MOSBY’S DRUG GUIDE for NURSING STUDENTS FOURTEENTH EDITION Administer drugs safely, accurately, and professionally

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MOSBY’S DRUG GUIDE for NURSING STUDENTS FOURTEENTH EDITION Administer drugs safely, accurately, and professionally. Student Resources on Evolve Evolve Access Code Inside I I s|Ml R REGISTER ... TODAY! 2019v1.0 YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/shop to search and browse for products. Place Sticker Here Enhance your learning with Evolve Student Resources. These online study tools and exercises can help deepen your understanding of textbook content so you can be more prepared for class, perform better on exams, and succeed in your course. Activate the complete learning experience that comes with each NEW textbook purchase by registering with your scratch-off access code at http://evolve.elsevier.com/nursingdrugupdates/ Skidmore/NDG/ If your school uses its own Learning Management System, your resources may be delivered on that platform. Consult with your instructor. If you rented or purchased a used book and the scratch-off code at right has already been revealed, the code may have been used and cannot be re-used for registration. To purchase a new code to access these valuable study resources, simply follow the link above. aMILoride 37 A Canada only Genetic Warning Adverse effects: italics  common; red  life-threatening Inhalation route (nebulizer) • Use Lamira Nebulizer System • May pretreat with short-acting beta 2 agonists • Allow to warm to room temperature • Shake well, pour medication into reservoir • Press and hold on/off button, mist will fl ow • Insert mouthpiece, take slow deep breaths, when done a beep will be heard • Clean after each use Intermittent IV INF route • Dilute 500 mg of product/100-200 ml of IV D 5 W, 0.9% NaCl and give over ½-1 hr; dilute insuffi cient volume to allow inf over 1-2 hr (infants); fl ush after administration with D 5 W or 0.9% NaCl; solution is clear or pale yellow; discard if precipitate or dark color develops • In children, amount of fl uid depends on ordered dose; in infants infuse over 1-2 hr • Give in evenly spaced doses to maintain blood level Y-site compatibilities: Acyclovir, alatrofl oxacin, aldesleukin, alemtuzumab, alfentanil, amifostine, aminophylline, amiodarone, amsacrine, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefepime, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifi batide, ertapenem, erythromycin, esmolol, etoposide, famotidine, fentaNYL, fi lgrastim, fl uconazole, fl udarabine, fl uorouracil, foscarnet, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, IL-2, imipenem-cilastatin, isoproterenol, ketorolac, labetalol, levofl oxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pantoprazole, papaverine, PEMEtrexed, penicillin G, pentazocine, perphenazine, PHENobarbital, phenylephrine, phytonadione, piperacillintazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, quinupristin-dalfopristin, ranitidine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/ clavulanate, tigecycline, tirofi ban, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, warfarin, zidovudine, zoledronic acid Patient/family education • Advise patient to contact prescriber if vaginal itching, loose foul-smelling stools, furry tongue occur; may indicate superinfection • Advise patient to report hypersensitivity: rash, itching, trouble breathing, facial edema and notify prescriber BLACK BOX WARNING: Monitor for hyperkalemia: MS: fatigue, muscle weakness; CARDIAC: dysrhythmias, hypotension; NEURO: paresthesias, confusion; RESP: dyspnea, monitor potassium level baseline and each dosage change, hyperkalemia is more common in renal disease, geriatrics, diabetes, if potassium  5.5 mEq/L immediately notify prescriber Evaluation Positive therapeutic outcome • Absence of signs/symptoms of infection: WBC 10,000/mm 3 , temp WNL; absence of red draining wounds; absence of earache • Reported improvement in symptoms of infection TREATMENT OF OVERDOSE: Withdraw product; administer EPINEPHrine, O 2 , hemodialysis, exchange transfusion in the newborn; monitor serum levels of product; may give ticarcillin or carbenicillin aMILoride (Rx) (a-milloh-ride) Midamor Func. class.: Potassium-sparing diuretic Chem. class.: Pyrazine Do not confuse: aMILoride /amLODIPine/ amiodarone ACTION: Inhibits sodium, potassium ATPase ion exchange in the distal tubule, cortical collecting duct resulting in inhibition of sodium reabsorption Black Box Warnings easily identify serious and lifethreatening FDA warnings Subheadings indicate various administration routes Easily confused drug names located beneath header dgc* 652 metoprolol Nurse Alert Key NCLEX® Drug Drug Specifi cs HIGH ALERT metoprolol (Rx) (met-oh-proelole) BEtaloc , Lopressor , Lopressor SR , Nu-Metop , Toprol-XL Func. class.: Antihypertensive, antianginal Chem. class.:  1 -Adrenergic blocker Do not confuse: Lopressor /Lyrica Toprol-XL/Topamax ACTION: Lowers B/P by -blocking effects; reduces elevated renin plasma levels; blocks  2 - adrenergic receptors in bronchial, vascular smooth muscle only at high doses, negative chronotropic effect Therapeutic outcome: Decreased B/P, heart rate, AV conduction USES: Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, New York Heart Association class II, III heart failure, cardiomyopathy Pharmacokinetics Absorption Well absorbed (PO); completely absorbed ( IV ) Distribution Crosses blood-brain barrier, placenta Metabolism Liver, extensively by CYP2D6, some may be poor metabolizers Excretion Kidneys, breast milk Half-life 3-7 hr Pharmacodynamics PO IV Onset 15 min Immediate Peak 2-4 hr 20 min Duration 6-19 hr 5-8 hr CONTRAINDICATIONS Hypersensitivity to -blockers, cardiogenic shock, heart block (2nd and 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome Precautions: Pregnancy, breastfeeding, geriatric, major surgery, diabetes mellitus, thyroid/ renal/hepatic disease, COPD, CAD, nonallergic bronchospasm, HF, bronchial asthma, CVA, children, depression, vasospastic angina BLACK BOX WARNING: Abrupt discontinuation DOSAGE AND ROUTES Hypertension Adult: PO 50 mg bid, or 100 mg/day; may give 100-450 mg in divided doses; ext rel 25-100 mg qday, titrate at weekly intervals, max 400 mg/day Child/adolescent 6-16 yr: PO ext rel 1 mg/kg up to 50 mg qday Geriatric: PO 25 mg/day initially, increase weekly as needed Myocardial infarction Adult: IV BOL (early treatment) 5 mg q2min  3 doses, then 50 mg PO 15 min after last dose and q6hr  48 hr (late treatment); PO maintenance 50-100 mg bid for 1-3 yr Heart failure (NYHA class II/III) Adult: PO ext rel 25 mg qd  2 wk (class II); 12.5 mg qd (class III) Angina Adult: PO 100 mg/day as a single dose or in 2 divided doses, increase qwk as needed, or 100 mg ext rel tab daily, max 400 mg/day ext rel Migraine prevention (unlabeled) Adult: PO 25-100 mg bid-qid; 50-200 mg daily (XL) Available forms: Tabs 25, 50, 100 mg; inj 1 mg/ml; ext rel tabs (tartrate) 100 mg; ext rel tabs (succinate) (XL) 25, 50, 100, 200 mg ADVERSE EFFECTS CNS: Insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue, weakness CV: HF, palpitations, dysrhythmias, cardiac arrest, hypotension, bradycardia, pulmonary/ peripheral edema, chest pain EENT: Blurred vision GI: Nausea, vomiting, colitis, cramps, diarrhea, constipation, fl atulence, dry mouth, hiccups GU: Impotence, urinary frequency HEMA: Agranulocytosis, eosinophilia, thrombocytopenic purpura INTEG: Rash, purpura, alopecia, dry skin, urticaria, pruritus RESP: Bronchospasm, dyspnea, wheezing ENDO: Hyper/hypoglycemia INTERACTIONS Individual drugs Cimetidine: increased metoprolol level Digoxin, diltiazem, EPINEPH [Show More]

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