LWBK786-FM.qxd 2/17/11 8:43 AM Page i LWBK786-FM.qxd 2/17/11 8:43 AM Page ii LWBK786-FM.qxd 2/17/11 8:43 AM Page iii LWBK786-FM.qxd 2/17/11 8:43 AM Page iv Staff The clinical treatments described and recommended in this publication are based on researchand consulta- Publisher tion with nursing, medical, and legal authorities. To the J.Christopher Burghardt best of our knowledge, these procedures refllect cur- rently accepted practice. Nevertheless, they can’t be Nursing Officer considered absolute and universal recommendations. Judith A.Schilling McCann, RN, MSN For individual applications, all recommendations must be considered in light of the patient’s clinical condition Clinical Director and, before administration of new or infrequently used Joan M.Robinson, RN, MSN drugs, in light of the latest package-insert information. Clinical Project Manager The authors and publisher disclaim any responsibility for any adverse effects resulting from the suggested Lorraine Hallowell, RN, BSN, RVS procedures, from any undetected errors, or from the Clinical Editors reader’s misunderstanding of the text. Lisa Morris Bonsall, RN, CRNP, MSN Janet Rader, RN, BSN ©2012 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part Dorothy Terry, RN of it may be reproduced, stored in a retrieval system, Product Director or transmitted, in any form or by any means—elec- David Moreau tronic, mechanical, photocopy, recording, or other- wise—without prior written permission of the publisher, Product Manager except for brief quotations embodied in critical articles Diane Labus and reviews and testing and evaluation materials provided by the publisher to instructors whose Editor schools have adopted its accompanying textbook. For Karen C.Comerford information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756. Copy Editors Heather Ditch, Mary T.Durkin Printed in China. Editorial Assistants Karen J.Kirk, Jeri O’Shea, Linda K.Ruhf NDH32-010511 Creative Director ISSN 0273-320X Doug Smock ISBN-13: 978-1-60913-619-2 ISBN-10: 1-60913-619-5 Art Director Elaine Kasmer Designer Joseph John Clark Project Manager,Electronic Projects John Macalino Vendor Manager Beth Martz Manufacturing Manager Beth J.Welsh Production Services Aptara, Inc. LWBK786-FM.qxd 2/17/11 5:34 PM Page v Contents Anatomy of a monograph....................................………… inside front cover Contributors and consultants..........……………………………………………vi How to use Nursing2012 Drug Handbook® ......…………………………….vii Quick guide to special symbols, logos, and highlighted terms ........………xi Guide to abbreviations........……………………………………………………xii General information 1. Drug actions, interactions, and reactions ..............……………………………1 2. Drug therapy across the lifespan................……………………………………5 3. Safe drug administration..........………………………………………………13 4. Selected drug classifications............…………………………………………19 Alphabetical listing of drugs by generic name........……………………59 Appendices....………………………………………………………………1422 Pregnancy risk categories ......…………………………………………………1422 Controlled substance schedules..........…………………………………………1422 Quick guide to combination drugs..........………………………………………1423 Common combination drugs: Indications and dosages..............………………1428 Vaccines and toxoids: Indications and dosages..............………………………1448 Vitamins and minerals: Indications and dosages................……………………1459 Therapeutic drug monitoring guidelines............………………………………1468 Cytochrome P-450 enzymes and common drug interactions ............................1476 Drugs that prolong the QTc interval ..........……………………………………1478 Dialyzable drugs ........…………………………………………………………1479 Abbreviations to avoid........……………………………………………………1483 Herbal supplements........………………………………………………………1485 Drugs that shouldn’t be crushed or chewed............……………………………1492 Avoiding common drug errors: Best practices and prevention..............………1495 Pediatric drugs commonly involved in drug errors............……………………1498 Elder care medication tips..........………………………………………………1501 Additional new drugs: Indications and dosages ............………………………1502 Index …………………………………………………………………………1505 v LWBK786-FM.qxd 2/17/11 8:43 AM Page vi Contributors and consultants Steven R.Abel,PharmD,FASHP Michael A.Mancano,RPh,PharmD Assistant Dean for Clinical Programs Clinical Associate Professor/Associate Bucke Professor & Head Chairman Department of Pharmacy Practice Department of Pharmacy Practice Purdue University College of Pharmacy Temple University School of Pharmacy W. Lafayette, Ind. Philadelphia Lawrence Carey,PharmD Chijioke Okafor,PharmD Associate Program Director, Physician Medical Science Liaison Assistant Program Bristol-Myers Squibb Philadelphia University Plainsboro, N.J. Jason C.Cooper,PharmD Keith M.Olsen,PharmD,FCCP,FCCM Clinical Pharmacist/Clinical Assistant Professor and Chair Professor Department of Pharmacy Practice Medical University of South Carolina University of Nebraska Medical Center Charleston Omaha Jennifer Faulkner,PharmD,BCPP Christine K.O’Neil,PharmD,BCPS,CGP, Director of Education, Pharmacy Service FCCP Central Texas Veterans Health Care System Professor Temple Duquesne University School of Pharmacy Pittsburgh Julie Ann Genuario,BS Pharm Staff Pharmacist Melissa Rinaldi,RPh,PharmD Pottstown (Pa.) Memorial Medical Center Clinical Pharmacist ExcelleRx Tatyana Gurvich,PharmD Philadelphia Clinical Pharmacologist USC School of Pharmacy Suzzanne Tairu,PharmD Los Angeles, Calif. Medical Science Liaison UCB Pharma Inc. Toshal S.Hallowell,BS Pharm Atlanta Staff Pharmacist Edward M. Kennedy Community Health Rachel Clark Vetri,PharmD,BCOP Center Associate Professor of Pharmacy Practice Worcester, Mass. Temple University School of Pharmacy Philadelphia Collette Bishop Hendler,RN,MS,CCRN, CIC Christopher S.Wisniewski,PharmD,BCPS Infection Control Nurse Assistant Professor Abington (Pa.) Memorial Hospital Department of Clinical Pharmacy & Outcome Sciences Shelly Ikeme,PharmD,MPH,MBA South Carolina College of Pharmacy— Immunoscience Medical Science-Research MUSC Campus Liaison Clinical Pharmacist, Medication Use Bristol-Myers Squibb Policy and Informatics New York Medical University of South Carolina Patrick J.Kiel,PharmD,BCPS Charleston Clinical Pharmacy Specialist— Hematology/Stem Cell Transplant Indiana University Simon Cancer Center— Clarian Health Indianapolis vi LWBK786-FM.qxd 2/17/11 8:43 AM Page vii How to use Nursing2012 Drug Handbook® The best-selling nursing drug guide for Introductory chapters more than 30 years, Nursing Drug Hand- Chapter 1, “Drug actions, interactions, and bookis meticulously reviewed and updated reactions,” explains how drugs work in the annually by pharmacists and nurses to in- body. It provides a general overview of clude the most current, relevant informa- drug properties (absorption, distribution, tion that practicing nurses and students metabolism, and excretion) and other sig- need to know to administer medications nificant factors affecting drug action (in- safely in any health care setting. As in pre- cluding protein binding, patient’s age, un- vious editions, Nursing2012 Drug Hand- derlying disease, dosage form, and route bookemphasizes nursing and safety aspects and timing of administration). Also dis- of drug administration without attempting cussed are drug interactions, adverse reac- to replace detailed pharmacology texts. tions, and toxic reactions. Chapter 2, “Drug Only the most essential information is in- therapy across the lifespan,” discusses the cluded, and helpful graphic symbols, logos, danger associated with indiscriminant use and highlighting draw special attention to of drugs during pregnancy and breast-feed- critical details that can’t be overlooked. Re- ing and the special precautions women freshingly redesigned, this 32nd edition en- should take when medications are neces- sures easy readability and even quicker ac- sary. This chapter also covers the unique cess to content that busy nurses need on the challenges of giving drugs to children and go, with larger type and a brand-new alpha- elderly patients and offers practical sugges- betically arranged format. tions on how to minimize problems with these special populations. Chapter 3, “Safe New to this edition drug administration,” explores the ongoing In this enhanced 32nd edition, look for involvement of governmental and non- these exciting new changes: governmental organizations weighing in on ●Alphabetical format—complete generic drug safety issues and the necessary meas- drug entries (monographs) arranged A to Z, ures nurses must take to prevent medication with tabbed pages for quick retrieval of in- errors from occurring. formation Chapter 4, “Selected drug classifica- ●Thoroughly updated text with over 1,025 tions,” summarizes the indications, ac- generic and 3,300 brand names listed, 823 tions, and contraindications and cautions comprehensive drug monographs, and 26 of more than 60 drug classes represented generic drugs newly approved by the in Nursing2012 Drug Handbook.Generic FDA—over 3,000 clinical changes in all drugs within each class are also listed, al- ●New introductory chapter covering safe lowing nurses to quickly identify and drug administration—includes communica- compare similar drugs when patients can’t tion and education improvements, the use tolerate or don’t respond to a particular of technologies, and additional strategies to drug. reduce drug errors ●3 new safety-related appendices addressing Drug monographs best practices to avoid or prevent drug errors, Each generic drug monograph in pediatric drugs commonly involved in drug Nursing2012 Drug Handbookincludes the errors, and elder care medication tips most pertinent clinical information nurses ●Fresh, appealing design with larger type, must know to administer medications safe- crisper headings, highlighted backgrounds ly, monitor for potential interactions and (for generic drug headings and I.V. infor- adverse effects, implement necessary care mation), and easy-to-spot logos and icons measures, and provide appropriate patient (such as black box warnings and alerts) teaching. Entries are arranged alphabetical- ●Expanded color Photoguide insert, with ly, with the generic drug name prominently actual-sized images of 398 tablets and capsules. displayed—along with its “tall man” vii LWBK786-FM.qxd 2/17/11 8:43 AM Page viii viii How to use Nursing2012 Drug Handbook® lettering (if applicable), pronunciation, cor- elderly patients or those with renal or he- responding brand (or trade) names, thera- patic impairment. peutic class, pharmacologic class, and pregnancy risk category—on a shaded Administration background for quick and easy identifica- Here, readers will find guidelines for safely tion. Banners or symbols to identify new administering drugs by all applicable FDA-approved drugs, drugs that warrant a routes, including P.O., I.V., I.M., subcuta- special safety alert, or drugs that appear in neous, ophthalmic, inhalational, topical, the color photoguide are also included in rectal, vaginal, transdermal, and buccal. A this highlighted area. special screened background highlights I.V. Specific information for each drug is administration guidelines (including specif- then systematically organized under the ic instructions on how to reconstitute, mix, headings below. Special icons and logos and store I.V. medications) and potential may be used throughout, as warranted, to I.V. incompatibilities. point out the drug’s safety concerns. For example, a clinical alert logo (t) pro- Action vides important advice about life-threat- This section succinctly describes the mech- ening effects associated with the drug or anism of action—that is, how the drug pro- its administration; a black box warning vides its therapeutic effect. For example, ( Black Box Warning) represents a specif- although all antihypertensives lower blood ic warning issued by the FDA. (See pressure, they don’t all do so by the same Anatomy of a monograph, on the inside process. Also included, in table form, are book cover, for a visual guide to the vari- the onset, peak (described in terms of effect ous symbols that may appear within a or peak blood level), and duration of drug drug entry.) action for each route of administration, if data are available or applicable. Values Available forms listed are for patients with normal renal func- This section lists the preparations available tion unless otherwise specified. The drug’s for each drug (for example, tablets, cap- half-life is also provided when known. sules, solutions for injection) and specifies available dosage forms and strengths. Adverse reactions Dosage strengths specifically available in In this section, adverse reactions to each Canada are designated with a dagger (†). drug are listed according to body system. Preparations that may be obtained over the The most common adverse reactions (those counter, without a prescription, are marked experienced by at least 10% of people tak- with an open diamond ((cid:3)). ing the drug in clinical trials) appear in italic type; less common reactions (1% to 9%) Indications & dosages are in roman type; life-threatening reac- General dosage information for adults and tions appear in bold italictype; and reac- children is found in this section. Dosage in- tions that are common and life-threatening structions reflect current trends in therapeu- are in BOLDCAPITALLETTERS. tics and can’t be considered absolute or universal. For individual patients, dosage Interactions instructions must be considered in light of Within this section, readers can find each the patient’s condition. drug’s confirmed, clinically significant in- Indications and dosages that aren’t ap- teractions with other drugs (additive ef- proved by the FDA are followed by a fects, potentiated effects, and antagonistic closed diamond ((cid:4)). It should be noted effects); herbs; foods; beverages; and that only evidence-based off-label uses are lifestyle behaviors (such as alcohol use, sun included in this edition. An “Adjust-a- exposure, or smoking). Interactions with a dose” logo appearing within this section rapid onset are highlighted in color; inter- indicates the need for a special dosage ad- actions with a delayed onset are in bold justment for certain patients, such as type.