Download ascorbic acid (as-kor-bika-sid) - DavisPlus

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Use Cautiously in: Recurrent kidney stones; OB: Avoid chronic use of large doses
ascorbic acid (as-kor-bik a-sid)
Adverse Reactions/Side Effects
CNS: drowsiness, fatigue, headache, insomnia. GI: cramps, diarrhea, heartburn,
nausea, vomiting. GU: kidney stones. Derm: flushing. Hemat: deep vein thrombosis, hemolysis (in G6PD deficiency), sickle cell crisis. Local: pain at subcut or IM
in pregnant women.
Apo-C, Ascorbicap, Cebid, Cecon, Cecore-500, Cemill, Cenolate, Cetane, Cevalin,
Cevi-Bid, Flavorcee, Mega-C/A Plus, Ortho/CS, Sunkist
Classification
Therapeutic: vitamins
Pharmacologic: water soluble vitamins
Pregnancy Category C
Indications
Treatment and prevention of vitamin C deficiency (scurvy) with dietary supplementation. Supplemental therapy in some GI diseases during long-term parenteral nutrition
or chronic hemodialysis. States of increased requirements such as: Pregnancy, Lactation, Stress, Hyperthyroidism, Trauma, Burns, Infancy. Unlabeled Use: Prevention
of the common cold.
Action
Necessary for collagen formation and tissue repair. Involved in oxidation reduction
reactions; tyrosine, folic acid, iron, and carbohydrate metabolism; lipid and protein
synthesis; cellular respiration; and resistance to infection. Therapeutic Effects:
Replacement in deficiency states. Supplementation during increased requirements.
Pharmacokinetics
Absorption: Actively absorbed after oral administration by a saturable process.
Distribution: Widely distributed. Crosses the placenta; enters breast milk.
Metabolism and Excretion: Converted to compounds that are excreted by the
kidneys.
Half-life: Unknown.
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sites.
Interactions
Drug-Drug: If urinary acidification occurs, mayqexcretion andpeffects of mexiletine, amphetamine, or tricyclic antidepressants. Large doses (⬎10 g/day)
maypresponse to warfarin.qiron toxicity when given concurrently with deferoxamine.
Route/Dosage
PO (Adults): Scurvy— 500 mg/day for at least 14 days. Prevention of deficiency— 50– 100 mg/day.
PO (Children): Scurvy— 100– 300 mg/day for at least 14 days. Prevention of deficiency— 30– 45 mg/day.
IM (Adults): Scurvy— 100– 500 mg/day for at least 14 days.
IM (Children): Scurvy— 100– 300 mg/day for at least 14 days.
IV (Adults and Children): Prevention of deficiency— determined by need.
NURSING IMPLICATIONS
Assessment
● Vitamin C Deficiency: Assess for signs of vitamin C deficiency (faulty bone and
tooth development, gingivitis, bleeding gums, loosened teeth) before and during
therapy.
● Lab Test Considerations: Megadoses of ascorbic acid (⬎10 times the RDA requirement) may cause false-negative results for occult blood in the stool.
● May causepserum bilirubin andqurine oxalate, urate, and cysteine levels.
TIME/ACTION PROFILE (response to skeletal and hemorrhagic changes in scurvy)
Potential Nursing Diagnoses
ROUTE
ONSET
PEAK
DURATION
PO, IM, IV, subcut
2 days–3 wk
unknown
unknown
Imbalanced nutrition: less than body requirements (Indications)
Deficient knowledge, related to diet and medication regimen (Patient/Family Teaching)
Contraindications/Precautions
Contraindicated in: Tartrazine hypersensitivity (some products contain tartrazine— FDC yellow dye #5).
⫽ Canadian drug name.
Implementation
● Often ordered as a part of multivitamin supplementation, because inadequate diet
often results in multiple-vitamin deficiency.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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● Additive Compatibility: amikacin, calcium chloride, calcium gluconate, chlor-
2
● Pressure in ampules may be increased at room temperature; wrap with protective
cover before breaking.
● PO: Extended-release tablets and capsules should be swallowed whole without
crushing, breaking, or chewing; contents of capsules may be mixed with jelly or
jam. Chewable tablets should be chewed well or crushed before swallowing. Oral
solution may be taken directly by mouth or mixed with fruit juice, cereal, or other
food.
● IM: IM is usually the preferred parenteral route.
IV Administration
● pH: 5.5– 7.0.
● Continuous Infusion: Diluent: Dilute dose in 1000 mL D5W, D10W, 0.9%
NaCl, 0.45% NaCl, LR or Ringer’s solution, dextrose/saline or dextrose/Ringer’s
combinations. Rate: Infuse slowly.
● Y-Site Compatibility: alfentanil, amikacin, atracurium, atropine, aztreonam,
bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate,
cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, cefuroxime, chlorpromazine, cimetidine, clindamycin, cyanocobalamin, cyclosporine, dexamethasone,
digoxin, diphenhydramine, dobutamine, dopamine, doxycycline, enalaprilat,
ephedrine, epinephrine, epoetin alfa, esmolol, famotidine, fentanyl, fluconazole,
folic acid, furosemide, gentamicin, glycopyrrolate, heparin, hydrocortisone, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, lidocaine, magnesium sulfate, mannitol, meperidine, metaraminol, methoxamine,
methyldoapte, methylprednisolone, metoclopramide, metoprolol, morphine,
multivitamins, nafcillin, nalbuphine, naloxone, nitroglycerin, norepinephrine, ondansetron, oxacillin, oxytocin, penicillin G, pentazocine, phenobarbital, phentolamine, phenylephrine, phytonadione, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, rantidine,
sodium bicarbinate, streptokinase, succinylcholine, sufentanil, theophylline, thiamine, ticarcillin/clavulanate, tobramycin, tolazoline, trimetaphan, vancomycin,
vasopressin, verapamil, warfarin.
● Y-Site Incompatibility: aminophylline, azathioprine, ceftazidime, ceftriaxone,
chloramphenicol, diazepam, diazoxide, erythromycin, etomidate, ganciclovir, hydralazine, hydroxycobalamin, midazolam, nitroprusside, papaverine, pentamidine, pentobarbital, phenytoin, thiopental, trimethoprim/sulfamethoxazole.
promazine, colistimethate, cyanocobalamin, diphenhydramine, heparin, levofloxacin, methyldopate, penicillin G potassium, polymyxin B, procaine, prochlorperazine, promethazine, verapamil.
● Additive Incompatibility: bleomycin, nafcillin, sodium bicarbonate, theophylline.
Patient/Family Teaching
● Advise patient to take medication as directed and not to exceed dose prescribed.
Excess doses may lead to diarrhea and urinary stone formation. If a dose is
missed, skip dose and return to dose schedule.
● Vitamin C Deficiency: Encourage patient to comply with diet recommendations
of health care professional. Explain that the best source of vitamins is a well-balanced diet.
● Foods high in ascorbic acid include citrus fruits, tomatoes, strawberries, cantaloupe, and raw peppers. Gradual loss of ascorbic acid occurs when fresh food is
stored, but not when it is frozen. Rapid loss is caused by drying, salting, and cooking.
● Patients self-medicating with vitamin supplements should be cautioned not to exceed RDA. The effectiveness of megadoses of vitamins for treatment of various
medical conditions is unproven and may cause side effects. Abrupt withdrawal of
megadoses of ascorbic acid may cause rebound deficiency.
Evaluation/Desired Outcomes
● Decrease in the symptoms of ascorbic acid deficiency.
Why was this drug prescribed for your patient?
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