Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (156 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(er′i-bu′lin)
Halaven
Func. class.:
Antineoplastics—non-taxane
Do not confuse:
eribulin
/epirubicin/erlotinib
Potent antimitotic agent, different from taxanes, vinca alkaloids, epothilones; blocks cell progression during G2-M phase; inhibits the growth phase of microtubules and sequesters tubules, leading to the disruption of mitotic spindles and apoptotic cell death
Metastatic breast cancer in patients who have received at least 2 chemotherapy regimens
Hypersensitivity, pregnancy (D)
Precautions:
Breastfeeding, neonates, infants, children, bradycardia, electrolyte imbalances, heart failure, hypokalemia, hypomagnesemia, infertility, neutropenia, peripheral neuropathy, QT prolongation, hepatic/renal disease
Calculator
• Adult:
IV
1.4 mg/m
2
over 2-5 min on days 1 and 8, repeat q21days
•
Recommendations for dose delay:
for ANC <1000/mm
3
, platelets <75,000/mm
3
, or grade 3 or 4 nonhematologic toxicities: do not administer; the day 8 dose may be delayed a maximum of 1 wk; for the day 8 dose, if toxicities do not resolve to ≤ Grade 2 by day 15: omit the dose; for the day 8 dose, if toxicities resolve or improve to ≤ Grade 2 by day 15: administer eribulin at reduced dose (see below), initiate the next cycle no sooner than 2 wk later
•
Dose adjustments for hematologic toxicity:
ANC <500/mm
3
for >7 days or ANC <1000/mm
3
with fever or infection: permanently reduce dose to 1.1 mg/m
2
; platelets <25,000/mm
3
or <50,000/mm
3
requiring transfusion: permanently reduce dose to 1.1 mg/m
2
; if day 8 of previous cycle omitted or delayed: permanently reduce dose to 1.1 mg/m
2
; while receiving 1.1 mg/m
2
, if recurrence of hematologic event occurs, or if day 8 of previous cycle omitted or delayed: permanently reduce dose to 0.7 mg/m
2
; while receiving 0.7 mg/m
2
, if recurrence of hematologic event occurs, or if day 8 of previous cycle omitted or delayed: discontinue
•
Dose adjustments of eribulin for nonhematologic toxicity during treatment:
any Grade 3 or 4 nonhematologic toxicity: permanently reduce dose to 1.1 mg/m
2
; if day 8 of previous cycle omitted or delayed: permanently reduce dose to 1.1 mg/m
2
; while receiving 1.1 mg/m
2
, if recurrence of Grade 3 or 4 nonhematologic toxicity occurs, or if day 8 of previous cycle omitted or delayed: permanently reduce dose to 0.7 mg/m
2
; while receiving 0.7 mg/m
2
, if recurrence of Grade 3 or 4 nonhematologic toxicity occurs, or if day 8 of previous cycle omitted or delayed: discontinue
Available forms:
Sol for inj 1 mg/2 ml
•
Visually inspect for particulate matter, discoloration as solution and container permit; withdraw required amount (0.5 mg/ml) from single-use vial, give undiluted over 2-5 min or diluted in 100 ml 0.9% NaCl and give as intermittent inf; do not give through line with dextrose or any other product
CNS:
Depression, dizziness,
fatigue
, fever, headache, insomnia,
peripheral neuropathy
CV:
QT prolongation,
peripheral edema
GI:
Abdominal pain, anorexia, constipation, diarrhea, dyspepsia, nausea, vomiting, weight loss
HEMA:
Anemia, neutropenia, thrombocytopenia
INTEG:
Alopecia
, rash, stomatitis
META:
Hypokalemia
MS:
Arthralgia, myalgia, bone/back pain
RESP:
Cough, dyspnea
SYST:
Infection
Protein binding 49%-65%; inhibits CYP3A4; excreted in feces 82%; urine 9%; elimination half-life 40 hr; increased levels in hepatic/renal disease
Increase:
QT prolongation—arsenic trioxide, astemizole, bepridil, chloroquine, certain phenothiazines (chlorproMAZINE, mesoridazine, thioridazine), cisapride, clarithromycin, class IA antiarrhythmics (disopyramide, procainamide, quiNIDine), class III antiarrhythmics (amiodarone, bretylium, dofetilide, ibutilide, sotalol), dextromethorphan; quiNIDine, dronedarone, droperidol, erythromycin, halofantrine, haloperidol, levomethadyl, methadone, pentamidine, pimozide, posaconazole, probucol, propafenone, saquinavir, sparfloxacin terfenadine, troleandomycin, and ziprasidone; also to a lesser degree abarelix, alfuzosin, amoxapine, apomorphine, artemether; lumefantrine, asenapine, β-agonists, ofloxacin, cloZAPine, cyclobenzaprine, dasatinib, dolasetron, flecainide, gatifloxacin, gemifloxacin, halogenated anesthetics, iloperidone, lapatinib, levofloxacin, local anesthetics, lopinavir; ritonavir, magnesium sulfate; potassium sulfate; sodium sulfate, maprotiline, mefloquine, moxifloxacin, nilotinib, norfloxacin, octreotide, ciprofloxacin, OLANZapine, ondansetron, paliperidone, palonosetron, some phenothiazines (fluPHENAZine, perphenazine, prochlorperazine, trifluoperazine), QUEtiapine, ranolazine, risperiDONE, sertindole, SUNItinib, tacrolimus, telavancin, telithromycin, tetrabenazine, tricyclic antidepressants, venlafaxine, vardenafil, vorinostat
•
Peripheral neuropathy: pain, numbness in extremities
•
Infection: increased temperature, sore throat, flulike symptoms
•
QT prolongatation:
assess for drug interactions that may occur; monitor ECG, heart rate
•
Bone marrow depression:
CBC, differential, serum creatinine, BUN, electrolytes, LFTs at baseline, periodically; increased AST/ALT >3 × ULN or total bilirubin >1.5 × ULN involve greater chance of Grade 4 or febrile neutropenia
•
Storage at room temp for 4 hr or 24 hr refrigerated
•
Infection:
to notify prescriber of increased temperature, sore throat, fatigue, flulike symptoms
•
QT prolongation:
to report extra heart beats
•
Peripheral neuropathy:
to report tingling, pain in extremities
•
About reason for product and expected results
•
To avoid other medications, supplements unless approved by provider; serious drug interactions may occur
•
About hair loss, use of wig or hairpiece
•
To notify prescriber if pregnancy is planned or suspected (pregnancy [D]), to avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(er-loe′tye-nib)
Tarceva
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Epidermal growth factor receptor inhibitor
Not fully understood; inhibits intracellular phosphorylation of cell-surface receptors associated with epidermal growth factor receptors
Non–small-cell lung cancer (NSCLC), pancreatic cancer
Unlabeled uses:
Squamous cell head and neck cancer
Pregnancy (D), breastfeeding
Precautions:
Children, geriatric patients, ocular/pulmonary/renal/hepatic disorders, bradycardia, heart failure, hypokalemia, infertility, QT prolongation
Calculator
• Adult:
PO
150 mg/day
• Adult:
PO
100 mg/day in combination with gemcitabine 1000 mg/m
2
cycle 1, days 1, 8, 15, 22, 29, 36, 43 of 8-wk cycle; cycle 2 and subsequent cycle, days 1, 8, 15 of 4-wk cycle
•
Dosage increase is advised
•
Dosage reduction may be needed
• Adult:
PO
interrupt if total bilirubin >3 times ULN and/or transaminases >5 times ULN
• Adult:
PO
150 mg daily
Available forms:
Tabs 25, 100, 150 mg
•
1 hr before or 2 hr after food; at same time of day
CNS:
CVA,
anxiety, depression, headache, rigors
CV:
MI/ischemia
EENT:
Ocular changes,
conjunctivitis, eye pain
GI:
Nausea, diarrhea, vomiting, anorexia, mouth ulceration
,
hepatic failure, GI perforation
GU:
Renal impairment/failure
HEMA:
Deep vein thrombosis
INTEG:
Rash
,
Stevens-Johnson–like skin reaction, toxic epidermal necrolysis
MISC:
Fatigue, infection
RESP:
Interstitial lung disease,
cough, dyspnea
,
ARDS, pulmonary fibrosis
SYST:
Hepatorenal syndrome
Slowly absorbed (60%); peak 3-7 hr; excreted in feces (86%), urine (<4%); metabolized by CYP3A4; terminal half-life 36 hr; protein binding 93%
Increase:
GI bleeding, may be fatal—warfarin
Increase:
erlotinib concentrations—CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin, telithromycin)
Increase:
plasma concentration of warfarin, metoprolol
Increase:
myopathy—HMG-CoA reductase inhibitors
Decrease:
erlotinib levels—CYP3A4 inducers (phenytoin, rifampin, carBAMazepine, PHENobarbital), proton-pump inhibitors
Decrease:
erlotinib levels—St. John’s wort
Decrease:
erlotinib level; dose may need to be increased
Increase:
effect of erlotinib—grapefruit juice
•
Serious skin toxicities: toxic epidermal necrolysis, Stevens-Johnson syndrome
MI/ischemia, CVA
in patients with pancreatic cancer
Pulmonary changes:
lung sounds, cough, dyspnea; interstitial lung disease may occur, may be fatal; discontinue therapy if confirmed
•
Ocular changes:
eye irritation, corneal erosion/ulcer, aberrant eyelash growth
•
GI symptoms: frequency of stools; if diarrhea is poorly tolerated, therapy may be discontinued for ≤14 days, monitor for dehydration, fluid status during period of vomiting and diarrhea
•
Blood studies: INR, LFTs, PT
•
Hepatic failure:
interrupt dosing if severe changes to liver function occur (total bilirubin >3× ULN and/or transaminases >5× ULN when normal pretreatment LFTs)
•
GI perforation/bleeding:
some cases have been fatal
•
Therapeutic response: decrease in NSCLC cells, pancreatic cancer cells
To report adverse reactions immediately: SOB, severe abdominal pain, persistent diarrhea or vomiting, ocular changes, skin eruptions
•
About reason for treatment, expected results
•
To use reliable contraception during treatment (pregnancy D); to avoid breastfeeding
•
To avoid use with other products, herbs, supplements unless approved by provider
•
To avoid smoking, decreases effect of this product