H

haloperidol

(Apo-Haloperidol , Haldol, Haldol Decanoate, Novo-Peridol )

BLACK BOX ALERT Increased risk of mortality in elderly pts with dementia-related psychosis with use of injections.

Do not confuse Haldol with Halcion or Stadol.

Administration/handling

IV

◀ ALERT ▶ Only haloperidol lactate is given IV.

Reconstitution • May give undiluted. • May add to 50–100 ml of D₅W.

Rate of Administration • Give IV push at rate of 5 mg/min. • Infuse IV piggyback over 30 min. • For IV infusion, up to 25 mg/hr has been used (titrated to pt response).

Storage • Discard if precipitate forms, discoloration occurs. • Store at room temperature; do not freeze. • Protect from light.

IM

Parenteral Administration • Pt should remain recumbent for 30–60 min to minimize hypotensive effect. • Prepare Decanoate IM injection using 21-gauge needle. • Do not exceed maximum volume of 3 ml per IM injection site. • Inject slow, deep IM into upper outer quadrant of gluteus maximus.

PO

• Give without regard to meals. • Scored tablets may be crushed. • Dilute oral concentrate with water or juice. • Avoid skin contact with oral concentrate; may cause contact dermatitis.

IV incompatibilities

Allopurinol (Aloprim), amphotericin B complex (Abelcet, AmBisome, Amphotec), cefepime (Maxipime), fluconazole (Diflucan), foscarnet (Foscavir), heparin, nitroprusside (Nipride), piperacillin/tazobactam (Zosyn).

IV compatibilities

Dobutamine (Dobutrex), dopamine (Intropin), fentanyl (Sublimaze), hydromorphone (Dilaudid), lidocaine, lorazepam (Ativan), midazolam (Versed), morphine, nitroglycerin, norepinephrine (Levophed), propofol (Diprivan).

Indications/routes/dosage

Usual dosage

IM (Lactate): ADULTS, ELDERLY: 2–5 mg q4–8h as needed. CHILDREN 6–12 YRS: 1–3 mg/dose q4–8h as needed. Maximum: 0.15 mg/kg/day. (Decanoate): ADULTS, ELDERLY: 10–20 times stabilized oral dose, given at 4-wk intervals.

PO: ADULTS, ELDERLY: 0.5–5 mg 2–3 times/day. Maximum: 30 mg/day. CHILDREN 3–12 YRS (15–40 KG): 0.25–0.5 mg/day. May increase by 0.25–0.5 mg q5–7days. Maximum: 0.15 mg/kg/day.

Side effects

Frequent: Blurred vision, constipation, orthostatic hypotension, dry mouth, swelling or soreness of female breasts, peripheral edema. Occasional: Allergic reaction, difficulty urinating, decreased thirst, dizziness, diminished sexual function, drowsiness, nausea, vomiting, photosensitivity, lethargy.

Adverse effects/toxic reactions

Extrapyramidal symptoms (EPS) appear to be dose related and typically occur in first few days of therapy. Marked drowsiness/lethargy, excessive salivation, fixed stare may be mild to severe in intensity. Less frequently noted are severe akathisia (motor restlessness), acute dystonias: torticollis (neck muscle spasm), opisthotonos (rigidity of back muscles), oculogyric crisis (rolling back of eyes). Tardive dyskinesia (tongue protrusion, puffing of cheeks, chewing/puckering of the mouth) may occur during long-term therapy or after drug discontinuance and may be irreversible. Elderly female pts have greater risk of developing this reaction.

Nursing considerations

Baseline assessment

Assess behavior, appearance, emotional status, response to environment, speech pattern, thought content.

Intervention/evaluation

Monitor B/P, heart rate. Supervise suicidal-risk pt closely during early therapy (as depression lessens, energy level improves, increasing suicide potential). Monitor for rigidity, tremor, mask-like facial expression, fine tongue movement. Assess for therapeutic response (interest in surroundings, improvement in self-care, increased ability to concentrate, relaxed facial expression). Monitor EKG and QT interval. Therapeutic serum level: 0.2–1 mcg/ml; toxic serum level: greater than 1 mcg/ml.

Patient/family teaching

• Full therapeutic effect may take up to 6 wks. • Do not abruptly withdraw from long-term drug therapy. • Sugarless gum, sips of water may relieve dry mouth. • Drowsiness generally subsides during continued therapy. • Avoid tasks that require alertness, motor skills until response to drug is established. • Avoid alcohol. • Report muscle stiffness. • Avoid exposure to sunlight, overheating, dehydration (increased risk of heatstroke).

heparin

hep-a-rin

(Hepalean , Hepalean Leo , Hep-Lock)

Do not confuse heparin with Hespan.

classification

PHARMACOTHERAPEUTIC: Sulfated polysaccharide; blood modifier. CLINICAL: Anticoagulant (see p. 32C).

Action

Interferes with blood coagulation by blocking conversion of prothrombin to thrombin and fibrinogen to fibrin. Therapeutic Effect: Prevents further extension of existing thrombi or new clot formation. No effect on existing clots.

Pharmacokinetics

Well absorbed following subcutaneous administration. Protein binding: Very high. Metabolized in liver. Removed from circulation via uptake by reticuloendothelial system. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 1–6 hrs.

Uses

Prophylaxis and treatment of thromboembolic disorders; anticoagulant for extracorporeal and dialysis procedures; maintain patency of IV devices. OFF-LABEL: STEMI, non-STEMI, unstable angina, anticoagulant used during percutaneous coronary intervention.

Precautions

Contraindications: Severe thrombocytopenia, uncontrolled active bleeding (unless secondary to DIC). Cautions: IM injections, peptic ulcer disease, menstruation, recent surgery or invasive procedures, severe hepatic/renal/biliary disease, indwelling catheters. Pts at risk for bleeding (e.g., bacterial endocarditis, uncontrolled hypertension, platelet defects).

Lifespan considerations

Pregnancy/Lactation: Use with caution, particularly during last trimester, immediate postpartum period (increased risk of maternal hemorrhage). Does not cross placenta. Not distributed in breast milk. Pregnancy Category C. Children: No age-related precautions noted. Benzyl alcohol preservative may cause gasping syndrome in infants. Elderly: More susceptible to hemorrhage. Age-related renal impairment may increase risk of bleeding.

Interactions

DRUG: Other anticoagulants, platelet aggregation inhibitors, thrombolytics may increase risk of bleeding. HERBAL: Cat’s claw, dong quai, evening primrose, feverfew, garlic, ginkgo, ginseng, horse chestnut, red clover have additional antiplatelet activity. FOOD: None known. LAB VALUES: May increase free fatty acids, serum AST, ALT, aPPT. May decrease serum cholesterol.

Availability (Rx)

Injection Solution: 10 units/ml (Hep-Lock), 100 units/ml, 1,000 units/ml, 5,000 units/ml, 10,000 units/ml, 20,000 units/ml. Premix Solution for Infusion: 25,000 units/250 ml infusion, 25,000 units/500 ml infusion.

Administration/handling

◀ ALERT ▶ Do not give by IM injection (pain, hematoma, ulceration, erythema).

IV

◀ ALERT ▶ Used in full-dose therapy. Intermittent IV dosage produces higher incidence of bleeding abnormalities. Continuous IV route preferred.

Reconstitution • Premix solution requires no reconstitution.

Rate of Administration • Use constant-rate IV infusion pump.

Storage • Store at room temperature.

Subcutaneous

◀ ALERT ▶ Used in low-dose therapy. • After withdrawal of heparin from vial, change needle before injection (prevents leakage along needle track). • Inject above iliac crest or in abdominal fat layer. Do not inject within 2 inches of umbilicus or any scar tissue. • Withdraw needle rapidly, apply prolonged pressure at injection site. Do not massage. • Rotate injection sites.

IV incompatibilities

Amiodarone (Cordarone), amphotericin B complex (Abelcet, AmBisome, Amphotec), ciprofloxacin (Cipro), dacarbazine (DTIC), diazepam (Valium), dobutamine (Dobutrex), doxorubicin (Adriamycin), filgrastim (Neupogen), gentamicin (Garamycin), haloperidol (Haldol), idarubicin (Idamycin), labetalol (Trandate), nicardipine (Cardene), phenytoin (Dilantin), quinidine, tobramycin (Nebcin), vancomycin (Vancocin).

IV compatibilities

Ampicillin/sulbactam (Unasyn), aztreonam (Azactam), calcium gluconate, cefazolin (Ancef), ceftazidime (Fortaz), ceftriaxone (Rocephin), dexmedetomidine (Precedex), digoxin (Lanoxin), diltiazem (Cardizem), dopamine (Intropin), enalapril (Vasotec), famotidine (Pepcid), fentanyl (Sublimaze), furosemide (Lasix), hydromorphone (Dilaudid), insulin, lidocaine, lorazepam (Ativan), magnesium sulfate, methylprednisolone (Solu-Medrol), midazolam (Versed), milrinone (Primacor), morphine, nitroglycerin, norepinephrine (Levophed), oxytocin (Pitocin), piperacillin/tazobactam (Zosyn), procainamide (Pronestyl), propofol (Diprivan).

Indications/routes/dosage

Line flushing

IV: ADULTS, ELDERLY, CHILDREN: 100 units q6–8h. INFANTS WEIGHING LESS THAN 10 KG: 10 units q6–8h.

Unstable angina, NSTEMI, acute coronary syndrome

IV Infusion: ADULTS, ELDERLY: 60 units/kg bolus (maximum: 4,000 units), then 12 units/kg/hr (maximum: 1,000 units/hr).

Treatment of DVT/PE

IV Infusion: ADULTS, ELDERLY: 80 units/kg bolus (maximum: 5,000 units), then 18 units/kg/hr adjusted according to aPTT.

Usual pediatric/neonatal dose

IV Infusion: 75 units/kg bolus over 10 min, then initial maintenance dose of 28 units/kg/hr. Adjust to maintain aPTT of 60–85 sec.

Prevention of thromboembolic disorders

Subcutaneous: ADULTS, ELDERLY: 5,000 units q8–12h.

Side effects

Occasional: Pruritus, burning (particularly on soles of feet) caused by vasospastic reaction. Rare: Pain, cyanosis of extremity 6–10 days after initial therapy lasting 4–6 hrs, hypersensitivity reaction (chills, fever, pruritus, urticaria, asthma, rhinitis, lacrimation, headache).

Adverse effects/toxic reactions

Bleeding complications ranging from local ecchymoses to major hemorrhage occur more frequently in high-dose therapy, intermittent IV infusion, women 60 yrs and older. Antidote: Protamine sulfate 1–1.5 mg IV for every 100 units heparin subcutaneous within 30 min of overdose, 0.5–0.75 mg for every 100 units heparin subcutaneous if within 30–60 min of overdose, 0.25–0.375 mg for every 100 units heparin subcutaneous if 2 hrs have elapsed since overdose, 25–50 mg if heparin was given by IV infusion.

Nursing considerations

Baseline assessment

Cross-check dose with co-worker. Determine aPTT before administration and 24 hrs following initiation of therapy, then q24–48hrs for first wk of therapy or until maintenance dose is established. Follow with aPTT determinations 1–2 times weekly for 3–4 wks. In long-term therapy, monitor 1–2 times a mo.

Intervention/evaluation

Monitor aPTT (therapeutic range at 1.5–2.5 times normal) diligently. Assess Hct, platelet count, AST, ALT. Monitor urine and stool for occult blood. Assess for decrease in B/P, increase in pulse rate, complaint of abdominal/back pain, severe headache (may be evidence of hemorrhage). Question for increase in amount of discharge during menses. Assess peripheral pulses; skin for ecchymosis, petechiae. Check for excessive bleeding from minor cuts, scratches. Assess gums for erythema, gingival bleeding. Assess urine output for hematuria. Avoid IM injections due to potential for hematomas. When converting to warfarin (Coumadin) therapy, monitor PT results (will be 10%–20% higher while heparin is given concurrently).

Patient/family teaching

• Use electric razor, soft toothbrush to prevent bleeding. • Report any sign of red or dark urine, black or red stool, coffee-ground vomitus, blood-tinged mucus from cough. • Do not use any OTC medication without physician approval (may interfere with platelet aggregation). • Wear or carry identification that notes anticoagulant therapy. • Inform dentist, other physicians of heparin therapy. • Limit alcohol.

*hydrALAZINE

hye-dral-a-zeen

(Apo-Hydralazine , Apresoline , Novo-Hylazin )

Do not confuse hydralazine with hydroxyzine.

Fixed-combination(s)

Apresazide: hydralazine/hydrochlorothiazide (a diuretic): 25 mg/25 mg, 50 mg/50 mg, 100 mg/50 mg. BiDil: hydralazine/isosorbide (a nitrate): 37.5 mg/20 mg.

classification

PHARMACOTHERAPEUTIC: Vasodilator. CLINICAL: Antihypertensive (see p. 63C).

Action

Direct vasodilating effects on arterioles. Therapeutic Effect: Decreases B/P, systemic vascular resistance.

Pharmacokinetics

Route	Onset	Peak	Duration
PO	20–30 min	N/A	Up to 8 hrs
IV	5–20 min	N/A	1–4 hrs

Well absorbed from GI tract. Widely distributed. Protein binding: 85%–90%. Metabolized in liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 3–7 hrs (increased in renal impairment).

Uses

Management of moderate to severe hypertension. OFF-LABEL: Hypertension secondary to eclampsia, preeclampsia. Treatment of HF.

Precautions

Contraindications: Coronary artery disease, mitral valvular rheumatic heart disease, dissecting aortic aneurysm. Cautions: Renal impairment, cerebrovascular disease, positive ANA titer.

Lifespan considerations

Pregnancy/Lactation: Drug crosses placenta. Unknown if distributed in breast milk. Thrombocytopenia, leukopenia, petechial bleeding, hematomas have occurred in newborns (resolved within 1–3 wks). Pregnancy Category C. Children: No age-related precautions noted. Elderly: More sensitive to hypotensive effects. Age-related renal impairment may require dosage adjustment.

Interactions

DRUG: Diuretics, other antihypertensives may increase hypotensive effect. HERBAL: Ephedra, ginseng, yohimbe may worsen hypertension. Garlic may increase antihypertensive effect. FOOD: Any foods may increase absorption. LAB VALUES: May produce positive direct Coombs’ test.

Availability (Rx)

Injection Solution: 20 mg/ml. Tablets: 10 mg, 25 mg, 50 mg, 100 mg.

Administration/handling

IV

Rate of Administration • May give undiluted. • Administer slowly: maximum rate 5 mg/min (0.2 mg/kg/min for children).

Storage • Store at room temperature.

PO

• Best given with food at regularly spaced meals. • Tablets may be crushed.

IV incompatibilities

Ampicillin (Polycillin), furosemide (Lasix).

IV compatibilities

Dobutamine (Dobutrex), heparin, hydrocortisone (Solu-Cortef), nitroglycerin, potassium chloride.

Indications/routes/dosage

Hypertension

PO: ADULTS: Initially, 10 mg 4 times a day for first 2–4 days. May increase to 25 mg 4 times/day balance of first wk. May increase by 10–25 mg/dose gradually to 50 mg 4 times/day. Usual range: 25–100 mg in 2–3 divided doses. Maximum: 300 mg/day. ELDERLY: Initially, 10 mg 2–3 times a day. May increase by 10–25 mg q2–5 days. CHILDREN: Initially, 0.75–1 mg/kg/day in 2–4 divided doses, not to exceed 25 mg/dose. May increase over 3–4 wks. Maximum: 7.5 mg/kg/day (5 mg/kg/day in infants). Maximum daily dose: 200 mg.

IV, IM: ADULTS, ELDERLY: Initially, 10–20 mg/dose q4–6h. May increase to 40 mg/dose. CHILDREN: Initially, 0.1–0.2 mg/kg/dose (maximum: 20 mg) q4–6h, as needed, up to 1.7–3.5 mg/kg/day in 4–6 divided doses.

HF

PO: ADULTS, ELDERLY: Initially, 10–25 mg 3–4 times/day up to 225–300 mg/day in combination with isosorbide dinitrate.

Dosage in renal impairment

Dosage interval is based on creatinine clearance.

Creatinine Clearance	Dosage
10–50 ml/min	q8h
Less than 10 ml/min	q8–24h

Side effects

Occasional: Headache, anorexia, nausea, vomiting, diarrhea, palpitations, tachycardia, angina pectoris. Rare: Constipation, ileus, edema, peripheral neuritis (paresthesia), dizziness, muscle cramps, anxiety, hypersensitivity reactions (rash, urticaria, pruritus, fever, chills, arthralgia), nasal congestion, flushing, conjunctivitis.

Adverse effects/toxic reactions

High dosage may produce lupus erythematosus–like reaction (fever, facial rash, muscle/joint aches, glomerulonephritis, splenomegaly). Severe orthostatic hypotension, skin flushing, severe headache, myocardial ischemia, cardiac arrhythmias may develop. Profound shock may occur with severe overdosage.

Nursing considerations

Baseline assessment

Obtain B/P, pulse immediately before each dose, in addition to regular monitoring (be alert to fluctuations).

Intervention/evaluation

Monitor B/P, pulse, ANA titer. Monitor for headache, palpitations, tachycardia. Assess for peripheral edema of hands, feet. Monitor daily pattern of bowel activity, stool consistency.

Patient/family teaching

• To reduce hypotensive effect, go from lying to standing slowly. • Report muscle/joint aches, fever (lupus-like reaction), flu-like symptoms. • Limit alcohol use.

hydrochlorothiazide

hye-dro-klor-oh-thy-ah-zide

(Apo-Hydro , Microzide, Novo-Hydrazide )

Do not confuse Microzide with Maxzide.

Fixed-combination(s)

classification

PHARMACOTHERAPEUTIC: Sulfonamide derivative. CLINICAL: Thiazide diuretic, antihypertensive (see pp. 63C, 104C).

Action

Diuretic: Blocks reabsorption of water, sodium, potassium at cortical diluting segment of distal tubule. Antihypertensive: Reduces plasma, extracellular fluid volume, peripheral vascular resistance by direct effect on blood vessels. Therapeutic Effect: Promotes diuresis; reduces B/P.

Pharmacokinetics

Route	Onset	Peak	Duration
PO (diuretic)	2 hrs	4–6 hrs	6–12 hrs

Variably absorbed from GI tract. Primarily excreted unchanged in urine. Not removed by hemodialysis. Half-life: 5.6–14.8 hrs.

Uses

Treatment of mild to moderate hypertension, edema in HF, nephrotic syndrome. OFF-LABEL: Treatment of lithium-induced diabetes insipidus.

Precautions

Contraindications: Anuria, history of hypersensitivity to sulfonamides or thiazide diuretics. Cautions: Severe renal/hepatic impairment, diabetes mellitus, elderly or debilitated, history of gout, moderate to high cholesterol, hypercalcemia.

Lifespan considerations

Pregnancy/Lactation: Crosses placenta. Small amount distributed in breast milk. Breastfeeding not recommended. Pregnancy Category B (D if used in pregnancy-induced hypertension). Children: No age-related precautions noted, except jaundiced infants may be at risk for hyperbilirubinemia. Elderly: May be more sensitive to hypotensive, electrolyte effects. Age-related renal impairment may require dosage adjustment.

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Tags: Saunders Nursing Drug Handbook 2015

Mar 8, 2017 | Posted by admin in NURSING | Comments Off

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*hydrALAZINE

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