Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (21 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(add-a-lim′yu-mab)
Humira
Func. class.:
Antirheumatic agent (disease modifying), immunomodulator, anti-TNF
Chem. class.:
Recombinant human IgG1 monoclonal antibody, DMARD
Do not confuse:
Humira
/Humulin/Humalog
A form of human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF); elevated levels of TNF are found in patients with rheumatoid arthritis
Reduction of signs and symptoms and inhibition of progression of structural damage in patients with moderate to severe active rheumatoid arthritis who are ≥18 years of age and who have not responded to other disease-modifying agents, juvenile rheumatoid arthritis (JRA), psoriatic arthritis, Crohn’s disease, moderate to severe plaque psoriasis, ankylosing spondylitis, ulcerative colitis
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, CNS
demyelinating disease, lymphoma, CHF, hepatitis B carriers, manitol hypersensitivity, latex allergy, neoplastic disease
Black Box Warning:
Active infections, risk of lymphomas/leukemias, TB
Calculator
• Adult:SUBCUT
40 mg every other wk or every wk if not combined with methotrexate;
IV
(unlabeled) 0.25-3 mg/kg q2-4wk
• Child
≥
4 yr/adolescent
≥
30 kg: SUBCUT
40 mg every other wk
• Child ≥4 yr/adolescent ≥15 kg to <30 kg: SUBCUT
20 mg every other wk
• Child
≥
4 yr/adolescent
<
15 kg: SUBCUT
24 mg/m
2
BSA (up to 40 mg total) every other wk, then 20 mg every other wk
• Adult:SUBCUT
160 mg given as 4 inj on day 1 or 2 inj each on days 1 and 2, then 80 mg at wk 2 and 40 mg every other wk starting at wk 4
• Adult:SUBCUT
80 mg baseline as 2 inj then 40 mg every other wk starting 1 wk after initial dose × 16 wk
Available form:
Inj 40 mg/0.8 ml; 20 mg/0.4 ml (pediatric)
•
Do not admix with other sol or medications; do not use filter; protect from light; give at 45-degree angle using abdomen, thighs; rotate inj sites; discard unused portions
CNS:
Headache
CV:
Hypertension
EENT:
Sinusitis
GI:
Abdominal pain, nausea, hepatic damage
HEMA:
Leukopenia pancytopenia, aplastic anemia, agranulocytopenia
INTEG:
Rash, inj site reaction
MISC:
Flulike symptoms, UTI, back pain, lupus-like syndrome,
increased cancer risk,
antibody development to this drug;
risk of infection (TB, invasive fungal infections, other opportunistic infections), may be fatal, Stevens-Johnson syndrome, anaphylaxis
RESP:
URI
,
pulmonary fibrosis, bronchitis
Absorption 65%, terminal half-life 2 wk, lower clearance with advancing age (40-75 yr), high RA factor
Increase:
serious infections—other TNF blockers, rilonacept
•
Do not use with anakinra, serious infections may occur
•
Do not give concurrently with vaccines; immunizations should be brought up to date before treatment
Increase:
ALT, cholesterol
•
RA:
pain, stiffness, ROM, swelling of joints before, during treatment
•
For inj site pain, swelling, redness; usually occur after 2 inj (4-5 days), use cold compress to relieve pain/swelling
Black Box Warning:
For infections (fever, flulike symptoms, dyspnea, change in urination, redness/swelling around any wounds), stop treatment if present; some serious infections including sepsis may occur, may be fatal; patients with active infections should not be started on this product
•
May reactivate hepatitis B in chronic carriers, may be fatal
Black Box Warning:
Latent TB before therapy, treat before starting this product
•
Anaphylaxis, latex allergy:
stop therapy if lupuslike syndrome develops
•
Blood dyscrasias:
CBC, differential periodically
Black Box Warning:
For neoplastic disease (lymphomas/leukemia) in children, adolescents, hepatosplenic T-cell lymphoma is more likely in adolescent males with Crohn’s disease or ulcerative colitis
•
Therapeutic response: decreased inflammation, pain in joints, decreased joint destruction
•
About self-administration if appropriate: inj should be made in thigh, abdomen, upper arm; rotate sites at least 1 inch from old site; do not inject in areas that are bruised, red, hard
•
That if medication is not taken when due, inject next dose as soon as remembered and inject next dose as scheduled
•
Not to take any live virus vaccines during treatment
•
To report signs of infection, allergic reaction, or lupuslike syndrome, immediately
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(add-ee-foh′veer)
Hepsera
Func. class.:
Antiviral
Chem. class.:
Adenosine monophosphate analog
Inhibits hepatitis B virus DNA polymerase by competing with natural substrates and by causing DNA termination after its incorporation into viral DNA; causes viral DNA death
Chronic hepatitis B
Hypersensitivity
Precautions:
Pregnancy (C), labor, breastfeeding, children, geriatric patients, dialysis, females, obesity, organ transplant
Black Box Warning:
Severe renal disease, impaired hepatic function, lactic acidosis, HIV
Calculator
• Adult/adolescent: PO
10 mg/day, optimal duration unknown
• Adult: PO
CCr ≥50 ml/min 10 mg q24hr; CCr 30-49 ml/min 10 mg q48hr; CCr 10-29 ml/min 10 mg q72hr; hemodialysis 10 mg q7days after dialysis
Available forms:
Tabs 10 mg
•
By mouth without regard for food
•
Take with full glass of water
CNS:
Headache
GI:
Dyspepsia
, abdominal pain, nausea, vomiting, diarrhea, hepatomegaly, flatulence,
pancreatitis
GU:
Hematuria, glycosuria,
nephrotoxicity, Fanconi syndrome, renal failure
MISC:
Fever, rash, weight loss, cough
PO:
Rapidly absorbed from GI tract, peak 1
3
/
4
hr, excreted by kidneys 45%, terminal half-life 7.48 hr
•
Do not use in combination with emtricitabine/tenofovir, emtricitabine/rilpivirine, emtricitabine/efavirenz/tenofovir
Increase:
serum conc and possible toxicity—aminoglycosides, memantine, emtricitabine, efavirenz, dofetilide, digoxin, cyclosporine, amiloride, quiNINE, quiNIDine, procainamide, pemetrexed, midodrine, metFORMIN, NSAIDs, vancomycin, trospium, triamterene, tenofovir, tacrolimus, ranitidine, cimetidine, morphine
Black Box Warning:
Increase:
lactic acidosis, severe hepatomegaly, NNRTIs, NRTIs, antiretroviral protease inhibitors
Increase:
ALT, AST, amylase, creatine kinase
Black Box Warning:
Nephrotoxicity: increasing CCr, BUN
Black Box Warning:
HIV antibody testing before beginning treatment, HIV resistance may occur in chronic hepatitis B patients
Black Box Warning:
For lactic acidosis, severe hepatomegaly with stenosis; for use of NNRTIs, NRTIs, antiretroviral protease inhibitors (PIs), lactic acidosis with severe hepatomegaly is more common in females, obese patients, and with prolonged nucleoside use
•
Geriatric patients more carefully; may develop renal, cardiac symptoms more rapidly
Black Box Warning:
For exacerbations of hepatitis after discontinuing treatment, monitor LFTs, hepatitis B serology
•
Pregnancy: If planned or suspected; if pregnant call the Pregnancy Registry 800-258-4263
•
Storage in cool environment; protect from light
•
Therapeutic response: decreased symptoms of chronic hepatitis B, improving LFTs
•
That optimal duration of treatment is unknown, that product is not a cure, that transmission may still occur
•
To avoid use with other medications unless approved by prescriber
•
To notify prescriber of decreased urinary output
•
Not to stop abruptly unless directed, worsening of hepatitis may occur
•
To report immediately dyspnea, nausea, vomiting, abdominal pain, weakness, dizziness, cold extremities
•
To notify prescriber if pregnancy is planned or suspected, avoid breastfeeding