Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (227 page)
(ix-ab-ep′i-lone)
Ixempra
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Epothilone
Microtubule stabilizing agent; microtubules are needed for cell division
Breast cancer
Pregnancy (D), breastfeeding, hypersensitivity to products with polyoxyethylated castor oil, neutropenia of <1500/mm
3
, thrombocytopenia
Black Box Warning:
Hepatic disease
Precautions:
Children, geriatric patients, alcoholism, bone marrow suppression, cardiac dysrhythmias, cardiac/renal disease, diabetes mellitus, peripheral neuropathy, ventricular dysfunction
Calculator
• Adult: IV INF
40 mg/m
2
over 3 hr q3wk plus capecitabine
PO
2000 mg/m
2
/day in 2 divided doses on days 1-14 q21days; in those with BSA >2.2 m
2
, dose should be calculated for a BSA of 2.2 m
2
• Adult: IV INF
40 mg/m
2
over 3 hr q3wk; in those with BSA >2.2 m
2
, dose should be calculated for a BSA of 2.2 m
2
• Adult: IV INF
20 mg/m
2
over 3 hr q3wk
Available forms:
Powder for inj 15, 45 mg
•
Premedicate with histamine antagonists 1 hr before use, prevents hypersensitivity
•
Antiemetic 30-60 min before product and prn
•
Let kit stand at room temp for 30 min; to reconstitute, withdraw supplied diluent (8 ml for 15-mg vials, 23.5 ml for 45-mg vials); slowly inject sol into vial; gently swirl and invert to mix, final conc 2 mg/ml; further dilute in LR in DEHP-free bags, final conc should be between 0.2 and 0.6 mg/ml; after added, mix by manual rotation
•
Diluted sol stable for 6 hr at room temp; inf must be completed within 6 hr
•
Use in-line filter, 0.2-1.2 micron
•
Give over 3 hr
CNS:
Peripheral neuropathy
, impaired cognition, chills, fatigue, fever, flushing, headache, insomnia,
asthenia
CV:
Bradycardia,
hypotension
,
abnormal ECG,
angina,
atrial flutter, cardiomyopathy,
chest pain, edema,
MI,
vasculitis
GI:
Nausea, vomiting, diarrhea
, abdominal pain, anorexia, colitis, constipation, gastritis, jaundice, GERD, hepatic failure, trismus
GU:
Renal failure
HEMA:
Neutropenia, thrombocytopenia, anemia,
infections, coagulopathy
INTEG:
Alopecia
, rash, hot flashes
META:
Hypokalemia, metabolic acidosis
MS:
Arthralgia, myalgia
RESP:
Bronchospasm,
cough, dyspnea
SYST:
Hypersensitivity reactions
,
anaphylaxis,
dehydration,
radiation recall reaction
Metabolized in liver by P45CYP3A4; excreted in feces (65%) and urine (21%); terminal half-life 52 hr
Increase:
ixabepilone level—CYP3A4 inhibitors (amiodarone, amprenavir, aprepitant, atazanavir, chloramphenicol, clarithromycin, conivaptan, cycloSPORINE, danazol, darunavir, dalforpistin, delavirdine, diltiazem, erythromycin, estradiol, fluconazole, fluvoxaMINE, fosamprenavir, imatinib, indinavir, isoniazid, itraconazole, ketoconazole, lopinavir, miconazole, nefazodone, nelfinavir, propoxyphene, ritonavir, RU-486, saquinavir, tamoxifen, telithromycin, troleandomycin, verapamil, voriconazole, zafirlukast)
Decrease:
ixabepilone levels—CYP3A4 inducers (aminoglutethimide, barbiturates, bexarotene, bosentan, carBAMazepine, dexamethasone, efavirenz, griseofulvin, modafinil, nafcillin, nevirapine, OXcarbazepine, phenytoin, rifamycin, topiramate)
•
Avoid use with St. John’s wort
•
Avoid use with grapefruit products
•
CBC, differential, platelet count prior to treatment and weekly; withhold product if WBC is <1500/mm
3
or platelet count is <100,000/mm
3
, notify prescriber
•
Monitor temp q4hr (may indicate beginning infection)
Black Box Warning:
Liver function tests before, during therapy (bilirubin, AST, ALT, LDH) prn or monthly; check for jaundiced skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
•
VS during 1st hr of infusion; check IV site for signs of infiltration
Hypersensitivity reactions, anaphylaxis
including hypotension, dyspnea, angioedema, generalized urticaria; discontinue inf immediately; keep emergency equipment available
•
Effects of alopecia on body image; discuss feelings about body changes
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report signs of infection: fever, sore throat, flulike symptoms
•
To report signs of anemia: fatigue, headache, faintness, SOB
•
To report any complaints or side effects to nurse or prescriber
•
That hair may be lost during treatment; that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture
•
That pain in muscles and joints 2-5 days after inf is common
•
To use nonhormonal type of contraception
•
To avoid receiving vaccinations while receiving product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(kee-toe-koe′na-zole)
Func. class.:
Antifungal
Chem. class.:
Imidazole derivative
Alters cell membrane permeability and inhibits several fungal enzymes, thereby leading to cell death
Systemic candidiasis, chronic mucocandidiasis, oral thrush, candiduria, coccidioidomycosis, histoplasmosis, chromomycosis, paracoccidioidomycosis, blastomycosis; tinea cruris, tinea corporis, tinea versicolor,
Pityrosporum ovale
Unlabeled uses:
Cushing’s syndrome, advanced prostatic cancer, candidiasis/fungal prophylaxis, fungal keratitis, leishmaniasis
Breastfeeding, hypersensitivity, fungal meningitis
Black Box Warning:
Coadministration with other products (ergot derivatives, cisapride, or triazolam) may cause fatal cardiac arrhythmias due to inhibition of CYP3A4 enzyme system
Precautions:
Pregnancy (C), children <2 yr, renal disease, achlorhydria (product-induced)
Black Box Warning:
Hepatic disease
Calculator
• Adult:
PO
200-400 mg/day for 1-2 wk (candidiasis), 6 wk (other infections)
• Child ≥2 yr:
PO:
3.3-6.6 mg/kg/day as a single daily dose
• Adult:
PO
400 mg tid
Available forms:
Tabs 200 mg; oral susp 100 mg/5 ml
•
In the presence of acid products only; do not use alkaline products, proton pump inhibitors, H
2
-antagonists, antacids within 2 hr of product; may give coffee, tea, acidic fruit juices, cola
•
With food to decrease GI symptoms
•
With HCl if achlorhydria is present; dissolve tab/4 ml of aqueous sol 0.2 N hydrochloric acid; use straw to avoid contact; rinse with water afterward and swallow
CNS:
Headache, dizziness, somnolence
GI:
Nausea, vomiting, anorexia, diarrhea, abdominal pain,
hepatotoxicity
GU:
Gynecomastia, impotence
HEMA:
Thrombocytopenia, leukopenia, hemolytic anemia
INTEG:
Pruritus, fever, chills, photophobia, rash, dermatitis, purpura, urticaria
SYST:
Anaphylaxis, angioedema
PO:
Peak 1-2 hr; half-life 2 hr, terminal 8 hr; metabolized in liver; excreted in bile, feces; requires acid pH for absorption; distributed poorly to CSF; highly protein bound
Increase:
effect of CNS depression—chlordiazePOXIDE, clonazePAM, clorazepate, diazepam, estazolam, flurazepam, prazepam, quazepam, avoid concurrent use
Decrease:
effect of—theophylline
Decrease:
metabolism of PACLitaxel
Increase:
hepatotoxicity—other hepatotoxic products, alcohol
Increase:
anticoagulant effect—warfarin, anticoagulants
Increase:
effect of toxicity: alfentanil, ALPRAZolam, amprenavir, ARIPiprazole, atorvastatin, calcium channel blockers, carBAMazepine, clarithromycin, corticosteroids, cyclophosphamide, cycloSPORINE, donepezil, eletriptan, erythromycin, fentaNYL, ifosfamide, indinavir, lovastatin, midazolam, nelfinavir, nisoldipine, quiNIDine, ritonavir, saquinavir, sildenafil, simvastatin, SUFentanil, tamoxifen, triazolam, vinBLAStine, vinca alkaloids, vinCRIStine, zolpidem
Decrease:
action of ketoconazole—antacids, H
2
-receptor antagonists, anticholinergics, phenytoin, isoniazid, rifampin, ddI, gastric acid pump inhibitors
Increase:
alkaline phosphatase, LFTs, lipids
Decrease:
Hgb, WBC, platelets
•
Infection symptoms before and after treatment
•
C&S before starting treatment
•
Allergic reaction: rash, photosensitivity, urticaria, dermatitis
Black Box Warning:
Hepatotoxicity: nausea, vomiting, jaundice, clay-colored stools, fatigue; hepatic studies (ALT, AST, bilirubin) if patient receiving long-term therapy, use cautiously in those with hepatic disease
•
Using with CYP3A4 inhibitors can lead to increased product level, toxicity
•
Storage in tight container at room temp
•
Therapeutic response: decreased fever, malaise, rash, negative C&S for infectious organism, absence of scaling
•
That long-term therapy may be needed to clear infection (1 wk-6 mo, depending on infection)
•
To avoid hazardous activities if dizziness occurs
•
To take 2 hr before administration of other products that increase gastric pH (antacids, H
2
-blockers, omeprazole, sucralfate, anticholinergics)
•
About the importance of compliance with product regimen, that testing will be done periodically to indicate if infection has been eradicated
•
To decrease nausea, divide dose with meals
•
Not to use any products (OTC, herbal) unless approved by prescriber
Black Box Warning:
To notify prescriber of GI symptoms, signs of hepatic dysfunction (fatigue, nausea, anorexia, vomiting, dark urine, pale stools)
•
To use sunglasses to prevent photophobia (rare)
•
To notify prescriber if pregnancy is planned or suspected; do not breastfeed