DULoxetine (cymbalta) PDF

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Medications Worksheet Drug Generic Name & Trade Name Generic: DULoxetine Trade: Cymbalta

Classification & Uses Ther. Class: antidepressant Pharm. Class: selective serotonin & norepinephrine reuptake inhibitor Use: depression

Drug Action (How it works)

Adverse Reactions

Inhibits serotonin and norepinephrine reuptake in the CNS. Both antidepressant and pain inhibition are centrally mediated.

neuroleptic malignant syndrome (↑ fever, confusion, rigid muscle, fluctuation in BP, ↑heart rate) , seizures, suicidal thoughts, hepatotoxicity, pancreatit is, erythema multiforme, stevensjohnson syndrome, serotonin syndrome (agitation, dilate pupils, confusion, ↑ HR, sweating) IV Route: _____ Consider below:

Oral Route_____ Consider below: CAUTION renal impairment, hepatic impairment, hx of suicide or mania, seizure disorder, diabetic, angle-closure glaucoma Can it be crushed? No & don’t sprinkle Given with food? Yes or without Given with other medications? Interactions? MAO inhibitors, tricyclic antidepressants, SSRIs, triptans, (NSAIDS, aspirin, warfarin increase bleeding) No St. Johns wort

Dilution required? Compatible with IV solution? Compatible with other meds? Push Rate? Flush needed?

Safe Dosage Range Onset: unkn Peak: 6 hr Duration: 12 hr Half-life: 12 hr Pt is taking 60 mg Side Effects fatigue, drowsiness, insomnia, activation of mania, dizziness, fainting, falls, nightmares, blurred vision, ↑ intraocular pressure, ↑ BP, orthostatic hypotension , constipation, ↓appetite, dry mouth, nausea, diarrhea, ↑ liver enzymes, gastritis, vomiting, hyponatremia, dysuria, abnormal orgasm, erectile dysfunction, ↓ libido, urinary retention, ↑ sweating, pruritus, rash, tremor Alternative Route :____________ Necessary Considerations:

Nursing Implications (Pre-Administration and Follow-up: Pertinent labs, assessment and interventions) Assess for sexual dysfunction (erectile dysfunction; decreased libido). Monitor BP before and periodically during therapy. Monitor appetite and nutritional intake. Weigh weekly. Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression. Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberrations [hyperreflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans). Assess for rash periodically during therapy. Assess mental status (orientation, mood, and behavior). Lab Test Considerations:  ↑ ALT, AST, bilirubin, CPK, and alkaline phosphatase  May cause hyponatremia.  Monitor blood sugar and hemoglobin A1c. May cause slight ↑ in blood glucose. Patient/Family Teaching:  Encourage patient and family to be alert for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania, mania, worsening of depression and suicidal ideation, especially during early antidepressant therapy. If these symptoms occur, notify health care professional.  May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness  Advise patient to make position changes slowly to minimize orthostatic hypotension and falls  Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken  Instruct patient to notify health care professional if signs of serotonin syndrome (mental status changes: agitation, hallucinations, coma; autonomic instability: tachycardia, labile BP, hyperthermia; neuromuscular aberrations: hyperreflexia, incoordination; and/or gastrointestinal symptoms: nausea, vomiting, diarrhea), liver damage (pruritus, dark urine, jaundice, right upper quadrant tenderness, unexplained "flu-like" symptoms) or rash occur.  Advise patient to avoid taking alcohol during duloxetine therapy....