Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (142 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(dox-oh-roo′bi-sin)
Adriamycin
Func. class.:
Antineoplastic, antibiotic
Chem. class.:
Anthracycline glycoside
Do not confuse:
DOXOrubicin /
DOXOrubicin liposomal/DAUNOrubicin
Inhibits DNA synthesis primarily; replication is decreased by binding to DNA, which causes strand splitting; active throughout entire cell cycle; a vesicant
Wilms’ tumor; bladder, breast, lung, ovarian, stomach, thyroid cancer; Hodgkin’s/non-Hodgkin’s disease; acute lymphoblastic leukemia; myeloblastic leukemia; neuroblastomas; lymphomas; soft tissue/bone sarcomas
Pregnancy (D) 1st trimester, breastfeeding, hypersensitivity, systemic infections, cardiac disorders, severe myelosuppression, lifetime dose of 550 mg/m
2
Black Box Warning:
Hepatic disease
Precautions:
Accidental exposure, cardiac disease, dental work, electrolyte imbalance, infection, hyperuricemia
Black Box Warning:
Bone marrow suppression, extravasation, heart failure, secondary malignancy; requires an experienced clinician
Calculator
•
Adult: IV
60-75 mg/m
2
every 3 wk, or may be used in combination with other antineoplastics with 40-60 mg/m
2
every 21-28 days, max cumulative dose 550 mg/m
2
or 450 mg/m
2
if prior DAUNOrubicin, cyclophosphamide, mediastinal XRT
Adult: IV
Bilirubin 1.2-3 mg/dl, give 50% of dose; bilirubin 3.1-5 mg/dl, give 25% of dose
Adult: IV
CCr < 10 ml/min give 75% of dose
Available forms:
Powder for inj 10, 20, 50 mg; inj 2 mg/ml
•
Give antiemetic 30-60 min before product to prevent vomiting
•
Give allopurinol or sodium bicarbonate to maintain uric acid levels, alkalization of urine
•
Use cytotoxic handling procedures: Inspect for particulate and discoloration before use
Black Box Warning:
Do not give IM, subcut
Black Box Warning:
If extravasation occurs, stop infusion and complete via another vein, preferably in another limb
•
Aluminum needles may be used during administration, avoid aluminum during storage
•
Rapid injection can cause facial flushing or erythema along the vein
•
To avoid risks with reconstitution, the commercially available injection may be used; there are still risks involved in handling the injection
•
Do not use diluents containing preservatives to reconstitute powder for injection
•
Reconstitute 10, 20, 50, 100 mg of DOXOrubicin with 5, 10, 25, 50 ml, respectively, of nonbacteriostatic NS injection (2 mg/ ml), shake until completely dissolved; use reconstituted solution within 24 hr. Do not expose to sunlight
•
IV injection
Inject reconstituted solution over >3–5 min via
Y
-site or 3-way stopcock into a free-flowing IV infusion of NS or D
5
W. A butterfly needle inserted into a large vein is preferred.
Black Box Warning:
Care should be taken to avoid extravasation because the drug is extremely irritating to extravascular tissue
Y-site compatibilities:
Alemtuzumab, alfentanil, amifostine, amikacin, anidulafungin, argatroban, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceftizoxime, chlorproMAZINE, cimetidine, ciprofloxacin, CISplatin, cladribine, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, gemcitabine, gentamicin, granisetron, haloperidol, hydrocortisone, HYDROmorphone, ifosfamide, imipenem cilastatin, inamrinone, isoproterenol, ketorolac, labetalol, leucovorin, levorphanol, lidocaine, linezolid, LORazepam, mannitol, mechlorethamine, melphalan, meperidine, mesna, methotrexate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, mitoMYcin, morphine, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pancuronium, phenylephrine, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, quinupristin-dalfopristin, ranitidine, sargramostim, sodium acetate, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, zidovudine, zoledronic acid
CV:
Increased B/P, sinus tachycardia, PVCs, chest pain, bradycardia, extrasystoles,
irreversible cardiomyopathy, acute left ventricular failure
GI:
Nausea, vomiting
, anorexia,
mucositis
,
hepatotoxicity
GU:
Impotence, sterility, amenorrhea, gynecomastia, hyperuricemia, urine discoloration
HEMA:
Thrombocytopenia, leukopenia, anemia
INTEG:
Rash
,
necrosis at inj site,
dermatitis, reversible
alopecia
, cellulitis, thrombophlebitis at inj site
SYST:
Anaphylaxis
Half-life 30 min, terminal 16.5 hr; metabolized by liver; crosses placenta; excreted in urine, bile, breast milk
Increase:
life-threatening dysrhythmias—posaconazole, fluconazole, do not use together
Increase:
QT prolongation—other drugs that increase QT prolongation
Increase:
neutropenia, thrombocytopenia—progesterone
Increase:
Cardiomyopathy—calcium-channel blockers
Increase:
Toxicity—other antineoplastics, cycloSPORINE, radiation, mercaptopurine
Increase:
Hemorrhagic cystitis risk, cardiac toxicity—cyclophosphamide
Increase:
Effect of phenytoin, fosphenytoin
Increase:
DOXOrubicin effect—streptozocin
Decrease:
DOXOrubicin effect—PHENobarbital
Decrease:
Antibody response—live virus vaccine
Decrease:
Antineoplastic effect—hematopoietic progenitor cell; do not use 24 hr before or after treatment
Decrease:
Clearance of DOXOrubicin—PACLitaxel
Increase:
uric acid
Black Box Warning:
Bone marrow depression:
CBC, differential, platelet count weekly; withhold or reduce dose of product if WBC is <1500/mm
3
or platelet count is <50,000/mm
3
; notify prescriber of these results
Renal studies:
BUN, serum uric acid, urine CCr, electrolytes before, during therapy
I&O ratio:
Report fall in urine output to <30 ml/hr
Monitor temp:
Fever might indicate beginning infection
Black Box Warning:
Hepatotoxicity:
hepatic studies before, during therapy: bilirubin, AST, ALT, alk phos as needed or monthly; check for jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
Black Box Warning:
Dysrhythmias:
ECG; watch for ST-T wave changes, low QRS and T, possible dysrhythmias (sinus tachycardia, heart block, PVCs), ejection fraction before treatment, signs of irreversible cardiomyopathy, can occur up to 6 mo after treatment begins
•
Bleeding: hematuria, guaiac, bruising, petechiae of mucosa or orifices every 8 hr
•
Effects of alopecia on body image; discuss feelings about body changes; almost total alopecia is expected
•
Buccal cavity every 8 hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
•
Alkalosis if severe vomiting is present
Black Box Warning:
Extravasation:
local irritation, pain, burning at inj site; a vesicant; if extravasation occurs, stop drug, restart at another site, apply ice, elevate extremity to reduce swelling; if resolution does not occur, surgical debridement may be required
•
GI symptoms: frequency of stools, cramping
•
Increased fluid intake to 2-3 L/day to prevent urate, calculi formation
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
•
Storage at room temp for 24 hr after reconstituting
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To add 2-3 L of fluids unless contraindicated before and for 24-48 hr after to decrease possible hemorrhagic cystitis
•
To report any complaints, side effects to nurse or prescriber
•
That hair may be lost during treatment; that wig or hairpiece might make patient feel better; that new hair might be different in color, texture
•
To avoid foods with citric acid, hot or rough texture
•
To report any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily
•
That urine, other body fluids may be red-orange for 48 hr
•
To avoid crowds and persons with infections when granulocyte count is low
•
That barrier contraceptive measures are recommended during therapy and for 4 mo after (pregnancy [D]); to avoid breastfeeding
•
To avoid vaccinations