/325 mg. Reprexain CIII: hydrocodone/ibuprofen (an NSAID): 5 mg/200 mg. Tussend: hydrocodone/pseudoephedrine (a sympathomimetic)/guaifenesin (an expectorant): 2.5mg/30mg/100mg per 5 ml. Vicodin ES: hydrocodone/acetaminophen: 7.5 mg/750 mg. Vicodin HP: hydrocodone/acetaminophen: 10 mg/650 mg. Vicodin: hydrocodone/acetaminophen: 5 mg/500 mg. Vicoprofen: hydrocodone/ibuprofen (an NSAID): 7.5 mg/200 mg. Zydone: hydrocodone/acetaminophen: 5 mg/400 mg; 7.5 mg/400 mg; 10 mg/400 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Opioid agonist (Schedule III). CLINICAL: Narcotic analgesic, antitussive.
ACTION
A narcotic analgesic and antitussive that binds with opioid receptors in the CNS. Therapeutic Effect: Alters the perception of and emotional response to pain; suppresses cough reflex.
PHARMACOKINETICS
Route Onset Peak Duration
PO (analgesic) 10U20 min 30U60 min 4U6 hr
PO (antitussive) N/A N/A 4U6 hr
Well absorbed from the GI tract. Metabolized in the liver. Primarily excreted in urine. Half-life: 3.8 hr (increased in elderly).
USES
Relief of moderate to moderately severe pain, nonproductive cough.
PRECAUTIONS
CONTRAINDICATIONS: None known. 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. May prolong labor if administered in latent phase of first stage of labor, or before cervical dilation of 4U5 cm has occurred. Respiratory depression may occur in neonate if mother received opiates during labor. Regular use of opiates during pregnancy may produce withdrawal symptoms (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, seizures) in the neonate. Pregnancy Category C (D if used for prolonged periods or at high dosages at term). Children: Those younger than 2 yr may be more susceptible to respiratory depression. Elderly: May be more susceptible to respiration depression, may cause paradoxical excitement. Age-related renal impairment, prostatic hypertrophy or obstruction may increase risk of urinary retention; dosage adjustment recommended.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS or respiratory depression and hypotension. MAOIs: May produce a severe, sometimes fatal reaction; plan to administer ¼ of usual hydrocodone dose. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum amylase and lipase levels.
ADMINISTRATION/HANDLING
PO
N Give without regard to meals. N Tablets may be crushed.
INDICATIONS/ROUTES/DOSAGE
ANALGESIA
PO: ADULTS, CHILDREN OLDER THAN 12 YR: 5U15 mg q4U6h. ELDERLY: 2.5U10 mg q4U6h.
COUGH
PO: ADULTS, ELDERLY: 5U10 mg q4U6h as needed. Maximum: 15 mg/dose. CHILDREN: 0.6 mg/kg/day in 3U4 divided doses at intervals of at least 4 hr. Maximum single dose: 10 mg (children older than 12 yr), 5 mg (children 2U12 yr), 1.25 mg (children younger than 2 yr).
PO (EXTENDED-RELEASE): ADULTS: 10 mg q12h. CHILDREN 6U12 YR: 5 mg q12h.
SIDE EFFECTS
FREQUENT: Sedation, hypotension, diaphoresis, facial flushing, dizziness, somnolence. OCCASIONAL: Urine retention, blurred vision, constipation, dry mouth, headache, nausea, vomiting, difficult or painful urination, euphoria, dysphoria.
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. The patient who uses hydrocodone repeatedly may develop a tolerance to the drug's analgesic effect as well as physical dependence. The drug may have a prolonged duration of action and cumulative effect in patients with hepatic or renal impairment.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Analgesic: Assess onset, type, location, duration of pain. Effect of medication is reduced if full pain recurs before next dose. Antitussive: Assess type, severity, frequency of cough.
INTERVENTION/EVALUATION
Palpate bladder for urinary retention. Monitor pattern of daily bowel activity and stool consistency. Initiate deep breathing and coughing exercises, particularly in patients with pulmonary impairment. Assess for clinical improvement; record onset of relief of pain or cough.
PATIENT/FAMILY TEACHING
N Change positions slowly to avoid orthostatic hypotension. N Avoid tasks that require alertness, motor skills until response to drug is established. N Tolerance or dependence may occur with prolonged use at high dosages. N Avoid alcohol. N Report nausea, vomiting, constipation, shortness of breath, difficulty breathing. N May take with food.
hydrochlorothiazide H
high-drow-chlor-oh-thigh-ah-zide
(Apo-Hydro J, Aquazide H, Esidrix, HydroDIURIL, Microzide, Oretic)
FIXED-COMBINATION(S)
Accuretic: hydrochlorothiazide/quinapril (an angiontensin-converting enzyme [ACE] inhibitor): 12.5 mg/10 mg; 12.5 mg/20 mg; 25 mg/20 mg. Aldactazide: hydrochlorothiazide/spironolactone (a potassium-sparing diuretic): 25 mg/25 mg; 50 mg/50 mg. Aldoril: hydrochlorothiazide/methyldopa (an antihypertensive): 15 mg/250 mg; 25 mg/250 mg; 30 mg/500 mg; 50 mg/500 mg. Apresazide: hydrochlorothiazide/hydralazine (a vasodilator): 25 mg/25 mg; 50 mg/50 mg; 50 mg/100 mg. Atacand HCT: hydrochlorothiazide/candesartan (an angiotensin II receptor antagonist): 12.5 mg/16 mg; 12.5 mg/32 mg. Avalide: hydrochlorothiazide/irbesartan (an angiotensin II receptor antagonist): 12.5 mg/150 mg; 12.5 mg/300 mg, 25 mg/300 mg. Benicar HCT: hydrochlorothiazide/olmesartan (an angiotensin II receptor antagonist): 12.5 mg/20 mg; 12.5 mg/40 mg; 25 mg/40 mg. Capozide: hydrochlorothiazide/captopril (an ACE inhibitor): 15 mg/25 mg; 15 mg/50 mg; 25 mg/25 mg; 25 mg/50 mg. Diovan HCT: hydrochlorothiazide/valsartan (an angiotensin II receptor antagonist): 12.5 mg/80 mg; 12.5 mg/160 mg. Dyazide/Maxide: hydrochlorothiazide/triamterene (a potassium-sparing diuretic): 25 mg/37.5 mg; 25 mg/50 mg; 50 mg/75 mg. Hyzaar: hydrochlorothiazide/losartan (an angiotensin II receptor antagonist): 12.5 mg/50 mg; 12.5 mg/100 mg; 25 mg/100 mg. Inderide: hydrochlorothiazide/propranolol (a beta-blocker): 25 mg/40 mg; 25 mg/80 mg; 50 mg/80 mg; 50 mg/120 mg; 50 mg/160 mg. Lopressor HCT: hydrochlorothiazide/metoprolol (a beta-blocker): 25 mg/50 mg; 25 mg/100 mg; 50 mg/100 mg. Lotensin HCT: hydrochlorothiazide/bepridil (a calcium channel blocker): 6.25 mg/5 mg; 12.5 mg/10 mg; 12.5 mg/20 mg; 25 mg/20 mg. Micardis HCT: hydrochlorothiazide/telmisartan (an angiotensin II receptor antagonist): 12.5 mg/40 mg; 12.5 mg/80 mg. Moduretic: hydrochlorothiazide/amiloride (a potassium-sparing diuretic): 50 mg/5 mg. Normozidehydrochlorothiazide/labetalol (a beta-blocker): 25 mg/100 mg; 25 mg/300 mg. Prinzide/Zestoretic: hydrochlorothiazide/lisinopril (an ACE inhibitor): 12.5 mg/10 mg; 12.5 mg/20 mg; 25 mg/20 mg. Teveten HCT: hydrochlorothiazide/eprosartan (an angiotensin II receptor antagonist): 12.5 mg/600 mg; 25 mg/600 mg. Timolide: hydrochlorothiazide/timolol (a beta-blocker): 25 mg/10 mg. Uniretic: hydrochlorothiazide/moexipril (an ACE inhibitor): 12.5 mg/7.5 mg; 25 mg/15 mg. Vaseretic: hydrochlorothiazide/enalapril (an ACE inhibitor): 12.5 mg/5 mg; 25 mg/10 mg. Ziac: hydrochlorothiazide/bisoprolol (a beta-blocker): 6.25 mg/5 mg; 6.25 mg/10 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Sulfonamide derivative. CLINICAL: Thiazide diuretic, antihypertensive.
ACTION
A sulfonamide derivative that acts as a thiazide diuretic and antihypertensive. As a diuretic blocks reabsorption of water, sodium, and potassium at the cortical diluting segment of the distal tubule. As an antihypertensive reduces plasma, extracellular fluid volume, and peripheral vascular resistance by direct effect on blood vessels. Therapeutic Effect: Promotes diuresis; reduces BP.
PHARMACOKINETICS
Route Onset Peak Duration
PO (diuretic) 2 hr 4U6 hr 6U12 hr
Variably absorbed from the GI tract. Primarily excreted unchanged in urine. Not removed by hemodialysis. Half-life: 5.6U14.8 hr.
USES
Treatment of mild to moderate hypertension, edema in CHF, nephrotic syndrome. OFF-LABEL: Treatment of diabetes insipidus, prevention of calcium-containing renal calculi.
PRECAUTIONS
CONTRAINDICATIONS: Anuria, history of hypersensitivity to sulfonamides or thiazide diuretics, renal decompensation. CAUTIONS: Severe renal disease, hepatic impairment, diabetes mellitus, elderly or debilitated, thyroid disorders.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Crosses placenta. Small amount distributed in breast milk; breast-feeding not advised. Pregnancy Category B (D if used in pregnancy-induced hypertension). Children: No age-related precautions noted, except jaundiced infants may be at risk for hyperbilirubinemia. Elderly: May be more sensitive to hypotensive, electrolyte effects. Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Cholestyramine, colestipol: May decrease the absorption and effects of hydrochlorothiazide. Digoxin: May increase the risk of digoxin toxicity associated with hydrochlorothiazide-induced hypokalemia. Lithium: May increase the risk of lithium toxicity. HERBAL: None known. FOOD: None known. LAB VALUES: May increase blood glucose and serum cholesterol, LDL, bilirubin, calcium, creatinine, uric acid, and triglyceride levels. May decrease urinary calcium, and serum magnesium, potassium, and sodium levels.
AVAILABILITY (Rx)
CAPSULES (MICROZIDE): 12.5 mg. ORAL SOLUTION: 50 mg/5 ml. TABLETS (AQUAZIDE, ORETIC): 25 mg, 50 mg, 100 mg.
ADMINISTRATION/HANDLING
PO
N May give with food or milk if GI upset occurs, preferably with breakfast (may prevent nocturia).
INDICATIONS/ROUTES/DOSAGE
EDEMA
PO: ADULTS, ELDERLY: 25U100 mg/day as a single or in divided doses. CHILDREN 2U12 YR: 1U2 mg/kg. Maximum: 100 mg/day. INFANTS YOUNGER THAN 2 YR: 1U2 mg/kg. Maximum: 37.5 mg/day.
HYPERTENSION
PO: ADULTS, ELDERLY: Initially, 12.5U25 mg once daily. May increase up to 50U100 mg/day as a single or in divided doses. CHILDREN 2U12 YR: 1U2 mg/kg. Maximum: 100 mg/day. INFANTS YOUNGER THAN 2 YR: 1U2 mg/kg. Maximum: 37.5 mg/day.
SIDE EFFECTS
EXPECTED: Increase in urinary frequency and urine volume. FREQUENT: Potassium depletion. OCCASIONAL: Orthostatic hypotension, headache, GI disturbances, photosensitivity.
ADVERSE REACTIONS/TOXIC EFFECTS
Vigorous diuresis may lead to profound water and electrolyte depletion, resulting in hypokalemia, hyponatremia, and dehydration. Acute hypotensive episodes may occur. Hyperglycemia may occur during prolonged therapy. Pancreatitis, blood dyscrasias, pulmonary edema, allergic pneumonitis, and dermatologic reactions occur rarely. Overdose can lead to lethargy and coma without changes in electrolytes or hydration.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Check vital signs, especially BP for hypotension before administration. Assess baseline electrolytes; particularly check for hypokalemia. Evaluate skin turgor, mucous membranes for hydration status. Evaluate for peripheral edema. Assess muscle strength, mental status. Note skin temperature, moisture. Obtain baseline weight. Initiate I&O.
INTERVENTION/EVALUATION
Continue to monitor BP, vital signs, electrolytes, I&O, daily weight. Note extent of diuresis. Watch for changes from initial assessment (hypokalemia may result in weakness, tremor, muscle cramps, nausea, vomiting, altered mental status, tachycardia; hyponatremia may result in confusion, thirst, cold and clammy skin). Be especially alert for potassium depletion in patients taking digoxin (cardiac arrhythmias). Potassium supplements are frequently ordered. Check for constipation (may occur with exercise diuresis).
PATIENT/FAMILY TEACHING
N Expect increased frequency and volume of urination. N To reduce hypotensive effect, rise slowly from lying to sitting position, permit legs to dangle momentarily before standing. N Eat foods high in potassium, such as whole grains (cereals), legumes, meat, bananas, apricots, orange juice, potatoes (white, sweet), raisins. N Protect skin from sun and ultraviolet rays (photosensitivity may occur).
hydrocodone bitartrate A
high-drough-koe'-doan
(Hycodan J, Robidone J)
FIXED-COMBINATION(S)
Anexsia: hydrocodone/acetaminophen (a non-narcotic analgesic): 5 mg/500 mg; 7.5 mg/650 mg; 10 mg/650 mg. Duocet: hydrocodone/acetaminophen: 5 mg/500 mg. Hycet: hydrocodone/acetaminophen: 7.5 mg/325 mg per 15 ml. Hycodan: hydrocodone/homatropine (an anticholinergic): 5mg/1.5 mg. Hycotuss, Vitussin: hydrocodone/guaifenesin (an expectorant): 5mg/100mg. Lorcet: hydrocodone/acetaminophen: 7.5 mg/650 mg; 10 mg/650 mg. Lortab Elixer: hydrocodone/acetaminophen: 2.5 mg/167 mg per 5 ml. Lortab with ASA: hydrocodone/aspirin: 5 mg/500 mg. Lortab: hydrocodone/acetaminophen: 2.5 mg/500 mg; 5 mg/500 mg; 7.5 mg/500 mg; 10 mg/500 mg. Norco: hydrocodone/acetaminophen: 10 mg/325 mg. Reprexain CIII: hydrocodone/ibuprofen (an NSAID): 5 mg/200 mg. Tussend: hydrocodone/pseudoephedrine (a sympathomimetic)/guaifenesin (an expectorant): 2.5mg/30mg/100mg per 5 ml. Vicodin ES: hydrocodone/acetaminophen: 7.5 mg/750 mg. Vicodin HP: hydrocodone/acetaminophen: 10 mg/650 mg. Vicodin: hydrocodone/acetaminophen: 5 mg/500 mg. Vicoprofen: hydrocodone/ibuprofen (an NSAID): 7.5 mg/200 mg. Zydone: hydrocodone/acetaminophen: 5 mg/400 mg; 7.5 mg/400 mg; 10 mg/400 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Opioid agonist (Schedule III). CLINICAL: Narcotic analgesic, antitussive.
ACTION
A narcotic analgesic and antitussive that binds with opioid receptors in the CNS. Therapeutic Effect: Alters the perception of and emotional response to pain; suppresses cough reflex.
PHARMACOKINETICS
Route Onset Peak Duration
PO (analgesic) 10U20 min 30U60 min 4U6 hr
PO (antitussive) N/A N/A 4U6 hr
Well absorbed from the GI tract. Metabolized in the liver. Primarily excreted in urine. Half-life: 3.8 hr (increased in elderly).
USES
Relief of moderate to moderately severe pain, nonproductive cough.
PRECAUTIONS
CONTRAINDICATIONS: None known. 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. May prolong labor if administered in latent phase of first stage of labor, or before cervical dilation of 4U5 cm has occurred. Respiratory depression may occur in neonate if mother received opiates during labor. Regular use of opiates during pregnancy may produce withdrawal symptoms (irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting, diarrhea, yawning, sneezing, seizures) in the neonate. Pregnancy Category C (D if used for prolonged periods or at high dosages at term). Children: Those younger than 2 yr may be more susceptible to respiratory depression. Elderly: May be more susceptible to respiration depression, may cause paradoxical excitement. Age-related renal impairment, prostatic hypertrophy or obstruction may increase risk of urinary retention; dosage adjustment recommended.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS or respiratory depression and hypotension. MAOIs: May produce a severe, sometimes fatal reaction; plan to administer ¼ of usual hydrocodone dose. HERBAL: None known. FOOD: None known. LAB VALUES: May increase serum amylase and lipase levels.
ADMINISTRATION/HANDLING
PO
N Give without regard to meals. N Tablets may be crushed.
INDICATIONS/ROUTES/DOSAGE
ANALGESIA
PO: ADULTS, CHILDREN OLDER THAN 12 YR: 5U15 mg q4U6h. ELDERLY: 2.5U10 mg q4U6h.
COUGH
PO: ADULTS, ELDERLY: 5U10 mg q4U6h as needed. Maximum: 15 mg/dose. CHILDREN: 0.6 mg/kg/day in 3U4 divided doses at intervals of at least 4 hr. Maximum single dose: 10 mg (children older than 12 yr), 5 mg (children 2U12 yr), 1.25 mg (children younger than 2 yr).
PO (EXTENDED-RELEASE): ADULTS: 10 mg q12h. CHILDREN 6U12 YR: 5 mg q12h.
SIDE EFFECTS
FREQUENT: Sedation, hypotension, diaphoresis, facial flushing, dizziness, somnolence. OCCASIONAL: Urine retention, blurred vision, constipation, dry mouth, headache, nausea, vomiting, difficult or painful urination, euphoria, dysphoria.
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. The patient who uses hydrocodone repeatedly may develop a tolerance to the drug's analgesic effect as well as physical dependence. The drug may have a prolonged duration of action and cumulative effect in patients with hepatic or renal impairment.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Analgesic: Assess onset, type, location, duration of pain. Effect of medication is reduced if full pain recurs before next dose. Antitussive: Assess type, severity, frequency of cough.
INTERVENTION/EVALUATION
Palpate bladder for urinary retention. Monitor pattern of daily bowel activity and stool consistency. Initiate deep breathing and coughing exercises, particularly in patients with pulmonary impairment. Assess for clinical improvement; record onset of relief of pain or cough.
PATIENT/FAMILY TEACHING
N Change positions slowly to avoid orthostatic hypotension. N Avoid tasks that require alertness, motor skills until response to drug is established. N Tolerance or dependence may occur with prolonged use at high dosages. N Avoid alcohol. N Report nausea, vomiting, constipation, shortness of breath, difficulty breathing. N May take with food.
hydrochlorothiazide H
high-drow-chlor-oh-thigh-ah-zide
(Apo-Hydro J, Aquazide H, Esidrix, HydroDIURIL, Microzide, Oretic)
FIXED-COMBINATION(S)
Accuretic: hydrochlorothiazide/quinapril (an angiontensin-converting enzyme [ACE] inhibitor): 12.5 mg/10 mg; 12.5 mg/20 mg; 25 mg/20 mg. Aldactazide: hydrochlorothiazide/spironolactone (a potassium-sparing diuretic): 25 mg/25 mg; 50 mg/50 mg. Aldoril: hydrochlorothiazide/methyldopa (an antihypertensive): 15 mg/250 mg; 25 mg/250 mg; 30 mg/500 mg; 50 mg/500 mg. Apresazide: hydrochlorothiazide/hydralazine (a vasodilator): 25 mg/25 mg; 50 mg/50 mg; 50 mg/100 mg. Atacand HCT: hydrochlorothiazide/candesartan (an angiotensin II receptor antagonist): 12.5 mg/16 mg; 12.5 mg/32 mg. Avalide: hydrochlorothiazide/irbesartan (an angiotensin II receptor antagonist): 12.5 mg/150 mg; 12.5 mg/300 mg, 25 mg/300 mg. Benicar HCT: hydrochlorothiazide/olmesartan (an angiotensin II receptor antagonist): 12.5 mg/20 mg; 12.5 mg/40 mg; 25 mg/40 mg. Capozide: hydrochlorothiazide/captopril (an ACE inhibitor): 15 mg/25 mg; 15 mg/50 mg; 25 mg/25 mg; 25 mg/50 mg. Diovan HCT: hydrochlorothiazide/valsartan (an angiotensin II receptor antagonist): 12.5 mg/80 mg; 12.5 mg/160 mg. Dyazide/Maxide: hydrochlorothiazide/triamterene (a potassium-sparing diuretic): 25 mg/37.5 mg; 25 mg/50 mg; 50 mg/75 mg. Hyzaar: hydrochlorothiazide/losartan (an angiotensin II receptor antagonist): 12.5 mg/50 mg; 12.5 mg/100 mg; 25 mg/100 mg. Inderide: hydrochlorothiazide/propranolol (a beta-blocker): 25 mg/40 mg; 25 mg/80 mg; 50 mg/80 mg; 50 mg/120 mg; 50 mg/160 mg. Lopressor HCT: hydrochlorothiazide/metoprolol (a beta-blocker): 25 mg/50 mg; 25 mg/100 mg; 50 mg/100 mg. Lotensin HCT: hydrochlorothiazide/bepridil (a calcium channel blocker): 6.25 mg/5 mg; 12.5 mg/10 mg; 12.5 mg/20 mg; 25 mg/20 mg. Micardis HCT: hydrochlorothiazide/telmisartan (an angiotensin II receptor antagonist): 12.5 mg/40 mg; hydrochlorothiazide/labetalol (a beta-blocker): 25 mg/100 mg; 25 mg/300 mg. Prinzide/Zestoretic: hydrochlorothiazide/lisinopril (an ACE inhibitor): 12.5 mg/10 mg; 12.5 mg/20 mg; 25 mg/20 mg. Teveten HCT: hydrochlorothiazide/eprosartan (an angiotensin II receptor antagonist): 12.5 mg/600 mg; 25 mg/600 mg. Timolide: hydrochlorothiazide/timolol (a beta-blocker): 25 mg/10 mg. Uniretic: hydrochlorothiazide/moexipril (an ACE inhibitor): 12.5 mg/7.5 mg; 25 mg/15 mg. Vaseretic: hydrochlorothiazide/enalapril (an ACE inhibitor): 12.5 mg/5 mg; 25 mg/10 mg. Ziac: hydrochlorothiazide/bisoprolol (a beta-blocker): 6.25 mg/5 mg; 6.25 mg/10 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Sulfonamide derivative. CLINICAL: Thiazide diuretic, antihypertensive. 12.5 mg/80 mg. Moduretic: hydrochlorothiazide/amiloride (a potassium-sparing diuretic): 50 mg/5 mg. Normozide:
ACTION
A sulfonamide derivative that acts as a thiazide diuretic and antihypertensive. As a diuretic blocks reabsorption of water, sodium, and potassium at the cortical diluting segment of the distal tubule. As an antihypertensive reduces plasma, extracellular fluid volume, and peripheral vascular resistance by direct effect on blood vessels. Therapeutic Effect: Promotes diuresis; reduces BP.
PHARMACOKINETICS
Route Onset Peak Duration
PO (diuretic) 2 hr 4U6 hr 6U12 hr
Variably absorbed from the GI tract. Primarily excreted unchanged in urine. Not removed by hemodialysis. Half-life: 5.6U14.8 hr.
USES
Treatment of mild to moderate hypertension, edema in CHF, nephrotic syndrome. OFF-LABEL: Treatment of diabetes insipidus, prevention of calcium-containing renal calculi.
PRECAUTIONS
CONTRAINDICATIONS: Anuria, history of hypersensitivity to sulfonamides or thiazide diuretics, renal decompensation. CAUTIONS: Severe renal disease, hepatic impairment, diabetes mellitus, elderly or debilitated, thyroid disorders.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Crosses placenta. Small amount distributed in breast milk; breast-feeding not advised. Pregnancy Category B (D if used in pregnancy-induced hypertension). Children: No age-related precautions noted, except jaundiced infants may be at risk for hyperbilirubinemia. Elderly: May be more sensitive to hypotensive, electrolyte effects. Age-related renal impairment may require dosage adjustment.
INTERACTIONS
DRUG: Cholestyramine, colestipol: May decrease the absorption and effects of hydrochlorothiazide. Digoxin: May increase the risk of digoxin toxicity associated with hydrochlorothiazide-induced hypokalemia. Lithium: May increase the risk of lithium toxicity. HERBAL: None known. FOOD: None known. LAB VALUES: May increase blood glucose and serum cholesterol, LDL, bilirubin, calcium, creatinine, uric acid, and triglyceride levels. May decrease urinary calcium, and serum magnesium, potassium, and sodium levels.
AVAILABILITY (Rx)
CAPSULES (MICROZIDE): 12.5 mg. ORAL SOLUTION: 50 mg/5 ml. TABLETS (AQUAZIDE, ORETIC): 25 mg, 50 mg, 100 mg.
ADMINISTRATION/HANDLING
PO
N May give with food or milk if GI upset occurs, preferably with breakfast (may prevent nocturia).
INDICATIONS/ROUTES/DOSAGE
EDEMA
PO: ADULTS, ELDERLY: 25U100 mg/day as a single or in divided doses. CHILDREN 2U12 YR: 1U2 mg/kg. Maximum: 100 mg/day. INFANTS YOUNGER THAN 2 YR: 1U2 mg/kg. Maximum: 37.5 mg/day.
HYPERTENSION
PO: ADULTS, ELDERLY: Initially, 12.5U25 mg once daily. May increase up to 50U100 mg/day as a single or in divided doses. CHILDREN 2U12 YR: 1U2 mg/kg. Maximum: 100 mg/day. INFANTS YOUNGER THAN 2 YR: 1U2 mg/kg. Maximum: 37.5 mg/day.
SIDE EFFECTS
EXPECTED: Increase in urinary frequency and urine volume. FREQUENT: Potassium depletion. OCCASIONAL: Orthostatic hypotension, headache, GI disturbances, photosensitivity.
ADVERSE REACTIONS/TOXIC EFFECTS
Vigorous diuresis may lead to profound water and electrolyte depletion, resulting in hypokalemia, hyponatremia, and dehydration. Acute hypotensive episodes may occur. Hyperglycemia may occur during prolonged therapy. Pancreatitis, blood dyscrasias, pulmonary edema, allergic pneumonitis, and dermatologic reactions occur rarely. Overdose can lead to lethargy and coma without changes in electrolytes or hydration.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Check vital signs, especially BP for hypotension before administration. Assess baseline electrolytes; particularly check for hypokalemia. Evaluate skin turgor, mucous membranes for hydration status. Evaluate for peripheral edema. Assess muscle strength, mental status. Note skin temperature, moisture. Obtain baseline weight. Initiate I&O.
INTERVENTION/EVALUATION
Continue to monitor BP, vital signs, electrolytes, I&O, daily weight. Note extent of diuresis. Watch for changes from initial assessment (hypokalemia may result in weakness, tremor, muscle cramps, nausea, vomiting, altered mental status, tachycardia; hyponatremia may result in confusion, thirst, cold and clammy skin). Be especially alert for potassium depletion in patients taking digoxin (cardiac arrhythmias). Potassium supplements are frequently ordered. Check for constipation (may occur with exercise diuresis).
PATIENT/FAMILY TEACHING
N Expect increased frequency and volume of urination. N To reduce hypotensive effect, rise slowly from lying to sitting position, permit legs to dangle momentarily before standing. N Eat foods high in potassium, such as whole grains (cereals), legumes, meat, bananas, apricots, orange juice, potatoes (white, sweet), raisins. N Protect skin from sun and ultraviolet rays (photosensitivity may occur).
hydromorphone hydrochloride A
hye-droe-mor-fone
(Dilaudid, Dilaudid-5, Dilaudid HP, Hydromorph Contin J, Hydrostat IR)
Do not confuse with morphine or Dilantin.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Opioid agonist (Schedule II). CLINICAL: Narcotic analgesic, antitussive.
ACTION
An opioid agonist that binds to opioid receptors in the CNS, reducing the intensity of pain stimuli from sensory nerve endings. Therapeutic Effect: Alters the perception of and emotional response to pain; suppresses cough reflex.
PHARMACOKINETICS
Route Onset Peak Duration
PO 30 min 90U120 min 4 hr
IV 10U15 min 15U30 min 2U3 hr
IM 15 min 30U60 min 4U5 hr
Subcutaneous 15 min 30U90 min 4 hr
Rectal 15U30 min N/A N/A
Well absorbed from the GI tract after IM administration. Widely distributed. Metabolized in the liver. Excreted in urine. Half-life: 1U3 hr.
USES
Relief of moderate to severe pain, persistent nonproductive cough.
PRECAUTIONS
CONTRAINDICATIONS: Obstetrical analgesia, respiratory depression in the absence of resuscitative equipment, status asthmaticus. 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. Unknown if distributed in breast milk. May prolong labor if administered in latent phase of first stage of labor or before cervical dilation of 4U5 cm has occurred. Respiratory depression may occur in neonate if mother receives opiates during labor. Regular use of opiates during pregnancy may produce withdrawal symptoms in the 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: Those younger than 2 yr may be more susceptible to respiratory depression. Elderly: May be more susceptible to respiratory depression, may cause paradoxical excitement. Age-related renal impairment, prostatic hypertrophy or obstruction may increase risk of urinary retention; dosage adjustment recommended.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS or respiratory depression and hypotension. MAOIs: May produce a severe, sometimes fatal reaction; plan to administer ¼ of usual hydromorphone dose. HERBAL: St. John's wort: May increase sedation. FOOD: None known. LAB VALUES: May increase serum amylase and lipase concentrations.
AVAILABILITY (Rx)
LIQUID: 1 mg/ml (Dilaudid-5), 5 mg/5 ml (Dilaudid). TABLETS: 2 mg (Dilaudid, Hydrostat IR), 3 mg (Dilaudid, Hydrostat IR), 4 mg (Dilaudid), 8 mg (Dilaudid). INJECTION: 1 mg/ml (Dilaudid), 2 mg/ml (Dilaudid), 4 mg/ml (Dilaudid), 10 mg/ml (Dilaudid HP). SUPPOSITORY (DILAUDID): 3 mg.
ADMINISTRATION/HANDLING
L IV
O ALERT P High concentration injection (10 mg/ml) should be used only in those tolerant to opiate agonists, currently receiving high doses of another opiate agonist for severe, chronic pain due to cancer.
Reconstitution N May give undiluted. N May further dilute with 5 ml sterile water for injection or 0.9% NaCl.
Rate of administration N Administer IV push very slowly (over 2U5 min). N Rapid IV increases risk of severe adverse reactions (chest wall rigidity, apnea, peripheral circulatory collapse, anaphylactoid effects, cardiac arrest).
Storage N Store at room temperature; protect from light. N Slight yellow discoloration of parenteral form does not indicate loss of potency.
IM, SUBCUTANEOUS
N Use short 25- to 30-gauge needle for subcutaneous injection. N Administer slowly; rotate injection sites. N Patients with circulatory impairment experience higher risk of overdosage because of delayed absorption of repeated administration.
PO
N Give without regard to meals. N Tablets may be crushed.
RECTAL
N Refrigerate suppositories. N Moisten suppository with cold water before inserting well up into rectum.
IV INCOMPATIBILITIES
Amphotericin B complex (Abelcet, AmBisome, Amphotec), cefazolin (Ancef, Kefzol), diazepam (Valium), phenobarbital, phenytoin (Dilantin), total parenteral nutrition (TPN).
IV COMPATIBILITIES
Diltiazem (Cardizem), diphenhydramine (Benadryl), dobutamine (Dobutrex), dopamine (Intropin), fentanyl (Sublimaze), furosemide (Lasix), heparin, lorazepam (Ativan), magnesium sulfate, metoclopramide (Reglan), midazolam (Versed), milrinone (Primacor), morphine, propofol (Diprivan).
INDICATIONS/ROUTES/DOSAGE
ANALGESIA
PO: ADULTS, ELDERLY, CHILDREN WEIGHING 50 KG AND MORE: 2U4 mg q3U4h. Range: 2U8 mg/dose. CHILDREN OLDER THAN 6 MO AND WEIGHING LESS THAN 50 KG: 0.03U0.08 mg/kg/dose q3U4h.
IV: ADULTS, ELDERLY, CHILDREN WEIGHING MORE THAN 50 KG: 0.2U0.6 mg q2U3h. CHILDREN WEIGHING 50 KG OR LESS: 0.015 mg/kg/dose q3U6h as needed.
RECTAL: ADULTS, ELDERLY: 3 mg q4U8h.
PATIENT-CONTROLLED ANALGESIA (PCA)
IV: ADULTS, ELDERLY: 0.05U0.5 mg at 5U15 min lockout. Maximum (4-hr): 4U6 mg.
EPIDURAL: ADULTS, ELDERLY: Bolus dose of 1U1.5 mg at rate of 0.04U0.4 mg/hr. Demand dose of 0.15 mg at 30 min lockout.
COUGH
PO: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YR: 1 mg q3U4h. CHILDREN 6U12 YR: 0.5 mg q3U4h.
SIDE EFFECTS
FREQUENT: Somnolence, dizziness, hypotension (including orthostatic hypotension), decreased appetite. OCCASIONAL: Confusion, diaphoresis, facial flushing, urine retention, constipation, dry mouth, nausea, vomiting, headache, pain at injection site. RARE: Allergic reaction, depression.
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. The patient who uses hydromorphone repeatedly may develop a tolerance to the drug's analgesic effect as well as physical dependence. This drug may have a prolonged duration of action and cumulative effect in patients with hepatic or renal impairment.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Analgesic: Assess onset, type, location, duration of pain. Effect of medication is reduced if full pain recurs before next dose. Antitussive: Assess type, severity, frequency of cough.
INTERVENTION/EVALUATION
Monitor vital signs; assess for pain relief, cough. Assess breath sounds. Increase fluid intake, environmental humidity to decrease viscosity of lung secretions. To prevent pain cycles, instruct patient to request pain medication as soon as discomfort begins. Assess pattern of daily bowel activity and stool consistency (especially in long-term use). Initiate deep breathing and coughing exercises, particularly in patients with pulmonary impairment. Assess for clinical improvement; record onset of relief of pain or cough.
PATIENT/FAMILY TEACHING
N Avoid alcohol, tasks that require alertness/motor skills until response to drug is established. N Tolerance or dependence may occur with prolonged use at high dosages. N Change positions slowly to avoid orthostatic hypotension.
*hydrOXYzine
high-drox-ih-zeen
(Apo-Hydroxyzine J, Atarax, Hyzine, Novohydroxyzin J, Vistacort, Vistaject-50, Vistaril, Vistaril IM)
Do not confuse hydroxyzine with hydralazine or hydroxyurea.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Piperazine derivative. CLINICAL: Antihistamine, antianxiety, antispasmodic, antiemetic, antipruritic.
ACTION
A piperazine derivative that competes with histamine for receptor sites in the GI tract, blood vessels, and respiratory tract. May exert CNS depressant activity in subcortical areas. Diminishes vestibular stimulation and depresses labyrinthine function. Therapeutic Effect: Produces anxiolytic, anticholinergic, antihistaminic, and analgesic effects; relaxes skeletal muscle; controls nausea and vomiting.
PHARMACOKINETICS
Route Onset Peak Duration
PO 15U30 min N/A 4U6 hr
Well absorbed from the GI tract and after parenteral administration. Metabolized in the liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 20U25 hr (increased in the elderly).
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, asthma, COPD.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category C. Children: Not recommended in newborns or premature infants (increased risk of anticholinergic effects). Paradoxical excitement may occur. Elderly: Increased risk of dizziness, sedation, confusion. Hypotension, hyperexcitability may occur.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS depressant effects. MAOIs: May increase anticholinergic and CNS depressant effects. HERBAL: None known. FOOD: None known. LAB VALUES: May cause false-positive urine 17-hydroxycorticosteroid determinations.
AVAILABILITY (Rx)
CAPSULES (VISTARIL): 25 mg, 50 mg, 100 mg. ORAL SUSPENSION (VISTARIL): 25 mg/5 ml. SYRUP (ATARAX): 10 mg/5 ml. TABLETS (ATARAX): 110 mg, 25 mg, 50 mg, 100 mg. INJECTION (HYZINE, VISTACOT, VISTAJECT-50, VISTARIL IM): 25 mg/ml, 50 mg/ml.
ADMINISTRATION/HANDLING
IM
O ALERT P Significant tissue damage, thrombosis, gangrene may occur if injection is given subcutaneous, intra-arterial, or by IV.
N IM may be given undiluted. N Use Z-track technique of injection to prevent subcutaneous infiltration. N Inject deep IM into gluteus maximus or midlateral thigh in adults, midlateral thigh in children.
PO
N Shake oral suspension well. N Scored tablets may be crushed; do not crush or break capsule.
INDICATIONS/ROUTES/DOSAGE
ANXIETY
PO: ADULTS, ELDERLY: 25U100 mg 4 times a day. Maximum: 600 mg/day.
NAUSEA AND VOMITING
IM: ADULTS, ELDERLY: 25U100 mg/dose q4U6h.
PRURITUS
PO: ADULTS, ELDERLY: 25 mg 3U4 times a day.
PREOPERATIVE SEDATION
PO: ADULTS, ELDERLY: 50U100 mg.
IM: ADULTS, ELDERLY: 25U100 mg.
USUAL PEDIATRIC DOSAGE
PO: CHILDREN: 2 mg/kg/day in divided doses q6U8h.
IM: CHILDREN: 0.5U1 mg/kg/dose q4U6h.
SIDE EFFECTS
Side effects are generally mild and transient. FREQUENT: Somnolence, dry mouth, marked discomfort with IM injection. OCCASIONAL: Dizziness, ataxia, asthenia, slurred speech, headache, agitation, increased anxiety. RARE: Paradoxical CNS reactions, such as hyperactivity or nervousness in children and excitement or restlessness in elderly or debilitated patients (generally noted during first 2 wk of therapy, particularly in presence of uncontrolled pain).
ADVERSE REACTIONS/TOXIC EFFECTS
A hypersensitivity reaction, including wheezing, dyspnea, and chest tightness, may occur.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Anxiety: Offer emotional support to anxious patient. Assess motor responses (agitation, trembling, tension), autonomic responses (cold and clammy hands, diaphoresis). Antiemetic: Assess for dehydration (poor skin turgor, dry mucous membranes, longitudinal furrows in tongue).
INTERVENTION/EVALUATION
For those on long-term therapy, liver and renal function tests, blood counts should be performed periodically. Monitor lung sounds for signs of hypersensitivity reaction. Monitor serum electrolytes in patients with severe vomiting. Assess for paradoxical reaction, particularly during early therapy. Assist with ambulation if drowsiness, lightheadedness occurs.
PATIENT/FAMILY TEACHING
N Marked discomfort may occur with IM injection. N Sugarless gum, sips of tepid water may relieve dry mouth. N Drowsiness usually diminishes with continued therapy. N Avoid tasks that require alertness, motor skills until response to drug is established.
*hydrOXYzine
high-drox-ih-zeen
(Apo-Hydroxyzine J, Atarax, Hyzine, Novohydroxyzin J, Vistacort, Vistaject-50, Vistaril, Vistaril IM)
Do not confuse hydroxyzine with hydralazine or hydroxyurea.
CLASSIFICATION
PHARMACOTHERAPEUTIC: Piperazine derivative. CLINICAL: Antihistamine, antianxiety, antispasmodic, antiemetic, antipruritic.
ACTION
A piperazine derivative that competes with histamine for receptor sites in the GI tract, blood vessels, and respiratory tract. May exert CNS depressant activity in subcortical areas. Diminishes vestibular stimulation and depresses labyrinthine function. Therapeutic Effect: Produces anxiolytic, anticholinergic, antihistaminic, and analgesic effects; relaxes skeletal muscle; controls nausea and vomiting.
PHARMACOKINETICS
Route Onset Peak Duration
PO 15U30 min N/A 4U6 hr
Well absorbed from the GI tract and after parenteral administration. Metabolized in the liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 20U25 hr (increased in the elderly).
PRECAUTIONS
CONTRAINDICATIONS: None known. CAUTIONS: Narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, asthma, COPD.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category C. Children: Not recommended in newborns or premature infants (increased risk of anticholinergic effects). Paradoxical excitement may occur. Elderly: Increased risk of dizziness, sedation, confusion. Hypotension, hyperexcitability may occur.
INTERACTIONS
DRUG: Alcohol, other CNS depressants: May increase CNS depressant effects. MAOIs: May increase anticholinergic and CNS depressant effects. HERBAL: None known. FOOD: None known. LAB VALUES: May cause false-positive urine 17-hydroxycorticosteroid determinations.
AVAILABILITY (Rx)
CAPSULES (VISTARIL): 25 mg, 50 mg, 100 mg. ORAL SUSPENSION (VISTARIL): 25 mg/5 ml. SYRUP (ATARAX): 10 mg/5 ml. TABLETS (ATARAX): 110 mg, 25 mg, 50 mg, 100 mg. INJECTION (HYZINE, VISTACOT, VISTAJECT-50, VISTARIL IM): 25 mg/ml, 50 mg/ml.
ADMINISTRATION/HANDLING
IM
O ALERT P Significant tissue damage, thrombosis, gangrene may occur if injection is given subcutaneous, intra-arterial, or by IV.
N IM may be given undiluted. N Use Z-track technique of injection to prevent subcutaneous infiltration. N Inject deep IM into gluteus maximus or midlateral thigh in adults, midlateral thigh in children.
PO
N Shake oral suspension well. N Scored tablets may be crushed; do not crush or break capsule.
INDICATIONS/ROUTES/DOSAGE
ANXIETY
PO: ADULTS, ELDERLY: 25U100 mg 4 times a day. Maximum: 600 mg/day.
NAUSEA AND VOMITING
IM: ADULTS, ELDERLY: 25U100 mg/dose q4U6h.
PRURITUS
PO: ADULTS, ELDERLY: 25 mg 3U4 times a day.
PREOPERATIVE SEDATION
PO: ADULTS, ELDERLY: 50U100 mg.
IM: ADULTS, ELDERLY: 25U100 mg.
USUAL PEDIATRIC DOSAGE
PO: CHILDREN: 2 mg/kg/day in divided doses q6U8h.
IM: CHILDREN: 0.5U1 mg/kg/dose q4U6h.
SIDE EFFECTS
Side effects are generally mild and transient. FREQUENT: Somnolence, dry mouth, marked discomfort with IM injection. OCCASIONAL: Dizziness, ataxia, asthenia, slurred speech, headache, agitation, increased anxiety. RARE: Paradoxical CNS reactions, such as hyperactivity or nervousness in children and excitement or restlessness in elderly or debilitated patients (generally noted during first 2 wk of therapy, particularly in presence of uncontrolled pain).
ADVERSE REACTIONS/TOXIC EFFECTS
A hypersensitivity reaction, including wheezing, dyspnea, and chest tightness, may occur.
NURSING CONSIDERATION
BASELINE ASSESSMENT
Anxiety: Offer emotional support to anxious patient. Assess motor responses (agitation, trembling, tension), autonomic responses (cold and clammy hands, diaphoresis). Antiemetic: Assess for dehydration (poor skin turgor, dry mucous membranes, longitudinal furrows in tongue).
INTERVENTION/EVALUATION
For those on long-term therapy, liver and renal function tests, blood counts should be performed periodically. Monitor lung sounds for signs of hypersensitivity reaction. Monitor serum electrolytes in patients with severe vomiting. Assess for paradoxical reaction, particularly during early therapy. Assist with ambulation if drowsiness, lightheadedness occurs.
PATIENT/FAMILY TEACHING
N Marked discomfort may occur with IM injection. N Sugarless gum, sips of tepid water may relieve dry mouth. N Drowsiness usually diminishes with continued therapy. N Avoid tasks that require alertness, motor skills until response to drug is established.
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