Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (314 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(peg-loe′ti-kase)
Krystexxa
Func. class.:
Antigout agent
Chem. class.:
Pegylated, recombinant, mammalian urate oxidase enzyme
Lowers plasma uric acid concentration by converting uric acid to allantoin, which is readily excreted by the kidneys
Chronic gout in patients experiencing treatment failure
Hypersensitivity, G6PD deficiency
Precautions:
Pregnancy (C), breastfeeding, children/infants/neonates, African-American patients, heart failure
Black Box Warning:
Requires specialized setting, experienced clinician
Calculator
• Adult:
IV INF
8 mg over 2 hr q2wk
Available forms:
Sol for inj 8 mg/ml
•
Reconstitute:
Visually inspect for particulate matter, discoloration whenever sol/container permits, use aseptic technique, withdraw 8 mg (1 ml) of product/250 ml 0.9% NaCl or 0.45% NaCl, invert several times to mix, do not shake; discard remaining product in vial
•
Premedicate:
With antihistamines and corticosteroids in all patients and acetaminophen if deemed necessary to prevent anaphylaxis, inf site reactions
•
Infusion:
If refrigerated, allow to come to room temp, do not warm artificially; give over 120 min, do not give IV push or bolus; use inf by gravity feed, syringe-type pump, or inf pump; given in a specialized setting by those who can manage anaphylaxis or inj site reactions;
monitor during and for 1 hr after infusion; if reaction occurs, slow or stop infusion, may be restarted at a slower rate; do not admix
•
Storage of diluted product in refrigerator or at room temp for up to 4 hr; refrigerator is preferred, protect from light, do not freeze, use within 4 hr of preparation
CNS:
Dizziness, fatigue, fever
CV:
Chest pain
,
heart failure,
hypotension
GI:
Nausea
, vomiting, diarrhea, constipation
GU:
Nephrolithiasis
HEMA:
Anemia
INTEG:
Ecchymosis,
erythema, pruritus, urticaria
MS:
Back pain, arthralgia, muscle spasm
SYST:
Antibody formation, infection, anaphylaxis, infusion
-
related reactions
RESP:
Dyspnea
, upper respiratory infection
Remains primarily in intravascular space after administration, elimination half-life 2 wk, mean nadir uric acid concentration 24-72 hr
Do not use with urate-lowering agents (allopurinol, probenecid, febuxostat, sulfinpyrazone)
•
Gout:
pain in big toe, feet, knees, redness, swelling, tenderness lasting a few days to weeks; intake of alcohol, purines, if patient is overweight or taking diuretics
•
Obtain uric acid levels at baseline, before administration; 2 consecutive uric acid levels of >6 mg/dl may indicate therapy failure; greater chance of anaphylaxis; infection-related reactions
Black Box Warning:
Specialized care setting: use only in facility where emergency equipment is available, anaphylaxis may occur
Black Box Warning:
Infusion reactions: monitor for reactions for ≥1 hr after use
•
Therapeutic response: decrease uric acid levels; relief of pain, swelling, redness in toes, feet, knees
•
About reason for inf, expected results
•
To notify prescriber during inf of allergic reactions or redness, swelling, pain at inf site
•
That continuing follow-up exams and uric acid levels will be needed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERT(pem-ah-trex′ed)
Alimta
Func. class.:
Antineoplastic-antimetabolite
Chem. class.:
Folic acid antagonist
Inhibits multiple enzymes that reduce folic acid, which is needed for cell replication
Malignant pleural mesothelioma in combination with CISplatin; non–small-cell lung cancer as single agent; nonsquamous, non–small-cell lung cancer (1st-line treatment)
Unlabeled uses:
Bladder, breast, colorectal, gastric, head/neck, pancreatic, renal cancers
Pregnancy (D), hypersensitivity, ANC <1500 cells/mm
3
, CCr <45 ml/min, thrombocytopenia (<100,000/mm
3
), anemia
Precautions:
Breastfeeding, children, renal/hepatic disease
Calculator
• Adult:
IV INF
500-600 mg/m
2
given over 10 min on day 1 of 21-day cycle with CISplatin 75 mg/m
2
infused over 2 hr beginning 1/2 hr after end of pemetrexed inf
• Adult:
IV INF
CCr <45 ml/min, not recommended
Available forms:
Inj, single-use vials, 100, 500 mg
•
Vit B
12
and low-dose folic acid as prophylactic measure to treat related hematologic, GI toxicity; 400-1000 mcg/day × 7 days prior to 1st dose and × 21 days after last dose, vit B
12
1 mg IM 1 wk prior to 1st dose and q 3 cycles (9 wk) thereafter
•
Premedicate with corticosteroid (dexamethasone) given PO bid day before, day of, and day after administration of PEMEtrexed
•
Use cytotoxic handling procedures
•
Reconstitute 500-mg vial/20 ml 0.9% NaCl inj (preservative free) = 25 mg/ml, swirl until dissolved, further dilute with 100 ml 0.9% NaCl inj (preservative free), give as IV inf over 10 mg
•
Use only 0.9% NaCl inj (preservative free) for reconstitution, dilution
•
Do not begin a new cycle unless neutrophils (ANC) are ≥1500 cells/mm
3
, platelets are ≥100,000 cells/mm
3
, CCr is ≥45 ml/min
•
Platelet nadir <50,000/mm
3
regardless of the ANC:
If necessary, delay until platelet count recovery, reduce PEMEtrexed and CISplatin by 50%; grade 3/4 toxicity occurs after 2 reductions, discontinue both products
•
ANC nadir <500/mm
3
when platelet nadir is ≥50,000/mm
3
:
If necessary, delay until ANC recovery, reduce PEMEtrexed and CISplatin by 75%; if grade 3/4 toxicity occurs after 2 reductions, discontinue both products
•
CTC Grade 3/4 nonhematologic toxicity including diarrhea requiring hospitalization and excluding neurotoxicity, mucositis, and grade 3 transaminase elevations:
Withhold therapy until pretherapy value or condition, reduce by 75% both products, if grade 3 or 4 toxicity occurs after 2 reductions, discontinue both products
•
CTC grade 3/4 mucositis:
Withhold therapy until pretherapy condition, reduce 50% of PEMEtrexed, if grade 3 or 4 mucositis occurs after 2 dosage reductions, discontinue both products
•
CTC grade 2 neurotoxicity:
Withhold therapy until pretherapy value or condition, reduce dose of CISplatin by 50%
•
CTC grade 3/4 neurotoxicity:
discontinue both products
Y-site compatibilities:
Acyclovir sodium, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, CARBOplatin, carmustine, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, dolasetron, DOPamine, doxacurium, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, ertapenem, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cilastatin, insulin (regular), isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium, mannitol, meperidine, meropenem, mesna, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, midazolam, milrinone, mitoMYcin, mivacurium, morphine, moxifloxacin, nafcillin, naloxone, nesiritide, nitroglycerin, norepinephrine, octreotide, oxaliplatin, PACLitaxel, pamidronate, pancuronium, PENTobarbital, PHENobarbital, piperacillin-tazobactam, polymyxin B, potassium chloride/phosphates, procainamide,
promethazine, propranolol, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, trimethobenzamide, vancomycin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, zidovudine, zoledronic acid
CNS:
Fatigue
,
fever
,
mood alteration, neuropathy
CV:
Thrombosis/embolism,
chest pain
, arrhythmia exacerbation
GI:
Nausea, vomiting, anorexia, diarrhea, ulcerative stomatitis, constipation, dysphagia, dehydration
GU:
Renal failure,
creatinine elevation
HEMA:
Neutropenia, leukopenia, thrombocytopenia, myelosuppression, anemia
INTEG:
Rash, desquamation
RESP:
Dyspnea
SYST:
Infection with/without neutropenia, radiation recall reaction, toxic epidermal necrolysis, Stevens-Johnson syndrome, anaphylaxis
Not metabolized; excreted in urine (unchanged 70%-90%); not known if excreted in breast milk; half-life 3.5 hr, 81% protein binding
Increase:
bleeding risk—NSAIDs, anticoagulants, platelet inhibitors, salicylates, thrombolytics
Decrease:
clearance of PEMEtrexed—nephrotoxic products
Previous radiation treatments; radiation recall reactions have occurred (erythema, exfoliative dermatitis, pain, burning)
Bone marrow depression:
CBC, differential, platelet count; monitor for nadir, recovery; new cycle should not begin if ANC <1500 cells/mm
3
, platelets <100,000 cells/mm
3
, CCr <45 ml/min
•
Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy
•
I&O ratio; report fall in urine output to <30 ml/hr
•
Monitor temp q4hr; fever may indicate beginning infection; no rectal temp
Neurotoxicity:
CTC grade 2: withhold until resolution to at least pretherapy value/condition, reduce CISplatin by 50%; CTC grade 3-4: immediately discontinue product and CISplatin if given in combination
•
Mucositis:
CTC 3-4: withhold until resolution to at least pretherapy value/condition, reduce dose by 50%; if grade 3/4 occurs after 2 dosage reductions, discontinue product and CISplatin
•
Bleeding:
bleeding time, coagulation time during treatment; bleeding: hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr
•
Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
Severe allergic reaction/toxic epidermal necrolysis:
rash, urticaria, itching, flushing
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
•
Storage at 77° F, excursions permitted at 59° F to 86° F, not light sensitive, discard unused portions
•
Therapeutic response: decreased spread of malignancy
•
To report any complaints, side effects to nurse or prescriber: black, tarry stools, chills, fever, sore throat, bleeding, bruising, cough, SOB, dark or bloody urine
•
To avoid foods with citric acid, hot or rough texture if stomatitis is present
•
To report stomatitis: any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily, to report symptoms to nurse, to use good oral hygiene
•
That contraceptive measures recommended during therapy, for #8 wk after cessation of therapy; to discontinue breastfeeding because toxicity to infant may occur
•
To avoid alcohol, salicylates, live vaccines
•
To avoid use of razors, commercial mouthwash
•
To eat foods high in folic acid; to take supplements as prescribed