Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (136 page)
(doe-byoo′ta-meen)
Func. class.:
Adrenergic direct-acting β
1
-agonist, cardiac stimulant
Chem. class.:
Catecholamine
Do not confuse:
DOBUTamine
/DOPamine
Causes increased contractility, increased cardiac output without marked increase in heart rate by acting on β
1
-receptors in heart; minor α and β
2
effects
Cardiac decompensation due to organic heart disease or cardiac surgery
Unlabeled uses:
Cardiogenic shock in children; congenital heart disease in children undergoing cardiac catheterization
Hypersensitivity, idiopathic hypertrophic subaortic stenosis
Precautions:
Pregnancy (B), breastfeeding, children, hypertension, CAD, MI, hypovolemia, dysrhythmias, sulfite hypersensitivity, renal failure, geriatric patients
Calculator
• Adult and child: IV INF
0.5-1 mcg/kg/min; titrate to 2-20 mcg/kg/min may increase to 40 mcg/kg/min if needed
Available forms:
Inj 12.5 mg/ml, 250 mg/20 ml
•
Visually inspect parenteral products for particulate matter and discoloration before administration whenever solution and container permit
Note:
Infusions ≤72 hr have been given without development of tolerance. However, beta-receptor desensitization can occur with prolonged infusions of any beta-adrenergic agonist, including DOBUTamine, or as a consequence of sympathetic compensatory mechanisms associated with advanced congestive heart failure, resulting in alterations in DOBUTamine pharmacodynamics. Experience with intravenous DOBUTamine in controlled trials does not extend beyond 48 hr of repeated boluses and/or continuous infusions.
•
Must be diluted before administration
•
Infuse into a large vein
•
Concentrate for injection must be diluted with ≥50 ml of a compatible IV solution (strongly alkaline [e.g., sodium bicarbonate] solutions are incompatible). A common dilution is 500 mg (40 ml) in 210 ml D
5
W or NS (withdraw 40 ml from a 250 ml bag) to produce a final concentration of 2000 mcg/ml; or 1000 mg (80 ml) in 170 ml D
5
W or NS (withdraw 80 ml from a 250 ml bag) to produce a final concentration of 4000 mcg/ml. Maximum concentration should not exceed 5000 mcg/ml and should be adjusted according to the patient’s fluid requirements.
•
Administer diluted solution by IV inf using a controlled-infusion device.
•
Premixed bags of DOBUTamine in D
5
W solutions can exhibit a pink color that increase with time. This color change is due to slight oxidation of the drug, but there is no significant loss of potency
•
Do not administer DOBUTamine simultaneously with solutions containing sodium bicarbonate or strong alkaline solutions (incompatible)
•
Infusion of DOBUTamine should be started at a low rate and titrated frequently to reach the optimal dosage (see Dosage). Dosage titration is guided by the patient’s response, including systemic blood pressure, urine flow, frequency of ectopic activity, heart rate, and (whenever possible) measurements of cardiac output, central venous pressure, and/or pulmonary capillary wedge pressure
Y-site compatibilities:
Alfentanil, alprostadil, amifostine, amikacin, aminocaproic acid, amiodarone, anidulafun
gin, argatroban, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clarithromycin, cloNIDine, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, irinotecan, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, mechlorethamine, meperidine, meropenem, metaraminol, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, miconazole, milrinone, minocycline, mitoXANtrone, morphine, multiple vitamins injection, mycophenolate mofetil, nafcillin, nalbuphine, naloxone, netilmicin, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, pentamidine, pentazocine, phenylephrine, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sodium acetate, succinylcholine, SUFentanil, tacrolimus, temocillin, teniposide, theophylline, thiamine, thiotepa, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Anxiety
, headache, dizziness, fatigue
CV:
Palpitations,
tachycardia,
hyper/hypotension, PVCs, angina
ENDO:
Hypokalemia
GI:
Heartburn, nausea, vomiting
MS:
Muscle cramps (leg)
RESP:
Dyspnea
IV:
Onset 1-2 min, peak 10 min, half-life 2 min, metabolized in liver (inactive metabolites), excreted in urine
Increase:
severe hypertension—guanethidine
Increase:
dysrhythmias—general anesthetics
Increase:
pressor effect, dysrhythmias—atomoxetine, COMT inhibitors, tricyclics, MAOIs, oxytocics
Decrease:
DOBUTamine action—other β-blockers
•
Hypovolemia;
if present, correct first; administer cardiac glycoside before DOBUTamine
•
Oxygenation/perfusion deficit:
check B/P, chest pain, dizziness, loss of consciousness
•
Heart failure:
S
3
gallop, dyspnea, neck venous distention, bibasilar crackles in patients with CHF, cardiomyopathy, palpate peripheral pulses; report if extremities become cold or mottled or if peripheral pulses decrease
•
ECG
during administration continuously; if B/P increases, product is decreased; CVP or PCWP, cardiac output during inf; report changes
•
Serum electrolytes, urine output
Sulfite sensitivity,
which may be life threatening
•
Storage of reconstituted sol for 24 hr if refrigerated
•
Therapeutic response: increased B/P with stabilization, increased urine output
•
About the reason for product administration;
to report dyspnea, chest pain, numbness of extremities, headache, IV site discomfort
Administer a β
1
-adrenergic blocker; reduce IV or discontinue, ensure oxygenation/ventilation; for severe tachydysrhythmias (ventricular), give lidocaine or propranolol
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(doe-se-tax′el)
Taxotere
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Taxane
Do not confuse:
Taxotere
/Taxol
Inhibits reorganization of microtubule network needed for interphase and mitotic cellular functions; also causes abnormal bundles of microtubules during cell cycle and multiple esters of microtubules during mitosis
Locally advanced or metastatic breast cancer, non–small-cell lung cancer, androgen-independent metastatic prostate cancer, postsurgery operable node-positive breast cancer, induction treatment of locally advanced squamous cell of the head and neck
Unlabeled uses:
Malignant melanoma, ovarian cancer, front-line use with bevacizumab for metastatic breast cancer, adjuvant treatment of breast cancer with CARBOplatin and trastuzumab, gastric adenocarcinoma
Pregnancy (D), breastfeeding, hypersensitivity to this product, bilirubin exceeding upper normal limit
Black Box Warning:
Other products with polysorbate 80, neutropenia of <1500/mm
3
Precautions:
Children, cardiovascular disease, pulmonary disorders, bone marrow depression, herpes zoster, pleural effusion
Black Box Warning:
Edema, hepatic disease, lung cancer, taxane hypersensitivity
•
Other regimens are used
•
Adult: IV
60-100 mg/m
2
given over 1 hr q3wk; if neutrophil count is <500 cells/mm
3
for >1 wk, reduce dose by 25%
•
Adult: IV
(TAC regimen) 75 mg/m
2
1 hr after DOXOrubicin 50 mg/m
2
and cyclophosphamide 500 mg/m
2
q3wk × 6 cycles
•
Adult: IV
(TAC regimen) docetaxel 75 mg/m
2
with cyclophosphamide 600 mg/m
2
q21days × 4 cycles
•
Adult: IV
75 mg/m
2
over 1 hr q3wk; if neutrophil count is <500 cells/mm
3
for >1 wk, reduce dose to 55 mg/m
2
; if patient develops grade 3 peripheral neuropathy, stop product
•
Adult: IV
75 mg/m
2
over 1 hr then CISplatin 75 mg/m
2
IV
given over 30-60 min q3wk; reduce dose to 65 mg/m
2
in those with hematologic or non-hematologic toxicities
•
Adult: IV
75 mg/m
2
given over 1 hr q3wk with 5 mg predniSONE
PO
bid continuously; give dexamethasone 8 mg
PO
at 12 hr, 3 hr, and 1 hr prior to docetaxel; if neutrophil count is <500 cells/mm
3
for more than 1 wk or other toxicities occur, reduce dose to 60 mg/m
2
•
Adult: IV
75 mg/m
2
over 1 hr, then CISplatin 100 mg/m
2
over 1 hr on day 1, then 5FU 1000 mg/m
2
/day
CONT INF
× 5 days, repeat cycle q3wk
•
Adult: IV
75 mg/m
2
q3wk, given with CISplatin, fluorouracil
•
Adult: IV
100 mg/m
2
over 1 hr q3wk
Available forms:
Inj 20 mg/0.5 ml, 20 mg/ml, 80 mg/2 ml, 80 mg/4 ml
•
Premedicate with dexamethasone 8 mg
PO
bid × 3 days starting 1 day prior to treatment
•
Antiemetic 30-60 min before product and prn
•
Use cytotoxic handling procedures
•
Use non-PVC bag and use non-DEHP tubing
•
Allow vials to warm to room temp; withdraw all diluent, inject in vial of docetaxel; rotate gently to mix; allow to stand to decrease foaming, then withdraw the required amount (10 mg/ml), inject in 250 ml of 0.9% NaCl, D
5
W; mix gently; give over 1 hr
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephapirin, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, codeine, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOPamine, doripenem, doxacurium, DOXOrubicin HCL, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, mannitol, meperidine, meropenem, mesna, methotrexate, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, mivacurium, morphine, nafcillin, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, pentamidine,
pentazocine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, polymyxin B, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, riTUXimab, rocuronium, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Seizures
CV:
Hypotension, fluid retention, peripheral edema
, flushing,
MI, sinus tachycardia
GI:
Nausea, vomiting, diarrhea
,
hepatotoxicity,
stomatitis, colitis
HEMA:
Neutropenia, leukopenia, thrombocytopenia, anemia,
bleeding, infections,
myelosuppression
INTEG:
Alopecia
, nail pain, rash, skin eruptions
MISC:
Amenorrhea, fever of unknown origin,
secondary malignancy, Stevens-Johnson syndrome
MS:
Arthralgia, myalgia
, back pain, weakness
NEURO:
Peripheral neuropathy
RESP:
Dyspnea,
pulmonary edema, fibrosis, embolism
SYST:
Hypersensitivity reactions
Metabolized in liver, excreted in feces, terminal half-life 11.1 hr
Increase:
CYP3A inhibition: anastrozole (high doses), aprepitant, fosaprepitant, clarithromycin, conivaptan, delavirdine, efavirenz (induces or inhibits), erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, itraconazole, ketoconazole, mibefradil, nefazodone, voriconazole, and others
Increase:
CYP3A induction: barbiturates, bosentan, carBAMazepine, nevirapine, phenytoin, fosphenytoin, rifabutin, rifampin, rifapentine, troglitazone
Increase:
myelosuppression—other antineoplastics, radiation
Decrease:
immune response—live virus vaccines
Black Box Warning:
CBC, differential, platelet count before treatment and weekly; withhold product if WBC is <1500/mm
3
or platelet count is <100,000/mm
3
; notify prescriber
Black Box Warning:
DOCEtaxel, polysorbate 80 hypersensitivity: contraindicated
Black Box Warning:
Edema: oral corticosteroids should be given as premedication, assess for fluid retention
Black Box Warning:
Lung cancer: increased mortality in those with increased LFTs and a history of platinum-based products
•
Monitor temp; fever may indicate beginning of infection
Black Box Warning:
Hepatic disease:
hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) prn or monthly; check for jaundiced skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
•
CNS changes:
confusion, paresthesias, peripheral neuropathy, dysethenia, pain, weakness; if severe, product should be discontinued
•
VS during 1st hr of inf, check IV site for signs of infiltration
Black Box Warning:
Hypersensitive reactions, anaphylaxis,
including hypotension, dyspnea, angioedema, generalized urticaria; discontinue infusion immediately
•
Bone marrow depression/bleeding:
hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr; obtain prescription for viscous lidocaine (Xylocaine); avoid invasive procedures
•
Effects of alopecia on body image; discuss feelings about body changes
•
Confirmation that dexamethasone was given 12 hr and 6 hr before inf begins
•
Storage of prepared sol up to 27 hr in refrigerator
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report signs of
infection:
fever, sore throat, flulike symptoms
•
To report signs of
anemia:
fatigue, headache, faintness, SOB, irritability
•
To report
bleeding;
to avoid use of razors, commercial mouthwash
•
To avoid use of aspirin, ibuprofen
•
That hair may be lost during treatment; that a wig or hairpiece may make patient feel better; that new hair may be different in color and texture
•
That pain in muscles and joints 2-5 days after inf is common
•
To use barrier contraception during and for several months after treatment, pregnancy (D); to avoid breastfeeding
•
To avoid receiving vaccinations while taking product