Download Cohort 11 Group 4 AM Shift Bauyon, Leslie Cagungao, Giselle Dela

Cohort 11
Group 4
AM Shift
Bauyon, Leslie
Cagungao, Giselle
Dela Pena, Arrianne
Dioso, Prime
Letigio, Althea
Luna, Edward
Munar, Sheerna
Navarro, Michelle
Nocon, Pia
Pacis, Jomar
Santos, Aldrin
CLONIDINE HYDROCHLORIDE
Catapres, Catapres-TTS, Dixaril , Duraclon
Classification
cardiovascular agent; central-acting antihypertensive; analgesic
Indication
Step 2 drug in stepped-care approach to treatment of hypertension, either alone
or with diuretic or other antihypertensive agents. Epidural administration as adjunct
therapy for severe pain.
Contraindication
Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa,
scleroderma, SLE
Warnings/precautions
Avoid abrupt discontinuation. Tabs may cause rash if have allergic reaction to
patch. Continue tabs to within 4 hours of surgery resume and as soon as possible
thereafter. Do not remove patch for surgery. Caution with severe coronary insufficiency,
conduction disturbances, recent MI, cerebrovascular disease or chronic cardioversion
due to potential risk of altered electrical conductivity or MRI due to occurrence of burn
Action
Centrally acting antiadrenergic derivative. Stimulates alpha 2-adrenergic receptors
in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma
concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate.
Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release
from kidneys.
Side effects
CV: Hypotension (epidural), postural hypotension (mild), peripheral edema, ECG
changes, tachycardia, bradycardia, flushing, rapid increase in BP with abrupt
withdrawal. GI: Dry mouth, constipation, abdominal pain, pseudo-obstruction of large
bowel, altered taste, nausea, vomiting, hepatitis, hyperbilirubinemia, weight gain
(sodium retention).
CNS: Drowsiness, sedation, dizziness, headache, fatigue, weakness,
sluggishness, dyspnea, vivid dreams, nightmares, insomnia, behavior changes,
agitation, hallucination, nervousness, restlessness, anxiety, mental depression. Skin:
Rash, pruritus, thinning of hair, exacerbation of psoriasis; with transdermal patch:
hyperpigmentation, recurrent herpes simplex, skin irritation, contact dermatitis, mild
erythema. Special Senses: Dry eyes. Urogenital: Impotence, loss of libido.
Adverse Reactions
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dry mouth
drowsiness
dizziness
constipation
sedation
impotence or sexual dysfunction
nausea
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vomiting
alopecia
weakness
orthostatic symptoms
nervousness
localized skin reactions (patch)
Dosage
Adults: (patch) apply to hairless, intact area of upper arm or chest weekly. Taper
withdrawal of previous antihypertensive. Initial: 0.1mg/24hr patch weekly. Titrate: may
increase after 1-2 weeks. Max: 0.6mg/24hr. (tab) initial:0.1mg bid. Titrate: may increase
by 0.1mg weekly. Usual: 0.2-0.6mg/day in divided doses. Max: 2.4mg/day. (patch, tab)
renal impairment: adjust according to degree impairment.
Nursing Responsibilities
Assessment & Drug Effects
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Monitor BR closely. Determine positional changes (supine, sitting, standing).
With epidural administration, frequently monitor BP and HR. Hypotension is a
common side effect that may require intervention.
Monitor BP closely whenever a drug is added to or withdrawn from therapeutic
regimen.
Monitor I&O during period of dosage adjustment. Report change in I&O ratio or
change in voiding pattern.
Determine weight daily. Patients not receiving a concomitant diuretic agent may
gain weight, particularly during first 3 or 4 d of therapy, because of marked
sodium and water retention.
Supervise closely patients with history of mental depression, as they may be
subject to further depressive episodes.
ZOLPIDEM TITRATE
Ambien
Classification
laxatives, osmotics
Definition
A white powder for reconstitution. MiraLax (polyethylene glycol 3350, NF) is a
synthetic
This medication is used to treat occasional constipation. It works by holding
water in the stool to soften the stool and increases the number of bowel movements. It
is known as an osmotic-type laxative.
Molecular weight: polyglycol having an average molecular weight of 3350. The
actual molecular weight is not less than 90.0 percent and not greater than 110.0 percent
of the nominal value.
Chemical Formula
The chemical formula is HO(C2H4O)n H in which n represents the average
number of oxyethylene groups. Below 55° C it is a free flowing white powder freely
soluble in water.
Indication
Short-term treatment of insomnia
Dose
1 packet
Route
P.O.
Dosage
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
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Duration of therapy should be limited to 7-10 days
Adults: Oral: 10 mg immediately before bedtime; maximum dose: 10 mg
Elderly: 5 mg immediately before bedtime
Hemodialysis: Not dialyzable
Dosing adjustment in hepatic impairment: Decrease dose to 5 mg
Administration


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Ingest immediately before bedtime due to rapid onset of action
Monitoring Parameters: Daytime alertness; respiratory and cardiac status
Reference Range: 80-150 ng/mL
Patient Education
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Use exactly as directed; do not increase dose or frequency or discontinue without
consulting prescriber.
Drug may cause physical and/or psychological dependence.
While using this medication, do not use alcohol or other prescription or OTC
medications (especially, pain medications, sedatives, antihistamines, or
hypnotics) without consulting prescriber.
Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid
intake.
You may experience drowsiness, dizziness, or blurred vision (use caution when
driving or engaging in tasks requiring alertness until response to drug is known);
nausea (small, frequent meals, frequent mouth care, chewing gum, or sucking
lozenges may help); or diarrhea (buttermilk, boiled milk, yogurt may help).
Report CNS changes (confusion, depression, increased sedation, excitation,
headache, abnormal thinking, insomnia, or nightmares); muscle pain or
weakness; respiratory difficulty; chest pain or palpitations; or ineffectiveness of
medication.
Breast-feeding precaution: Consult prescriber if breast-feeding.
Nursing Implications

Patients may require assistance with ambulation; lower doses in the elderly are
usually effective; institute safety measures
Additional Information

Causes less disturbances in sleep stages as compared to benzodiazepines.
Time spent in sleep stages 3 and 4 are maintained; decreases sleep latency.
Should not be prescribed in quantities exceeding a 1-month supply.
Anesthesia and Critical Care Concerns/Other Considerations

Causes less disturbances in sleep stages as compared to benzodiazepines; time
spent in sleep stages 3 and 4 are maintained. Zolpidem decreases sleep latency;
should not be prescribed in quantities exceeding a 1-month supply.
References
 http://health.yahoo.com/sleep-medications/zolpidem/healthwise--d00910a1.html
 http://www.rxlist.com/ambien-drug.htm
POLYETHYLENE GLYCOL (PEG)
Miralax
Classification
laxatives, osmotics
Definition
A white powder for reconstitution. MiraLax (polyethylene glycol 3350, NF) is a
synthetic
This medication is used to treat occasional constipation. It works by holding water in the
stool to soften the stool and increases the number of bowel movements. It is known as
an osmotic-type laxative.
Molecular weight: polyglycol having an average molecular weight of 3350. The
actual molecular weight is not less than 90.0 percent and not greater than 110.0 percent
of the nominal value.
Chemical Formula
The chemical formula is HO(C2H4O)n H in which n represents the average
number of oxyethylene groups. Below 55° C it is a free flowing white powder freely
soluble in water.
Indication
constipation
Dose
1 packet
Route
P.O.
Pharmakodynamics
Onset: unknown
Peak: 2-4 days
Duration: unknown
Normal dosage range: 17g. (one heaping teaspoon) in 8oz. of water may be
used for up to two weeks
Mechanism of Action
Acts as an osmotic agent, drawing water into the lumen of the GI tract. Indicated
for evacuation of the GI tract without water or electrolyte imbalance.
Precaution
Ask patient if with any allergic reaction to the medication
Side effects
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Bloating, cramps, gas, nausea
High doses may cause diarrhea and excessive frequency
Contraindications
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Gi obstructions, gastric retention, toxic colitis, megacolon
Use cautiously in abdominal pain of uncertain cause, particularly if accompanied
by fever
Nursing consideration
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Inform patient that 2-4 days may be required to produce a bowel movement.
Should not be used for more than 2 weeks.
Take on prescribed time. Skip the one missed and return to regular schedule. Do
not take two doses at once.
Prolonged, frequent or excessive use may result in electrolyte imbalance and
laxative dependence .
Advice patient to notify health care professional if unusual cramps, bloating or
diarrhea occurs.
Reference

http://www.scribd.com/doc/6686280/MiraLax
CINACALCET
Sensipar
Classification
Calcimimetic agent
Indications
Sensipar® is indicated for the treatment of secondary hyperparathyroidism in
patients with Chronic Kidney Disease on dialysis.
Sensipar® is indicated for the treatment of hypercalcemia in patients with
parathyroid carcinoma.
Contraindications
Sensipar® is contraindicated
component(s) of this product.
in
patients
with
hypersensitivity
to
any
Pharmacokinetics
Absorption and Distribution
After oral administration of cinacalcet, maximum plasma concentration (Cmax) is
achieved in approximately 2 to 6 hours. A food-effect study in healthy volunteers
indicated that the Cmax and area under the curve (AUC(0-inf)) were increased 82% and
68%, respectively, when cinacalcet was administered with a high-fat meal compared to
fasting. Cmax and AUC(0-inf) of cinacalcet were increased 65% and 50%, respectively,
when cinacalcet was administered with a low-fat meal compared to fasting.
After absorption, cinacalcet concentrations decline in a biphasic fashion with a
terminal half-life of 30 to 40 hours. Steady-state drug levels are achieved within 7 days.
The mean accumulation ratio is approximately 2 with once-daily oral administration. The
median accumulation ratio is approximately 2 to 5 with twice-daily oral administration.
The AUC and Cmax of cinacalcet increase proportionally over the dose range of 30 to
180 mg once daily. The pharmacokinetic profile of cinacalcet does not change over time
with once- daily dosing of 30 to 180 mg. The volume of distribution is high
(approximately 1000 L), indicating extensive distribution. Cinacalcet is approximately 93
to 97% bound to plasma protein(s). The ratio of blood cinacalcet concentration to
plasma cinacalcet concentration is 0.80 at a blood cinacalcet concentration of 10 ng/mL.
Metabolism and Excretion
Cinacalcet is metabolized by multiple enzymes, primarily CYP3A4, CYP2D6 and
CYP1A2. After administration of a 75 mg radiolabeled dose to healthy volunteers,
cinacalcet was rapidly and extensively metabolized via: 1) oxidative N-dealkylation to
hydrocinnamic acid and hydroxy-hydrocinnamic acid, which are further metabolized via
β-oxidation and glycine conjugation; the oxidative Ndealkylation process also generates
metabolites that contain the naphthalene ring; and 2) oxidation of the naphthalene ring
on the parent drug to form dihydrodiols, which are further conjugated with glucuronic
acid. The plasma concentrations of the major circulating metabolites including the
cinnamic acid derivatives and glucuronidated dihydrodiols markedly exceed parent drug
concentrations. The hydrocinnamic acid metabolite was shown to be inactive at
concentrations up to 10 μM in a cell-based assay measuring calcium-receptor
activation. The glucuronide conjugates formed after cinacalcet oxidation were shown to
have a potency approximately 0.003 times that of cinacalcet in a cell-based assay
measuring a calcimimetic response. Renal excretion of metabolites was the primary
route of elimination of radioactivity. Approximately 80% of the dose was recovered in
the urine and 15% in the feces.
Pharmacodynamics
Reduction in intact PTH (iPTH) levels correlated with cinacalcet concentrations in
CKD patients. The nadir in iPTH level occurs approximately 2 to 6 hours post dose,
corresponding with the Cmax of cinacalcet. After steady state is reached, serum
calcium concentrations remain constant over the dosing interval in CKD patients.
How Supplied
Sensipar® 30 mg tablets are formulated as light-green, film-coated, oval-shaped
tablets printed with “AMGEN” on one side and “30”on the opposite side, packaged in
bottles of 30 tablets. (NDC 55513-073-30)
Sensipar® 60 mg tablets are formulated as light-green, film-coated, oval-shaped
tablets printed with “AMGEN” on one side and “60”on the opposite side, packaged in
bottles of 30 tablets. (NDC 55513-074-30)
Sensipar® 90 mg tablets are formulated as light-green, film-coated, oval-shaped
tablets printed with “AMGEN” on one side and “90”on the opposite side, packaged in
bottles of 30 tablets. (NDC 55513-075-30)
Dosage and Administration
Sensipar® tablets should be taken whole and should not be divided. Sensipar®
should be taken with food or shortly after a meal.
Dosage must be individualized
All iPTH measurements during the Sensipar® trials were obtained using the
Nichols IRMA.
In patients with end-stage renal disease, testosterone levels are often below the
normal range. In a placebo-controlled trial in patients with CKD on dialysis, there were
reductions in total and free testosterone in male patients following six months of
treatment with Sensipar®. Levels of total testosterone decreased by a median of 15.8%
in the Sensipar® -treated patients and by 0.6% in the placebo-treated patients. Levels
of free testosterone decreased by a median of 31.3% in the Sensipar® -treated patients
and by 16.3% in the placebo-treated patients. The clinical significance of these
reductions in serum testosterone is unknown.
Side Effects
Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease on
Dialysi9
In 3 double-blind placebo-controlled clinical trials, 1126 CKD patients on dialysis
received study drug (656 Sensipar®, 470 placebo) for up to 6 months. The most
frequently reported adverse events (incidence of at least 5% in the Sensipar® group
and greater than placebo) are provided in Table 2. The most frequently reported events
in the Sensipar® group were nausea, vomiting, and diarrhea.
Table 2. Adverse Event Incidence ( ≥ 5%) in Patients on Dialysis
Placebo
Sensipar®
Event*:
(n
=
470) (n
=
656)
(%)
(%)
Nausea
19
31
Vomiting
15
27
Diarrhea
20
21
Myalgia
14
15
Dizziness
8
10
Hypertension
5
7
Asthenia
4
7
Anorexia
4
6
Pain Chest, Non-Cardiac
4
6
Access Infection
4
5
* Included are events that were reported at a greater
incidence in the Sensipar ® group than in the placebo group.
The incidence of serious adverse events (29% vs. 31%) was similar in the
Sensipar® and placebo groups, respectively.
Nursing Considerations
It is recommended that Sensipar® be taken with food or shortly after a meal.
Tablets should be taken whole and should not be divided.
SIMVASTATIN
Zocor
Classification
Cholesterol-lowering agent; Antilipemic
Indication
Simvastatin is used for reducing total cholesterol, LDL cholesterol, and
triglycerides, and for increasing HDL cholesterol. In patients with coronary heart
disease, diabetes, peripheral vessel disease, or history of stroke or other
cerebrovascular disease, simvastatin is prescribed for reducing the risk of mortality by
reducing death from coronary heart disease, reducing nonfatal myocardial infarction
(heart attack) and stroke, and reducing the need for coronary and noncoronary
revascularization procedures
Contraindications
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•
•
•
Hypersensitivity to simvastatin or to any of the excipients
Active liver disease or unexplained persistent elevations of serum transaminases
Pregnancy and lactation (see section 4.6)
Concomitant administration of potent CYP3A4 inhibitors (e.g. itraconazole,
ketoconazole, HIV protease inhibitors, erythromycin, clarithromycin, telithromycin
and nefazodone) (see section 4.5).
Pharmacokinetics
Simvastatin is an inactive lactone which is readily hydrolyzed in vivo to the
corresponding beta hydroxyacid, a potent inhibitor of HMG CoA reductase.
Hydrolysis takes place mainly in the liver; the rate of hydrolysis in human plasma is very
slow.
Absorption
In man simvastatin is well absorbed and undergoes extensive hepatic first-pass
extraction. The extraction in the liver is dependent on the hepatic blood flow. The liver is
the primary site of action of the active form. The availability of the beta hydroxyacid to
the systemic circulation following an oral dose of simvastatin was found to be less than
5 % of the dose. Maximum plasma concentration of active inhibitors is reached
approximately 1 2 hours after administration of simvastatin. Concomitant food intake
does not affect the absorption.
The pharmacokinetics of single and multiple doses of simvastatin showed that no
accumulation of medicinal product occurred after multiple dosing.
Distribution
The protein binding of simvastatin and its active metabolite is > 95 %.
Elimination
Simvastatin is a substrate of CYP3A4 (see sections 4.3 and 4.5). The major
metabolites of simvastatin present in human plasma are the beta hydroxyacid and four
additional active metabolites. Following an oral dose of radioactive simvastatin to man,
13 % of the radioactivity was excreted in the urine and 60 % in the faeces within 96
hours. The amount recovered in the faeces represents absorbed medicinal product
equivalents excreted in bile as well as unabsorbed medicinal product. Following an
intravenous injection of the beta hydroxyacid metabolite, its half-life averaged 1.9
hours. An average of only 0.3 % of the IV dose was excreted in urine as inhibitors.
Pharmacodynamics
Pharmacotherapeutic group: HMG CoA reductase inhibitor
ATC-Code: C10A A01
After oral ingestion, simvastatin, which is an inactive lactone, is hydrolyzed in the
liver to the corresponding active beta hydroxyacid form which has a potent activity in
inhibiting HMG CoA reductase (3 hydroxy – 3 methylglutaryl CoA reductase). This
enzyme catalyses the conversion of HMG CoA to mevalonate, an early and ratelimiting step in the biosynthesis of cholesterol.
'Zocor' has been shown to reduce both normal and elevated LDL C
concentrations. LDL is formed from very-low-density protein (VLDL) and is catabolised
predominantly by the high affinity LDL receptor. The mechanism of the LDL lowering
effect of 'Zocor' may involve both reduction of VLDL-cholesterol (VLDL C)
concentration and induction of the LDL receptor, leading to reduced production and
increased catabolism of LDL C. Apolipoprotein B also falls substantially during
treatment with 'Zocor'. In addition, 'Zocor' moderately increases HDL C and reduces
plasma TG. As a result of these changes the ratios of total- to HDL C and LDL- to HDL
C are reduced.
How Supplied
Tablets: 5, 10, 20, 40, and 80 mg.
Oral disintegrating tablets: 10, 20, 40, and 80 mg.
Dosage
The dose range for is 5-80 mg/day given preferably in the evening. The usual
staring dose is 20-40 mg once daily. Dose adjustments are made at weekly intervals.
Administration
Take this medication by mouth usually once daily in the evening, with or without
food. Certain medical conditions (e.g., familial hypercholesterolemia) may require more
frequent dosage instructions as directed by your doctor. Dosage is based on your
medical condition, response to therapy, and use of certain interacting medicines. Many
of the drugs listed in the Drug Interactions section may increase the chances of muscle
injury when used with simvastatin. Consult your doctor or pharmacist for more details.
Limit the amount of grapefruit or grapefruit juice you may eat or drink (less than 1 quart
a day) while being treated with this medication, unless specifically directed otherwise.
Grapefruit juice may increase the amount of certain medications in your bloodstream.
Consult your doctor or pharmacist for more details. If you also take certain other drugs
to lower your cholesterol (bile acid-binding resins such as cholestyramine or colestipol),
take simvastatin at least 1 hour before or at least 2 hours after these medications. Use
this medication regularly in order to get the most benefit from it. Remember to use it at
the same time each day. It may take up to 4 weeks before the full benefit of this drug
takes effect. It is important to continue taking this medication even if you feel well. Most
people with high cholesterol or triglycerides do not feel sick.
Side Effects
The most common side effects of simvastatin are headache, nausea, vomiting,
diarrhea, abdominal pain, muscle pain, and abnormal liver tests. Hypersensitivity
reactions have also been reported. The most serious potential side effects are liver
damage and muscle inflammation or breakdown.
Simvastatin is a statin. Therefore it shares side effects, such as liver and muscle
damage associated with all statins. Serious liver damage caused by statins is rare.
More often, statins cause abnormalities of liver tests, and, therefore, periodic
measurement of liver tests in the blood is recommended for all statins. Abnormal tests
usually return to normal even if a statin is continued, but if the abnormal test value is
greater than three times the upper limit of normal, the statin usually is stopped. Liver
tests should be measured before simvastatin is started and periodically thereafter or if
there is a medical concern about liver damage. Liver tests should be performed before
the 80 mg dose of simvastatin is initiated, three months after initiation and then
periodically thereafter.
Inflammation of the muscles caused by statins can lead to a serious breakdown
of muscle cells called rhabdomyolysis. Rhabdomyolysis causes the release of muscle
protein (myoglobin) into the blood. Myoglobin can cause kidney failure and even death.
When used alone, statins cause rhabdomyolysis in less than one percent of patients. To
prevent the development of rhabdomyolysis, patients taking simvastatin should contact
their healthcare provider immediately if they develop unexplained muscle pain,
weakness, or muscle tenderness.
Nursing Considerations
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Monitor the client’s blood lipid levels (cholesterol, triglycerides, low-density
lipoprotein [LDL], and high-density lipoprotein [HDL] every 6 to 8 wk for the first 6
months after lovastatin therapy and then every 3 to 6 months. For lipid level
profile, the client should fast for 12 to 14 hours. Desired cholesterol value is <200
mg/dL; triglyceride value is <150 mg/dL (can vary); LDL is <130 mg/dL; and HDL
is >60mg/dL. Cholesterol levels of >240 mg/dL, LDL levels of >160 mg/dL, and
HDL levels of <35mg/dL can lead to severe cardiovascular or cerebral vascular
accident.
Monitor laboratory tests for liver function, such as ALT, ALP, and GGTP.
Antilipemic drugs may cause liver disorder.
Observe for signs and symptoms of GI upset. Taking the drug with sufficient
water or with meals may alleviate some of the GI discomfort.
GENTAMICIN SULFATE
Classifications
antiinfective; aminoglycoside antibiotic
Dosage and Route
Moderate to Severe Infection
Adult: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided
doses Intrathecal 4–8 mg preservative free q.d. Topical 1–2 drops of solution in eye
q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.
Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg
preservative free q.d.
Neonate: IV/IM 2.5 mg/kg q12–24h
Acute Pelvic Inflammatory Disease
Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h
Prophylaxis of Bacterial Endocarditis
Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h
Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h
Broad-spectrum aminoglycoside
purpurea. Action is usually bacteriocidal.
antibiotic
derived
from
Micromonospora
Indication
Parenteral use restricted to treatment of serious infections of GI, respiratory, and
urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic
antimicrobial agents are ineffective or are contraindicated. Has been used in
combination with other antibiotics. Also used topically for primary and secondary skin
infections and for superficial infections of external eye and its adnexa.
Contraindication
History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic.
Safe use during pregnancy (category C) or lactation is not established
Side effects
Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic
neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory
paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension.
GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin;
hepatomegaly, splenomegaly. Hematologic: Increased or decreased reticulocyte
counts;
granulocytopenia,
thrombocytopenia
(fever,
bleeding
tendency),
thrombocytopenic purpura, anemia. Body as a Whole: Hypersensitivity (rash, pruritus,
urticaria, exfoliative dermatitis, eosinophilia, burning sensation of skin, drug fever, joint
pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular
necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum
creatinine; decreased creatinine clearance. Other: Local irritation and pain following IM
use; thrombophlebitis, abscess, superinfections, syndrome of hypocalcemia (tetany,
weakness, hypokalemia, hypomagnesemia).
Nursing Considerations
Assessment & Drug Effects




Lab tests: Perform C&S and renal function prior to first dose and periodically
during therapy; therapy may begin pending test results. Determine creatinine
clearance and serum drug concentrations at frequent intervals, particularly for
patients with impaired renal function, infants (renal immaturity), older adults,
patients receiving high doses or therapy beyond 10 d, patients with fever or
extensive burns, edema, obesity.
Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.
Note: Dosages are generally adjusted to maintain peak serum gentamicin
concentrations of 4– 10 g/mL, and trough concentrations of 1–2 g/mL. Peak
concentrations above 12 g/mL and trough concentrations above 2 g/mL are
associated with toxicity.
Draw blood specimens for peak serum gentamicin concentration 30 min–1h after
IM administration, and 30 min after completion of a 30–60 min IV infusion. Draw
blood specimens for trough levels just before the next IM or IV dose. Use
nonheparinized tubes to collect blood.
CLOPIDOGREL (AS BISULFATE)
Plavix
Classification
Antiplatelet agent
Action
Inhibits platelet aggregation by blocking ADP receptors on platelets, prevents
clumping of platelets.
Indication
Reduction of atherosclerotic events in: recent MI or stroke, peripheral arterial
disease; non-ST-segment elevation acute coronary syndrome (unstable angina/non-Qwave MI) or ST-segment elevation acute MI; see literature.
Contraindication
Active pathologic bleeding (eg, peptic ulcer, intracranial hemorrhage).
Risk of bleeding (eg, surgery, ulcers, trauma, concomitant NSAIDs). Severe
hepatic or renal disease. Consider discontinuing 5 days before elective surgery.
Pregnancy (Cat.B). Nursing mothers: not recommended.
Side effects
Bleeding, GI upset/ulcers, bruising, rash, pruritus, dizziness, headache; rare:
thrombotic thrombocytopenic purpura, neutropenia, agranulocytosis.
Interaction
Caution with drugs that increase risk of bleeding (eg, NSAIDs, warfarin), and with
drugs metabolized by CYP2C9 (eg, phenytoin, tolbutamide, tamoxifen, warfarin,
torsemide, fluvastatin, many NSAIDs).
Pharmacodynamics
Onset: 3-7 days
Peak: within 24 hours
Duration:5 days
Normal dosage range: 75mg once daily
Availability
75mg, 300mg; tabs
Nursing Consideration



Assess for symptoms of MI, stroke during treatment.
Monitors liver function studies: AST, ALT, bilirubin, creatinine if patient is on long
term therapy.
Monitor blood studies: CBC, Hgb, Hct, protime, cholesterol if the patient is on
long term therapy; thrombocytopenia and neutropenia may occur.
CAPSAICIN
Capsagel, Salonpas-Hot, Zostrix
Classification
Antipruritic, Topical analgesic
Dosage
Pain: Topical (0.025-0.075% cream) three to five times daily. Apply thin film of
cream. No residue should remain. Less frequent use (<3 times daily) may decrease
clinical efficacy and increase local discomfort. Avoid contact with eyes and broken or
irritated skin. For Post Herpetic Neuralgia, apply to skin only after zoster lesions have
healed. Transient burning may occur on application but generally disappears in several
days.
Psoriasis: Topical (0.01-0.025% cream) four to six times daily.
Mode of Action
Capsaicin is a naturally occurring substance derived from plants of the
Solanaceae family (red peppers) with the chemical name trans-8-methyl-N-vanillyl-6noneamide. The precise mechanism of action is not fully understood but capsaicin
renders skin and joints insensitive to pain by initial release then depletion of substance
P (the principal chemical mediator) in peripheral sensory neurons and in joint tissues.
Initial exposure to capsaicin induces an intense excitation after which the neurons
become temporarily inactive. Capsaicin decreases substance P induced activation of
inflammatory mediators involved with the pathogenesis of rheumatoid arthritis.
Capsaicin may provide effective relief of burning, shooting neuropathic pain and pain
associated with inflammatory joint diseases. Capsaicin does not appear to act directly
on central cells in the brain and spinal cord
Indication
For temporary relief of pain from rheumatoid arthritis, osteoarthritis, post
mastectomy pain and relief of neuralgias e.g. diabetic neuropathy, post herpetic
neuralgia, phantom limb pain; treatment of psoriasis vulgaris, hemodialysis associated
pruritus
Contraindication



broken skin
skin irritation
previous allergic reactions to capsaicin, hot peppers, other drugs, dyes, foods,
preservatives



breastfeeding
pregnancy or current attempts to become pregnant
not to be used by children under 2 years of age
Pharmacokinetics
Onset: 14-28 days (up to 4 weeks)
Peak effect: variable
Duration of Action: 3-6 hours
Pharmacodynamics
Elimination: hepatic
Side effects/adverse effects





Warmth, stinging, or burning on the application site may occur. If any of these
effects persist or worsen, contact your doctor or pharmacist promptly.
Coughing, sneezing, watery eyes, or throat irritation may occur if you breathe in
the dried residue from the medication. Use caution to avoid inhaling the residue.
If your doctor has directed you to use this medication, remember that he or she
has judged that the benefit to you is greater than the risk of side effects. Many
people using this medication do not have serious side effects.
Tell your doctor immediately if any of these unlikely but serious side effects
occur: blistering/swelling at the application site.
A very serious allergic reaction to this drug is rare. However, seek immediate
medical attention if you notice any symptoms of a serious allergic reaction,
including: rash, itching/swelling (especially of the face/tongue/throat), severe
dizziness, trouble breathing.
Nursing considerations
Instruct patient the following:
1. For the cream, gel, and lotion forms, apply a thin layer of medication to the affected
area and rub in gently and thoroughly. You may want to use a cotton ball/swab or
latex glove to apply the medication to avoid touching the medication with your
hands.
2. Do not apply the medication in the eyes, mouth, nostrils, or genitals. If you do get
the medication in those areas, flush with plenty of water. Also, do not apply this
medication to skin that is injured or irritated (e.g., cut, scraped, sunburned).
3. Do not apply this medication immediately before or after activities such as bathing,
swimming, sun bathing, or heavy exercise. Do not bandage or wrap the affected
4.
5.
6.
7.
8.
area or use a heating pad on that area. Doing so may increase the risk of side
effects.
After applying the medication, wash your hands unless you are using this
medication to treat the hands. If treating the hands, wait at least 30 minutes after
applying the medication to wash your hands.
Use this medication regularly to get the most benefit from it. To help you remember,
use it at the same time each day.
Capsaicin may cause transient burning on initial application. Local reactions
diminish with continued therapy but can be persistent and severe in some patients.
Avoid mixing capsaicin cream with other topical medications
This medication may sometimes take up to 2 months to work. Tell your doctor if your
condition persists for more than 7 days, if it worsens, or if it keeps returning. If you
think you may have a serious medical problem, seek immediate medical attention.
B COMPLEX-VITAMIN C-FOLIC ACID
Nephro-vite
Classification
Multivitamins
Dosage
Take this medication by mouth, usually once daily or as directed by the
physician.
Mode of Action
Vitamins are important building blocks of the body and help keep you in good
health. B vitamins include thiamine, riboflavin, niacin/niacinamide, vitamin B6, vitamin
B12, folic acid, and pantothenic acid.
Indication


For the distinctive nutritional needs of renal patients.
To treat or prevent vitamin deficiency due to poor diet, certain illnesses, or during
pregnancy.
Contraindication

Hypersensitivity to the drug
Side effects/adverse effects


Constipation, diarrhea, or upset stomach may occur. These effects are usually
temporary and may disappear as your body adjusts to this medication. If any of
these effects persist or worsen, contact your doctor or pharmacist promptly.
A very serious allergic reaction to this drug is rare. However, seek immediate
medical attention if you notice any of the following symptoms of a serious allergic
reaction: rash, itching, swelling, severe dizziness, trouble breathing.
Nursing considerations
Instruct patient the following:
1. If you are taking chewable tablets, chew the tablet thoroughly before swallowing.
2. If you are taking a timed-release capsule or tablet, swallow it whole. Do not crush,
chew, or break the capsule/tablet. Doing so can destroy the long action of the drug
and may increase side effects.
3. If you are taking a liquid product, use a medication-measuring device to carefully
measure the dose. Do not use a household spoon. Some liquid products need to be
shaken before each dose. Some products that contain vitamin B12 need to be
placed under the tongue and held there before swallowing. Follow label directions
carefully to get the most benefit.
4. Take this medication regularly in order to get the most benefit from it. To help you
remember, take it at the same time each day.
5. Avoid taking more than one multivitamin product at the same time unless your doctor
tells you to. Taking similar vitamin products together can result in a vitamin overdose
or serious side effects.
6. Avoid the regular use of salt substitutes in your diet if your multivitamin contains
potassium. If you are on a low-salt diet, ask your doctor before taking a vitamin or
mineral supplement.
7. Do not take this medication with milk, other dairy products, calcium supplements, or
antacids that contain calcium. Calcium may make it harder for your body to absorb
certain ingredients of the multivitamin.
8. Use this medication as directed on the label, or as your doctor has prescribed. Do
not use the medication in larger amounts or for longer than recommended.
9. Take your multivitamin with a full glass of water.
10. Liquid multivitamins may sometimes be mixed with water, fruit juice, or infant formula
(but not milk or other dairy products). Follow the directions on the medicine label.
11. Store this medication at room temperature away from moisture and heat. Keep the
liquid medicine from freezing.
12. Store multivitamins in their original container. Storing multivitamins in a glass
container can ruin the medication.
13. Do not take multivitamins without telling your doctor if you are pregnant or plan to
become pregnant. Some vitamins and minerals can harm an unborn baby if taken in
large doses. You may need to use a prenatal vitamin specially formulated for
pregnant women.
14. Multivitamins can pass into breast milk and may harm a nursing baby. Do not use
this medication without telling your doctor if you are breast-feeding a baby.
LEVOCARNITINE

Is a naturally occurring substance that functions in the transport of long-chain
fatty acids for energy production by the body.
Classification

Amino acid derivative
Indication




Levocarnitine is indicated for the prevention and treatment of carnitine deficiency
in patients with end stage renal disease (ESRD) who are undergoing
hemodialysis
Carnitine deficiency maybe due to:
o Congenital defect in synthesis or utilization
o Presence of uremia
o Reduced renal synthesis
o Removal during dialysis (similar to shape and size of creatinine, thus can
be easily dialyzed out during dialysis treatment)
o Lack of red meat and dairy products in patient’s diet
L-carnitine administration in dialysis patients is associated with:
o An increase in hematocrit / hemoglobin
o A decrease in EPO dose while maintaining the hematocrit at the same
level
o Relationship between carnitine, EPO and hematocrit:
erytrhrocyte
membranes are unstable, resulting in shortened lifespan and hemolysis;
by establishing the erythrocyte membrane, carnitine decreases hemolysis
and improves anemia
Other benefits of L-carnitine:
o Decreased muscle cramps and weakness
o Decreased intradialytic hypotension
o Increased cardiac output
o Increased exercise capacity
Contraindication

None known
Adverse Reaction

Transient nausea and vomiting have been observed. Less frequent are body
odor, nausea and gastritis. Seizures have been reported to occur in patients.
Storage



Store vials at room temperature (25 degrees C).
Discard unused portion of an open vial (formulation does not contain
preservative)
Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration. DO NOT USE IF DISCOLORED OR IF
PARTICULATE MATTER IS VISIBLE.
Dosage and Administration

Recommended starting dose: 10-20 mg/kg dry body weight as a slow 2-3 minute
bolus injection into the venous return line after each dialysis session.
OR

1 g daily as a divided oral dose
Nursing Considerations

Treatment should be continued for at least 3-6 months as the response to Lcarnitine takes weeks to develop
LEVOCARNITINE – CRITERIA FOR ADMINISTRATION


Intravenous Levocarnitine will be covered only for those ESRD patients who
have been on dialysis for a minimum of three months, have a low serum Lcarnitine level and one of the following criteria:
o Erythropoietin-resistant anemia
o Chronic hypotension
Effective immediately, physicians are required to provide medical documentation
for new orders for the administration of Levocarnitine. The following documents
must be reviewed, completed and signed by the physician, prior to
administration:
o FMCNA Criteria for Administration of Levocarnitine (FMCNA CS-I-173
Form) - establishes the criteria for administration of Levocarnitine in
FMCNA facilities
o Levocarnitine Administration Checklist (FMCNA CS-I-170 Form) - this
checklist must be completed in conjunction with an initial order for
Levocarnitine. The physician must select one of the following criteria, as
identified in the FMCNA Criteria for Administration of Levocarnitine, prior
to administration:
 Erythropoietin-resistant anemia
 Chronic unresponsive intradialytic hypotension
Levocarnitine Follow-Up (FMCNA CS-I-171 Form) - the physician must
complete this documentation every six (6) months after initiation of
Levocarnitine therapy.
Nursing staff may assist the physician in recording the medical information on the
checklist and six (6) month follow-up, and must sign the document in the
appropriate area. The original signed documents must be placed in the patient’s
medical record to ensure timely retrieval if required by a fiscal intermediary to
provide evidence that the patient has been appropriately evaluated and treated
by the physician.
o

References






FMC Procedure Manual, Fresenius Medical Care, North America 2007
Ahmad S, Manual of Clinical Dialysis 1999, 13:127-128
Labonia WD, L-carnitine effects on hemodialyzed patients treated with
erythropoietin. Am J Kidney Dis 1995, 26:75
Megri K, Trombert JC, Zannier A. Role of L-carnitine deficiency in persistent
anemia of maintenance hemodialysis (MHD) patients treated by erythropoietin
(EPO)[Abstract] Societe Francaise De Nephrologie Toulouse 1997; 153
Nilsson-Ehle P, Cederblad G, Fagher B et al. Plasma lipoproteins, liver function
and glucose metabolism in hemodialysis patients: lack of effect of L-carnitine
supplementation Scand J. Clin Lab Invest 1985, 45:179-184
Trovato G, Ginardi V, Di Marco V et al. Long term L-carnitine on chronic anemia
DEXTROSE - DEXTROSE HYDROUS INJECTION, SOLUTION
Hospira 50%
Dextrose Injection, USP



Concentrated dextrose in water
Concentrated source of carbohydrate calories for intravenous infusion.
NOTE: These solutions are hypertonic.
Description
50% Dextrose Injection, USP (concentrated dextrose in water) is a sterile,
nonpyrogenic, hypertonic solution of Dextrose, USP in water for injection for intravenous
administration after appropriate admixture or dilution.
The solutions contain no bacteriostat, antimicrobial agent or added buffer and are
intended only for use as a single-dose injection following admixture or dilution. .
Dextrose Injection, USP is a parenteral fluid and nutrient replenisher.
Clinical Pharmacology
When administered intravenously, solutions containing carbohydrate in the form
of dextrose restore blood glucose levels and provide calories. Carbohydrate in the form
of dextrose may aid in minimizing liver glycogen depletion and exerts a protein sparing
action. Dextrose injection undergoes oxidation to carbon dioxide and water.
Indications and Uses
50% Dextrose Injection, USP (concentrated dextrose in water) in partial-fill
containers is indicated for admixture with amino acids or dilution with other compatible
I.V. fluids to provide variable final dextrose concentrations for intravenous infusion in
patients whose condition requires parenteral nutrition.
Contraindications
A concentrated dextrose solution should not be used when intracranial or
intraspinal hemorrhage is present nor in the presence of delirium tremens if the patient
is already dehydrated.
Dextrose injection without electrolytes should not be administered simultaneously
with blood through the same infusion set because of the possibility that
pseudoagglutination of red cells may occur.
Warnings
Hypertonic dextrose solutions should be given
and possible hyperosmolar syndrome may result
Symptoms of hyperosmolar syndrome, such as
consciousness, especially in patients with chronic
carbohydrate intolerance.
slowly. Significant hyperglycemia
from too rapid administration.
mental confusion and loss of
uremia and those with known
The intravenous administration of these solutions can cause fluid and/or solute
overloading resulting in dilution of serum electrolyte concentrations, overhydration,
congested states or pulmonary edema.
This product contains aluminum that may be toxic. Aluminum may reach toxic
levels with prolonged parenteral administration if kidney function is impaired. Premature
neonates are particularly at risk because their kidneys are immature, and they require
large amounts of calcium and phosphate solutions, which contain aluminum.
For Peripheral Vein Administration
Hypertonic dextrose solutions (above 5% concentration) should be given slowly,
preferably through a small bore needle into a large vein, to minimize venous irritation.
For Central Venous Administration
Concentrated dextrose should be administered via central vein after appropriate
admixture or dilution when required.
Precautions
Electrolyte deficits, particularly in serum potassium and phosphate, may occur
during prolonged use of concentrated dextrose solutions. Blood electrolyte monitoring is
essential, and fluid and electrolyte imbalances should be corrected. Essential vitamins
and minerals also should be provided as needed.
To minimize hyperglycemia and consequent glycosuria, it is desirable to monitor
blood and urine glucose and if necessary, add insulin. When concentrated dextrose
infusion is abruptly withdrawn, it is advisable to follow with the administration of 5% or
10% dextrose to avoid rebound hypoglycemia.
Solutions containing dextrose should be used with caution in patients with known
subclinical or overt diabetes mellitus.
Care should be exercised to insure that the needle (or catheter) is well within the
lumen of the vein and that extravasation does not occur.
Concentrated dextrose solutions should not be administered subcutaneously or
intramuscularly.
Do not administer unless solution is clear and container is undamaged. Discard
unused portion. .
Adverse Reactions
Hyperosmolar syndrome, resulting from excessively rapid administration of
concentrated dextrose may cause hypovolemia, dehydration, mental confusion and/or
loss of consciousness.
If an adverse reaction does occur, discontinue the infusion, evaluate the patient,
institute appropriate therapeutic countermeasures and save the remainder of the fluid
for examination if deemed necessary.
Overdosage
In the event of overhydration or solute overload during therapy, reevaluate the
patient and institute appropriate corrective measures. See WARNINGS and
PRECAUTIONS.
Dosage and Administration
Concentrated Dextrose in Water is administered by slow intravenous infusion (a)
After admixture with amino acid solutions or (b) After dilution with other compatible I.V.
fluids. Dosage should be adjusted to meet the requirements of each individual patient.
Reference

http://www.drugs.com/pdr/potassium-chloride.html
HYDROCORTISONE SODIUM SUCCINATE
Solu-Cortef
Classification
Anti-inflammatory Adrenocortical Steroid
Dosage Form
for Injection
Actions
Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also
have salt-retaining properties, are used as replacement therapy in adrenocortical
deficiency states. Their synthetic analogs are primarily used for their potent antiinflammatory effects in disorders of many organ systems.
Glucocorticoids cause profound and varied metabolic effects. In addition, they
modify the body's immune response to diverse stimuli.
Hydrocortisone sodium succinate has the same metabolic and anti-inflammatory
actions as hydrocortisone. When given parenterally and in equimolar quantities, the two
compounds are equivalent in biologic activity. Following the intravenous injection of
hydrocortisone sodium succinate, demonstrable effects are evident within one hour and
persist for a variable period. Excretion of the administered dose is nearly complete
within 12 hours. Thus, if constantly high blood levels are required, injections should be
made every 4 to 6 hours. This preparation is also rapidly absorbed when administered
intramuscularly and is excreted in a pattern similar to that observed after intravenous
injection.
Contraindications
The use of Solu-Cortef Sterile Powder is contraindicated in premature infants
because the 100 mg, 250 mg, 500 mg and 1000 mg ACT-O-VIAL System contain
benzyl alcohol. Benzyl alcohol has been reported to be associated with a fatal "Gasping
Syndrome" in premature infants. Solu-Cortef Sterile Powder is also contraindicated in
systemic fungal infections and patients with known hypersensitivity to the product and
its constituents.
Mode of Administration
This preparation may be administered by intravenous injection, by intravenous
infusion, or by intramuscular injection, the preferred method for initial emergency use
being intravenous injection. Following the initial emergency period, consideration should
be given to employing a longer acting injectable preparation or an oral preparation.
Therapy is initiated by administering Solu-Cortef Sterile Powder intravenously over a
period of 30 seconds (eg, 100 mg) to 10 minutes (eg, 500 mg or more). In general, high
dose corticosteroid therapy should be continued only until the patient's condition has
stabilized—usually not beyond 48 to 72 hours.
Route of Administration
INTRAMUSCULAR, INTRAVENOUS
Side Effects
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest;
swelling of the mouth, face, lips, or tongue); black, tarry stools; changes in body fat;
changes in menstrual periods; changes in skin color; chest pain; easy bruising or
bleeding; mental or mood changes (eg, depression); muscle pain, weakness, or
wasting; swelling of feet or legs; seizures; severe nausea or vomiting; sudden severe
dizziness or headache; symptoms of infection (eg, fever, chills, sore throat); tendon or
bone pain; thinning of the skin; unusual skin sensation; unusual weight gain; vision
changes or other eye problems; vomit that looks like coffee grounds.
Nursing Measures










Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and
minimize HPA suppression.
Space multiple doses evenly throughout the day.
Do not give IM injections if patient has thrombocytopenic purpura.
Rotate sites of IM repository injections to avoid local atrophy.
Use minimal doses for minimal duration to minimize adverse effects.
Taper doses when discontinuing high-dose or long-term therapy.
Arrange for increased dosage when patient is subject to unusual stress.
Use alternate-day maintenance therapy with short-acting corticosteroids
whenever possible.
Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.
Provide antacids between meals to help avoid peptic ulcer.
References

Fekety R. Infections associated with corticosteroids and immunosuppressive
therapy. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases.
Philadelphia: WBSaunders Company 1992:1050–1. 2. Stuck AE, Minder CE,
Frey FJ. Risk of infectious complications in patients taking glucocorticoids. Rev
Infect Dis 1989:11(6):954–63.
MAGNESIUM SULFATE
Classification
Anti-convulsant, Anti-Arrhythmics
Dosage
Arrythmia: IV 1-6 grams over several minutes then continuous IV infusion 3-20
mg/min for 5-48 hours
Action
Decreased acetylcholine released
Indications


Magnesium replacement
Arrhythmia
Contraindications


Heart block and myocardial damage.
Toxemia of pregnancy.
Nursing Management



Monitor I&O. Make sure urine output is 100 ml or more in 4 hours before each
dose.
Take appropriate seizure preacautions.
Keep IV Ca Gluconate at bedside.
Reference

http://www.scribd.com/doc/-Emergency-Drugs
SEVELAMER CARBONATE
Renvela
Classification

phosphate binder
Indication


control of serum phosphorus in patients with chronic kidney disease (CKD) on
dialysis
It helps prevent hypocalcemia (low levels of calcium in the body) caused by
elevated phosphorus. It binds with phosphate in the digestive tract, which
decreases the amount of phosphate absorbed into the body.
Contraindication




Hypersensitivity
Hypophosphatemia
Patients with bowel obstruction
patients with dysphagia, swallowing disorders, severe gastrointestinal (GI)
motility disorders including severe constipation, or major GI tract surgery
Pharmacokinetics/Pharmacodynamics
Mechanism of Action
Renvela contains sevelamer carbonate, a non-absorbed phosphate binding
crosslinked polymer, free of metal and calcium. It contains multiple amines separated by
one carbon from the polymer backbone. These amines exist in a protonated form in the
intestine and interact with phosphate molecules through ionic and hydrogen bonding. By
binding phosphate in the dietary tract and decreasing absorption, sevelamer carbonate
lowers the phosphate concentration in the serum.
Pharmacodynamics
In addition to effects on serum phosphate levels, sevelamer hydrochloride has
been shown to bind bile acids in vitro and in vivo in experimental animal models. Bile
acid binding by ion exchange resins is a well-established method of lowering blood
cholesterol. Because sevelamer binds bile acids, it may interfere with normal fat
absorption and thus may reduce absorption of fat soluble vitamins such as A, D and K.
In clinical trials of sevelamer hydrochloride, both the mean total and LDL cholesterol
declined by 15-31%. This effect is observed after 2 weeks. Triglycerides, HDL
cholesterol and albumin did not change.
Pharmacokinetics
A mass balance study using 14C-sevelamer hydrochloride, in 16 healthy male
and female volunteers showed that sevelamer hydrochloride is not systemically
absorbed. No absorption studies have been performed in patients with renal disease.
Dosage and Administration
Starting dose is one or two 800 mg tablets three times per day with meals. Adjust
by one tablet per meal in two week intervals as needed to obtain serum phosphorus
target (3.5 to 5.5 mg/dL).
Availability: Tablets: 800 mg (3)
Nursing Administration







Avoid taking any other medicines within 1 hour before or 3 hours after you take
this medication. Renvela can bind to other medications and make them less
effective.
Serum bicarbonate and chloride levels should be monitored
Vitamins D, E, K (coagulation parameters), and folic acid levels should be
monitored
The most frequently occurring adverse reactions in a short-term study with
sevelamer carbonate tablets were nausea and vomiting
Patients should be informed to take Renvela with meals and to adhere to their
prescribed diets
Do not crush, chew, or break the sevelamer tablet. Swallow the pill whole.
Sevelamer tablets expand when they are wet, and breaking or crushing the pill
may make it harder to swallow.
Before taking sevelamer, tell your doctor if you are taking ciprofloxacin (Cipro), a
heart rhythm medication, or a seizure medication.
POTASSIUM ACETATE
Classification
Electrolyte
Indication


Prophylaxis and treatment of moderate to severe potassium loss when PO
therapy is not feasible
Potassium acetate is used as an additive for preparing specific IV formulas when
client needs cannot be met by usual nutrient or electrolyte preparation.
Contraindication

severe renal insufficiency or adrenal insufficiency and in diseases where high
potassium levels may be encountered
Pharmacokinetics

From 80-90% of potassium intake is excreted by the kidney and is partially
reabsorbed from the glomerular filtrate.
Dosage

40 mEq (2 mEq/mL)
Each 20 mL vial contains 3.93 g of potassium acetate which provides 40 mEq
each of potassium (K+) and acetate (CH3COO−).
Mode of Administration

Potassium Acetate Injection, USP, 40 mEq is administered intravenously only
after dilution in a larger volume of fluid. The dose and rate of administration are
dependent upon the individual needs of the patient. ECG and serum potassium
should be monitored as a guide to dosage.
Nursing Administration

To avoid potassium intoxication, infuse potassium-containing solutions slowly.
Potassium replacement therapy should be monitored whenever possible by




continuous or serial electrocardiography (ECG). Serum potassium levels are not
necessarily dependable indicators of tissue potassium levels.
Do not administer unless solution is clear and seal is intact. Discard unused
portion.
High plasma concentrations of potassium may cause death by cardiac
depression, arrhythmias or arrest.
Use with caution in the presence of cardiac disease, particularly in digitalized
patients or in the presence of renal disease.
Solutions containing acetate ion should be used with caution as excess
administration may result in metabolic alkalosis.