I have a copy of the 2006 Nursing Spectrum Drug Handbook and would like to compliment you on this book. I have praised the great aspects of the Nursing Spectrum Drug Handbook.
Common abbreviations Inside front cover
Safe drug administration
Contents
Appendices
Young, RN, MBA Chief Nursing Officer, Division of Nursing The Cleveland Clinic Foundation Cleveland, Ohio. Teresa Dowdell, BS, RPh Associate Professor College of Nursing at University of South Florida Tampa, Fla.
Introduction
By helping you gain a thorough understanding of medications and stay abreast of emerging drug data, we'll serve as your advocate and help you protect your patients from medication errors and adverse drug reactions.
Targeting excellence
General drug administration guidelines
If the patient is scheduled for diagnostic testing, decide whether to withhold the dose until the end of the test. The prescribing physician selects the route based on factors such as the patient's condition and the desired onset of action.
User’s guide to Nursing Spec- trum Drug Handbook 2008
Crushing can alter the delivered dose, causing the patient to receive a bolus of a drug intended to be released slowly over several hours. During drug therapy, monitor the patient to determine the effectiveness of the drug and to detect signs and symptoms of an adverse reaction or interaction.
Avoiding dangerous abbreviations
A to Z drug monographs Part 1 presents individual drug mono-
Trade names. A drug's generic trade name, or brand name, is the proprietary brand name under which it is marketed. Pregnancy risk category. This section lists the category assigned by the Food and Drug Administration (FDA) to indicate the drug's potential hazard to the fetus when taken during pregnancy.
Understanding pregnancy risk categories
This section indicates the category assigned by the Food and Drug Administration (FDA) to indicate the drug's potential hazard to the fetus when taken during pregnancy. Availability. This section lists the physical forms in which the drug is manufactured and dispensed, plus available strengths (the amount of active ingredient present) for each form.
Schedules of controlled substances
Operation. This section summarizes how a drug achieves its therapeutic effect—the action that occurs when it reaches its target site and combines with cell receptors for the drug to cause specific physiological responses. Indications and dosages. Marked with a red scored pill icon 1 for quick identification, this section details the FDA-approved indications of the drug for adults, children, infants, and neonates (if applicable), along with recommended doses, routes of administration, and dosing frequency for each indication.
High-alert drugs
Drug classes, vitamins and minerals, herbs and supplements
Monographs on therapeutic drug classes introduce you to the general properties of the entire drug class. These monographs also give you an idea of which drug the prescriber may order if a particular drug from the same class is not suitable for your patient.
Appendices, selected references, and index
The use of herbal remedies and supplements is on the rise – yet many users and health care practitioners are in the dark about these products' adverse effects and possible interactions with prescription and over-the-counter drugs. This section provides basic information that can help your patient use herbs more safely.
Website and other bonuses
Acknowledgments
Action
Availability
Contraindications
Precautions
Administration
Adverse reactions
Interactions
Patient monitoring
Patient teaching
2Instruct the patient to stop taking the drug and seek immediate medical attention if they experience any allergic symptoms such as fatigue, general ill feeling, pain, rash, fever, difficulty breathing, cough, laryngitis, or severe nausea, vomiting, diarrhea, or abdominal pain. 2Advise the patient to contact the prescriber immediately if he develops symptoms of hepatic dysfunction (unusual tiredness, weakness, nausea, itching, yellowing of the eyes or skin, upper right abdominal tenderness, or flu-like symptoms).
Restrict patient to bed rest for 6 to 8 hours after discontinuation of drug or 4 hours after discontinuation of heparin (whichever comes first). Advise the patient to minimize gastrointestinal distress by eating small, frequent portions of food and drinking plenty of fluids.
Advise him to use a soft toothbrush and electric shaver to avoid gum and skin damage.
Dosage adjustment
Advise the patient to move slowly in a sitting or standing position to avoid dizziness or lightheadedness from a sudden drop in blood pressure. Advise the patient to avoid driving and other hazardous activities until they know how the drug affects concentration, alertness, vision, coordination, and physical dexterity.
2Instruct the patient to contact the prescriber immediately if they experience seizures, chest pain, suicidal thoughts or symptoms of liver problems (such as unusual tiredness or yellowing of the skin or eyes). Advise the patient to obtain medical alert identification and carry or carry it with them at all times.
Tell him that although this drug does not cause hypoglycemia when used alone, hypoglycemia symptoms may occur if he takes it with other hypoglycemia. Urge patient to keep oral glucose on hand to correct mild hypoglycemia; inform him that sugar in candy will not correct hypoglycemia.
Off-label uses
Medicine. Alpha-agonists (such as nasal decongestants and other beta-adrenergic blockers): increased risk of severe hypertension. Ergot alkaloids: increased risk of peripheral ischemia and gangrene Glyburide in patients with type 2 diabetes: decreased hypoglycaemic effect Lidocaine: increased lidocaine blood level and possible toxicity.
Observe closely for marked bradycardia or hypotension when administering a drug containing reserpine or other catecholamine depleting agents. Instruct the patient, parents or other caregivers not to use the medicinal product at the same time as other paracetamol-containing products.
Inform patients with chronic alcoholism that drugs may increase the risk of serious liver damage. Patient should be careful to avoid driving and other dangerous activities until he knows how the drug affects concentration and alertness.
Dilute solution before administration for acetaminophen overdose, to reduce the risk of vomiting and to reduce the drug's unpleasant odor and irritating or sclerosing properties. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Corticosteroids: increased salicylate excretion and decreased blood level Furosemide: increased diuretic effect Live varicella virus vaccine: increased risk of Reye's syndrome. Methotrexate: Decreased excretion of methotrexate and increased blood levels, with a greater risk of toxicity. Nizatidine: increased salicylate level in the blood.
Metabolic: poor blood glucose control Musculoskeletal: joint, muscle, back and leg pain; arthritis; bone disorders; spinal bone overgrowth; increased muscle tone or rigidity; ten- dinitis. 2Be aware that women using this drug should avoid alcohol-containing foods, beverages, medications, and over-the-counter products during therapy and for 2 months afterward.
Herbs. Acetaminophen, barbiturates, carbamazepine, digitoxin, digoxin, furosemide, glutethimide, hydantoin, methotrexate, nizatidine, phenothiazines, phenylbutazones, propoxyphene, salicylates, sulfonylinamides-teprocyclines, sulfonylinalines, tesuloniline-pressure, sulfonylinalines, suppressors, sulfonylureas, sulfonylureas. alines, sulphonyl-pressure, methotrexate. valproic acid: decreased absorption of these drugs.
Instruct the patient to drink six to eight glasses of fluids daily to prevent constipation. Tell the patient to use a soft toothbrush and an electric razor to avoid injury to gums and skin.
Advise the patient to minimize indigestion by eating small, frequent meals and drinking plenty of fluids. Instruct the patient to minimize indigestion by eating small, frequent meals of healthy foods and drinking plenty of fluids.
2Monitor for signs and symptoms of infection if patient is receiving concomitant corticosteroids or other immunosuppressants (due to risk of worsening infection). Teach the patient how to recognize and report signs and symptoms of an allergic reaction and other side effects.
Medicinal herbs. Aloe, sea buckthorn bark or berries, cascara sagrada, rhubarb root, senna leaf or fruits: increased adenosine effect. Review, as appropriate, all other significant and life-threatening side effects and interactions, especially those related to the above drugs, foods, herbs, and behaviors.
Advise the patient to minimize gastrointestinal distress by eating small, frequent portions of healthy food and drinking plenty of fluids. 2Educate the patient to recognize and promptly report signs and symptoms of allergic reactions or infusion reactions.
Tell the patient to swallow the extended-release tablets whole and not to mix them with food. Advise patient to limit intake of caffeinated foods and beverages and to avoid herbs unless approved by physician.
2 Advise patient to immediately report chest pain, irregular or rapid heartbeat, easy bruising or bleeding, or abdominal pain. Inform the patient that he will have blood tests and chest x-rays taken during treatment.
Instruct the patient to minimize gastrointestinal distress by eating small, frequent portions of food and drinking plenty of fluids. 2Tell the patient to immediately report an irregular or rapid heartbeat or easy bruising or bleeding.
2Tell the patient to report severe vomiting, severe chest or abdominal pain, difficulty swallowing, or abdominal swelling immediately. Instruct the patient to take the medication first thing in the morning on an empty stomach, with only 6 to 8 oz of water.
Herbs. Atenolol, cimetidine, diltiazem, itraconazole, ketoconazole, ritonavir: increased blood levels of alfuzosin. Foods. Any food: increased absorption of alfuzosin. Advise the patient to avoid driving and other hazardous activities until they know if the drug makes them dizzy.
Instruct the patient to apply a generous amount of gel to the affected skin area and allow it to dry for 3 to 5 minutes before covering the area with clothing. Care should be taken that the patient avoids applying gel to mucous membranes or to normal surrounding skin lesions.
Monitor patient for serious adverse effects, especially burns caused by exposure to sunlight or sunlamps. 2 Inform patient that drug increases sensitivity to sunlight and that exposure to sunlight or sunlamps (even through window glass or on a cloudy day) may cause severe burns of treated areas.
Caution the patient to avoid driving and other hazardous tasks until he knows how the drug affects concentration and alertness. Advise the patient to avoid alcohol, caffeinated drinks and foods, mineral water and orange juice during treatment.
If a second dose is needed, tell the patient to take it at least 2 hours after the first dose. Instruct the patient to avoid driving and other dangerous activities until they know how the drug affects concentration and alertness.
2 Stop therapy immediately if patient develops constipation or signs or symptoms of ischemic colitis. 2 Instruct the patient to contact the prescriber immediately if she develops constipation or symptoms of insufficient blood flow to the bowel (such as new or worse bowel pain or bloody bowel movements).
2 Before administration, know that the drug is approved with the following marketing restrictions: Make sure the patient understands that the drug has serious risks, the patient reads and signs the patient-physician agreement, and the patient follows the directions in the accompanying medication guide. Advise the patient to avoid driving and other hazardous activities until he knows how the drug affects concentration and alertness.
Pay attention to excessive CNS depression if the patient is taking antidepressants, other benzodiazepines, antihistamines or opioids at the same time. Ask him to immediately contact the doctor who prescribed the medicine if he thinks he is a danger to himself or others.
Instruct patient to report signs and symptoms of GI bleeding and hypophosphatemia (loss of appetite, malaise, muscle weakness). Inform the patient that he will need to undergo periodic blood tests and bone mineral density tests if he receives long-term treatment.
Advise the patient to establish an effective bedtime routine and to take the medicine several hours before bedtime to minimize insomnia. Advise the patient to minimize GI distress by eating small, frequent portions of food and drinking plenty of fluids.
As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above. Drug. Antihypertensive drugs: increased risk of hypotension Drug diagnostic tests. Calcium: decreased level.
Instruct the patient to report fever, cough, difficulty breathing, sore throat, and other signs and symptoms of infection immediately. Instruct the patient to notify the prescriber if they urinate more or less than usual.
2 Instruct the patient to immediately report signs and symptoms of hyperkalemia (tingling, fatigue, muscle weakness, or paralysis). Warn the patient to avoid driving and other dangerous activities until he knows how the drug affects concentration and alertness.
Advise patient to minimize GI inflammation by taking drug with meals; eat small, regular portions of healthy food; and drink plenty of fluids. 2 Instruct the patient to immediately report signs and symptoms of thrombophlebitis, pulmonary embolism, or unusual bleeding.
Drug-drug. Adenosine: reduction of the antiarrhythmic effect of adenosine. Barbiturates, nicotine, phenytoin, rifampin: reduction of the level of aminophylline in the blood. Instruct the patient to minimize GI distress by eating small, frequent portions of food and drinking plenty of fluids.
Calcium channel blockers, cimetidine, ciprofloxacin, disulfiram, erythromycin, hormonal contraceptives, influenza vaccine, interferon, methotrexate: increased aminophylline blood level. Phenytoin: decreased amiodarone blood level or increased phenytoin blood level (when using amiodarone for more than 2 weeks).
Check the digoxin blood level if the patient is receiving digoxin; monitor PT or international normalized ratio if patient is on anticoagulants. Levodopa: delayed or decreased absorption of levodopa, hypertension MAO inhibitors: hypotension, tachycardia, potentially fatal reactions Rifabutin, rifampin, rifapentine: decreased amitriptyline blood concentration and effects.
As appropriate, review all other significant adverse reactions, especially those related to the drugs and behaviors mentioned above.
2 Urge patient to report unexplained muscle pain, tenderness, or weakness immediately—especially if accompanied by malaise or fever. 2 Instruct the patient to immediately report signs and symptoms of liver damage, such as nausea, fatigue, anorexia, jaundice, dark urine, light-colored stools, intense itching, or tender abdomen.
2 Pay attention to signs and symptoms of neuroleptic malignant syndrome (high fever, rapid pulse and breathing, profuse sweating). 2 Tell the patient to contact the prescribing physician immediately if high fever, rapid pulse and breathing, profuse sweating, changes in mental status, or involuntary movements occur.
Monitor patient's temperature and watch for other signs and symptoms of superinfection (especially oral or rectal candidiasis). 2 Instruct the patient to immediately report signs and symptoms of hypersensitivity reactions, such as rash, fever or chills.
2 Instruct patient to report signs or symptoms of hypersensitivity reaction, such as rash, fever, or chills, immediately. Ask him to report any new signs or symptoms of infection (especially mouth or rectum).
Adults: Amphotericin B desoxycholate – If the patient tolerates the test dose, gradually increase from the initial recommended dose of 0.25 to 0.3 mg/kg daily by slow I.V. Cutaneous leishmaniasis Adults and children: Amphotericin B desoxycholate - If patient tolerates test dose, gradually increase from initial recommended dose of 0.25 to 0.5 mg/kg/day given by slow I.V.
Instruct the patient to take an oral dose with 8 oz of water 1 hour before or 2 hours after a meal. 2 Instruct patient to immediately report signs and symptoms of hypersensitivity reaction, such as rash, fever, or chills.
Check the patient's temperature and be alert for other signs and symptoms of superinfection, especially oral or rectal candidiasis. Tell the patient to report signs and symptoms of infection or other problems at the injection site.
Instruct him to report new signs or symptoms of infection, especially in the mouth or rectum. 2 Tell the patient to contact the prescribing physician if a rash or signs or symptoms of depression develop.
Teach the patient to press the capsule and shake it under the nose until the angina is relieved (usually after one to six inhalations). As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.
Tell the patient that the drug may cause a temporary drop in blood pressure if he sits or stands up suddenly. Warn the patient to avoid driving and other hazardous activities until they know how the drug affects concentration, alertness, and vision.
Tell him to use a soft toothbrush and electric shaver to avoid gum and skin damage. If applicable, review all other significant and life-threatening adverse reactions and interactions, especially those related to the above-mentioned drugs, tests, foods, and herbs.
2 Advise the patient to immediately report signs and symptoms of thromboembolic disease and circulatory overload. Advise the patient to avoid driving and other hazardous activities until the drug affects concentration and alertness.
If patient has abnormal liver function tests during therapy, monitor for evidence of worsening liver function and weigh risks and benefits of continued therapy. 2 Instruct the patient to report rash, itching, unusual bruising or bleeding, unusual tiredness or yellowing of skin or eyes.
Do not dilute with other solutions or inject through the same I.V. line with other drugs or electrolytes. As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests mentioned above.
2 Tell the patient to immediately report any signs and symptoms of an allergic reaction or bleeding tendency.
Advise patient to minimize GI upset and unpleasant taste by eating small, frequent portions of healthy foods and drinking plenty of fluids. If applicable, review all other significant side effects and interactions, especially those related to the above drugs.
Adults: 0.2 mL (2-mg) test dose injected subcutaneously during the "off" state in an environment where medical personnel can monitor blood pressure. If patient does not tolerate 0.4 ml test dose, 0.3 ml test dose can be given during separate "off" period no earlier than 2 hours after 0.4 ml test dose.
Warn the patient to avoid driving and other hazardous activities until they know how the drug affects concentration, hearing, strength, balance and alertness. If applicable, review all other significant and life-threatening side effects and interactions, especially those related to the drugs listed above.
Drug drug. Oral Anticoagulants: Prolonged prothrombin time, increased International Normalized Ratio, increased risk of bleeding. Advise him to use a soft toothbrush and an electric razor to avoid gum and skin injuries.
2 Assess the patient for neuroleptic malignant syndrome (fever, altered mental status, muscle stiffness, arrhythmia, tachycardia, sweating).
Watch for signs and symptoms of APL differentiation syndrome (fever, shortness of breath, weight gain, pulmonary infiltrates, and pleural or pericardial effusions). 2Instruct the patient to immediately report signs and symptoms of allergic reactions, fever, difficulty breathing, and seizures.
2Instruct the patient to report immediately any allergic reactions, severe abdominal pain, and unusual bleeding or bruising. Tell him to use a soft toothbrush and an electric razor to avoid injury to gums and skin.
Tell the patient that the drug may cause a temporary decrease in blood pressure if it rises or falls suddenly. As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.
MAOIs: hyperthermia, myoclonus, rapid changes in vital signs. Potent CYP2D6 Inhibitors: Increased atomoxetine effects in children weighing less than 70 kg. To minimize insomnia, advise the patient to establish an effective bedtime routine and to take the medicine in a single morning dose or in divided half doses in the morning and late afternoon or early evening.
Drug diagnostic tests.Alanine amino-transferase, aspartate aminotransferase, creatine kinase: increased levels Drug-food.Grapefruit juice: increased blood drug level, greater risk of side effects. 2 Advise patient to immediately report allergic reaction, irregular heartbeat, unusual bruising or bleeding, unusual fatigue, yellowing of skin or eyes, or muscle weakness.
Middle-middle. Antacids, colestipol: decreased atorvastatin blood level Azole antifungal drugs, cyclosporine, erythromycin, fibric acid derivatives, niacin, other HMG-CoA inhibitors: increased risk of myopathy.
Preoperatively to reduce secretions and block cardiac vagal reflexes Adults and children weighing more than 40.8 kg (90 lb): 0.4 to 0.6 mg I.M., IV. or subcutaneously 30 to 60 minutes before anesthesia.
Adverse effects
As appropriate, review all other significant and life-threatening adverse reactions, especially those related to the tests mentioned above.
2 Instruct the patient to call the prescriber immediately if rash, easy bruising or bleeding, or respiratory symptoms occur. Increase dose in increments after 6 to 8 weeks and then at 4-week intervals; use dose increments of 0.5 mg/kg/day to a maximum dose of 2.5 mg/kg/day.
As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and behaviors mentioned above.
2Instruct the patient to immediately report severe diarrhea or any signs or symptoms of a hypersensitivity reaction, such as rash or difficulty breathing. If applicable, review all other significant and life-threatening side effects and interactions, especially those related to the above tests.
Adults: Screening phase - before pump implantation and intrathecal infusion, give a test dose to check responsiveness. If the patient is still unresponsive, a final test dose of 100 mcg/2 mL can be given 24 hours later.
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia, oral blisters, oral candidiasis, GI bleeding. Advise the patient that he may be more susceptible to infection due to the immunosuppressive effect of the drug.
Adults and children aged 12 and over: When previous therapy was bronchodilator alone, 40 to 80 mcg by oral inhalation (QVAR) b.i.d.;. Children aged 5 to 11: When previous therapy was bronchodilator alone, 40 mcg by oral inhalation (QVAR) b.i.d.; maximum of 80 mcg b.i.d.
Instruct the patient to hold the inhaled drug in the airway for several seconds before exhaling and to wait 1 minute between inhalations. 2 Tell the patient to immediately report any change in urination pattern, difficulty breathing, or swelling of the throat or lips.
Advise patient to be careful during activities that require physical or mental alertness because drugs cause sedation. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors listed above.
Barbiturates, phenytoin, rifampicin: Stimulation of the metabolism of betamethasone, reducing the effects of the drug. Digoxin: increased risk of digoxin toxicity. Hormonal contraceptives: blocking the metabolism of betamethasone Insulin, oral hypoglycaemia: increased required dose of betamethasone Live virus vaccines: reduced antibody response to vaccine, increased risk of neurological complications.
Advise the patient to take the oral dose on an empty stomach 1 hour before or 2 hours after a meal to avoid GI upset. Instruct the patient to move slowly when sitting or standing to avoid dizziness or light-headedness due to decreased blood pressure.
2 Tell the patient to call the prescriber immediately if they experience dizziness, heavy bleeding, abdominal pain or difficulty urinating, or if a wound opens. Advise the patient to tell the prescriber if they are scheduled for surgery; the drug may slow wound healing.
Advise the patient not to habitually use bisacodyl or other laxatives, as this may lead to laxative dependence.
Instruct the patient not to swallow (do not chew) enteric-coated tablets earlier than 1 hour before or after taking antacids or dairy products. Tell the patient to notify the prescriber if he has febrile diarrhea for more than 48 hours.
Be aware that the drug is usually given together with antibiotics (such as tetracycline or amoxicillin) when prescribed for peptic ulcers. Ask the patient to weigh himself daily at the same time and report a gain of 3 to 4 lb/day.
Drug drug. Abciximab, anticoagulants (including heparin, low molecular weight heparins and heparinoids), thrombolytics, ticlopidine: increased risk of bleeding.
2 Know that cumulative doses in excess of 400 units should be given with extreme caution due to an increased risk of pulmonary toxicity. Antineoplastics: increased risk of haematological and pulmonary toxicity. Cardiac glycosides: decreased cardiac glycosides in the blood.
Monitor CBC with white cell differentiation and watch for signs and symptoms of blood dyscrasias. Monitor respiratory status and watch for shortness of breath, cough, and other signs and symptoms of upper respiratory infection.
Advise the patient to minimize adverse GI effects by eating small, frequent portions of healthy food and ensuring adequate fluid intake. Review, as appropriate, all other significant and life-threatening side effects and interactions, especially those related to the above drugs and foods.
Inform the patient that he will have regular CBC measurements and liver function tests during therapy.
Gently swirl the vial to mix the medicine; then withdraw at least 20 units (0.5 ml of solution) and squeeze out air bubbles. Then inject the drug in divided doses of 0.1 ml at each of five sites (two in each corrugator muscle, one in the procerus muscle).
Instruct patient to report signs and symptoms of infection, especially flu-like illness and EENT and respiratory infections. To minimize constipation, instruct the patient to exercise regularly, increase dietary fiber intake, and drink plenty of fluids (3000 mL per day).
If the patient is taking over-the-counter antihistamines, monitor them closely to avoid possible overdose. Urge the patient to tell all prescribers what medications and over-the-counter preparations they are taking.
2 Instruct the patient to contact the prescriber immediately if he develops itching, rash, fever, swelling of the face and neck, or difficulty breathing. Tell female patient to inform prescriber if pregnant or planning to become pregnant.
Advise the patient to take the drug in the morning to prevent nocturia and to take the second dose (if necessary) in the late afternoon. Instruct the patient to move slowly when sitting or standing to avoid dizziness or lightheadedness from a sudden drop in blood pressure.
Calcium, magnesium, platelets, potassium, sodium: decreased levels Medicinal herbs. Dandelion: interference with diuretic activity. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors listed above.
Drug drug. Withdrawal from benzodiazepines, corticosteroids, other antidepressants, over-the-counter stimulants, phenothiazines, theophylline: increased risk of seizures. Drug behavior. Alcohol use or cessation: increased risk of seizures. Sun exposure: increased risk of photosensitivity.
Advise the patient to keep regular appointments for periodic blood tests and liver and kidney tests. Drug-food.Grapefruit juice:increased blood buspirone level and effects Medicinal herbs.Hops, kava, skullcap, valerian:increased CNS depression Drug behavior.Alcohol use:increased CNS depression.
Advise him to avoid contact with people with known infections and to avoid public transport if possible. Advise the patient to avoid activities that may cause injury and to use a soft toothbrush and electric shaver to prevent injury to the gums and skin.
Nephrotoxic and ototoxic agents (such as aminoglycosides, loop diuretics): additional nephrotoxicity and ototoxicity Tioguanine: increased risk of hepatotoxicity. 2 Know that the drug can cause respiratory distress in infants in neonates or pregnant patients, especially if given within 2 hours of delivery.
Advise patient using nasal spray that runny nose, sneezing, and nasal irritation may occur during the first few days as he adjusts to spraying. Advise patient to blow nose before using spray, to take daily intranasal dose as one spray in one nostril, and to alternate nostrils with each dose.
Advise patient to tell prescriber if he is using other drugs or if he has abdominal pain, nausea, vomiting, or a sudden change in bowel habits lasting 2 weeks or longer.
Instruct the patient to use reliable birth control methods and to contact the prescriber if she suspects she is pregnant. Urge patient to use reliable birth control methods because drug can harm fetus if she becomes pregnant.
2 Instruct the patient to immediately report nausea, vomiting, diarrhea, mouth ulcers, swollen joints, temperature above 100.5oF (38oC), and other signs or symptoms of infection. Advise patient to report fever, rash, sore throat, mouth sores, fast or irregular heartbeat, chest pain, or cough.
