Saunders Nursing Drug Handbook

1574 Pages·2012·27.05 MB·English

2
morphine

M

underlined – top prescribed drug

morphine

HIGH
ALERT

mor-feen
(Astramorph PF, Avinza, DepoDur,
Duramorph PF, Infumorph, Kadian,
M-Eslon
, MS Contin, MSIR
,
Oramorph SR, Roxanol)
BLACK BOX ALERT Be alert for signs
of abuse, misuse, diversion. Epidural:
Monitor for delayed sedation. Sustained-
release: Do not crush or chew. MS Con-
tin: Use only in opioid-tolerant pts requir-
ing over 400 mg/day. Kadian: Use only in
opioid-tolerant pts. Avinza: Alcohol dis-
rupts extended-release timing. Dura-
morph PF: Risk of severe and/or sus-
tained cardiopulmonary depression.

CLASSIFICATION

PHARMACOTHERAPEUTIC: Narcotic
agonist. CLINICAL: Opiate analgesic
(Schedule II) (see p. 142C).

ACTION
Binds with opioid receptors within CNS.
Therapeutic Effect: Alters pain percep-
tion, emotional response to pain.

PHARMACOKINETICS
Variably absorbed from GI tract. Readily
absorbed after IM, subcutaneous admin-
istration. Protein binding: 20%–35%.
Widely distributed. Metabolized in liver.
Primarily excreted in urine. Removed by
hemodialysis. Half-life: 2–4 hrs (in-
creased in hepatic disease).

USES
Relief of moderate to severe, acute, or
chronic pain; analgesia during labor. Drug
of choice for pain due to MI, dyspnea from
pulmonary edema not resulting from chem-
ical respiratory irritant. DepoDur: Epidu-
ral (lumbar) single dose management of
surgical pain.

PRECAUTIONS

Contraindications: Acute or severe asthma,
GI obstruction, paralytic ileus, severe he-
patic/renal impairment, severe respiratory
depression. Cautions: Biliary tract disease,

morphine

HIGH
ALERT

mor-feen
(Astramorph PF, Avinza, DepoDur,
Duramorph PF, Infumorph, Kadian,
M-Eslon
, MS Contin, MSIR
,
Oramorph SR, Roxanol)
BLACK BOX ALERT Be alert for signs
of abuse, misuse, diversion. Epidural:
Monitor for delayed sedation. Sustained-
release: Do not crush or chew.
:
MS Con-
tin: Use only in opioid-tolerant pts requir-
:
ing over 400 mg/day. Kadian: Use only in
:
opioid-tolerant pts. Avinza: Alcohol dis-
:
rupts extended-release timing. Dura-
morph PF: Risk of severe and/or sus-
:
tained cardiopulmonary depression.

CLASSIFICATION

PHARMACOTHERAPEUTIC:
Narcotic
agonist. CLINICAL: Opiate analgesic
(Schedule II) (see p. 142C).

ACTION
Binds with opioid receptors within CNS.
Therapeutic Effect: Alters pain percep-
tion, emotional response to pain.

PHARMACOKINETICS
Variably absorbed from GI tract. Readily
absorbed after IM, subcutaneous admin-
istration. Protein binding: 20%–35%.
Widely distributed. Metabolized in liver.
Primarily excreted in urine. Removed by
hemodialysis. Half-life: 2–4 hrs (in-
creased in hepatic disease).

USES
Relief of moderate to severe, acute, or
chronic pain; analgesia during labor. Drug
of choice for pain due to MI, dyspnea from
pulmonary edema not resulting from chem-
ical respiratory irritant. DepoDur: Epidu-
ral (lumbar) single dose management of
surgical pain.

PRECAUTIONS

Contraindications: Acute or severe asthma,
GI obstruction, paralytic ileus, severe he-
patic/renal impairment, severe respiratory
depression. Cautions: Biliary tract disease,

pancreatitis, Addison’s disease, hypothy-
roidism, urethral stricture, prostatic hy-
perplasia, debilitated pts, those with CNS
depression, toxic psychosis, seizure disor-
ders, alcoholism.

LIFESPAN CONSIDERATIONS

Pregnancy/Lactation: Crosses placenta.
Distributed in breast milk. Pregnancy Cat-
egory C (D if used for prolonged periods
or at high dosages at term). Children:
Paradoxical excitement may occur; those
younger than 2 yrs are more susceptible to
respiratory depressant effects. Elderly:
Paradoxical excitement may occur.

INTERACTIONS

DRUG: Alcohol, other CNS depressants
may increase CNS effects, respiratory de-
pression, hypotension. HERBAL: Gotu
kola, kava kava, St. John’s wort, va-
lerian may increase CNS depression.
FOOD: None known. LAB VALUES: May
increase serum amylase, lipase.

AVAILABILITY (Rx)

Injection, Liposomal Suspension (Depo-
Dur): 10 mg/ml. Injection, Solution: 2
mg/ml, 4 mg/ml, 5 mg/ml, 10 mg/ml,
15 mg/ml, 25 mg/ml, 50 mg/ml. Injec-
tion, Solution (Epidural, Intrathecal, IV
Infusion) (Astramorph PF, Duramorph PF):
0.5 mg/ml, 1 mg/ml.

Capsules, Extended-Release (Avinza):
30 mg, 45 mg, 60 mg, 75 mg, 90 mg, 120
mg.

Capsules, Sustained-Release (Ka-

20 mg, 30 mg, 50 mg, 60 mg, 80
mg, 100 mg, 200 mg.

ADMINISTRATION/HANDLING

Reconstitution • May give undiluted.
• For IV injection, may dilute 2.5–15 mg
morphine in 4–5 ml Sterile Water for Injec-
tion. • For continuous IV infusion, dilute to
concentration of 0.1–1 mg/ml in D5W and
give through controlled infusion device.
Rate of administration • Always admin-
ister very slowly. Rapid IV increases risk of
severe adverse reactions (apnea, chest wall

pancreatitis, Addison’s disease, hypothy-
roidism, urethral stricture, prostatic hy-
perplasia, debilitated pts, those with CNS
depression, toxic psychosis, seizure disor-
ders, alcoholism.

LIFESPAN CONSIDERATIONS

Pregnancy/Lactation: Crosses placenta.
Distributed in breast milk. Pregnancy Cat-
egory C (D if used for prolonged periods
or at high dosages at term). Children:
Paradoxical excitement may occur; those
younger than 2 yrs are more susceptible to
respiratory depressant effects. Elderly:
Paradoxical excitement may occur.

INTERACTIONS

DRUG: Alcohol, other CNS depressants
may increase CNS effects, respiratory de-
pression, hypotension. HERBAL: Gotu
kola, kava kava, St. John’s wort, va-
lerian may increase CNS depression.
FOOD: None known. LAB VALUES: May
increase serum amylase, lipase.

AVAILABILITY (Rx)

Injection, Liposomal Suspension (Depo-
Dur): 10 mg/ml. Injection, Solution: 2
mg/ml, 4 mg/ml, 5 mg/ml, 10 mg/ml,
15 mg/ml, 25 mg/ml, 50 mg/ml. Injec-
tion, Solution (Epidural, Intrathecal, IV
Infusion) (Astramorph PF, Duramorph PF):
0.5 mg/ml, 1 mg/ml.

Capsules,

IV

Extended-Release (Avinza):

30 mg, 45 mg, 60 mg, 75 mg, 90 mg, 120

Capsules, Sustained-Release (Ka-

20
dian):
mg, 30 mg, 50 mg, 60 mg, 80
mg, 100 mg, 200 mg.

ADMINISTRATION/HANDLING

Reconstitution • May give undiluted.
• For IV injection, may dilute 2.5–15 mg
morphine in 4–5 ml Sterile Water for Injec-
tion. • For continuous IV infusion, dilute to
concentration of 0.1–1 mg/ml in D5W and
give through controlled infusion device.
Rate of administration • Always admin-
ister very slowly. Rapid IV increases risk of
severe adverse reactions (apnea, chest wall

Uses section in each
monograph notes the
standard and off-label
uses for a particular
drug.

Lifespan Considerations
in each monograph note
factors to be considered
for geriatric, pediatric,
pregnant, or nursing
populations. Appendix H
provides additional
resources.

Interactions identify
potential herbal,
drug, and food
interactions with a
particular drug.

Black Box Alerts
advise about the
increased risks of a
particular drug.

Top prescribed
drugs are underlined.

3

M

Canadian trade name
Non-Crushable Drug
High Alert drug

rigidity, peripheral circulatory collapse,
cardiac arrest, anaphylactoid effects).
Storage Store at room temperature.

May give either diluted or undiluted.
Do not use an in-line fi lter.
Store
solution in refrigerator; do not freeze. May
store at room temperature for 7 days.
Following withdrawal from vial, use
within 4 hrs. Gently invert vial to resus-
pend drug; avoid aggressive agitation.

Amphotericin B complex (Abelcet, AmBi-
some, Amphotec), cefepime (Maxip-
ime), doxorubicin (Doxil), lipids, phe-
nytoin (Dilantin), thiopental.

Amiodarone (Cordarone), atropine, bu-
metanide (Bumex), bupivacaine (Mar-
caine, Sensorcaine), diltiazem (Cardizem),
diphenhydramine (Benadryl), dobutamine
(Dobutrex), dopamine (Intropin), glyco-
pyrrolate (Robinul), heparin, hydroxyzine
(Vistaril), lidocaine, lorazepam (Ativan),
magnesium, midazolam (Versed), milri-
none (Primacor), nitroglycerin, potas-
sium, propofol (Diprivan), total parenteral
nutrition (TPN).

INDICATIONS/ROUTES/DOSAGE

ALERT Dosage should be titrated to
desired effect.

PO (IMMEDIATE-RELEASE): ADULTS,
ELDERLY: 10–30 mg q3–4h as needed.
CHILDREN: 0.15–0.3 mg/kg q3–4h as
needed.
PO (EXTENDED-RELEASE [AVINZA]):
ADULTS, ELDERLY:
Dosage requirement
should be established using prompt-
release formulations and is based on total
daily dose. Avinza is given once a day only.
PO (EXTENDED-RELEASE [KADIAN]):
ADULTS, ELDERLY:
Dosage requirement
should be established using prompt-
release formulations and is based on total
daily dose. Dose is given once a day or di-
vided and given q12h.

rigidity, peripheral circulatory collapse,
cardiac arrest, anaphylactoid effects).
Storage
Store at room temperature.

May give either diluted or undiluted.
Do not use an in-line fi lter.
Store
solution in refrigerator; do not freeze. May
store at room temperature for 7 days.
Following withdrawal from vial, use
within 4 hrs. Gently invert vial to resus-
pend drug; avoid aggressive agitation.

Amphotericin B complex (Abelcet, AmBi-
some, Amphotec), cefepime (Maxip-
ime), doxorubicin (Doxil), lipids, phe-
nytoin (Dilantin), thiopental.

Amiodarone (Cordarone), atropine, bu-
metanide (Bumex), bupivacaine (Mar-
caine, Sensorcaine), diltiazem (Cardizem),
diphenhydramine (Benadryl), dobutamine
(Dobutrex), dopamine (Intropin), glyco-
pyrrolate (Robinul), heparin, hydroxyzine
(Vistaril), lidocaine, lorazepam (Ativan),
magnesium, midazolam (Versed), milri-
none (Primacor), nitroglycerin, potas-
sium, propofol (Diprivan), total parenteral
nutrition (TPN).

INDICATIONS/ROUTES/DOSAGE
Dosage should be titrated to
desired effect.

PO (IMMEDIATE-RELEASE): ADULTS,
ELDERLY: 10–30 mg q3–4h as needed.
CHILDREN: 0.15–0.3 mg/kg q3–4h as
needed.
PO (EXTENDED-RELEASE [AVINZA]):
ADULTS,
ELDERLY:
Dosage requirement
should be established using prompt-
release formulations and is based on total
daily dose. Avinza is given once a day only.
PO (EXTENDED-RELEASE [KADIAN]):
ADULTS,
ELDERLY:
Dosage requirement
should be established using prompt-
release formulations and is based on total
daily dose. Dose is given once a day or di-
vided and given q12h.

IV:
ADULTS, ELDERLY: Loading dose:
5–10 mg. Intermittent bolus: 0.5–3
mg. Lockout interval: 5–12 min. Con-
tinuous infusion: 1–10 mg/hr. 4-hr
limit: 20–30 mg.

SIDE EFFECTS
Sedation, decreased B/P (in-
cluding orthostatic hypotension), diapho-
resis, facial fl ushing, constipation, dizzi-
ness, drowsiness, nausea, vomiting.
Allergic reaction (rash, pruri-
tus), dyspnea, confusion, palpitations,
tremors, urinary retention, abdominal
cramps, vision changes, dry mouth, head-
ache, decreased appetite, pain/burning at
injection site.
Paralytic ileus.

ADVERSE EFFECTS/
TOXIC REACTIONS
Overdose results in respiratory depression,
skeletal muscle fl accidity, cold/clammy
skin, cyanosis, extreme drowsiness pro-
gressing to seizures, stupor, coma. Toler-
ance to analgesic effect, physical depen-
dence may occur with repeated use.

BASELINE ASSESSMENT
Pt should be in recumbent position be-
fore drug is given by parenteral route.
Assess onset, type, location, duration of
pain.

INTERVENTION/EVALUATION
Monitor vital signs 5–10 min after IV ad-
ministration, 15–30 min after subcutane-
ous, IM. Be alert for decreased respira-
tions, B/P. Check for adequate voiding.
Monitor daily pattern of bowel activity and
stool consistency. Avoid constipation.

PATIENT/FAMILY TEACHING
Discomfort may occur with injection.
Change positions slowly to avoid ortho-
static hypotension. Avoid tasks that re-
quire alertness, motor skills until response
to drug is established. Avoid alcohol, CNS
depressants.

IV:
ADULTS, ELDERLY: Loading dose:
5–10 mg. Intermittent bolus: 0.5–3
mg. Lockout interval: 5–12 min. Con-
tinuous infusion: 1–10 mg/hr. 4-hr
limit: 20–30 mg.

SIDE EFFECTS
Sedation, decreased B/P (in-
cluding orthostatic hypotension), diapho-
resis, facial fl ushing, constipation, dizzi-
ness, drowsiness, nausea, vomiting.
Allergic reaction (rash, pruri-
tus), dyspnea, confusion, palpitations,
tremors, urinary retention, abdominal
cramps, vision changes, dry mouth, head-
ache, decreased appetite, pain/burning at
injection site.
Paralytic ileus.

ADVERSE EFFECTS/
TOXIC REACTIONS
Overdose results in respiratory depression,
skeletal muscle fl accidity, cold/clammy
skin, cyanosis, extreme drowsiness pro-
gressing to seizures, stupor, coma. Toler-
ance to analgesic effect, physical depen-
dence may occur with repeated use.

BASELINE ASSESSMENT
Pt should be in recumbent position be-
fore drug is given by parenteral route.
Assess onset, type, location, duration of
pain.

INTERVENTION/EVALUATION
Monitor vital signs 5–10 min after IV ad-
ministration, 15–30 min after subcutane-
ous, IM. Be alert for decreased respira-
tions, B/P. Check for adequate voiding.
Monitor daily pattern of bowel activity and
stool consistency. Avoid constipation.

PATIENT/FAMILY TEACHING
Discomfort may occur with injection.
Change positions slowly to avoid ortho-
static hypotension.
Avoid tasks that re-
quire alertness, motor skills until response
to drug is established.
Avoid alcohol, CNS
depressants.

•
•
•

•

morphine

•

Epidural, Liposomal
•
•
•

•
•

IV INCOMPATIBILITIES

IV COMPATIBILITIES

Analgesia

•

Epidural, Liposomal
•
•
•

•
•

IV INCOMPATIBILITIES

IV COMPATIBILITIES

Analgesia

Patient-Controlled Analgesia (PCA)

Frequent:

Occasional:

Rare:

NURSING CONSIDERATIONS

Patient-Controlled Analgesia (PCA)

Frequent:

Occasional:

Rare:

NURSING CONSIDERATIONS

IV Incompatibilities/
Compatibilities present
important information for
IV drugs.

Adverse Reactions
highlight the particularly
dangerous side effects.

Side Effects section in
each drug monograph
specifies the frequency of
particular side effects.

New to this Edition!
• 29 drugs recently
approved by the FDA

• Hundreds of updates and
revisions

• More than 300 Black Box
Alerts

High Alert drugs
are shaded in purple
for easy identification.

Once you register, you will have access to your
ONLINE RESOURCES:

• 200 Most Common Medications

• Content Updates

• Conversion Table

• Herbals: Common Natural Medicines

• Less Frequently Used Drugs

• Non-Crushable Drugs

• Orphan Drugs

• Signs and Symptoms of Electrolyte Imbalance

• QT-Interval Prolongation and Medication Safety

• Techniques of Medication Administration

• Updates and Alerts

REGISTER TODAY!

MORE THAN
A TEXTBOOK

YOU’VE JUST PURCHASED

ACTIVATE THE COMPLETE LEARNING EXPERIENCE
THAT COMES WITH YOUR BOOK BY REGISTERING AT
http://evolve.elsevier.com/SaundersNDH

Saunders

NURSING
DRUG
HANDBOOK
2014

BARBARA B. HODGSON, RN, OCN

Morton Plant Mease Northbay Hospital
Former Staff Nurse
New Port Richey, Florida;
St. Joseph’s Hospital
Former Staff Nurse in the Cancer Institute
Tampa, Florida

ROBERT J. KIZIOR, BS, RPh

Education Coordinator
Department of Pharmacy
Alexian Brothers Medical Center
Elk Grove Village, Illinois

3251 Riverport Lane
St. Louis, Missouri 63043

SAUNDERS NURSING DRUG HANDBOOK 2014
ISBN: 978-1-4557-0739-3

ISSN: 1098-8661

Copyright © 2014, 2013, 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2003,
2002, 2001, 2000, 1999, 1998, 1997, 1996, 1995, 1994, 1993 by Saunders, an imprint of
Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek permission,
further information about the Publisher’s permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our
website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Pub-
lisher (other than as may be noted herein).

NOTICES

Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treat-
ment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in eval-
uating and using any information, methods, compounds, or experiments described herein. In using
such information or methods, they should be mindful of their own safety and the safety of others,
including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer of
each product to be administered, to verify the recommended dose or formula, the method and dura-
tion of administration, and contraindications. It is the responsibility of practitioners, relying on their
own experience and knowledge of their patients, to make diagnoses, to determine dosages and the
best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products lia-
bility, negligence or otherwise, or from any use or operation of any methods, products, instructions,
or ideas contained in the material herein.

ISBN: 978-1-4557-0739-3

Director, eContent Solutions: Robin Carter
Content Manager: Lauren Lake
Publishing Services Manager: Pat Joiner
Senior Project Manager: Joy Moore
Designer: Ashley Eberts

Printed in the United States of America

Last digit is the print number:
9
8
7
6
5
4
3
2
1

CONTENTS

DRUGS BY DISORDER
xv

DRUG CLASSIFICATIONS
1C

A–Z DRUG ENTRIES
1

APPENDIXES
1278

A. Calculation of Doses
1279

B. Controlled Drugs (United States)
1280

C. Chronic Wound Care
1281

D. Drugs of Abuse
1285

E. Equianalgesic Dosing
1290

F. FDA Pregnancy Categories
1291

G. Herbals: Common Natural Medicines
1292

H. Lifespan, Cultural Aspects,

and Pharmacogenomics of Drug Therapy
1298

I. Normal Laboratory Values
1302

J. Cytochrome P450 (CYP) Enzymes
1304

K. Poison Antidote Chart
1307

L. Preventing Medication Errors and Improving

Medication Safety
1311

M. Recommended Childhood and Adult
Immunizations
1314

N. Parenteral Fluid Administration
1320

O. Spanish Phrases Often Used in Clinical
Settings
1322

GENERAL INDEX
1331

iii

PAGEBURST INTEGRATED RESOURCES
e21

I dedicate this work to my daughter Lauren, a true friend, for her unconditional love;
my daughter Kathryn, always supportive, always encouraging; and my son Keith, a
source of great pride to us all. This is also dedicated to my sons-in-law, Jim and Andy,
who have added so very much to my family, and to my grandchildren, Paige Olivia,
Logan James, Ryan James, and Dylan Boyd. I couldn’t love you more.

Barbara B. Hodgson, RN, OCN

To all health care professionals, who in the expectation of little glory or material
reward, dedicate themselves to the art and science of healing.

Robert J. Kizior, BS, RPh

iv

v

AUTHOR BIOGRAPHIES

Barbara B. Hodgson, RN, OCN
Born and raised in Michigan, Barbara was married and raising a young family in Chi-
cago when she decided to fulfill a lifelong dream and become a nurse. After gradua-
tion, she started her own business as author and publisher of Medcards, The Total
Medication Reference Guide, the first of its kind. These drug cards were designed
to assist nursing students in understanding drug information to give knowledgeable
care to their patients.
In 1981, she met co-author Robert (Bob) Kizior, who was teaching a pharmacology
class. After class, Barbara approached him and asked if he would be interested in
working on Medcards with her. He agreed, and together they became so successful
that a few years later Barbara was able to fulfill another dream and move to Florida.
By 1987, Barbara was approached by W.B. Saunders and asked to author the Saun-
ders Nursing Drug Handbook. Since then, Barbara and Bob have worked together
on this handbook and on two more drug resources, the Saunders Electronic Nurs-
ing Drug Cards and the Saunders Drug Handbook for Health Professions.
Barbara specialized in oncology at the Cancer Institute, St. Joseph’s Hospital, in
Tampa, Florida, and at Morton Plant Mease Northbay Hospital in New Port Richey,
Florida. Barbara’s daughter Lauren is a nurse manager, and her daughter Kathryn, her
son Keith, and her son-in-law Jim are all nurses, working in their respective fields of
patient care.
Barbara’s favorite interests are spending time with her very busy, tight-knit family

and, when she has a rare moment, getting her hands full of dirt working in her garden.

Robert (Bob) J. Kizior, BS, RPh
Bob graduated from the University of Illinois School of Pharmacy and is licensed to
practice in the state of Illinois. He has worked as a hospital pharmacist for more than
40 years at Alexian Brothers Medical Center in Elk Grove Village, Illinois—a suburb of
Chicago. Bob is the Pharmacy Surgery Coordinator for the Department of Pharmacy,
where he participates in educational programs for pharmacists, nurses, physicians,
and patients. He plays a major role in coordinating pharmacy services in the OR satel-
lite. Bob is a former adjunct faculty member at William Rainey Harper Community
College in Palatine, Illinois. It was there that Bob first met Barbara and commenced
their long-standing professional association.
An avid fan of Big Ten college athletics, Bob also has eclectic tastes in music that
range from classical, big band, rock ’n’ roll, and jazz to country and western. Bob
spends much of his free time reviewing the professional literature to stay current on
new drug information.

vi

CONSULTANTS*

Linda Laskowski-Jones, RN, MS,
CS, CCRN, CEN

Christiana Care Health System
Newark, Delaware

Jessica K. Leet, RN, BSN
Cardinal Glennon Children’s Hospital
St. Louis, Missouri

Denise Macklin, BSN, RNC, CRNI
President, Professional Learning
Systems, Inc.
Marietta, Georgia

Nancy L. McCartney
Valencia Community College
Orlando, Florida

Judith L. Myers, MSN, RN
Health Sciences Center
St. Louis University School of Nursing
St. Louis, Missouri

Kimberly R. Pugh, MSEd, RN, BS
Nurse Consultant
Baltimore, Maryland

Regina T. Schiavello, BSN, RNC
Wills Eye Hospital
Philadelphia, Pennsylvania

Gregory M. Susla, PharmD, FCCM
National Institutes of Health
Bethesda, Maryland

Elizabeth Taylor
Tennessee Wesleyan College of Nursing
Fort Saunders Regional
Knoxville, Tennessee

Katherine B. Barbee, MSN, ANP,
F-NP-C

Kaiser Permanente
Washington, DC

Lisa Brown
Jackson State Community College
Jackson, Tennessee

Marla J. DeJong, RN, MS, CCRN,
CEN, Capt

Wilford Hall Medical Center
Lackland Air Force Base, Texas

Diane M. Ford, RN, MS, CCRN
Andrews University
Berrien Springs, Michigan

Denise D. Hopkins, PharmD
College of Pharmacy
University of Arkansas
Little Rock, Arkansas

Barbara D. Horton, RN, MS
Arnot Ogden Medical Center School
of Nursing
Elmira, New York

Mary Beth Jenkins, RN, CCRN,
CAPA

Elliott One Day Surgery Center
Manchester, New Hampshire

Kelly W. Jones, PharmD, BCPS
McLeod Family Medicine Center
McLeod Regional Medical Center
Florence, South Carolina

Autumn E. Korson
Western Michigan University
Bronson School of Nursing
Kalamazoo, Michigan

*The author acknowledges the work of the consultants in previous edition(s).

vii

REVIEWERS

James Anthony Graves, PharmD
Pharmacist
St. Mary’s Health Center
Jefferson City, Missouri

Joshua J. Neumiller, PharmD,
CDE, CGP, FASCP

Assistant Professor
Department of Pharmacotherapy
College of Pharmacy
Washington State University
Spokane, Washington

viii

PREFACE

Nurses are faced with the ever-challenging responsibility of ensuring safe and effective
drug therapy for their patients. Not surprisingly, the greatest challenge for nurses is
keeping up with the overwhelming amount of new drug information, including the
latest FDA-approved drugs and changes to already approved drugs, such as new uses,
dosage forms, warnings, and much more. Nurses must integrate this information into
their patient care quickly and in an informed manner.
Saunders Nursing Drug Handbook 2014 is designed as an easy-to-use source
of current drug information to help the busy nurse meet these challenges. What sepa-
rates this book from others is that it guides the nurse through patient care to better
practice and better care.
This handbook contains the following:

1. An IV compatibility chart. This handy chart is bound into the handbook to pre-
vent accidental loss.

2. The Classifications section. The action and uses for some of the most common
clinical and pharmacotherapeutic classes are presented. Unique to this handbook,
each class provides an at-a-glance table that compares all the generic drugs within
the classification according to product availability, dosages, side effects, and other
characteristics. Its blue half-page color tab ensures you can’t miss it!

3. An alphabetical listing of drug entries by generic name. Blue letter thumb
tabs help you page through this section quickly. Information on medications that
contain a Black Box Alert is an added feature of the drug entries. This alert iden-
tifies those medications for which the FDA has issued a warning that the drugs
may cause serious adverse effects. Tall Man lettering, with emphasis on certain syl-
lables to avoid confusing similar sounding/looking medications, is shown in slim
blue capitalized letters (e.g., *acetaZOLAMIDE). High Alert drugs with a blue icon

are considered dangerous by The Joint Commission and the Institute for

Safe Medication Practices (ISMP) because if they are administered incorrectly,
they may cause life-threatening or permanent harm to the patient. The entire
High Alert generic drug entry sits on a blue-shaded background so that it’s easy to
spot! To make scanning pages easier, each new entry begins with a shaded box
containing the generic name, pronunciation, trade name(s), fixed-combination(s),
and classification(s).

4. Herbal entries. In this edition, each herb is cross-referenced to Herbals: Common
Natural Medicines (Appendix G) so that you have the most comprehensive view of
herbal therapies related to patient care.

5. A comprehensive reference section. Appendixes include vital information on
calculation of doses; controlled drugs; chronic wound care; drugs of abuse; equi-
analgesic dosing; FDA pregnancy categories; herbals: common natural medicines;
lifespan, cultural aspects, and pharmacogenomics of drug therapy; normal labora-
tory values; cytochrome P450 enzymes; poison antidotes; preventing medication
errors; recommended childhood and adult immunizations; parenteral fluid admin-
istration; and Spanish phrases often used in clinical settings.

Preface
ix

6. Drugs by Disorder. You’ll find Drugs by Disorder in the front of the book for easy
reference. It lists common disorders and the drugs most often used for treatment.

7. The index. The comprehensive index is located at the back of the book on light
blue pages. Undoubtedly the best tool to help you navigate the handbook, the com-
prehensive index is organized by showing generic drug names in bold, trade names
in regular type, classifications in italics, and the page number of the main drug
entry listed first and in bold.

A DETAILED GUIDE TO THE SAUNDERS NURSING DRUG HANDBOOK
An intensive review by consultants and reviewers helped us to revise the Saunders
Nursing Drug Handbook so that it is most useful in both educational and clinical
practice. The main objective of the handbook is to provide essential drug information
in a user-friendly format. The bulk of the handbook contains an alphabetical listing of
drug entries by generic name.
To maintain the portability of this handbook and meet the challenge of keeping
content current, we have also included additional information for some medications
on the Evolve® Internet site. Users can also choose from 200 monographs for the most
commonly used medications and customize and print drug cards. Evolve® also in-
cludes drug alerts (e.g., medications removed from the market) and drug updates
(e.g., new drugs, updates on existing entries). Information is periodically added, al-
lowing the nurse to keep abreast of current drug information.
You’ll also notice that some entries for infrequently used medications are con-
densed to reflect only the absolutely essential points the nurse should know when
called on to administer them.
We have incorporated the IV Incompatibilities/Compatibilities
heading. The drugs

listed in this section are compatible or incompatible with the generic drug when admin-
istered directly by IV push, via a Y-site, or via IV piggyback. We have highlighted the
intravenous drug administration and handling information with a special heading icon

and have broken it down by Reconstitution, Rate of Administration, and Storage.
We present entries in an order that follows the logical thought process the nurse
undergoes whenever a drug is ordered for a patient:

• What is the drug?
• How is the drug classified?
• What does the drug do?
• What is the drug used for?
• Under what conditions should you not use the drug?
• How do you administer the drug?
• How do you store the drug?
• What is the dose of the drug?
• What should you monitor the patient for once he or she has received the drug?
• What do you assess the patient for?
• What interventions should you perform?
• What should you teach the patient?

x
Preface

The following are included within the drug entries:

Generic Name, Pronunciation, Trade Names. Each entry begins with the generic
name and pronunciation, followed by the U.S. and Canadian trade names. Exclusively
Canadian trade names are followed by a blue maple leaf
. Trade names that were

most prescribed in the year 2012 are underlined in this section.
Black Box Alert. This feature highlights drugs that carry a significant risk of serious
or life-threatening adverse effects. Black Box Alerts are ordered by the FDA.
Do Not Confuse With. Drug names that sound similar to the generic and/or trade
names are listed under this heading to help you avoid potential medication errors.
Fixed-Combination Drugs. Where appropriate, fixed-combinations, or drugs made
up of two or more generic medications, are listed with the generic drug.
Pharmacotherapeutic and Clinical Classification Names. Each full entry in-
cludes both the pharmacotherapeutic and clinical classifications for the generic drug.
The page number of the classification description in the front of the book is provided
in this section as well.
Action/Therapeutic Effect. This section describes how the drug is predicted to be-
have, with the expected therapeutic effect(s) under a separate heading.
Pharmacokinetics. This section includes the absorption, distribution, metabolism, ex-
cretion, and half-life of the medication. The half-life is bolded in blue for easy access.
Uses/Off-Label. The listing of uses for each drug includes both the FDA uses and the
off-label uses. The off-label heading is shown in bold blue for emphasis.
Precautions. This heading incorporates a discussion about when the generic drug is
contraindicated or should be used with caution. The cautions warn the nurse of spe-
cific situations in which a drug should be closely monitored.
Lifespan Considerations . This section includes the pregnancy category and lacta-
tion data and age-specific information concerning children and elderly people.
Interactions. This heading enumerates drug, food, and herbal interactions with the
generic drug. As the number of medications a patient receives increases, awareness of
drug interactions becomes more important. Also included is information about thera-
peutic and toxic blood levels in addition to the altered lab values that show what effects
the drug may have on lab results.
Product Availability. Each drug monograph gives the form and availability of the
drug. The icon
identifies non-crushable drug forms.

Administration/Handling. Instructions for administration are given for each route
of administration (e.g., IV, IM, PO, rectal). Special handling, such as refrigeration, is
also included where applicable. The routes in this section are always presented in the
order IV, IM, Subcutaneous, and PO, with subsequent routes in alphabetical order
(e.g., Ophthalmic, Otic, Topical). IV administration is broken down by reconstitu-
tion, rate of administration (how fast the IV should be given), and storage (including
how long the medication is stable once reconstituted).
IV Incompatibilities/IV Compatibilities
. These sections give the nurse the most
comprehensive compatibility information possible when administering medications by
direct IV push, via a Y-site, or via IV piggyback. This edition includes information about
lipids.
Indications/Routes/Dosage. Each full entry provides specific dosing guidelines for
adults, elderly people, children, and patients with renal and/or hepatic impairment.
Dosages are clearly indicated for each approved indication and route.