Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (215 page)
(IMIG/IGIM) (Rx)
Bay Gam 15%, Flebogamma 5%, Flebogamma DIF 5%, Gammagard, Gamunex 10%, Privigen 10%, Vivaglobin 10%
(IGIV, IVIG) (Rx)
Bay Gam 15%, Carimune NF, Flebogamma 5%, Flebogamma 10% DIF, Gammagard S/D, Gammagard Liquid 10%, Gammaked, Gammaplex, Gammar-P IV, Gamunex, Iveegam EN, Polygam S/D, Privigen, Vivaglobin
(SCIG/IGSC)
Bay Gam 15%, Flebogamma 5%, Flebogamma DIF 5%, Gammagard 10%, Gammaked, Gammaplex, Gamunex 10%, Privigen 10%, Vivaglobin, Hizentra
Func. class.:
Immune serum
Chem. class.:
IgG
Provides passive immunity to hepatitis A, measles, varicella, rubella, immune globulin deficiency; contains gamma globulin antibodies (IgG)
Immunodeficiency syndrome; B-cell chronic lymphocytic leukemia; Kawasaki syndrome; bone marrow transplantation; pediatric HIV infection; agammaglobulinemia; hepatitis A, B exposure; measles exposure; measles vaccine complications; purpura; rubella exposure; chickenpox exposure; chronic inflammatory demyelinating polyneuropathy
Unlabeled uses:
IV posttransfusion purpura, Guillain-Barré syndrome, refractory pemphigus vulgaris, West Nile virus, meningitis, myasthenia gravis, thrombocytopenia encephalitis, HIV, cytomegalovirus, neonatal jaundice, RSV infection, primary humoral immunodeficiency, refractory pemphigus vulgaris
Coagulopathy, hemophilia, IgA deficiency, thrombocytopenia
Precautions:
Pregnancy (C), breastfeeding, children, agammaglobulinemia, bleeding, hypogammaglobulinemia, infection, IV, viral infection
Calculator
• Adult/geriatric/adolescent/child/infant (unlabeled): IM
0.02 ml/kg for those who have not received hepatitis A vaccine and been exposed during the prior 2 wk
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Adult: IM
0.25 ml/kg (immunocompetent)
• Child (unlabeled): IM
0.5 ml/kg as a single dose, max 15 ml (immunocompromised)
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Adult: IM
0.6-1.2 ml/kg as soon as possible and if varicella-zoster immune globulin is not available
• Adult pregnant women: IM
0.55 ml/kg
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Adult: IM
1.32 ml/kg then 0.66 ml/kg (≥100 mg/kg) q3-4wk
• Adult/adolescent/child: IV
300-600 mg/kg q3-4wk
• Adult/adolescent/child: IV
100 mg/kg/mo; initially 200-400 mg/kg may be used
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Adult: IV
200-400 mg/kg q3-4wk
• Adolescent/child: IV
200 mg/kg q3-4wk
• Adult/adolescent/child: IV INF
300-600 mg/kg (3-6 ml/kg) q3-4wk, initial inf rate 1 mg/kg/min (max 8 mg/kg/min)
• Adult/adolescent/child: IV
200 mg/kg monthly, max 800 mg/kg/mo
• Adult/adolescent/child: IV
200 mg/kg/mo
• Adult/adolescent/child: IV
300-600 mg/kg q3-4wk
• Adult/adolescent/child ≥3 yr: IV
200-800 mg q3wk
• Adult/child: IV
400 mg/kg daily × 2-5 days; with acute ITP of childhood, only 2 of 5 days are needed if initial platelets are 30,000-50,000 mcl after 2 doses
• Adult/adolescent/child: IV
1000 mg/kg as a single dose; may give on alternate days for up to 3 doses
• Adult/adolescent/child: IV INF
total dose of 2000 mg/kg divided as 1000 mg/kg (10 ml/kg), give on 2 consecutive days; initial rate is 1 mg/kg/min (max 8 mg/kg/min); if after 1st dose adequate platelets are observed after 24 hr, may withhold 2nd dose
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Adult/adolescent ≥15 yr: IV
1 g/kg/day × 2 days
• Child: IV
400 mg/kg daily × 4 consecutive days or a single dose of 2000 mg/kg over 10 hr, given with aspirin 100 mg/kg/day through 14th day of illness, then 3-5 mg/kg each day thereafter for 5 wk
• Infant/child: IV
1000 mg/kg as a single dose or 400 mg/kg/day × 4 days beginning within 7 days of fever onset, with aspirin 80-100 mg/kg/day × 4 divided doses
• Adult/child >2 yr: SUBCUT INF
100-200 mg/kg q wk,
Vivaglobin
brand of SCIG 160 mg IgG/ml,
SUBCUT
inj 15 ml/inj site, given at max of 20 ml/hr
• Adult/child:
1.53 times previous IGIV dose in grams divided by number of wk between IGIV dose, multiply dose in q × 5 for dose in ml, adjust by 1.3 trough before last IGIV treatment, give by subcut infusion weekly
Available forms: IM:
Inj 2-, 10-ml vial (Bay Gam);
IV:
5%, 10% sol (Gamimune N); powder for inj 1-, 3-, 6-, 12-g vials (Carimune NF); 50 mg protein/ml in 2.5-, 5-, 10-g vials (Gammagard S/D); 1-, 2.5-, 5-, 10-g vials (Gammar-P IV); 500 mg, 1-, 2.5-, 5-g vials (Iveegam); 6-, 12-g vials (Panglobulin); 2.5-, 5-, 10-g vials (Polygam S/D); sol for inj 1-, 2.5-, 5-, 10-, 20-g vials (Gamunex); Human sol for inj: Flebogamma 5%, 10% DIF; subcut inj 10, 16, 20% single use
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IM ≤3 ml at 1 site; use large muscle mass
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Only with EPINEPHrine 1:1000, resuscitative equipment available
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Only within 2 wk of exposure to hepatitis A
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Gamimune N:
IV undiluted or dilute with D
5
; give 0.01 ml/kg/min; may increase to 0.02-0.04 ml/kg/min
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Venoglobulin-I:
(50 mg/ml sol) give 0.01-0.02 ml/kg/min; if no adverse reaction within 1/2 hr, increase to 0.04 ml/kg/min; store at room temp
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Gammagard:
reconstitute with sterile water for inj (50 mg protein/ml); give 0.5 ml/kg/hr, may increase to 4 ml/kg/hr; use inf set provided
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Gammar-IV:
give 0.01 ml/kg/min (50 mg/ml sol) × 15-30 min, may increase to 0.02 ml/kg/min, may increase to 0.03-0.06 ml/kg/min
Y-site compatibilities:
Fluconazole, sargramostim
CNS:
Headache, fatigue, malaise
GI:
Abdominal pain
HEMA:
Thromboembolism (Vivaglobin)
INTEG:
Pain at inj site, rash, pruritus, chills
MS:
Arthralgia, chest pain
SYST:
Lymphadenopathy,
anaphylaxis
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Do not administer live virus vaccines within 3 mo of this product
Interference:
glucose testing system
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Exposure date:
this product should be given within 6 days of measles, 7 days of hepatitis B, 14 days of hepatitis A
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Anaphylaxis:
diaphoresis, wheezing, chest tightness, hypotension
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Storage at 36° F-46° F (2° C-8° C)
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Prevention of infection, increased platelets
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That passive immunity is temporary
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About the treatment of anaphylaxis: EPINEPHrine, diphenhydrAMINE, oxygen, vasopressors, corticosteroids
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(in-da-kat′er-ol)
Arcapta Neohaler
Func. class.:
Beta-2 agonist, long acting respiratory
An agonist at β-2 receptors. These receptors are present in large numbers in the lungs and are located on bronchiolar smooth muscle. Stimulation of β-2 receptors in the lung causes relaxation of bronchial smooth muscle, which produces bronchodilation and an increase in bronchial airflow. These effects may be mediated, in part, by increased activity of adenyl cyclase, an intracellular enzyme responsible for the formation of cyclic-3′,5′-adenosine monophosphate (cAMP); has >24-fold agonist activity at β-2 receptors (primarily in the lung) compared to β-1 receptors (primarily in the heart)
Bronchitis, chronic obstructive pulmonary disease (COPD), emphysema
Acute bronchospasm, acute asthma attack, status asthmaticus, acute respiratory insufficiency, monotherapy of asthma, hypersensitivity
Precautions:
Ischemic cardiac disease (coronary artery disease), hypertension, cardiac arrhythmias, tachycardia, QT prolongation, congenital long QT syndrome, torsades de pointes history, hyperthyroidism (thyrotoxicosis, thyroid disease), pheochromocytoma, unusual responsiveness to other sympathomimetic amines, seizure disorder, diabetes mellitus, hypokalemia, milk protein hypersensitivity, severe hepatic disease; not indicated for neonates, infants, children, or adolescents under the age of 18 yr, pregnancy (category C), breastfeeding
Black Box Warning:
Asthma-related deaths
Calculator
• Adult: NH
75 mcg (contents of 1 capsule) inhaled once daily; administer at the same time every day, max 1 dose in 24 hours
Available forms:
Powder for inhalation 75 mcg
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For oral inhalation use only. DO NOT swallow the capsules; always use the Neohaler Inhaler; this inhaler should not be used with any other products. Do NOT use with a spacer
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Use dry hands to remove a capsule from the blister pack immediately before use and place into the capsule chamber of the Neohaler Inhaler; click closed; do not place capsule into the mouthpiece; then, holding the inhaler upright, depress buttons fully once to pierce capsule, a click will be heard; have patient breathe out fully away from inhaler, place inhaler in the mouth with buttons positioned to the left and right (not up and down), close lips around mouthpiece, then breathe deeply, rapidly, and steadily in through the inhaler. A whirring sound should be heard; if no sound is heard, check the chamber because the capsule may be stuck. Gently tap the base of the device to loosen capsule, if necessary. After inhalation, patient should hold the breath as long as comfortable while removing inhaler from the mouth; check the chamber to see if any powder remains in the capsule; repeat inhalation steps until no powder remains. Most patients empty the capsule in 1 or 2 inhalations. After administration, open chamber and discard empty capsule
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Advise coughing after administration is not problematic; as long as the capsule is empty the full dose has been administered
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The gelatin capsule might break into small pieces that pass through the inhaler screen and reach the mouth. Accidental inhalation or ingestion of these pieces is harmless; piercing capsule more than once increases risk of shattering capsule. Do not wash inhaler; keep it dry; a clean, dry, lint-free cloth may be used to wipe out the inhaler.
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Use the new inhaler provided with each new prescription
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To avoid the spread of infection, do not share inhaler
CNS:
Headache, tremor
CV:
Sinus tachycardia, hypertension, QT prolongation and ST-T wave changes, prolonged QTc (an increase of >60 ms from baseline), nonsustained ventricular tachycardia, supraventricular tachycardia (SVT) episodes, intermittent ectopic atrial rhythm
ENDO:
Hyperglycemia
GI:
Nausea, dry mouth (xerostomia)
META:
Hypokalemia
MS:
Muscle cramps/spasm, musculo-skeletal pain
RESP:
Paradoxical bronchospasm,
cough, dyspnea, sputum purulence or volume, wheezing, nasopharyngitis, pneumonia, sinusitis and upper respiratory tract infection
Protein binding 94%-96%, approximately 1/3 of total drug-related AUC over 24 hours, a hydroxylated derivative, glucuronate and dealkylate metabolites are present; metabolized by CYP3A4, CYP1A1, CYP2D6, UGT1A1; elimination multiphasic with terminal half-life of 45.5-126 hours; excreted renally (2%-6%), fecally (>90%); onset 5 min, peak 15 min, steady state 12-15 days
Increase QT prolongation:
Class IA/III antiarrhythmics, flecainide, propafenone some antipsychotics (phenothiazines, pimozide, haloperidol risperiDONE, sertindole ziprasidone), amoxapine, arsenic trioxide, astemizole, bepridil, cisapride, citalopram, chloroquine, clarithromycin, dasatinib, dolasetron, dronedarone, droperidol, erythromycin, halofantrine, halogenated anesthetics, levomethadyl, maprotiline, methadone, some quinolones (ofloxacin, gatifloxacin, gemifloxacin, grepafloxacin, levofloxacin, moxifloxacin, sparfloxacin), ondansetron, paliperidone, palonosetron, pentamidine, probucol, propafenone, ranolazine, SUNItinib, terfenadine, thioridazine, tricyclic antidepressants, troleandomycin, vorinostat, tetrabenazine
Increase hypokalemia:
Theophylline, aminophylline, corticosteroids
Increase cardiovascular reactions:
MAOIs, furazolidone, procarbazine, rasagiline
Black Box Warning:
Asthma-related death; not to be used in asthma
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COPD, emphysema, bronchospasm: monitor pulmonary function tests
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QT prolongation:
monitor ECG, ejection fraction for QT prolongation
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Paradoxical bronchospasm:
if paradoxical bronchospasm occurs, discontinue product immediately, use a short-acting β-agonist for rescue therapy, as appropriate
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To report dyspnea, wheezing, bronchospasm
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Not to use with other products unless approved by prescriber; there are many interactions
Black Box Warning:
Do not use for asthma