2 morphine M underlined – top prescribed drug morphine HIGH ALERT mor-feen (Astramorph PF, Avinza, DepoDur, Duramorph PF, Infumorph, Kadian, M-Eslon , MS Contin, MSIR , Oramorph SR, Roxanol) BLACK BOX ALERT Be alert for signs of abuse, misuse, diversion. Epidural: Monitor for delayed sedation. Sustained- release: Do not crush or chew. MS Con- tin: Use only in opioid-tolerant pts requir- ing over 400 mg/day. Kadian: Use only in opioid-tolerant pts. Avinza: Alcohol dis- rupts extended-release timing. Dura- morph PF: Risk of severe and/or sus- tained cardiopulmonary depression. CLASSIFICATION PHARMACOTHERAPEUTIC: Narcotic agonist. CLINICAL: Opiate analgesic (Schedule II) (see p. 142C). ACTION Binds with opioid receptors within CNS. Therapeutic Effect: Alters pain percep- tion, emotional response to pain. PHARMACOKINETICS Variably absorbed from GI tract. Readily absorbed after IM, subcutaneous admin- istration. Protein binding: 20%–35%. Widely distributed. Metabolized in liver. Primarily excreted in urine. Removed by hemodialysis. Half-life: 2–4 hrs (in- creased in hepatic disease). USES Relief of moderate to severe, acute, or chronic pain; analgesia during labor. Drug of choice for pain due to MI, dyspnea from pulmonary edema not resulting from chem- ical respiratory irritant. DepoDur: Epidu- ral (lumbar) single dose management of surgical pain. PRECAUTIONS Contraindications: Acute or severe asthma, GI obstruction, paralytic ileus, severe he- patic/renal impairment, severe respiratory depression. Cautions: Biliary tract disease, morphine HIGH ALERT mor-feen (Astramorph PF, Avinza, DepoDur, Duramorph PF, Infumorph, Kadian, M-Eslon , MS Contin, MSIR , Oramorph SR, Roxanol) BLACK BOX ALERT Be alert for signs of abuse, misuse, diversion. Epidural: Monitor for delayed sedation. Sustained- release: Do not crush or chew. : MS Con- tin: Use only in opioid-tolerant pts requir- : ing over 400 mg/day. Kadian: Use only in : opioid-tolerant pts. Avinza: Alcohol dis- : rupts extended-release timing. Dura- morph PF: Risk of severe and/or sus- : tained cardiopulmonary depression. CLASSIFICATION PHARMACOTHERAPEUTIC: Narcotic agonist. CLINICAL: Opiate analgesic (Schedule II) (see p. 142C). ACTION Binds with opioid receptors within CNS. Therapeutic Effect: Alters pain percep- tion, emotional response to pain. PHARMACOKINETICS Variably absorbed from GI tract. Readily absorbed after IM, subcutaneous admin- istration. Protein binding: 20%–35%. Widely distributed. Metabolized in liver. Primarily excreted in urine. Removed by hemodialysis. Half-life: 2–4 hrs (in- creased in hepatic disease). USES Relief of moderate to severe, acute, or chronic pain; analgesia during labor. Drug of choice for pain due to MI, dyspnea from pulmonary edema not resulting from chem- ical respiratory irritant. DepoDur: Epidu- ral (lumbar) single dose management of surgical pain. PRECAUTIONS Contraindications: Acute or severe asthma, GI obstruction, paralytic ileus, severe he- patic/renal impairment, severe respiratory depression. Cautions: Biliary tract disease, pancreatitis, Addison’s disease, hypothy- roidism, urethral stricture, prostatic hy- perplasia, debilitated pts, those with CNS depression, toxic psychosis, seizure disor- ders, alcoholism. LIFESPAN CONSIDERATIONS Pregnancy/Lactation: Crosses placenta. Distributed in breast milk. Pregnancy Cat- egory C (D if used for prolonged periods or at high dosages at term). Children: Paradoxical excitement may occur; those younger than 2 yrs are more susceptible to respiratory depressant effects. Elderly: Paradoxical excitement may occur. INTERACTIONS DRUG: Alcohol, other CNS depressants may increase CNS effects, respiratory de- pression, hypotension. HERBAL: Gotu kola, kava kava, St. John’s wort, va- lerian may increase CNS depression. FOOD: None known. LAB VALUES: May increase serum amylase, lipase. AVAILABILITY (Rx) Injection, Liposomal Suspension (Depo- Dur): 10 mg/ml. Injection, Solution: 2 mg/ml, 4 mg/ml, 5 mg/ml, 10 mg/ml, 15 mg/ml, 25 mg/ml, 50 mg/ml. Injec- tion, Solution (Epidural, Intrathecal, IV Infusion) (Astramorph PF, Duramorph PF): 0.5 mg/ml, 1 mg/ml. Capsules, Extended-Release (Avinza): 30 mg, 45 mg, 60 mg, 75 mg, 90 mg, 120 mg. Capsules, Sustained-Release (Ka- 20 mg, 30 mg, 50 mg, 60 mg, 80 mg, 100 mg, 200 mg. ADMINISTRATION/HANDLING Reconstitution • May give undiluted. • For IV injection, may dilute 2.5–15 mg morphine in 4–5 ml Sterile Water for Injec- tion. • For continuous IV infusion, dilute to concentration of 0.1–1 mg/ml in D5W and give through controlled infusion device. Rate of administration • Always admin- ister very slowly. Rapid IV increases risk of severe adverse reactions (apnea, chest wall pancreatitis, Addison’s disease, hypothy- roidism, urethral stricture, prostatic hy- perplasia, debilitated pts, those with CNS depression, toxic psychosis, seizure disor- ders, alcoholism. LIFESPAN CONSIDERATIONS Pregnancy/Lactation: Crosses placenta. Distributed in breast milk. Pregnancy Cat- egory C (D if used for prolonged periods or at high dosages at term). Children: Paradoxical excitement may occur; those younger than 2 yrs are more susceptible to respiratory depressant effects. Elderly: Paradoxical excitement may occur. INTERACTIONS DRUG: Alcohol, other CNS depressants may increase CNS effects, respiratory de- pression, hypotension. HERBAL: Gotu kola, kava kava, St. John’s wort, va- lerian may increase CNS depression. FOOD: None known. LAB VALUES: May increase serum amylase, lipase. AVAILABILITY (Rx) Injection, Liposomal Suspension (Depo- Dur): 10 mg/ml. Injection, Solution: 2 mg/ml, 4 mg/ml, 5 mg/ml, 10 mg/ml, 15 mg/ml, 25 mg/ml, 50 mg/ml. Injec- tion, Solution (Epidural, Intrathecal, IV Infusion) (Astramorph PF, Duramorph PF): 0.5 mg/ml, 1 mg/ml. Capsules, IV Extended-Release (Avinza): 30 mg, 45 mg, 60 mg, 75 mg, 90 mg, 120 Capsules, Sustained-Release (Ka- 20 dian): mg, 30 mg, 50 mg, 60 mg, 80 mg, 100 mg, 200 mg. ADMINISTRATION/HANDLING Reconstitution • May give undiluted. • For IV injection, may dilute 2.5–15 mg morphine in 4–5 ml Sterile Water for Injec- tion. • For continuous IV infusion, dilute to concentration of 0.1–1 mg/ml in D5W and give through controlled infusion device. Rate of administration • Always admin- ister very slowly. Rapid IV increases risk of severe adverse reactions (apnea, chest wall Uses section in each monograph notes the standard and off-label uses for a particular drug. Lifespan Considerations in each monograph note factors to be considered for geriatric, pediatric, pregnant, or nursing populations. Appendix H provides additional resources. Interactions identify potential herbal, drug, and food interactions with a particular drug. Black Box Alerts advise about the increased risks of a particular drug. Top prescribed drugs are underlined. 3 M Canadian trade name Non-Crushable Drug High Alert drug rigidity, peripheral circulatory collapse, cardiac arrest, anaphylactoid effects). Storage Store at room temperature. May give either diluted or undiluted. Do not use an in-line fi lter. Store solution in refrigerator; do not freeze. May store at room temperature for 7 days. Following withdrawal from vial, use within 4 hrs. Gently invert vial to resus- pend drug; avoid aggressive agitation. Amphotericin B complex (Abelcet, AmBi- some, Amphotec), cefepime (Maxip- ime), doxorubicin (Doxil), lipids, phe- nytoin (Dilantin), thiopental. Amiodarone (Cordarone), atropine, bu- metanide (Bumex), bupivacaine (Mar- caine, Sensorcaine), diltiazem (Cardizem), diphenhydramine (Benadryl), dobutamine (Dobutrex), dopamine (Intropin), glyco- pyrrolate (Robinul), heparin, hydroxyzine (Vistaril), lidocaine, lorazepam (Ativan), magnesium, midazolam (Versed), milri- none (Primacor), nitroglycerin, potas- sium, propofol (Diprivan), total parenteral nutrition (TPN). INDICATIONS/ROUTES/DOSAGE ALERT Dosage should be titrated to desired effect. PO (IMMEDIATE-RELEASE): ADULTS, ELDERLY: 10–30 mg q3–4h as needed. CHILDREN: 0.15–0.3 mg/kg q3–4h as needed. PO (EXTENDED-RELEASE [AVINZA]): ADULTS, ELDERLY: Dosage requirement should be established using prompt- release formulations and is based on total daily dose. Avinza is given once a day only. PO (EXTENDED-RELEASE [KADIAN]): ADULTS, ELDERLY: Dosage requirement should be established using prompt- release formulations and is based on total daily dose. Dose is given once a day or di- vided and given q12h. rigidity, peripheral circulatory collapse, cardiac arrest, anaphylactoid effects). Storage Store at room temperature. May give either diluted or undiluted. Do not use an in-line fi lter. Store solution in refrigerator; do not freeze. May store at room temperature for 7 days. Following withdrawal from vial, use within 4 hrs. Gently invert vial to resus- pend drug; avoid aggressive agitation. Amphotericin B complex (Abelcet, AmBi- some, Amphotec), cefepime (Maxip- ime), doxorubicin (Doxil), lipids, phe- nytoin (Dilantin), thiopental. Amiodarone (Cordarone), atropine, bu- metanide (Bumex), bupivacaine (Mar- caine, Sensorcaine), diltiazem (Cardizem), diphenhydramine (Benadryl), dobutamine (Dobutrex), dopamine (Intropin), glyco- pyrrolate (Robinul), heparin, hydroxyzine (Vistaril), lidocaine, lorazepam (Ativan), magnesium, midazolam (Versed), milri- none (Primacor), nitroglycerin, potas- sium, propofol (Diprivan), total parenteral nutrition (TPN). INDICATIONS/ROUTES/DOSAGE Dosage should be titrated to desired effect. PO (IMMEDIATE-RELEASE): ADULTS, ELDERLY: 10–30 mg q3–4h as needed. CHILDREN: 0.15–0.3 mg/kg q3–4h as needed. PO (EXTENDED-RELEASE [AVINZA]): ADULTS, ELDERLY: Dosage requirement should be established using prompt- release formulations and is based on total daily dose. Avinza is given once a day only. PO (EXTENDED-RELEASE [KADIAN]): ADULTS, ELDERLY: Dosage requirement should be established using prompt- release formulations and is based on total daily dose. Dose is given once a day or di- vided and given q12h. IV: ADULTS, ELDERLY: Loading dose: 5–10 mg. Intermittent bolus: 0.5–3 mg. Lockout interval: 5–12 min. Con- tinuous infusion: 1–10 mg/hr. 4-hr limit: 20–30 mg. SIDE EFFECTS Sedation, decreased B/P (in- cluding orthostatic hypotension), diapho- resis, facial fl ushing, constipation, dizzi- ness, drowsiness, nausea, vomiting. Allergic reaction (rash, pruri- tus), dyspnea, confusion, palpitations, tremors, urinary retention, abdominal cramps, vision changes, dry mouth, head- ache, decreased appetite, pain/burning at injection site. Paralytic ileus. ADVERSE EFFECTS/ TOXIC REACTIONS Overdose results in respiratory depression, skeletal muscle fl accidity, cold/clammy skin, cyanosis, extreme drowsiness pro- gressing to seizures, stupor, coma. Toler- ance to analgesic effect, physical depen- dence may occur with repeated use. BASELINE ASSESSMENT Pt should be in recumbent position be- fore drug is given by parenteral route. Assess onset, type, location, duration of pain. INTERVENTION/EVALUATION Monitor vital signs 5–10 min after IV ad- ministration, 15–30 min after subcutane- ous, IM. Be alert for decreased respira- tions, B/P. Check for adequate voiding. Monitor daily pattern of bowel activity and stool consistency. Avoid constipation. PATIENT/FAMILY TEACHING Discomfort may occur with injection. Change positions slowly to avoid ortho- static hypotension. Avoid tasks that re- quire alertness, motor skills until response to drug is established. Avoid alcohol, CNS depressants. IV: ADULTS, ELDERLY: Loading dose: 5–10 mg. Intermittent bolus: 0.5–3 mg. Lockout interval: 5–12 min. Con- tinuous infusion: 1–10 mg/hr. 4-hr limit: 20–30 mg. SIDE EFFECTS Sedation, decreased B/P (in- cluding orthostatic hypotension), diapho- resis, facial fl ushing, constipation, dizzi- ness, drowsiness, nausea, vomiting. Allergic reaction (rash, pruri- tus), dyspnea, confusion, palpitations, tremors, urinary retention, abdominal cramps, vision changes, dry mouth, head- ache, decreased appetite, pain/burning at injection site. Paralytic ileus. ADVERSE EFFECTS/ TOXIC REACTIONS Overdose results in respiratory depression, skeletal muscle fl accidity, cold/clammy skin, cyanosis, extreme drowsiness pro- gressing to seizures, stupor, coma. Toler- ance to analgesic effect, physical depen- dence may occur with repeated use. BASELINE ASSESSMENT Pt should be in recumbent position be- fore drug is given by parenteral route. Assess onset, type, location, duration of pain. INTERVENTION/EVALUATION Monitor vital signs 5–10 min after IV ad- ministration, 15–30 min after subcutane- ous, IM. Be alert for decreased respira- tions, B/P. Check for adequate voiding. Monitor daily pattern of bowel activity and stool consistency. Avoid constipation. PATIENT/FAMILY TEACHING Discomfort may occur with injection. Change positions slowly to avoid ortho- static hypotension. Avoid tasks that re- quire alertness, motor skills until response to drug is established. Avoid alcohol, CNS depressants. • • • • morphine • Epidural, Liposomal • • • • • IV INCOMPATIBILITIES IV COMPATIBILITIES Analgesia • Epidural, Liposomal • • • • • IV INCOMPATIBILITIES IV COMPATIBILITIES Analgesia Patient-Controlled Analgesia (PCA) Frequent: Occasional: Rare: NURSING CONSIDERATIONS Patient-Controlled Analgesia (PCA) Frequent: Occasional: Rare: NURSING CONSIDERATIONS IV Incompatibilities/ Compatibilities present important information for IV drugs. Adverse Reactions highlight the particularly dangerous side effects. Side Effects section in each drug monograph specifies the frequency of particular side effects. New to this Edition! • 29 drugs recently approved by the FDA • Hundreds of updates and revisions • More than 300 Black Box Alerts High Alert drugs are shaded in purple for easy identification. Once you register, you will have access to your ONLINE RESOURCES: • 200 Most Common Medications • Content Updates • Conversion Table • Herbals: Common Natural Medicines • Less Frequently Used Drugs • Non-Crushable Drugs • Orphan Drugs • Signs and Symptoms of Electrolyte Imbalance • QT-Interval Prolongation and Medication Safety • Techniques of Medication Administration • Updates and Alerts REGISTER TODAY! MORE THAN A TEXTBOOK YOU’VE JUST PURCHASED ACTIVATE THE COMPLETE LEARNING EXPERIENCE THAT COMES WITH YOUR BOOK BY REGISTERING AT http://evolve.elsevier.com/SaundersNDH Saunders NURSING DRUG HANDBOOK 2014 BARBARA B. HODGSON, RN, OCN Morton Plant Mease Northbay Hospital Former Staff Nurse New Port Richey, Florida; St. Joseph’s Hospital Former Staff Nurse in the Cancer Institute Tampa, Florida ROBERT J. KIZIOR, BS, RPh Education Coordinator Department of Pharmacy Alexian Brothers Medical Center Elk Grove Village, Illinois 3251 Riverport Lane St. Louis, Missouri 63043 SAUNDERS NURSING DRUG HANDBOOK 2014 ISBN: 978-1-4557-0739-3 ISSN: 1098-8661 Copyright © 2014, 2013, 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2003, 2002, 2001, 2000, 1999, 1998, 1997, 1996, 1995, 1994, 1993 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Pub- lisher (other than as may be noted herein). NOTICES Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treat- ment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in eval- uating and using any information, methods, compounds, or experiments described herein. In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and dura- tion of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products lia- bility, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-1-4557-0739-3 Director, eContent Solutions: Robin Carter Content Manager: Lauren Lake Publishing Services Manager: Pat Joiner Senior Project Manager: Joy Moore Designer: Ashley Eberts Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 CONTENTS DRUGS BY DISORDER xv DRUG CLASSIFICATIONS 1C A–Z DRUG ENTRIES 1 APPENDIXES 1278 A. Calculation of Doses 1279 B. Controlled Drugs (United States) 1280 C. Chronic Wound Care 1281 D. Drugs of Abuse 1285 E. Equianalgesic Dosing 1290 F. FDA Pregnancy Categories 1291 G. Herbals: Common Natural Medicines 1292 H. Lifespan, Cultural Aspects, and Pharmacogenomics of Drug Therapy 1298 I. Normal Laboratory Values 1302 J. Cytochrome P450 (CYP) Enzymes 1304 K. Poison Antidote Chart 1307 L. Preventing Medication Errors and Improving Medication Safety 1311 M. Recommended Childhood and Adult Immunizations 1314 N. Parenteral Fluid Administration 1320 O. Spanish Phrases Often Used in Clinical Settings 1322 GENERAL INDEX 1331 iii PAGEBURST INTEGRATED RESOURCES e21 I dedicate this work to my daughter Lauren, a true friend, for her unconditional love; my daughter Kathryn, always supportive, always encouraging; and my son Keith, a source of great pride to us all. This is also dedicated to my sons-in-law, Jim and Andy, who have added so very much to my family, and to my grandchildren, Paige Olivia, Logan James, Ryan James, and Dylan Boyd. I couldn’t love you more. Barbara B. Hodgson, RN, OCN To all health care professionals, who in the expectation of little glory or material reward, dedicate themselves to the art and science of healing. Robert J. Kizior, BS, RPh iv v AUTHOR BIOGRAPHIES Barbara B. Hodgson, RN, OCN Born and raised in Michigan, Barbara was married and raising a young family in Chi- cago when she decided to fulfill a lifelong dream and become a nurse. After gradua- tion, she started her own business as author and publisher of Medcards, The Total Medication Reference Guide, the first of its kind. These drug cards were designed to assist nursing students in understanding drug information to give knowledgeable care to their patients. In 1981, she met co-author Robert (Bob) Kizior, who was teaching a pharmacology class. After class, Barbara approached him and asked if he would be interested in working on Medcards with her. He agreed, and together they became so successful that a few years later Barbara was able to fulfill another dream and move to Florida. By 1987, Barbara was approached by W.B. Saunders and asked to author the Saun- ders Nursing Drug Handbook. Since then, Barbara and Bob have worked together on this handbook and on two more drug resources, the Saunders Electronic Nurs- ing Drug Cards and the Saunders Drug Handbook for Health Professions. Barbara specialized in oncology at the Cancer Institute, St. Joseph’s Hospital, in Tampa, Florida, and at Morton Plant Mease Northbay Hospital in New Port Richey, Florida. Barbara’s daughter Lauren is a nurse manager, and her daughter Kathryn, her son Keith, and her son-in-law Jim are all nurses, working in their respective fields of patient care. Barbara’s favorite interests are spending time with her very busy, tight-knit family and, when she has a rare moment, getting her hands full of dirt working in her garden. Robert (Bob) J. Kizior, BS, RPh Bob graduated from the University of Illinois School of Pharmacy and is licensed to practice in the state of Illinois. He has worked as a hospital pharmacist for more than 40 years at Alexian Brothers Medical Center in Elk Grove Village, Illinois—a suburb of Chicago. Bob is the Pharmacy Surgery Coordinator for the Department of Pharmacy, where he participates in educational programs for pharmacists, nurses, physicians, and patients. He plays a major role in coordinating pharmacy services in the OR satel- lite. Bob is a former adjunct faculty member at William Rainey Harper Community College in Palatine, Illinois. It was there that Bob first met Barbara and commenced their long-standing professional association. An avid fan of Big Ten college athletics, Bob also has eclectic tastes in music that range from classical, big band, rock ’n’ roll, and jazz to country and western. Bob spends much of his free time reviewing the professional literature to stay current on new drug information. vi CONSULTANTS* Linda Laskowski-Jones, RN, MS, CS, CCRN, CEN Christiana Care Health System Newark, Delaware Jessica K. Leet, RN, BSN Cardinal Glennon Children’s Hospital St. Louis, Missouri Denise Macklin, BSN, RNC, CRNI President, Professional Learning Systems, Inc. Marietta, Georgia Nancy L. McCartney Valencia Community College Orlando, Florida Judith L. Myers, MSN, RN Health Sciences Center St. Louis University School of Nursing St. Louis, Missouri Kimberly R. Pugh, MSEd, RN, BS Nurse Consultant Baltimore, Maryland Regina T. Schiavello, BSN, RNC Wills Eye Hospital Philadelphia, Pennsylvania Gregory M. Susla, PharmD, FCCM National Institutes of Health Bethesda, Maryland Elizabeth Taylor Tennessee Wesleyan College of Nursing Fort Saunders Regional Knoxville, Tennessee Katherine B. Barbee, MSN, ANP, F-NP-C Kaiser Permanente Washington, DC Lisa Brown Jackson State Community College Jackson, Tennessee Marla J. DeJong, RN, MS, CCRN, CEN, Capt Wilford Hall Medical Center Lackland Air Force Base, Texas Diane M. Ford, RN, MS, CCRN Andrews University Berrien Springs, Michigan Denise D. Hopkins, PharmD College of Pharmacy University of Arkansas Little Rock, Arkansas Barbara D. Horton, RN, MS Arnot Ogden Medical Center School of Nursing Elmira, New York Mary Beth Jenkins, RN, CCRN, CAPA Elliott One Day Surgery Center Manchester, New Hampshire Kelly W. Jones, PharmD, BCPS McLeod Family Medicine Center McLeod Regional Medical Center Florence, South Carolina Autumn E. Korson Western Michigan University Bronson School of Nursing Kalamazoo, Michigan *The author acknowledges the work of the consultants in previous edition(s). vii REVIEWERS James Anthony Graves, PharmD Pharmacist St. Mary’s Health Center Jefferson City, Missouri Joshua J. Neumiller, PharmD, CDE, CGP, FASCP Assistant Professor Department of Pharmacotherapy College of Pharmacy Washington State University Spokane, Washington viii PREFACE Nurses are faced with the ever-challenging responsibility of ensuring safe and effective drug therapy for their patients. Not surprisingly, the greatest challenge for nurses is keeping up with the overwhelming amount of new drug information, including the latest FDA-approved drugs and changes to already approved drugs, such as new uses, dosage forms, warnings, and much more. Nurses must integrate this information into their patient care quickly and in an informed manner. Saunders Nursing Drug Handbook 2014 is designed as an easy-to-use source of current drug information to help the busy nurse meet these challenges. What sepa- rates this book from others is that it guides the nurse through patient care to better practice and better care. This handbook contains the following: 1. An IV compatibility chart. This handy chart is bound into the handbook to pre- vent accidental loss. 2. The Classifications section. The action and uses for some of the most common clinical and pharmacotherapeutic classes are presented. Unique to this handbook, each class provides an at-a-glance table that compares all the generic drugs within the classification according to product availability, dosages, side effects, and other characteristics. Its blue half-page color tab ensures you can’t miss it! 3. An alphabetical listing of drug entries by generic name. Blue letter thumb tabs help you page through this section quickly. Information on medications that contain a Black Box Alert is an added feature of the drug entries. This alert iden- tifies those medications for which the FDA has issued a warning that the drugs may cause serious adverse effects. Tall Man lettering, with emphasis on certain syl- lables to avoid confusing similar sounding/looking medications, is shown in slim blue capitalized letters (e.g., *acetaZOLAMIDE). High Alert drugs with a blue icon are considered dangerous by The Joint Commission and the Institute for Safe Medication Practices (ISMP) because if they are administered incorrectly, they may cause life-threatening or permanent harm to the patient. The entire High Alert generic drug entry sits on a blue-shaded background so that it’s easy to spot! To make scanning pages easier, each new entry begins with a shaded box containing the generic name, pronunciation, trade name(s), fixed-combination(s), and classification(s). 4. Herbal entries. In this edition, each herb is cross-referenced to Herbals: Common Natural Medicines (Appendix G) so that you have the most comprehensive view of herbal therapies related to patient care. 5. A comprehensive reference section. Appendixes include vital information on calculation of doses; controlled drugs; chronic wound care; drugs of abuse; equi- analgesic dosing; FDA pregnancy categories; herbals: common natural medicines; lifespan, cultural aspects, and pharmacogenomics of drug therapy; normal labora- tory values; cytochrome P450 enzymes; poison antidotes; preventing medication errors; recommended childhood and adult immunizations; parenteral fluid admin- istration; and Spanish phrases often used in clinical settings. Preface ix 6. Drugs by Disorder. You’ll find Drugs by Disorder in the front of the book for easy reference. It lists common disorders and the drugs most often used for treatment. 7. The index. The comprehensive index is located at the back of the book on light blue pages. Undoubtedly the best tool to help you navigate the handbook, the com- prehensive index is organized by showing generic drug names in bold, trade names in regular type, classifications in italics, and the page number of the main drug entry listed first and in bold. A DETAILED GUIDE TO THE SAUNDERS NURSING DRUG HANDBOOK An intensive review by consultants and reviewers helped us to revise the Saunders Nursing Drug Handbook so that it is most useful in both educational and clinical practice. The main objective of the handbook is to provide essential drug information in a user-friendly format. The bulk of the handbook contains an alphabetical listing of drug entries by generic name. To maintain the portability of this handbook and meet the challenge of keeping content current, we have also included additional information for some medications on the Evolve® Internet site. Users can also choose from 200 monographs for the most commonly used medications and customize and print drug cards. Evolve® also in- cludes drug alerts (e.g., medications removed from the market) and drug updates (e.g., new drugs, updates on existing entries). Information is periodically added, al- lowing the nurse to keep abreast of current drug information. You’ll also notice that some entries for infrequently used medications are con- densed to reflect only the absolutely essential points the nurse should know when called on to administer them. We have incorporated the IV Incompatibilities/Compatibilities heading. The drugs listed in this section are compatible or incompatible with the generic drug when admin- istered directly by IV push, via a Y-site, or via IV piggyback. We have highlighted the intravenous drug administration and handling information with a special heading icon and have broken it down by Reconstitution, Rate of Administration, and Storage. We present entries in an order that follows the logical thought process the nurse undergoes whenever a drug is ordered for a patient: • What is the drug? • How is the drug classified? • What does the drug do? • What is the drug used for? • Under what conditions should you not use the drug? • How do you administer the drug? • How do you store the drug? • What is the dose of the drug? • What should you monitor the patient for once he or she has received the drug? • What do you assess the patient for? • What interventions should you perform? • What should you teach the patient? x Preface The following are included within the drug entries: Generic Name, Pronunciation, Trade Names. Each entry begins with the generic name and pronunciation, followed by the U.S. and Canadian trade names. Exclusively Canadian trade names are followed by a blue maple leaf . Trade names that were most prescribed in the year 2012 are underlined in this section. Black Box Alert. This feature highlights drugs that carry a significant risk of serious or life-threatening adverse effects. Black Box Alerts are ordered by the FDA. Do Not Confuse With. Drug names that sound similar to the generic and/or trade names are listed under this heading to help you avoid potential medication errors. Fixed-Combination Drugs. Where appropriate, fixed-combinations, or drugs made up of two or more generic medications, are listed with the generic drug. Pharmacotherapeutic and Clinical Classification Names. Each full entry in- cludes both the pharmacotherapeutic and clinical classifications for the generic drug. The page number of the classification description in the front of the book is provided in this section as well. Action/Therapeutic Effect. This section describes how the drug is predicted to be- have, with the expected therapeutic effect(s) under a separate heading. Pharmacokinetics. This section includes the absorption, distribution, metabolism, ex- cretion, and half-life of the medication. The half-life is bolded in blue for easy access. Uses/Off-Label. The listing of uses for each drug includes both the FDA uses and the off-label uses. The off-label heading is shown in bold blue for emphasis. Precautions. This heading incorporates a discussion about when the generic drug is contraindicated or should be used with caution. The cautions warn the nurse of spe- cific situations in which a drug should be closely monitored. Lifespan Considerations . This section includes the pregnancy category and lacta- tion data and age-specific information concerning children and elderly people. Interactions. This heading enumerates drug, food, and herbal interactions with the generic drug. As the number of medications a patient receives increases, awareness of drug interactions becomes more important. Also included is information about thera- peutic and toxic blood levels in addition to the altered lab values that show what effects the drug may have on lab results. Product Availability. Each drug monograph gives the form and availability of the drug. The icon identifies non-crushable drug forms. Administration/Handling. Instructions for administration are given for each route of administration (e.g., IV, IM, PO, rectal). Special handling, such as refrigeration, is also included where applicable. The routes in this section are always presented in the order IV, IM, Subcutaneous, and PO, with subsequent routes in alphabetical order (e.g., Ophthalmic, Otic, Topical). IV administration is broken down by reconstitu- tion, rate of administration (how fast the IV should be given), and storage (including how long the medication is stable once reconstituted). IV Incompatibilities/IV Compatibilities . These sections give the nurse the most comprehensive compatibility information possible when administering medications by direct IV push, via a Y-site, or via IV piggyback. This edition includes information about lipids. Indications/Routes/Dosage. Each full entry provides specific dosing guidelines for adults, elderly people, children, and patients with renal and/or hepatic impairment. Dosages are clearly indicated for each approved indication and route.