phenylephrine hydrochloride A
fen-ill-eh-frin
(AD-Nephrin, AK-Dilate, Despec-SF, Mydfrin, Neo-Synephrine, Neo-Synephrine Ophthalmic, Ocu-Phrin, Phenoptic, Prefrin, Rectasol, Sudafed PE Nasal Decongestant)
CLASSIFICATION
PHARMACOTHERAPEUTIC: Sympathomimetic, alpha receptor stimulant. CLINICAL: Nasal decongestant, mydriatic, vasopressor. ACTION
A sympathomimetic, alpha receptor stimulant that acts on the alpha-adrenergic receptors of vascular smooth muscle. Causes vasoconstriction of arterioles of nasal mucosa or conjunctiva, activates dilator muscle of the pupil to cause contraction, produces systemic arterial vasoconstriction. Therapeutic Effect: Decreases mucosal blood flow and relieves congestion and increases systolic BP.
PHARMACOKINETIC
Minimal absorption after intranasal and ophthalmic administration. Metabolized in the liver and GI tract. Primarily excreted in urine. Half-life: 2.5 hr.
USES
Nasal: Topical application to nasal mucosa reduces nasal secretion, promoting drainage of sinus secretions. Ophthalmic: Topical application to conjunctiva relieves congestion, itching, minor irritation; whitens sclera of eye. Parenteral: Vascular failure in shock, drug-induced hypotension.
PRECAUTIONS
CONTRAINDICATIONS: Acute pancreatitis, heart disease, hepatitis, narrow-angle glaucoma, pheochromocytoma, severe hypertension, thrombosis, ventricular tachycardia. CAUTIONS: Hyperthyroidism, bradycardia, heart block, severe arteriosclerosis.
B LIFESPAN CONSIDERATIONS: Pregnancy/Lactation: Crosses placenta. Distributed in breast milk. Pregnancy Category C. Children: May exhibit increased absorption, toxicity with nasal preparation. No age-related precautions noted with systemic use. Elderly: More likely to experience adverse effects.
INTERACTIONS
DRUG: Beta blockers: May have mutually inhibitory effects. Digoxin: May increase risk of arrhythmias. Ergonovine, oxytocin: May increase vasoconstriction. MAOIs: May increase vasopressor effects. Maprotiline, tricyclic antidepressants: May increase cardiovascular effects. Methyldopa: May decrease effects of methyldopa. HERBAL: None known. FOOD: None known. LAB VALUES: None known.
AVAILABILITY (OTC)
INJECTION: 1% (10 mg/ml). NASAL SOLUTION DROPS (NEO-SYNEPHRINE): 0.5%, 1%. NASAL SPRAY (NEO-SYNEPHRINE): 0.25%, 0.5%, 1%. OPHTHALMIC SOLUTION: 0.12% (AK-Nephrin), 2.5% (AK-Dilate, Mydfrin, Neofrin, Neo-Synephrine Ophthalmic, Ocu-Phrin, Phenoptic), 10% (AK-Dilate, Ocu-Phrin, Neo-Synephrine). ORAL LIQUID (DESPEC-SF): 5 mg/5 ml. TABLETS (SUDAFED PE NASAL DECONGESTANT): 10 mg.
ADMINISTRATION/HANDLING
L IV
Reconstitution N For IV push, dilute 1 ml of 10 mg/ml solution with 9 ml sterile water for injection to provide a concentration of 1 mg/ml. N For IV infusion, dilute 10-mg vial with 500 ml D5W or 0.9% NaCl to provide a concentration of 2 mcg/ml. Maximum concentration: 500 mg/250 ml.
Rate of administration N For IV push, give over 20U30 sec. N For IV infusion, give as per physician order.
Storage N Store vials at room temperature.
NASAL
N Instruct the patient to blow his or her nose before administering medication. N Tilt the patient's head, apply drops in 1 nostril. Keep the patient in the same position and wait 5 min before applying drops in other nostril. N Sprays should be administered into each nostril with head erect. N The patient should sniff briskly while squeezing container and wait 3U5 min before blowing nose gently. N Rinse tip of spray bottle.
OPHTHALMIC
N Instruct patient to tilt head backward, look up. N Gently pull lower lid down to form pouch and instill medication. N Do not touch tip of applicator to lids or any surface. N When lower lid is released, have patient keep eye open without blinking for at least 30 sec. N Apply gentle finger pressure to lacrimal sac (bridge of the nose, inside corner of the eye) for 1U2 min. N Remove excess solution around eye with tissue. N Wash hands immediately to remove medication on hands.
IV INCOMPATIBILITY
Thiopentothal (Pentothal).
IV COMPATIBILITIES
Amiodarone (Cordarone), dobutamine (Dobutrex), lidocaine, potassium chloride, propofol (Diprivan).
INDICATIONS/ROUTES/DOSAGE
NASAL DECONGESTANT
NASAL SPRAY, NASAL SOLUTION, NASAL TABLET: ADULTS, ELDERLY, CHILDREN 12 YR AND OLDER: 2U3 drops or 1U2 sprays of 0.25%U0.5% solution into each nostril q4h as needed, or 1 tablet q4h as needed (not more than 6 doses/24 hr. CHILDREN 6U11 YR: 2U3 drops or 1U2 sprays of 0.25% solution into each nostril q4h as needed. CHILDREN YOUNGER THAN 6 YR: 1 drop of 0.125% solution (dilute 0.5% solution with 0.9% NaCl to achieve 0.125%) in each nostril. Repeat q2U4h as needed. Do not use for more than 3 days.
CONJUNCTIVAL CONGESTION, ITCHING, AND MINOR IRRITATION; WHITENING OF SCLERA
OPHTHALMIC: ADULTS, ELDERLY, CHILDREN 12 YR AND OLDER: 1U2 drops of 0.12% solution q3U4h.
HYPOTENSION, SHOCK
IM, SUBCUTANEOUS: ADULTS, ELDERLY: 2U5 mg/dose q1U2h. CHILDREN: 0.1 mg/kg/dose q1U2h. Maximum: 5 mg.
IV BOLUS: ADULTS, ELDERLY: 0.1U0.5 mg/dose q10U15 min as needed. CHILDREN: 5U20 mcg/kg/dose q10U15min.
IV INFUSION: ADULTS, ELDERLY: 100U180 mcg/min. When BP is stabilized, maintenance rate: 40U60 mcg/min. CHILDREN: 0.1U0.5 mcg/kg/min. Titrate to desired effect.
SIDE EFFECTS
FREQUENT: Nasal: Rebound nasal congestion due to overuse, especially when used longer than 3 days. OCCASIONAL: Mild CNS stimulation (restlessness, nervousness, tremors, headache, insomnia, particularly in those hypersensitive to sympathomimetics, such as elderly patients). Nasal: Stinging, burning, drying of nasal mucosa. Ophthalmic: Transient burning or stinging, brow ache, blurred vision.
ADVERSE REACTIONS/TOXIC EFFECTS
Large doses may produce tachycardia and palpitations (particularly in those with cardiac disease), light-headedness, nausea, and vomiting. Overdose in those older than 60 yr may result in hallucinations, CNS depression, and seizures. Prolonged nasal use may produce chronic swelling of nasal mucosa and rhinitis.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
If phenylephine 10% ophthalmic is instilled into denuded or damaged corneal epithelium, corneal clouding may result.
INTERVENTION/EVALUATION
Monitor BP, heart rate.
PATIENT/FAMILY TEACHING
N Discontinue drug if adverse reactions occur. N Do not use for nasal decongestion for longer than 5 days, (rebound congestion). N Discontinue drug if insomnia, dizziness, weakness, tremor, palpitations occur. N Nasal: Stinging or burning of nasal mucosa may occur. N Opthalmic : Blurring of vision with eye instillation generally subsides with continued therapy. N Discontinue medication if redness or swelling of eyelids, itching appears.
*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.
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.
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