Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (357 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(rih-tuks′ih-mab)
Rituxan
Func. class.:
Antineoplastic—miscellaneous; DMARDs
Chem. class.:
Murine/human monoclonal antibody
Directed against the CD20 antigen that is found on malignant B lymphocytes; CD20 regulates a portion of cell-cycle initiation/differentiation
Non-Hodgkin’s lymphoma (CD20 positive, B-cell), bulky disease (tumors >10 cm), rheumatoid arthritis, Wegener’s granulomatosis, microscopic polyangitis
Unlabeled uses:
Acquired blood factor deficiency, acute lymphocytic leukemia (ALL), Burkitt’s lymphoma, chronic lymphocytic leukemia (CLL), hemolytic anemia, human herpesvirus 8, mantle cell lymphoma (MCL), multicentric Castleman’s disease, peripheral blood stem cell (PBSC) mobilization, refractory pemphigus vulgaris, relapsing/remitting MS, ITP with dexamethasone, steroid refractory chronic graft-versus-host disease
Hypersensitivity, murine proteins
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, pulmonary/cardiac/renal conditions
Black Box Warning:
Exfoliative dermatitis, infusion-related reactions, progressive multifocal leukoencephalopathy
Calculator
• Adult:
IV
375 mg/m
2
every wk × 4 doses, may re-treat with 4 more doses of 375 mg/m
2
/wk
• Adult:
IV
375 mg/m
2
on day 1 of each cycle for up to 8 cycles; may be given with cyclophosphamide IV 750 mg/m
2
on day 1, vinCRIStine IV 1.4 mg/m
2
(max 2 mg) on day 1, and predniSONE 40 mg/m
2
/day PO on days 1–5
• Adult:
IV
375 mg/m
2
IV every 8 wk × 12 doses as maintenance therapy starting 8 wk after the completion of induction chemotherapy with 8 doses of riTUXimab with 6–8 cycles of cyclophosphamide, vinCRIStine, and predniSONE 4–6 cycles of cyclophosphamide, DOXOrubicin, vinCRIStine, and predniSONE
• Adult:
IV
As a required component of the ibritumomab regimen; riTUXimab 250 mg/m
2
given within 4 hr before administration of Yttrium-90 ibritumomab that may occur on day 7, 8, or 9
• Adult 18–59 yr:
IV
375 mg/m
2
on day 1 of each cycle for up to 8 infusions
• Adult:
IV
375 mg/m
2
q wk × 4 wk repeated every 6 mo × 2 yr (total of 16 doses) as maintenance therapy starting 4 wk after the completion of first-line chemotherapy with 6 to 8 cycles of cyclophosphamide, vinCRIStine, and predniSONE (CVP)
Available forms:
Inj 10 mg/ml (100 mg/10 ml, 500 mg/50 ml)
•
Give methylPREDNISolone 100 mg or similar product 30 min before inf to decrease reactions
•
Hold antihypertensives 12 hr before administration
•
After diluting to final conc of 1-4 mg/ml; use 0.9% NaCl, D
5
W, gently invert bag to mix; do not mix with other products, give 50 mg/hr initially, if no reaction increase rate by 50 mg/hr to max 400 mg/hr
Y-site compatibilities:
Amcyclovir, amifostine, amikacin, aminophylline, ampicillin, ampicillin/sulbactam, aztreonam, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyclophosphamide, cytarabine, DACTINomycin, DAUNOrubicin hydrochloride, dexamethasone, dexrazoxane, digoxin, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin liposome, doxycycline, droperidol, enalaprilat, etoposide phosphate, famotidine, fentaNYL, filgrastim, floxuridine, fluconazole, fludarabine, fluorouracil, ganciclovir, gemcitabine, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem/cilastatin, irinotecan, leucovorin, levorphanol, LORazepam, magnesium sulfate, mannitol, meperidine, mesna, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, mitoMYcin, mitoXANtrone, morphine, nalbuphine, netilmicin, PACLitaxel, pentamidine, piperacillin/tazobactam, plicamycin, potassium chloride, prochlorperazine, promethazine, ranitidine, sargramostim, streptozocin, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tobramycin, trimethoprim/sulfamethoxazole, trimethobenzamide, vinBLAStine, vincCRIStine, vinorelbine, zidovudine
CNS:
Life-threatening brain infection (progressive multifocal leukoencephalopathy)
CV:
Cardiac dysrhythmias, heart failure, hypertension, MI, supraventricular tachycardia,
angina
GI:
Nausea, vomiting, anorexia
,
GI obstruction/perforation
GU:
Renal failure
HEMA:
Leukopenia, neutropenia, thrombocytopenia,
anemia
INTEG:
Irritation at site, rash
,
fatal mucocutaneous infections (rare)
MISC:
Fever
, chills, asthenia,
headache
,
angioedema,
hypotension, myalgia,
bronchospasm, ARDs
SYST:
Toxic epidermal necrolysis, tumor lysis syndrome, Stevens-Johnson syndrome, exfoliative dermatitis
Half-life 60-174 hr, binds to CD20 sites or lymphoma cells
Increase:
hypotension—antihypertensives, separate by 12 hr
Increase:
nephrotoxicity—CISplatin, avoid concurrent use; if used, monitor renal status
Increase:
bleeding—anticoagulants
•
Avoid with vaccines, toxoids
Black Box Warning:
Fatal inf reaction:
hypoxia, pulmonary infiltrates, ARDS, MI, ventricular fibrillation, cardiogenic shock; most fatal reactions occur with 1st inf; potentially fatal
Black Box Warning:
Severe mucocutaneous reactions:
Stevens-Johnson syndrome, lichenoid dermatitis, toxic epidermal lysis; occur 1-13 wk after product given, discontinue treatment immediately
Black Box Warning:
Tumor lysis syndrome:
acute renal failure requiring hemodialysis, hyperkalemia, hypocalcemia, hyperuricemia, hyperphosphatemia; allopurinol and adequate hydration may be needed
Black Box Warning:
Multifocal leukoencephalopathy:
confusion, dizziness, lethargy, hemiparesis; monitor periodically
•
CBC, differential, platelet count weekly; withhold product if WBC is <3500/mm
3
or platelet count <100,000/mm
3
; notify prescriber of results; product should be discontinued
•
ECG, serum creatinine/BUN, electrolytes, uric acid
•
GI symptoms: frequency of stools, abdominal pain, perforation/obstruction may occur
•
Infection:
fever, increased temperature, flulike symptoms in those with Wegener’s granulomatosis and microscopic polyangiitis in those using DMARDs
•
Storage of vials at 36° F-40° F, protect vials from direct sunlight, inf sol is stable at 36° F-46° F × 24 hr and at room temp for another 12 hr
•
Therapeutic response: prevention of increasing cancer progression
•
To avoid use with vaccines, toxoids
•
To use contraception during, for up to 12 mo after therapy
To report to prescriber possible infection (cough, fever, chills, sore throat), renal issues (painful urination, back/side pain), bleeding (gums, stools, urine, bruising, emesis, fatigue)
•
To avoid OTC products
•
To avoid crowds, those with known infections
•
To maintain fluid intake
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert