Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (211 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(i-foss′fa-mide)
Ifex
Func. class.:
Antineoplastic alkylating agent
Chem. class.:
Nitrogen mustard
Do not confuse:
ifosfamide
/cyclophosphamide
Alkylates DNA, RNA, inhibits enzymes that allow synthesis of amino acids in proteins; also responsible for cross-linking DNA strands; activity is not cell-cycle–stage specific
Testicular cancer
Unlabeled uses:
Soft-tissue sarcoma, Ewing’s sarcoma, non-Hodgkin’s lymphoma, lung/pancreatic sarcoma, bladder, breast, cervical, thymic cancer, desmoid tumor, Ewing’s sarcoma, rhabdomyosarcoma
Pregnancy (D), hypersensitivity
Black Box Warning:
Bone marrow suppression
Precautions:
Breastfeeding, children, renal/hepatic disease, accidental exposure, dehydration, dental disease, infection, IM injection, ocular exposure varicella
Black Box Warning:
Coma, hemorrhagic cystitis
Calculator
•
Adult: IV
1.2-2 g/m
2
/day × 5 days, repeat course q3wk, given with mesna, epirubicin, ondansetron alpha
•
Adult: IV
CCr 31-60 ml/min, give 75% of dose; CCr 10-30 ml/min, give 50% of dose; CCr <10 ml/min, do not give
Available forms:
Inj 1-, 3-g vials
•
Antiemetic 30-60 min before product to prevent vomiting
•
Visually inspect parenteral products for particulate matter and discoloration before use
•
Give as an intermittent infusion or continuous infusion
•
Well hydrate with ≥2 L/day of oral or IV fluids to prevent bladder toxicity
•
Must be given in combination with mesna to prevent hemorrhagic cystitis
•
Close hematologic monitoring is recommended; WBC count, platelet count, and hemoglobin should be obtained before each use and periodically thereafter
•
A urinalysis should be performed before each dose to monitor for hematuria
•
Reconstitute 1 or 3 grams with 20 or 60 ml, respectively, of sterile water for injection or bacteriostatic water for injection containing parabens or benzyl alcohol to give IV solutions containing 50 mg/ml
•
Solutions may be diluted further to achieve concentrations of 0.6–20 mg/ml in the following solutions: 5% dextrose for injection, 0.9% sodium chloride for injection, lactated Ringer’s for injection, or sterile water for injection
•
Infuse slowly over at least 30 min
•
Diluted and reconstituted solutions must be refrigerated and used within 24 hr
Additive compatibilities:
CARBOplatin, CISplatin, etoposide, fluorouracil, mesna
Y-site compatibilities:
Allopurinol, amifostine, amphotericin B cholesteryl, aztreonam, DOXOrubicin liposome, filgrastim, fludarabine, gallium, granisetron, melphalan, ondansetron, PACLitaxel, piperacillin/tazobactam, propofol, sargramostim, sodium bicarbonate, teniposide, thiotepa, vinorelbine
CNS:
Facial paresthesia, fever, malaise, somnolence, confusion, depression, hallucinations, dizziness, disorientation,
seizures, coma,
cranial nerve dysfunction,
encephalopathy
GI:
Nausea, vomiting, anorexia,
hepatotoxicity,
stomatitis, dyslipidemia, hyperglycemia, constipation, diarrhea
GU:
Hematuria, nephrotoxicity, hemorrhagic cystitis,
dysuria, urinary frequency
HEMA:
Thrombocytopenia, leukopenia, anemia,
retrograde ejaculation
INTEG:
Dermatitis, alopecia, pain at inj site, hyperpigmentation
META:
Metabolic acidosis
Metabolized by liver, saturation occurs at high doses, excreted in urine, half-life 7-15 hr, depends on dose
Increase:
myelosuppression—other antineoplastics, radiation
Increase:
toxicity—CYP3A4, a weak P-gp inhibitor, inducers, barbiturates, allopurinol
Increase:
bleeding risk—NSAIDs, anticoagulants, salicylates, thrombolytics
Decrease:
antibody response—live virus vaccines
Decrease:
effect of ifosfamide—CYP3A4 inhibitors
•
Do not use within 24 hr of hematopoietic progenitor cells
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) monthly or as needed; jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
Black Box Warning:
CBC, differential, platelet count weekly; withhold product if WBC <2000 or platelet count <50,000; notify prescriber; severe myelosuppression may occur
•
Monitor temp (may indicate beginning infection)
•
Blood dyscrasias (anemia, granulocytopenia); bruising, fatigue, bleeding, poor healing
•
Allergic reactions: dermatitis, exfoliative dermatitis, pruritus, urticaria
Black Box Warning:
I&O ratio; monitor for hematuria; hemorrhagic cystitis can occur; increase fluids to 3 L/day; urinalysis before each dose, not to give at night
Black Box Warning:
Neurologic symptoms: hallucinations, confusion, disorientation, coma; product should be discontinued
•
Bleeding: hematuria, guaiac, bruising or petechiae, mucosa or orifices
•
Storage of powder at room temp
•
Therapeutic response: decrease in size and spread of tumor
•
To notify prescriber of sore throat, swollen lymph nodes, malaise, fever; other infections may occur
•
Not to have vaccinations during or after treatment
•
That hair may be lost during treatment; that wig or hairpiece may make the patient feel better; that new hair may be different in color, texture
•
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 products, NSAIDs, ibuprofen because hemorrhage can occur
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (D)
•
To use contraceptive measures during therapy; not to breastfeed
•
To avoid crowds, persons with infections
•
To report confusion, hallucinations, extreme drowsiness, numbness, tingling; to avoid alcohol use for ≥4 mo after treatment
•
To avoid driving, hazardous activities until reaction is known
•
To use excessive fluids and urinate often to prevent hemorrhagic cystitis
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ill-o-pehr′ih-dohn)
Fanapt
Func. class.:
Antipsychotic
Chem. class.:
Benzisoxazole derivative
Unknown; may be mediated through both dopamine type 2 (D2) and serotonin type 2 (5-HT2) antagonism
Schizophrenia
Breastfeeding, hypersensitivity
Precautions:
Pregnancy (C), children, geriatric patients, renal/hepatic disease,
breast cancer, Parkinson’s disease, dementia with Lewy bodies, seizure disorder, QT prolongation, bundle branch block, acute MI, ambient temperature increase, AV block, stroke, substance abuse, suicidal ideation, tardive dyskinesia, torsade de pointes, blood dyscrasias
Black Box Warning:
Increased mortality in elderly patients with dementia-related psychosis
Calculator
• Adult: PO
1 mg bid day 1, 2 mg bid day 2, 4 mg bid day 3, 6 mg bid day 4, 8 mg bid day 5, 10 mg bid day 6, 12 mg bid day 7; max 24 mg/day in 2 divided doses; reduce dose by 50% in patient who is a poor metabolizer of CYP2D6 or when used with strong CYP2D6/CYP3A4 inhibitors
Available forms:
Tabs 1, 2, 4, 6, 8, 10, 12 mg; titration pack
•
Use without regard to meals
•
Reduced dose in geriatric patients
•
Anticholinergic agent for EPS
•
Avoid use with CNS depressants
CNS:
EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia; drowsiness
,
seizures, neuroleptic malignant syndrome,
dizziness, delirium, depression, paranoia, fatigue, hostility, lethargy, restlessness, vertigo, tremor
CV:
Orthostatic hypotension,
heart failure, AV block, QT prolongation,
tachycardia
EENT:
Blurred vision, cataracts, nystagmus, tinnitus
GI:
Nausea
, vomiting,
anorexia, constipation
, jaundice, weight gain/loss, abdominal pain, stomatitis
GU:
Hyperprolactinemia, urinary retention/incontinence, testicular pain,
renal failure
HEMA:
Agranulocytosis, leukopenia, neutropenia
MISC:
Renal artery occlusion, hyperglycemia, dyslipidemia
PO:
Extensively metabolized by liver to major active metabolite by CYP2D6, CYP3A4; protein binding 95%; peak 2-4 hr; excreted in urine and feces; terminal half-life 18 hr in extensive metabolizers; 33 hr in poor metabolizers
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRI
Increase:
sedation—other CNS depressants, alcohol
Increase:
iloperidone effect, decreased clearance—CYP2D6, CYP3A4 inhibitors (delavirdine, indinavir, isoniazid, itraconazole, dalfopristin, ritonavir, tipranavir), reduce dose
Increase:
QT prolongation—class IA/ III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, methadone, chloroquine, clarithromycin, droperidol, erythromycin, pentamidine
Decrease:
iloperidone action—CYP2D6, CYP3A4 inducers (carBAMazepine, barbiturates, phenytoins, rifampin)
Increase:
prolactin levels, cholesterol, glucose, lipids, triglycerides
Decrease:
potassium
•
Mental status before initial administration
•
I&O ratio; palpate bladder if urinary output is low
•
Bilirubin, CBC, hepatic studies monthly, monitor glucose, hyperglycemia may occur
•
Urinalysis before, during prolonged therapy, monitor potassium, magnesium and lipid panel
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep-pattern disturbances
•
B/P standing and lying; pulse, respirations; q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch
for ECG changes; QT prolongation may occur; dizziness, faintness, palpitations, tachycardia on rising
•
EPS, including akathisia, tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
Black Box Warning:
Serious reactions in the geriatric patient:
fatal pneumonia, heart failure, sudden death, not to be used in the elderly with dementia
Black Box Warning:
Neuroleptic malignant syndrome:
hyperthermia, increased CPK, altered mental status, muscle rigidity
•
Constipation, urinary retention daily; if these occur, increase bulk and water in diet
•
Weight gain, hyperglycemia, metabolic changes in diabetes
•
Supervised ambulation until patient is stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for long periods
•
Sips of water, candy, gum for dry mouth
•
Storage in tight, light-resistant container (PO)
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech
•
That orthostatic hypotension may occur; to rise from sitting or lying position gradually
•
To avoid hot tubs, hot showers, tub baths because hypotension may occur; that heat stroke may occur in hot weather; to take extra precautions to stay cool
•
To avoid abrupt withdrawal of product because EPS may result; that product should be withdrawn slowly, to review symptoms of neuroleptic malignant syndrome
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber because serious product interactions may occur; to avoid use of alcohol because increased drowsiness may occur
•
To avoid hazardous activities if drowsy or dizzy
•
To comply with product regimen
•
To report impaired vision, tremors, muscle twitching
•
To use contraception; to inform prescriber if pregnancy is planned or suspected
Lavage if orally ingested; provide airway;
do not induce vomiting