Download Hyoscyamine sulfate

Hyoscyamine
sulfate
IV
E
(hi g h- oh- S I G H -a hmeen )
CLASSIFICATION(S):
Cholinergic blocking drug
PREGNANCY CATEGORY: C
Rx: Anaspaz, Cystospaz, ED-SPAZ,
HyoMax–FT, IB-Stat, Levbid, Levsin,
Levsin Drops, Levsin/SL, Levsinex
Timecaps, Mar-Spas, Neosol, NuLev,
Symax Duotab, Symax FasTab, Symax-SL, Symax-SR.
SEE ALSO CHOLINERGIC BLOCKING
AGENTS, CHAPTER 2.
USES
(1) To control gastric secretion, visceral
spasm, and hypermotility in spastic colitis, spastic bladder, cystitis, pylorospasm, and associated abdominal
cramps. (2) Relieve symptoms in functional intestinal disorders (e.g., mild dysenteries and diverticulitis), infant colic,
biliary colic. (3) Adjunct to treat peptic
ulcer. (4) Irritable bowel syndrome (e.g.,
irritable colon, spastic colon, mucous
colitis, acute enterocolitis, functional GI
disorders). (5) Neurogenic bowel disturbances, including splenic flexure syndrome and neurogenic colon. (6) Reduce pain and hypersecretion in pancreatitis. (7) As a drying agent to relieve
symptoms of acute rhinitis. (8) In Parkinsonism to reduce rigidity and tremors and to control associated sialorrhea
and hyperhidrosis. (9) Treat poisoning
by anticholinesterase agents. (10) Treat
cystitis or renal colic. (11) Certain cases
of partial heart block associated with
vagal activity. (12) Preoperative medication to reduce salivary, tracheobronchial, and pharyngeal secretions. (13) Parenterally to reduce duoendal motility to
facilitate the diagnostic radiologic procedure, hypotonic duodenography.
May also improve radiologic visibility of
the kidneys.
ACTION/KINETICS
Action
One of the belladonna alkaloids; acts by
blocking the action of acetylcholine at
Bold Italic = life threatening side effect
the postganglionic nerve endings of the
parasympathetic nervous system.
Pharmacokinetics
1
t /2: 3.5 hr for tablets, 7 hr for extendedrelease capsules, and 9 hr for extendedrelease tablets. Majority of the drug is
excreted in the urine unchanged.
SPECIAL CONCERNS
• Heat prostration may occur if taken
in the presence of high environmental temperatures.
• Use with caution during lactation.
SIDE EFFECTS
Most Common
Dry mouth, drowsiness, flushing of face,
headache, blurred vision, photosensitivity, constipation, decreased sweating,
thirst.
See Cholinergic Blocking Agents, Chapter
2, for a complete list of possible side
effects.
HOW SUPPLIED
Capsules, Extended-Release: 0.375 mg;
Capsules, Timed-Release: 0.375 mg;
Drops: 0.125 mg/mL; Injection: 0.5
mg/mL; Oral Spray: 0.125 mg/mL; Tablets: 0.125 mg, 0.15 mg; Tablets, Chewable: 0.125 mg; Tablets, Controlled Release: 0.25 mg; Tablets, Extended-Release
/ Tablets, Sustained-Release: 0.375 mg
(includes Duotab containing 0.125 mg
immediate-release and 0.5 mg extended-release); Tablets, Oral Disintegrating: 0.125 mg; Tablets, Sublingual: 0.125
mg, 0.25 mg.
DOSAGE
• CAPSULES, EXTENDED-RELEASE;
TABLETS, EXTENDED-RELEASE; TABLETS, TIMED-RELEASE
Adults and children over 12 years of
age: 0.375–0.750 mg q 12 hr, not to
exceed 1.5 mg in 24 hr.
• DROPS
Adults and children over 12 years of
age: 0.125–0.25 mg (5–10 mL) q 4 hr,
not to exceed 1.5 mg (12 mL) in 24 hr.
Children, 2 to 12 years of age:
0.031–0.125 mg (0.22–1 mL) q 4 hr or as
needed, not to exceed 0.75 mg (6 mL)
in 24 hr. Children, under 2 years of
age: 3.4 kg: 4 drops q 4 hr, not to exceed 24 drops in 24 hr; 5 kg: 5 drops q
4 hr, not to exceed 30 drops in 24 hr; 7
kg: 6 drops q 4 hr, not to exceed 36
drops in 24 hr; 10 kg: 8 drops q 4 hr,
not to exceed 48 drops in 24 hr.
■ = black box warning
W = Available in Canada
• INJECTION
GI disorders.
Adults: 0.25–0.5 mg (0.5–1 mL). Some
clients need only one dose while others
require doses 2, 3, or 4 times per day at
4 hr intervals.
Diagnostic procedures.
Adults: 0.25–0.5 mg (0.5–1 mL) given IV
5 to 10 min prior to the procedure.
Preanesthetic medication.
Adults and children over 2 years of
age: 0.005 mg/kg 30–60 min prior to
the time of induction of anesthesia.
May also be given at the time the
preanesthetic sedative or narcotic is
given.
During surgery to reduce drug-induced
bradycardia.
Adults and children over 2 years of
age: Increments of 0.125 mg (0.25 mL)
IV repeated as needed.
Reverse neuromuscular blockade.
Adults and children over 2 years of
age: 0.2 mg (0.4 mL) for every 1 mg
neostigmine or equivalent dose of physostigmine or pyridostigmine.
• ORAL SPRAY
Children, 12 years and younger: 1–2
mL (1 or 2 sprays) q 4 hr as needed, up
to 12 mL/day (12 sprays/day).
• TABLETS; TABLETS, CHEWABLE;
TABLETS, SUBLINGUAL
Adults and children over 12 years of
age: 0.125–0.25 mg q 4 hr or as needed, not to exceed 1.5 mg in 24 hr.
• TABLETS, ORAL DISINTEGRATING
0.125 mg: Adults and children over
12 years: 1 or 2 tablets q 4 hr, up to 12/
day or 2 tablets 4 times per day. Chil1
dren, 2 to less than 12 years: /2–1 tablet q 4 hr, up to 6 per day.
0.25 mg: Adults and children over
1
12 years: /2–1 tablet 3–4 times per day,
30 min to 1 hr before meals and at bedtime. This dosage form is not recommended for children under 12 years old.
NURSING CONSIDERATIONS
E Do not confuse Levbid or Levsin with
Lithobid (lithium), Lopid (an antihyperlipidemic), or Lorabid (a beta-lactam
antibiotic).
ADMINISTRATION/STORAGE
1. May take hyoscyamine SL tablets
sublingually, PO, or chewed. May take
hyoscyamine tablets PO or SL.
C = see color insert
H = Herbal
2. Depending on the use, may give injection SC, IM, or IV.
IV 3. Visually inspect the injectable
form
for
particulate
matter/
discoloration.
ASSESSMENT
1. Note reasons for therapy, type, onset, characteristics of S&S.
2. List other agents trialed, outcome.
Reduce dose in elderly.
3. Determine evidence of glaucoma,
bladder neck or GI tract obstruction.
Assess for hyperthyroidism, CAD, CHF,
cardiac arrhythmias, hypertension, renal
disease, and hiatal hernia associated
with reflux esophagitis.
4. Assess elimination/output, abdomen, UGI, CT/US abdomen to R/O
pathology.
CLIENT/FAMILY TEACHING
1. Take as prescribed; avoid antacids
within 1 hr of taking drug (decreases
effectiveness).
2. Do not perform activities that require mental alertness until drug effects
realized; dizziness, drowsiness, and
blurred vision may occur.
3. Report any loss of symptom control
so provider can adjust dose and frequency of administration. Report diarrhea as it may be symptom of intestinal
obstruction, especially with a colostomy
or ileostomy.
4. Avoid excessive temperatures and
activity; drug impairs heat regulation
and may decrease perspiration, which
may cause fever, heat prostration, or
stroke.
5. Males with enlarged prostrate may
experience urinary retention/hesitancy;
report if persistent or bothersome.
6. Stop drug and report any mental
confusion, impaired gait, disorientation,
or hallucinations.
7. Avoid alcohol and CNS depressants.
Use dark glasses when outside to prevent blurred vision.
8. Keep all F/U to assess response and
for adverse SE.
OUTCOMES/EVALUATE
• 앗 GI motility
• Control of epigastric pain/spasm
IV = Intravenous
E = sound alike drug