Duvoid


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Duvoid

 [doo´void]
trademark for preparations of bethanechol chloride, a smooth muscle relaxant used to treat urinary retention.

betamethasone acetate and sodium phosphate

Celestone SoluspanDuvoid (CA), Myotonachol (CA), Myotonine (UK), PMS-Bethanecol Chloride (CA), Urecholine

Pharmacologic class: Glucocorticoid (inhalation)

Therapeutic class: Antiasthmatic, antiinflammatory (steroidal)

Pregnancy risk category C

Pharmacologic class: Cholinergic

Therapeutic class: Urinary and GI tract stimulant

Pregnancy risk category C

Action

Stabilizes lysosomal neutrophils and prevents their degranulation, inhibits synthesis of lipoxygenase products and prostaglandins, activates anti-inflammatory genes, and inhibits various cytokines

Availability

Solution for injection: 3 mg betamethasone sodium phosphate with 3 mg betamethasone acetate/ml

Suspension for injection (acetate, phosphate): 6 mg (total)/ml

Syrup: 0.6 mg/5 ml

Tablets: 0.6 mg

Tablets (effervescent): 0.5 mg

Tablets (extended-release): 1 mg

Indications and dosages

Inflammatory, allergic, hematologic, neoplastic, autoimmune, and respiratory diseases; prevention of organ rejection after transplantation surgery

Adults: 0.6 to 7.2 mg/day P.O. as single daily dose or in divided doses; or up to 9 mg I.M. of betamethasone acetate and sodium phosphate suspension.

Bursitis or tenosynovitis

Adults: 1 ml of suspension intrabursally

Rheumatoid arthritis or osteoarthritis

Adults: 0.5 to 2 ml of suspension intra-articularly

Off-label uses

• Respiratory distress syndrome

Contraindications

• Hypersensitivity to drug
• Breastfeeding

Precautions

Use cautiously in:
• systemic infections, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability
• patients receiving systemic corticosteroids
• pregnant patients
• children younger than age 6.

Administration

• Give as a single daily dose before 9:00 A.M.
• Give oral dose with food or milk.
• Administer I.M. injection deep into gluteal muscle (may cause tissue atrophy).

Don't give betamethasone acetate I.V.
• Be aware that typical suspension dosage ranges from one-third to one-half of oral dosage given q 12 hours.

To avoid adrenal insufficiency, taper dosage slowly and under close supervision when discontinuing.
• Know that drug may be given with other immunosuppressants.

Adverse reactions

CNS: headache, nervousness, depression, euphoria, psychoses, increased intracranial pressure

CV: hypertension, thrombophlebitis, thromboembolism

EENT: cataracts, burning and dryness of eyes, rebound nasal congestion, sneezing, epistaxis, nasal septum perforation, difficulty speaking, oropharyngeal or nasopharyngeal fungal infections

GI: nausea, vomiting, anorexia, dry mouth, esophageal candidiasis, peptic ulcers

Metabolic: decreased growth, hyperglycemia, cushingoid appearance, adrenal insufficiency or suppression

Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis

Respiratory: cough, wheezing, bronchospasm

Skin: facial edema, rash, contact dermatitis, acne, ecchymosis, hirsutism, petechiae, urticaria, angioedema

Other: loss of taste, bad taste, weight gain or loss, Churg-Strauss syndrome, increased susceptibility to infection, hypersensitivity reaction

Interactions

Drug-drug.Amphotericin B, loop and thiazide diuretics, ticarcillin: additive hypokalemia

Barbiturates, phenytoin, rifampin: stimulation of betamethasone metabolism, causing decreased drug effects

Digoxin: increased risk of digoxin toxicity

Fluoroquinolones (such as ciprofloxacin, norfloxacin): increased risk of tendon rupture

Hormonal contraceptives: blockage of betamethasone metabolism

Insulin, oral hypoglycemics: increased betamethasone dosage requirement, diminished hypoglycemic effects

Live-virus vaccines: decreased antibody response to vaccine, increased risk of neurologic complications

Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI effects

Drug-diagnostic tests.Calcium, potassium: decreased levels

Cholesterol, glucose: increased levels

Nitroblue tetrazolium test for bacterial

infection: false-negative result

Drug-herbs.Echinacea: increased immune-stimulating effects

Ginseng: increased immune-modulating effects

Drug-behaviors.Alcohol use: increased risk of gastric irritation and GI ulcers

Patient monitoring

• Monitor weight daily and report sudden increase, which suggests fluid retention.
• Monitor blood glucose level for hyperglycemia.
• Assess serum electrolyte levels for sodium and potassium imbalances.
• Watch for signs and symptoms of infection (which drug may mask).

Patient teaching

• Advise patient to report signs and symptoms of infection.
• Tell patient to report visual disturbances (long-term drug use may cause cataracts).
• Instruct patient to eat low-sodium, high potassium diet.

Advise patient to carry medical identification describing drug therapy.
• Inform female patients that drug may cause menstrual irregularities.

Caution patient not to stop taking drug abruptly.
• 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.


bethanechol chloride

Duvoid (CA), Myotonachol (CA), Myotonine (UK), PMS-Bethanecol Chloride (CA), Urecholine


Pharmacologic class: Cholinergic

Therapeutic class: Urinary and GI tract stimulant

Pregnancy risk category C

 

Action

Stimulates parasympathetic nervous system and cholinergic receptors, leading to increased muscle tone in bladder and increased frequency of ureteral peristaltic waves. Also stimulates gastric motility, increases gastric tone, and restores rhythmic GI peristalsis.

Availability

Tablets: 5 mg, 10 mg, 25 mg, 50 mg

Indications and dosages

Postpartal and postoperative non-obstructive urinary retention; urinary retention caused by neurogenic bladder

Adults: 10 to 50 mg P.O. three to four times daily; dosage may be determined by giving 5 or 10 mg q hour until response occurs or a total of 50 mg has been given.

Contraindications

• Hypersensitivity to drug
• GI or GU tract obstruction
• Hyperthyroidism
• Active or latent asthma
• Bradycardia
• Hypotension
• Atrioventricular conduction defects
• Coronary artery disease
• Seizure disorders
• Parkinsonism
• Peptic ulcer disease

Precautions

Use cautiously in:
• sensitivity to cholinergics or their effects and tartrazine (some products)
• pregnant or breastfeeding patients
• children.

Administration

• Give drug on empty stomach 1 hour before or 2 hours after a meal to help prevent nausea and vomiting.

Adverse reactions

CNS: headache, malaise, seizures

CV: bradycardia, hypotension, heart block, syncope with cardiac arrest

EENT: excessive lacrimation, miosis

GI: nausea, vomiting, diarrhea, abdominal discomfort, belching

GU: urinary urgency

Respiratory: increased bronchial secretions, bronchospasm

Skin: diaphoresis, flushing

Other: hypothermia

Interactions

Drug-drug.Anticholinergics: decreased bethanechol efficacy

Cholinesterase inhibitors: additive cholinergic effects

Depolarizing neuromuscular blockers: decreased blood pressure

Ganglionic blockers: severe hypotension

Procainamide, quinidine: antagonism of cholinergic effects

Drug-herbs.Angel's trumpet, jimson-weed, scopolia: antagonism of cholinergic effects

Patient monitoring

• Monitor blood pressure. Be aware that hypertensive patients may experience sudden blood pressure drop.
• Stay alert for orthostatic hypotension, a common adverse effect.
• Monitor fluid intake and output and residual urine volume.

Patient teaching

• Tell patient that drug is usually effective within 90 minutes of administration.
• Advise patient to take drug on empty stomach 1 hour before or 2 hours after a meal to avoid GI upset.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from blood pressure decrease.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

bethanechol

(be-than-e-kole) ,

Duvoid

(trade name),

Urabeth

(trade name),

Urecholine

(trade name)

Classification

Therapeutic: urinary tract stimulant
Pharmacologic: cholinergics
Pregnancy Category: C

Indications

Postpartum and postoperative nonobstructive urinary retention or urinary retention caused by neurogenic bladder.

Action

Stimulates cholinergic receptors. Effects include:
  • Contraction of the urinary bladder,
  • Decreased bladder capacity,
  • Increased frequency of ureteral peristaltic waves,
  • Increased tone and peristalsis in the GI tract,
  • Increased pressure in the lower esophageal sphincter,
  • Increased gastric secretions.

Therapeutic effects

Bladder emptying.

Pharmacokinetics

Absorption: Poorly absorbed after oral administration, requiring larger doses by mouth than subcutaneously.
Distribution: Does not cross the blood-brain barrier.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile (response on bladder muscle)

ROUTEONSETPEAKDURATION
PO30–90 min1 hr6 hr
Subcut5–15 min15–30 min2 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Mechanical obstruction of the GI or GU tract.
Use Cautiously in: History of asthma; Ulcer disease; Cardiovascular disease; Epilepsy; Hyperthyroidism; Sensitivity to cholinergic agents or effects; Obstetric / Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • headache
  • malaise

Ear, Eye, Nose, Throat

  • lacrimation
  • miosis

Respiratory

  • bronchospasm

Cardiovascular

  • heart block (life-threatening)
  • syncope/cardiac arrest (life-threatening)
  • bradycardia
  • hypotension

Gastrointestinal

  • abdominal discomfort (most frequent)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • salivation (most frequent)
  • vomiting (most frequent)

Genitourinary

  • urgency (most frequent)

Miscellaneous

  • flushing (most frequent)
  • sweating (most frequent)
  • hypothermia

Interactions

Drug-Drug interaction

Quinidine and procainamide may antagonize cholinergic effects.Additive cholinergic effects with cholinesterase inhibitors.Use with ganglionic blocking agents may result in severe hypotension.Do not use with depolarizing neuromuscular blocking agents.Effectiveness will be decreased by anticholinergics.Cholinergic effects may be antagonized by angel's trumpet, jimson weed, or scopolia.

Route/Dosage

Oral (Adults) 25–50 mg 3 times daily. Dose may be determined by administering 5–10 mg q 1–2 hr until response is obtained or total of 50 mg administered or by starting with 10 mg, giving 25 mg 6 hr later, then, if needed, 50 mg 6 hr later.
Oral (Children) 0.2 mg/kg 3 times daily or 0.15 mg/kg 4 times daily.
Subcutaneous (Adults) 5 mg 3–4 times daily. Dose may be determined by administering 2.5 mg q 15–30 min until response is obtained or total of 4 doses administered.
Subcutaneous (Children) 0.06 mg/kg 3 times daily or 0.05 mg/kg 4 times daily.

Availability (generic available)

Tablets: 5 mg, 10 mg, 25 mg, 50 mg
Injection: 5 mg/mL

Nursing implications

Nursing assessment

  • Monitor BP, pulse, and respirations before administering and for at least 1 hr after subcut administration.
  • Monitor intake and output ratios. Palpate abdomen for bladder distention. Notify physician or other health care professional if drug fails to relieve condition for which it was prescribed. Catheterization may be ordered to assess postvoid residual.
  • Lab Test Considerations: May cause an increase in serum AST, amylase, and lipase concentrations.
  • Observe patient for drug toxicity (sweating, flushing, abdominal cramps, nausea, salivation). If overdosage occurs, treatment includes atropine sulfate (specific antidote).

Potential Nursing Diagnoses

Impaired urinary elimination (Indications)

Implementation

  • A test dose is usually employed before maintenance to determine minimum effective dose.
    • Oral and subcut doses are not interchangeable.
  • Oral: Administer medication on an empty stomach, 1 hr before or 2 hr after meals, to prevent nausea and vomiting.
  • Subcutaneous: Parenteral solution is intended only for subcut administration. Do not give IM or IV. Inadvertent IM or IV administration may cause cholinergic overstimulation (circulatory collapse, drop in BP, abdominal cramps, bloody diarrhea, shock, and cardiac arrest).
    • Do not use if solution is discolored or contains a precipitate.

Patient/Family Teaching

  • Instruct patient to take medication exactly as directed. Missed doses should be taken as soon as possible within 2 hr; otherwise, return to regular dosing schedule. Do not double doses.
  • Caution patient to change positions slowly to minimize orthostatic hypotension.
  • Advise patient to report abdominal discomfort, salivation, sweating, or flushing to health care professional.

Evaluation/Desired Outcomes

  • Increase in bladder function and tone.

Duvoid

a trademark for a cholinergic receptor agonist (bethanechol chloride).