Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (313 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(peg-fill-grass′stim)
Neulasta
Func. class.:
Hematopoietic agent
Chem. class.:
Granulocyte colony-stimulating factor
Stimulates proliferation and differentiation of neutrophils
To decrease infection in patients receiving antineoplastics that are myelosuppressive; to increase WBC count in patients with product-induced neutropenia
Hypersensitivity to proteins of
Escherichia coli
, filgrastim
Precautions:
Pregnancy (C), breastfeeding, children <45 kg, adolescents, myeloid malignancies, sickle cell disease, leukocytosis, splenic rupture, ARDS, allergic-type reactions, peripheral blood stem cell (PBSC) mobilization
Calculator
• Adult:
SUBCUT
6 mg, give 1× per chemotherapy cycle
Available forms:
Sol for inj 6 mg/0.6 ml
•
Using single-use vials; after dose is withdrawn, do not reenter vial
•
Do not use 6-mg fixed dose in infants, children, or others <45 kg
•
Inspect sol for discoloration, particulates; if present, do not use
•
Do not administer during the period 14 days before and 24 hr after cytotoxic chemotherapy
CNS:
Fever, fatigue, headache, dizziness, insomnia, peripheral edema
GI:
Nausea
, vomiting, diarrhea, mucositis, anorexia, constipation, dyspepsia, abdominal pain, stomatitis,
splenic rupture
HEMA:
Leukocytosis, granulocytopenia, sickle cell crisis, hemoglobin S disease with crisis
INTEG:
Alopecia
MISC:
Chest pain, hyperuricemia,
anaphylaxis, influenza-like illness, angioedema, antibody formation
MS:
Skeletal pain
RESP:
Respiratory distress syndrome
Half-life: 15-80 hr; 20-38 hr (children)
•
Do not use product concomitantly, 2 wk before, or 24 hr after administration of cytotoxic chemotherapy
Increase:
release of neutrophils—lithium
Increase:
uric acid, LDH, alk phos
Allergic reactions, anaphylaxis:
rash, urticaria; discontinue product, have emergency equipment nearby
ARDS:
dyspnea, fever, tachypnea, occasionally confusion; obtain ABGs, chest x-ray; product may need to be discontinued
•
Bone pain;
give mild analgesics
•
Blood studies: CBC with differential, platelet count before treatment, 2× weekly; neutrophil counts may be increased for 2 days after therapy
•
B/P, respirations, pulse before and during therapy
•
Storage in refrigerator; do not freeze; may store at room temp up to 6 hr; avoid shaking, protect from light
•
Therapeutic response: absence of infection
•
How to perform the technique for self-administration if product to be given at home: dose, side effects, disposal of containers and needles; provide instruction sheet
•
To notify prescriber immediately of allergic reaction, trouble breathing, abdominal pain
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(peg-in-ter-feer′on)
Pegasys
PegIntron, SYLATRON
Func. class.:
Immunomodulator
Stimulates genes to modulate many biologic effects, including the inhibition of viral replication; inhibits ion cell proliferation, immunomodulation; stimulates effector proteins; decreases leukocyte, platelet counts
Chronic hepatitis C infections in adults with compensated liver disease; chronic hepatitis B in adults who are HBe AG positive, HBe AG negative; HCV patients coinfected with HIV; nonresponders or relapsers with chronic hepatitis C, malignant melanoma
Unlabeled uses:
Adenovirus, coronavirus, encephalomyocarditis virus, herpes simplex types 1 and 2, hepatitis D, acute hepatitis C, HIV, HPV, polio virus, rhinovirus, varicella-zoster, variola, vesicular stomatitis
Neonates, infants, sepsis; hypersensitivity to interferons, benzyl alcohol,
Escherichia coli
protein
Precautions:
Pregnancy (C), breastfeeding, children <18 yr, geriatric patients, thyroid disorders, myelosuppression, renal/hepatic disease, suicidal/homicidal ideation, preexisting ophthalmologic disorders, pancreatitis, hemodialysis
Black Box Warning:
Cardiac disease, depression, autoimmune disease, infection, use with ribavirin
Calculator
• Adult:
SUBCUT
180 mcg q wk × 48 wk; if poorly tolerated, reduce dose to 135 mcg q wk; in some cases, reduction to 90 mcg may be needed
• Adult
>
105 kg:
SUBCUT
1.5 mcg/kg/wk plus ribavirin 600 mg in
AM
and 800 mg in
PM
plus a HCV NS3/4A protease inhibitor;
86-105 kg:
150 mcg/0.5 ml (0.5 ml of 150 mcg vial or Redipen) per wk plus ribavirin 1200 mg/day in 2 divided doses plus a HCV NS3/4A protease inhibitor;
81-85 kg:
120 mcg/0.5 ml (0.5 ml of 120 mcg vial or Redipen) per wk plus ribavirin 1200 mg/day in 2 divided doses plus a HCV NS3/4A protease inhibitor;
76-80 kg:
120 mcg/0.5 ml (0.5 ml of 120 mcg vial or Redipen) per wk plus ribavirin 400 mg in
AM
and 600 mg in
PM
plus a HCV NS3/4A protease inhibitor;
66-75 kg:
96 mcg/0.4 ml (0.4 ml of 120 mcg vial or Redipen) per wk plus ribavirin 400 mg in
AM
and 600 mg in
PM
plus a HCV NS3/4A protease inhibitor;
61-65 kg:
96 mcg/0.4 ml (0.4 ml of 120 mcg vial or Redipen) per wk plus ribavirin 800 mg/day in 2 divided doses plus a HCV NS3/4A protease inhibitor;
51-60 kg:
80 mcg/0.5 ml (0.5 ml of 80 mcg vial or Redipen) per wk plus ribavirin 800 mg/day in 2 divided doses plus a HCV NS3/4A protease inhibitor;
40-50 kg:
64 mcg/0.4 ml (0.4 ml of 80 mcg vial or Redipen) per wk plus ribavirin 800 mg/day in 2 divided doses plus a HCV NS3/4A protease inhibitor;
<40 kg:
50 mcg/0.5 ml (0.5 ml of 50 mcg vial or Redipen) per wk plus ribavirin 800 mg/day in 2 divided doses plus a HCV NS3/4A protease inhibitor
• Adult:
SUBCUT
6 mcg/kg/wk × 8 wk then 3 mcg/kg/wk × ≤5 yr, premedicate with acetaminophen 500-1000 mg 30 min prior to first dose, prn for subsequent doses
Available forms:
Pegasys: inj 180 mcg/0.5 ml; Pegintron: 50, 80, 120, 150 mcg/0.5 ml; SYLATRON 296, 444, 888 mcg powder for inj
•
In evening to reduce discomfort, to allow patient to sleep through some side effects
•
Continue pediatric dose in those who turn 18 yr
•
Use prefilled syringes, store in refrigerator
•
Reconstitute with 1 ml of provided diluent/10-, 18-, or 50-million unit vials, swirl; sol for inj vials do not need reconstitution
CNS:
Headache, insomnia, dizziness
, anxiety, hostility, lability, nervousness, depression, fatigue, poor concentration, pyrexia,
suicidal ideation, homicidal ideation,
relapse of drug addiction, emotional lability, mania, psychosis
CV:
Ischemic CV events
ENDO:
Hypothyroidism, diabetes
GI:
Abdominal pain, nausea, diarrhea, anorexia, vomiting
, dry mouth,
fatal colitis, fatal pancreatitis
HEMA:
Thrombocytopenia,
neutropenia, anemia, lymphopenia
INTEG:
Alopecia, pruritus, rash
, dermatitis
MISC:
Blurred vision, inj site reaction, rigors
MS:
Back pain
, myalgia, arthralgia
RESP:
Cough, dyspnea
Half-life 15-80 hr, large variability in other pharmacokinetics
•
Use caution when giving with theophylline, myelosuppressive agents
Increase:
hepatic damage-NNRTIs, NRTIs, protein inhibitors
Increase:
triglycerides, ALT, neutrophils, platelets
Abnormal:
thyroid function test
•
Neuropsychiatric symptoms:
severe depression with suicidal ideation; monitor q3wk then 8 wk then q6mo
•
B/P, blood glucose, ophthalmic exam, pulmonary function
•
ALT, HCV viral load; patients who show no reduction in ALT, HCV unlikely to show benefit of treatment after 6 mo
•
Platelet counts, heme concentration, ANC, serum creatinine concentration, albumin, bilirubin, TSH, T
4
, AFP
Myelosuppression:
hold dose if neutrophil count is <500 × 10
6
/L or if platelets are <50 × 10
9
/L
•
Hypersensitivity:
discontinue immediately if hypersensitivity occurs
•
Infection:
vital signs, increased WBCs, fever; product may need to be discontinued
Colitis/pancreatitis:
may be fatal; diarrhea, fever, nausea, vomiting, severe abdominal pain; if these occur, product should be discontinued
•
Therapeutic response: decreased chronic hepatitis C signs, symptoms; undetectable viral load
•
Provide patient or family member with written, detailed information about product
•
Use 2 forms of effective contraception throughout treatment and for 6 mo after treatment (men and women) (combination therapy with ribavirin)
•
To avoid driving, other hazardous activity if dizziness, confusion, fatigue, somnolence occur
•
To use puncture-resistant container for disposal of needles/syringes if using at home
To report suicidal/homicidal ideation, visual changes, bleeding/bruising, pulmonary symptoms