The IV compatibility table provides data when 2 or more medications are given in a Y-site of administration. The data in this table largely represent physical incompatibilities (e.g., haze, precipitate, change in color). Therapeutic incompatibilities have not been included, so when using the table, professional judgement should be exercised.
Calcium Gluconate
Cefazolin
Ceftaroline Fosamil
Acyclovir
Acyclovir
IV Compatibilities
The IV compatibility table provides data when 2 or more medications are given in a Y-site of administration. The data in this table largely represent physical incompatibilities (e.g., haze, precipitate, change in color). Therapeutic incompatibilities have not been included, so when using the table, professional judgement should be exercised.
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AUTHOR BIOGRAPHIES
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 satellite. Bob is a former adjunct faculty member at William Rainey Harper Community College in Palatine, Illinois.
An avid sports fan, 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.
Keith J. Hodgson, RN, BSN, CCRN
Keith was born into a loving family in Chicago, Illinois. His mother, Barbara B. Hodgson, was an author and publisher of several medication products, and her work has been a part of his life since he was a child. By the time he was 4 years old, Keith was already helping his mother with drug cards by stacking the draft pages that were piled up throughout their home.
Because of his mother’s influence, Keith contemplated becoming a nurse in college, but his mind was fully made up after he shadowed his sister in the Emergency Department. Keith received his Associates Degree in Nursing from Hillsborough Community College and his Bachelor of Science in Nursing from the University of South Florida in Tampa, Florida. Keith started his career in the Emergency Department and now works in the Trauma / Neurological/Surgical Intensive Care Unit at St. Joseph’s Hospital in Tampa, Florida.
Keith’s favorite interests include music, reading, Kentucky basketball, and, if he gets the chance, watching every minute of the Olympic Games.
REVIEWERS
James Graves, PharmD Clinical Pharmacist
University of Missouri Hospital Columbia, Missouri
CONSULTANTS*
Katherine B. Barbee, MSN, ANP, F-NP-C
Kaiser Permanente Washington, District of Columbia
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
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
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
*The authors acknowledge the work of the consultants in previous editions.
ACKNOWLEDGMENTS
I would like to thank my co-author, Bob Kizior, for his knowledge, experience, support, and friendship. We would like to give special thanks to Sonya Seigafuse, Charlene Ketchum, Carrie Stetz, Tina Kaemmerer, and the entire Elsevier team for their superior dedication, hard work, and belief in us. Without this wonderful team, none of this would be possible.
Keith J. Hodgson, RN, BSN, CCRN
DEDICATION
I dedicate my work to the practicing nurse, those aspiring to become nurses, and to all health care professionals who are dedicated to the art and science of healing.
Bob Kizior, BS, RPh
I dedicate this work to my wife, Jen Hodgson, the love of my life; my sister, Lauren, a foundation for our family; my sister, Kathryn, for her love and support; my father, David Hodgson, the best father a son could have; my brothers-in-law, Andy and Nick, great additions to the family; the grandchildren, Paige Olivia, Logan James, Ryan James, and Dylan Boyd; and to my band of brothers, Peter, Jamie, Miguel, Ritch, George, Jon, Domingo, Ben, Craig, Pat, and Shay.
We also make a special dedication to Barbara B. Hodgson, RN, OCN. She truly was a piece of something wonderful. Barbara often gave her love and support without needing any in return and would do anything for a smile. Not only was she a colleague and a friend, she was also a small business owner, an artist, a dreamer, and an innovator. We hope the pride we offer in her honor comes close to what she always gave us. Her dedication and perseverance lives on.
Keith J. Hodgson, RN, BSN, CCRN
BIBLIOGRAPHY
Lexi-Comp’s Adult Drug Information Handbook, ed 30, Hudson, OH, 2021–2022, Lexi-Comp.
Medical Letter on Drugs and Therapeutics: 2020, 2021, Pharmacists Letter: 2021. Takemoto CK, Hodding JH, Kraus DM: Lexi-Comp’s Pediatric Dosage Handbook, ed 27, Hudson, OH, Lexi-Comp.
Trissel LA: Handbook of Injectable Drugs, ed 19, Bethesda, MD, 2016, American Society of Health-System Pharmacists.
ILLUSTRATION CREDITS
Kee JL, Hayes ER, McCuiston LE, editors: Pharmacology: A Nursing Process Approach, ed 7, Philadelphia, 2012, Saunders.
NEWLY APPROVED MEDICATIONS
Amivantamab (Rybrevant) A bispecific EGF receptor and MET antibody for treatment of adults with locally advanced or metastatic non–small-cell lung cancer (NSCLC)
Belantamab mafodotin-blmf (Blenrep) A monoclonal antibody for multiple myeloma
Dolutegravir (Tivicay)
Treatment of the infection caused by human immunodeficiency virus (HIV)
Dostarlimab-gxly (Jemperli) A monoclonal antibody for endometrial cancer
Emtricitabine
Treatment of the infection caused by HIV.
Evinacumab-dgnb (Evkeeza) A monoclonal antibody for homozygous familial hypercholesterolemia
Idecabtagene (Abecma) A B-cell maturation antigen (BCMA)–directed, genetically modified, autologous chimeric antigen receptor (CAR) T-cell immunotherapy for treatment of adults with relapsed or refractory multiple myeloma
Lamivudine
Treatment of the infection caused by HIV
Loncastuximab (Zynlonta) A monoclonal antibody for relapsed or refractory large B-cell lymphoma
Lurbinectedin (Zepzelca) An alkylating drug for metastatic small-cell lung cancer
Margetuximab-cmkb (Margenza)
An intravenous HER2/neu receptor antagonist for metastatic HER2-positive breast cancer
Naxitamab-gqgk (Danyelza) A monoclonal antibody for relapsed or refractory neuroblastoma in the bone or bone marrow
An oral gonadotropin-releasing hormone receptor antagonist for advanced prostate cancer
A CNS stimulant for ADHD
Tafasitamab-cxix (Monjuvi) A monoclonal antibody for diffuse large B-cell lymphoma
Tenecteplase (TNKase) Thrombolytic agent
Tenofovir
Treatment of the infection caused by HIV
Tepotinib (Tepmetko) A kinase inhibitor for metastatic non–small-cell lung cancer
Tivozanib (Fotivda) A kinase inhibitor for renal cell carcinoma
Umbralisib (Ukoniq) A kinase inhibitor for marginal zone lymphoma and follicular lymphoma
Vibegron (Gemtesa) An oral beta-3 agonist for overactive bladder
Viloxazine (Qelbree) A serotonin norepinephrine modulating agent (SNMA) for treatment of ADHD in pts 6 to 17 yrs of age
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 2023 is designed as an easy-to-use source of current drug information to help the nurse meet these challenges. What separates 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 prevent accidental loss.
2. The Drug 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 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 identifies 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 syllables to avoid confusing similar sounding/looking medications, is shown in capitalized letters (e.g., oxyCODONE). High Alert drugs with a color 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 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. A comprehensive reference section. Appendixes include vital information on calculation of doses; controlled drugs; chronic wound care; drugs of abuse; equianalgesic dosing; herbals: common natural medicines; lifespan, cultural aspects, and pharmacogenomics of drug therapy; normal laboratory values; drug interactions; antidotes or reversal agents; preventing medication errors; parenteral fluid administration; and Common Terminology Criteria for Adverse Events (CTCAE).
5. 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.
6. 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 comprehensive 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 100 monographs for the most commonly used medications and customize and print drug cards. Evolve® also includes drug alerts (e.g., medications removed from the market) and drug updates (e.g., new drugs, updates on existing entries). Information is periodically added, allowing the nurse to keep abreast of current drug information.
We have incorporated the IV Incompatibilities/Compatibilities heading. The drugs listed in this section are compatible or incompatible with the generic drug when administered 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?
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 maple leaf . Trade names that were most prescribed in the year 2020 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 entry includes both the pharmacotherapeutic and clinical classifications for the generic drug.
Action/Therapeutic Effect. This section describes how the drug is predicted to behave, with the expected therapeutic effect(s) under a separate heading.
Pharmacokinetics. This section includes the absorption, distribution, metabolism, excretion, 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 specific situations in which a drug should be closely monitored.
Lifespan Considerations . This section includes pregnancy/lactation data and agespecific 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 therapeutic and toxic blood levels in addition to effects the drug may have on lab results.
Product Availability. Each drug monograph gives the form and availability of the drug. The icon identifies noncrushable 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, SQ, and PO, with subsequent routes in alphabetical order (e.g., Ophthalmic, Otic, Topical). IV administration is broken down by reconstitution, 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.
Indications/Routes/Dosage. Each entry provides specific dosing guidelines for adults, elderly, children, and patients with renal and/or hepatic impairment. Dose modification for toxicity has been added where applicable. Dosages are clearly indicated for each approved indication and route.
Side Effects. Side effects are defined as those responses that are usually predictable with the drug, are not life-threatening, and may or may not require discontinuation of the drug. Unique to this handbook, side effects are grouped by frequency listed from highest occurrence percentage to lowest so that the nurse can focus on patient care without wading through myriad signs and symptoms of side effects.
Adverse Effects/Toxic Reactions. Adverse effects and toxic reactions are very serious and often life-threatening undesirable responses that require prompt intervention from a health care provider.
Nursing Considerations. Nursing considerations are organized as care is organized:
• What needs to be assessed or done before the first dose is administered? (Baseline Assessment)
• What interventions and evaluations are needed during drug therapy? (Intervention/Evaluation)
• What teaching is needed for the patient and family? (Patient/Family Teaching)
Saunders Nursing Drug Handbook is an easy-to-use source of current drug information for nurses, students, and other health care providers. It is our hope that this handbook will help you provide quality care to your patients. We welcome any comments to improve future editions of the handbook. Please contact us via the publisher at http://evolve.elsevier.com/SaundersNDH.
Robert J. Kizior, BS, RPh
Keith J. Hodgson, RN, BSN, CCRN
DRUGS BY DISORDER
Note: Not all medications appropriate for a given condition are listed, nor are those not listed inappropriate.
Generic names appear first, followed by brand names in parentheses.
