L
labetalol
(Apo-Labetalol 
, Normodyne 
, Trandate)
classification
Precautions
Contraindications: Bronchial asthma, cardiogenic shock, uncompensated HF, second- or third-degree heart block (except in pts with functioning pacemaker), severe bradycardia, conditions associated with severe, prolonged hypotension. Cautions: Compensated HF, severe anaphylaxis to allergens, myasthenia gravis, psychiatric disease, hepatic impairment, pheochromocytoma, diabetes mellitus; concurrent use with digoxin, verapamil, or diltiazem; arterial obstruction.
Lifespan considerations
Pregnancy/Lactation: Drug crosses placenta. Small amount distributed in breast milk. Pregnancy Category C (D if used in second or third trimester). Children: Safety and efficacy not established. Elderly: Age-related peripheral vascular disease may increase susceptibility to decreased peripheral circulation.
Interactions
DRUG: May decrease effects of beta2 agonists, theophylline. Beta blockers, digoxin may increase risk of bradycardia. HERBAL: Ephedra, ginseng, yohimbe may worsen hypertension. Garlic may increase antihypertensive effect. Licorice may cause water retention, increased serum sodium, decreased serum potassium. FOOD: None known. LAB VALUES: May increase serum antinuclear antibody titer (ANA), BUN, LDH, alkaline phosphatase, bilirubin, creatinine, potassium, triglycerides, lipoprotein, uric acid, AST, ALT.
Administration/handling
IV
ALERT 
Pt must be in supine position for IV administration and for 3 hrs after initially receiving medication (substantial drop in B/P upon standing should be expected).
Reconstitution • For IV infusion, dilute in D5W to provide concentration of 1–2 mg/ml.
Rate of Administration • For IV push, give over 2–3 min at 10-min intervals. • Do not administer faster than 2 mg/min. • For IV infusion, administer at rate of 2 mg/min initially. Rate is adjusted according to B/P. • Monitor B/P immediately before and q5–10min during IV administration (maximum effect occurs within 5 min).
Storage • Store at room temperature. • After dilution, IV solution is stable for 24 hrs. • Solution appears clear, colorless to light yellow. • Discard if discolored or precipitate forms.
IV incompatibilities
IV compatibilities
Amiodarone (Cordarone), calcium gluconate, dexmedetomidine (Precedex), diltiazem (Cardizem), dobutamine (Dobutrex), dopamine (Intropin), enalapril (Vasotec), fentanyl (Sublimaze), hydromorphone (Dilaudid), lidocaine, lorazepam (Ativan), magnesium sulfate, midazolam (Versed), milrinone (Primacor), morphine, nitroglycerin, norepinephrine (Levophed), potassium chloride, potassium phosphate, propofol (Diprivan).
Indications/routes/dosage
Hypertension
PO: ADULTS: Initially, 100 mg twice a day. Adjust in increments of 100 mg twice a day q2–3days. Maintenance: 100–400 mg twice a day. Maximum: 2.4 g/day. ELDERLY: Initially, 100 mg 1–2 times a day. May increase as needed. Maintenance: 100–200 mg twice daily. CHILDREN: 1–3 mg/kg/day in 2 divided doses. Maximum: 10–12 mg/kg/day up to 1,200 mg/day.
Side effects
Frequent (20%–11%): Drowsiness, dizziness, excessive fatigue. Occasional (10% or less): Dyspnea, peripheral edema, depression, anxiety, constipation, diarrhea, nasal congestion, weakness, diminished sexual function, transient scalp tingling, insomnia, nausea, vomiting, abdominal discomfort. Rare: Altered taste, dry eyes, increased urination, paresthesia.
Adverse effects/toxic reactions
May precipitate, aggravate HF due to decreased myocardial stimulation. Abrupt withdrawal may precipitate myocardial ischemia, producing chest pain, diaphoresis, palpitations, headache, tremor. May mask signs, symptoms of acute hypoglycemia (tachycardia, B/P changes) in diabetic pts.
Nursing considerations
Baseline assessment
Assess baseline renal/hepatic function tests. Assess B/P, apical pulse immediately before drug administration (if pulse is 60/min or less or systolic B/P is lower than 90 mm Hg, withhold medication, contact physician).
Intervention/evaluation
Monitor B/P for hypotension. Assess pulse for quality, irregular rate, bradycardia. Monitor EKG for cardiac arrhythmias. Monitor daily pattern of bowel activity, stool consistency. Assist with ambulation if dizziness occurs. Assess for evidence of HF: dyspnea (particularly on exertion or lying down), night cough, peripheral edema, distended neck veins. Monitor I&O (increase in weight, decrease in urine output may indicate HF).
Patient/family teaching
• Do not discontinue drug except upon advice of physician (abrupt discontinuation may precipitate heart failure). • Rise slowly from sitting position. • Compliance with therapy regimen is essential to control hypertension, arrhythmias. • Avoid tasks that require alertness, motor skills until response to drug is established. • Report shortness of breath, excessive fatigue, weight gain, prolonged dizziness, headache. • Do not use nasal decongestants, OTC cold preparations (stimulants) without physician approval. • Limit alcohol.
lacosamide
Do not confuse lacosamide with zonisamide.
classification
Lifespan considerations
IV
IV compatibilitiesIndications/routes/dosage
Note: IV dose is same as oral dose.
Partial-onset seizures
PO: ADULTS, CHILDREN 17 YRS AND OLDER: Initially, 50 mg twice daily (100 mg/day). May increase by 100 mg/day at weekly intervals, given as 2 daily divided doses up to maintenance dose of 200–400 mg/day, based on pt response, tolerability.
IV: ADULTS, CHILDREN 17 YRS AND OLDER: May be given undiluted or mixed in compatible diluent and given as 30- to 60-min infusion.
Side effects
Frequent (31%–13%): Dizziness, headache. Occasional (11%–5%): Nausea, double vision, vomiting, fatigue, blurred vision, ataxia (difficulty with balance, coordination, slurred speech), tremor, nystagmus (involuntary horizontal movement of eyeball). Rare (4%–2%): Vertigo, diarrhea, gait disturbances, memory impairment, depression, pruritus, injection site discomfort.
Nursing considerations
Baseline assessment
Review history of seizure disorder (intensity, frequency, duration, level of consciousness). Initiate seizure precautions. Hepatic/renal function tests, CBC should be performed before therapy begins and periodically during therapy.
Intervention/evaluation
Observe for recurrence of seizure activity. Assess for clinical improvement (decrease in intensity/frequency of seizures). Assist with ambulation if dizziness occurs. Assess for suicidal ideation, depression, behavioral changes. Drug should be withdrawn gradually (over a minimum of 1 wk) to minimize potential for increased seizure frequency.
lactulose
(Acilac 
, Apo-Lactulose 
, Constulose, Enulose, Generlac, Kristalose, Laxilose 
)
Do not confuse lactulose with lactose.
classification
Lifespan considerationsAdministration/handling
PO
• Store solution at room temperature. • Solution appears pale yellow to yellow, viscous liquid. Cloudiness, darkened solution does not indicate potency loss. • Drink water, juice, milk with each dose (aids stool softening, increases palatability). • Mix packets with 4 oz water.
Nursing considerations
Intervention/evaluation
Encourage adequate fluid intake. Assess bowel sounds for peristalsis. Monitor daily pattern of bowel activity, stool consistency; record time of evacuation. Assess for abdominal disturbances. Monitor serum electrolytes in pts with prolonged, frequent, excessive use of medication.
lamivudine
(Epivir, Epivir-HBV, Heptovir 
)
Do not confuse Epivir with Combivir, or lamivudine with lamotrigine.
classificationUses
Epivir: Treatment of HIV infection in combination with at least two other antiretroviral agents. Epivir-HBV: Treatment of chronic hepatitis B associated with evidence of hepatitis B viral replication and active liver inflammation. OFF-LABEL: Prophylaxis in health care workers at risk of acquiring HIV after occupational exposure to virus. Use as part of multidrug regimen.
Lifespan considerations
Pregnancy/Lactation: Drug crosses placenta. Unknown if distributed in breast milk. Breastfeeding not recommended (possibility of HIV transmission). Pregnancy Category C. Children: Safety and efficacy not established in those younger than 3 mos. Elderly: Age-related renal impairment may require dosage adjustment.
Indications/routes/dosage
HIV infection
PO: ADULTS WEIGHING 50 KG OR MORE: 150 mg twice a day or 300 mg once a day. ADULTS WEIGHING LESS THAN 50 KG: 4 mg/kg twice a day (up to 150 mg/dose). CHILDREN 4 MOS–16 YRS: 4 mg/kg twice a day (up to 150 mg/dose). INFANTS 1–3 MOS: 4 mg/kg twice/day. NEONATES YOUNGER THAN 30 DAYS: 2 mg/kg twice/day.
Dosage in renal impairment
Dosage and frequency are modified based on creatinine clearance.
| Creatinine Clearance | Dosage HIV | Dosage Hepatitis B |
| 30–49 ml/min | 150 mg once a day | 100 mg first dose, then 50 mg once a day |
| 15–29 ml/min | 150 mg first dose, then 100 mg once a day | 100 mg first dose, then 25 mg once a day |
| 5–14 ml/min | 150 mg first dose, then 50 mg once a day | 35 mg first dose, then 15 mg once a day |
| Less than 5 ml/min | 50 mg first dose, then 25 mg once a day | 35 mg first dose, then 10 mg once a day |
Nursing considerations
Baseline assessment
Establish baseline lab values, esp. renal function. Screen HIV pt for hepatitis B infection before initiating therapy.
Intervention/evaluation
Monitor BUN, serum creatinine, amylase, lipase, ALT, AST, bilirubin. Assess for headache, nausea, cough. Monitor daily pattern of bowel activity, stool consistency. Modify diet or administer laxative as needed. Assess for dizziness, sleep pattern. If pancreatitis in children occurs, movement aggravates abdominal pain; sitting up, flexing at the waist relieves the pain.
Patient/family teaching
• Continue therapy for full length of treatment. • Doses should be evenly spaced. • Lamivudine is not a cure for HIV infection, nor does it reduce risk of transmission to others. • Avoid tasks requiring alertness, motor skills until response to drug is established. • Avoid alcohol. • Closely monitor for symptoms of pancreatitis (severe, steady abdominal pain often radiating to the back, clammy skin, hypotension; nausea/vomiting may accompany abdominal pain).
lamotrigine
(Apo-Lamotrigine 
, Lamictal, Lamictal ODT, Lamictal XR, Novo-Lamotrigine 
)
Do not confuse Lamictal with Lamisil or Lomotil, or lamotrigine with labetalol or lamivudine.
classificationUses
Adjunctive therapy in adults and children with generalized tonic-clonic seizures and partial seizures, treatment of adults and children with generalized seizures of Lennox-Gastaut syndrome. Conversion to monotherapy in adults treated with another enzyme-inducing antiepileptic drug (EIAED) (e.g., valproic acid, carbamazepine, phenytoin, phenobarbital, primidone). Long-term maintenance treatment of bipolar disorder. Treatment of pts 2 yrs and older with primary generalized tonic-clonic seizures. Extended-release: Adjunctive therapy for primary generalized tonic-clonic and partial-onset seizures in pts 13 yrs and older. Conversion to monotherapy in pt 13 yrs and older with partial seizures receiving treatment with a single antiepileptic drug (AED).
Lifespan considerations
Pregnancy/Lactation: Distributed in breast milk. Breastfeeding not recommended. Increased fetal risk of oral cleft formation has been noted with use during pregnancy. Pregnancy Category C. Children: Safety and efficacy in those 18 yrs and younger with bipolar disorder, younger than 13 yrs with epilepsy not established. Elderly: Age-related renal impairment may require dosage adjustment.
Interactions
DRUG: Carbamazepine, phenobarbital, primidone, phenytoin, rifampin may decrease concentration. Valproic acid may increase concentration/effects. Oral contraceptives may decrease concentration. HERBAL: Evening primrose may decrease seizure threshold. FOOD: None known. LAB VALUES: None significant.
Availability (Rx)
Tablets: 25 mg, 100 mg, 150 mg, 200 mg. Tablets (Chewable): 2 mg, 5 mg, 25 mg. Tablets (Orally Disintegrating): 25 mg, 50 mg, 100 mg, 200 mg.
Tablets (Extended-Release): 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg.
Administration/handling
PO
• Give without regard to food. • Chewable tablets may be dispensed in water or diluted fruit juice, or swallowed whole. • Extended-release tablets must be swallowed whole; do not break, cut, crush, or divide. • Place orally disintegrating tablet on tongue, allow to dissolve. Pt must not break, cut, or chew. Can be swallowed without regard to food or water.
Indications/routes/dosage
Lennox-Gastaut, primary generalized tonic-clonic seizures, partial seizures
PO: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YRS: Initially, 25 mg/day for 2 wks, then increase to 50 mg/day for 2 wks. After 4 wks, may increase by 50 mg/day at 1- to 2-wk intervals. Maintenance: 225–375 mg/day in 2 divided doses. CHILDREN 2–12 YRS: Initially, 0.3 mg/kg/day in 1–2 divided doses for 2 wks, then increase to 0.6 mg/kg/day in 1–2 divided doses for 2 wks. After 4 wks, may increase by 0.6 mg/kg/day at 1- to 2-wk intervals. Maintenance: 4.5–7.5 mg/kg/day in 2 divided doses. Maximum: 300 mg/day in 2 divided doses.
Adjusted dosage with antiepileptic drugs containing valproic acid
PO: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YRS: Initially, 25 mg every other day for 2 wks, then increase to 25 mg/day for 2 wks. After 4 wks, may increase by 25–50 mg/day at 1- to 2-wk intervals. Maintenance: 100–400 mg/day in 2 divided doses (100–200 mg/day when taking lamotrigine with valproic acid alone). CHILDREN 2–12 YRS: Initially, 0.15 mg/kg/day in 1–2 divided doses for 2 wks, then increase to 0.3 mg/kg/day in 1–2 divided doses for 2 wks. After 4 wks, may increase by 0.3 mg/kg/day at 1- to 2-wk intervals. Maintenance: 1–5 mg/kg/day in 2 divided doses. Maximum: 200 mg/day in 2 divided doses.
Adjusted dosage with EIAED without valproic acid
PO: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YRS: Initially, 50 mg/day for 2 wks, then increase to 100 mg/day in 2 divided doses for 2 wks. After 4 wks, may increase by 100 mg/day at 1- to 2-wk intervals. Maintenance: 300–500 mg/day in 2 divided doses. CHILDREN 2–12 YRS: Initially, 0.6 mg/kg/day in 1–2 divided doses for 2 wks, then increase to 1.2 mg/kg/day in 1–2 divided doses for 2 wks. After 4 wks, may increase by 1.2 mg/kg/day at 1- to 2-wk intervals. Maintenance: 5–15 mg/kg/day in 2 divided doses. Maximum: 400 mg/day in 2 divided doses.
Conversion to monotherapy for pts receiving valproic acid
PO: ADULTS, ELDERLY, CHILDREN 16 YRS AND OLDER: Titrate lamotrigine to 200 mg/day, maintaining valproic acid dose. Maintain lamotrigine dose and decrease valproic acid to 500 mg/day, no greater than 500 mg/day/wk, then maintain 500 mg/day for 1 wk. Increase lamotrigine to 300 mg/day and decrease valproic acid to 250 mg/day. Maintain for 1 wk, then discontinue valproic acid and increase lamotrigine by 100 mg/day each wk until maintenance dose of 500 mg/day reached.
Side effects
Frequent (38%–14%): Dizziness, headache, diplopia (double vision), ataxia, nausea, blurred vision, drowsiness, rhinitis. Occasional (10%–5%): Rash, pharyngitis, vomiting, cough, flu-like symptoms, diarrhea, dysmenorrhea, fever, insomnia, dyspepsia. Rare: Constipation, tremor, anxiety, pruritus, vaginitis, hypersensitivity reaction.
Nursing considerations
Baseline assessment
Review history of seizure disorder (type, onset, intensity, frequency, duration, LOC), medication history (esp. other anticonvulsants), other medical conditions (e.g., renal impairment). Provide safety precautions; quiet, dark environment. Assess baseline mood, behavior.
Intervention/evaluation
Report occurrence of rash (drug discontinuation may be necessary). Assist with ambulation if dizziness, ataxia occurs. Assess for clinical improvement (decreased intensity/frequency of seizures). Assess for visual abnormalities, headache. Monitor for suicidal ideation, depression, behavioral changes.
Patient/ family teaching
• Take medication only as prescribed; do not abruptly discontinue medication after long-term therapy. • Avoid alcohol. • Avoid tasks that require alertness, motor skills until response to drug is established. • Carry identification card/bracelet to note anticonvulsant therapy. • Strict maintenance of drug therapy is essential for seizure control. • Report any rash, fever, swelling of glands, worsening depression, suicidal ideation, unusual changes in behavior, worsening of seizure control. • May cause photosensitivity reaction; avoid exposure to sunlight, artificial light.
lansoprazole
(Apo-Lansoprazole 
, First Lansoprazole, Prevacid, Prevacid Solu-Tab, Prevacid 24HR)
classificationPharmacokinetics
Rapid, complete absorption (food may decrease absorption) once drug has left stomach. Protein binding: 97%. Distributed primarily to gastric parietal cells. Metabolized in liver. Eliminated in bile and urine. Not removed by hemodialysis. Half-life: 1.5 hrs (increased in hepatic impairment, elderly).
Uses
Short-term treatment (4 wks and less) of healing, symptomatic relief of active duodenal ulcer; short-term treatment (8 wks and less) for healing, symptomatic relief of erosive esophagitis. Long-term treatment of pathologic hypersecretory conditions, including Zollinger-Ellison syndrome. Short-term treatment (8 wks and less) of active benign gastric ulcer, H. pylori–associated duodenal ulcer (part of multidrug regimen), maintenance treatment for healed duodenal ulcer. Treatment of gastroesophageal reflux disease (GERD), NSAID-associated gastric ulcer. OTC: Relief of frequent heartburn (2 or more days/wk). IV: Short-term treatment of erosive esophagitis.
Lifespan considerationsInteractions
DRUG: May decrease concentration of atazanavir. May interfere with absorption of ampicillin, digoxin, iron salts, ketoconazole. Sucralfate may delay absorption. May increase effect of warfarin. May decrease effect of clopidogrel. HERBAL: St. John’s wort may decrease concentration/effects. FOOD: Food may decrease absorption. LAB VALUES: May increase LDH, serum alkaline phosphatase, bilirubin, cholesterol, creatinine, AST, ALT, triglycerides, uric acid, Hgb, Hct. May produce abnormal albumin/globulin ratio, electrolyte balance, platelet, RBC, WBC count.
Availability (Rx)
Tablets, Orally Disintegrating (Prevacid Solu-Tab): 15 mg, 30 mg. Powder for Oral Suspension (First Lansoprazole): 3 mg/ml.
Capsules (Delayed-Release): (Prevacid): 15 mg, 30 mg. (Prevacid 24HR): 15 mg.
Administration/handling
PO
• Give while fasting or before meals (food diminishes absorption). • Do not cut/crush delayed-release capsules. • If pt has difficulty swallowing capsules, open capsules, sprinkle granules on 1 tbsp of applesauce, give immediately.
PO (solu-tab)
• Place tablet on tongue; allow to dissolve, then swallow. • May give via oral syringe or nasogastric tube. • May dissolve in 4 ml (15 mg) or 10 ml (30 mg) water.
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