Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (37 page)
(am-foe-ter′i-sin)
Abelcet
Func. class.:
Antifungal
Chem. class.:
Amphoteric polyene
Increases cell membrane permeability in susceptible fungi by binding sterols; alters cell membrane, thereby causing leakage of cell components, cell death
Indicated for the treatment of invasive fungal infections in patients who cannot tolerate or have failed conventional amphotericin B therapy; broad-spectrum activity against many fungal, yeast and mold pathogen infections, including Aspergillus, Zygomycetes, Fusarium, Cryptococcus, and many hard-to-treat Candida species; Aspergillus fumigatus, Aspergillus sp., Blastomyces dermatitidis, Candida albicans, Candida guilliermondii, Candida sp., Candida stellatoidea, Candida tropicalis, Coccidioides immitis, Cryptococcus sp., Histoplasma sp.
Hypersensitivity, severe bone marrow depression
Calculator
•Adult: IV
5 mg/kg/day as a single inf given at 2.5 mg/kg/hr
Available forms:
Susp for inj 100 mg/20-ml vial
Do not confuse four different types; these are not interchangeable: conventional amphotericin B, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome
•
Give product only after C&S confirms organism, product needed to treat condition; make sure product is used for life-threatening infections
•
Handle with aseptic technique because amphotericin B lipid complex (ABLC) does not contain any preservatives; visually inspect parenteral products for particulate matter and discoloration before use
•
Prepare the admixture for infusion by first shaking the vial until there is no evidence of yellow sediment on the bottom of the vial.
•
Transfer the appropriate amount of drug from the required number of vials into one or more sterile syringes using an 18-gauge needle.
•
Attach the provided 5-micron filter needle to the syringe; inject the syringe contents through the filter needle, into an IV bag containing the appropriate amount of D5W injection. Each filter needle may be used on the contents of no more than four 100-mg vials.
•
The suspension must be diluted with D5W injection to a final concentration of 1 mg/ml. For pediatric patients and patients with cardiovascular disease, the final concentration may be 2 mg/ml.
DO NOT USE SALINE SOLUTIONS OR MIX WITH OTHER DRUGS OR ELECTROLYTES
.
•
The diluted ready-for-use admixture is stable for up to 48 hr at 2-8 degrees C (36-46 degrees F) and an additional 6 hr at room temperature. Do not freeze.
•
Flush IV line with D
5
W injection before use or use a separate IV line;
DO NOT USE AN IN-LINE FILTER.
•
Before infusion, shake the bag until the contents are thoroughly mixed; max rate 2.5 mg/kg/hr. If the infusion time exceeds 2 hr, mix the contents by shaking the infusion bag every 2 hr.
Y-site compatibilities:
anidulafungin, ertapenem, octreotide
CNS:
Headache, fever, chills
, peripheral nerve pain, paresthesias, peripheral neuropathy,
seizures,
dizziness
CV:
Bradycardia, hypotension,
cardiac arrest
EENT:
Tinnitus, deafness, diplopia, blurred vision
GI:
Nausea, vomiting, anorexia
, diarrhea, cramps,
hemorrhagic gastroenteritis, acute liver failure
GU:
Hypokalemia
,
azotemia, hyposthenuria, renal tubular acidosis, nephrocalcinosis, permanent renal impairment, anuria, oliguria
HEMA:
Normochromic, normocytic anemia, thrombocytopenia, agranulocytosis, leukopenia, eosinophilia,
hyponatremia, hypomagnesemia
INTEG:
Burning, irritation
, pain,
necrosis at inj site with extravasation,
flushing, dermatitis
MS:
Arthralgia, myalgia, generalized pain, weakness, weight loss
SYST:
Toxic epidermal neurolysis, exfoliative dermatitis, anaphylaxis
IV:
Peak 1-2 hr; initial half-life (LAmB) mean 4-6 days; metabolized in liver; excreted in urine (metabolites), breast milk; protein binding 90%; poorly penetrates CSF, bronchial secretions, aqueous humor, muscle, bone; terminal half-life lipid complex mean 7 days
Increase:
nephrotoxicity—other nephrotoxic antibiotics (aminoglycosides, CISplatin, vancomycin, cycloSPORINE, polymyxin B)
Increase:
hypokalemia—corticosteroids, digoxin, skeletal muscle relaxants, thiazides
•
VS every 15-30 min during first inf; note changes in pulse, B/P
•
I&O ratio; watch for decreasing urinary output, change in specific gravity; discontinue product to prevent permanent damage to renal tubules
•
Blood studies: CBC, potassium, sodium, calcium, magnesium every 2 wk; BUN, creatinine 2-3 ×/wk
•
Weight weekly; if weight increases by more than 2 lb/wk, edema is present; renal damage should be considered
•
For renal toxicity:
increasing BUN, serum creatinine; if BUN is >40 mg/dl or if serum creatinine is >3 mg/dl, product may be discontinued, dosage reduced
•
For hepatotoxicity:
increasing AST, ALT, alk phos, bilirubin
•
For allergic reaction: dermatitis, rash; product should be discontinued, antihistamines (mild reaction) or EPINEPHrine (severe reaction) should be administered
•
For hypokalemia: anorexia, drowsiness, weakness, decreased reflexes, dizziness, increased urinary output, increased thirst, paresthesias
•
For ototoxicity: tinnitus (ringing, roaring in ears), vertigo, loss of hearing (rare)
•
Prior to dilution, store at 2°-8° C (36°-46° F), protected from moisture and light; do not freeze; the diluted, ready-for-use admixture is stable for up to 48 hours at 2°-8° C (36°-46° F) and an additional 6 hours at room temperature; do not freeze
•
Therapeutic response: decreased fever, malaise, rash, negative C&S for infecting organism
•
That long-term therapy may be needed to clear infection (2 wk-3 mo, depending on type of infection)
•
To notify prescriber of bleeding, bruising, or soft-tissue swelling
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
liposomal (LAmB)
(am-foe-ter′i-sin)
AmBisome
Func. class.:
Antifungal
Chem. class.:
Amphoteric polyene
Increases cell membrane permeability in susceptible fungi by binding to membrane sterols; alters cell membrane, thereby causing leakage of cell components, cell death
Resolution of infection
Empirical therapy for presumed fungal infection in febrile neutropenic patients; treatment of
Cryptococcal
Meningitis in HIV-infected patients; treatment of
Aspergillus
species,
Candida
species and/or
Cryptococcus
species infections refractory to amphotericin B deoxycholate, or in patients where renal impairment or unacceptable toxicity precludes the use of amphotericin B deoxycholate
(Aspergillus flavus, Aspergillus fumigatus, Blastomyces dermatitidis, Candida albicans, Candida krusei, Candida lusitaniae, Candida parapsilosis, Candida tropicalis, Cryptococcus neoformans)
; treatment of visceral leishmaniasis
Hypersensitivity, severe bone marrow depression
Calculator
• Adult and child ≥1 mo:
IV
3 mg/kg every 24 hr days 1-5, and days 14, 21 (immunocompetent), 4 mg/kg every 24 hr days 1-5, and days 10, 17, 24, 31, 38 (immunocompromised)
• Adult and child ≥1 mo:
IV
6 mg/kg/day
• Adult and child ≥1 mo:
IV
3 mg/kg/day
• Adult and child ≥1 mo:
IV
3-5 mg/kg/day
Available forms:
Powder for inj 50-mg vial
Do not confuse four different types; these are not interchangeable: conventional amphotericin B, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome
•
Give only after C&S confirms organism, product needed to treat condition; make sure product is used for life-threatening infections
•
Administer by IV infusion only; handle with aseptic technique as LAmB does not contain any preservatives
•
Visually inspect products for particulate matter and discoloration
•
LAmB
must
be reconstituted using sterile water for injection (without a bacteriostatic agent).
DO NOT RECONSTITUTE WITH SALINE OR ADD SALINE TO THE RECONSTITUTED SUSPENSION, DO NOT MIX WITH OTHER DRUGS;
doing so can cause a precipitate to form.
•
Reconstitute vials containing 50 mg of LAmB /12 ml of sterile water (4 mg/ml).
•
Immediately after the addition of water, SHAKE THE VIAL VIGOROUSLY for 30 sec; the suspension should be yellow and translucent. Visually inspect vial for particulate matter and continue shaking until product is completely dispersed.
•
Store suspension for up to 24 hours refrigerated if using sterile water for injection; do not freeze.
•
Calculate the amount of reconstituted (4 mg/ml) suspension to be further diluted and withdraw this amount into a sterile syringe.
•
Attach the provided 5-micron filter to the syringe; inject the syringe contents through the filter, into the appropriate
amount of D
5
W injection. Use only one filter per vial.
•
The suspension must be diluted with D
5
W injection to a final concentration of 1-2 mg/ml before administration. For infants and small children, lower concentrations (0.2-0.5 mg/ml) may be appropriate to provide sufficient volume for infusion.
•
Use injection of LAmB within 6 hr of dilution with D5W
•
Flush intravenous line with D5W injection before infusion. If this cannot be done, then a separate IV line must be used.
•
An inline membrane filter may be used provided the mean pore diameter of the filter is not less than 1 micron.
•
Administer by IV infusion using a controlled infusion device over a period of approximately 120 min. Infusion time may be reduced to approximately 60 min in patients who tolerate the infusion. If discomfort occurs during infusion, the duration of infusion may be increased.
•
30 min before inf to reduce fever, chills, headache
•
Storage protected from moisture and light; diluted solution is stable for 24 hr at room temp
Y-site compatibilities:
Acyclovir, amifostine, aminophylline, anidulafungin, atropine, azithromycin, bivalirudin, bumetanide, buprenorphine, busulfan, butorphanol, CARBOplatin, carmustine, ceFAZolin, ceFOXitin, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, clindamycin, cyclophosphamide, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, diphenhydrAMINE, doxacurium, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, ertapenem, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fludarabine, fluorouracil, fosphenytoin, furosemide, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, ifosfamide, isoproterenol, ketorolac, levorphanol, lidocaine, linezolid, mesna, methotrexate, methylPREDNISolone, metoprolol, milrinone, mitoMYcin, nesiritide, nitroglycerin, nitroprusside, octreotide, oxaliplatin, oxytocin, palonosetron, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENObarbital, phenylephrine, piperacillin/tazobactam, potassium chloride, procainamide, ranitidine, SUFentanil, tacrolimus, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, trimethoprim-sulfamethoxazole, vasopressin, vinCRIStine, voriconazole, zidovudine
CNS:
Headache, fever, chills
, peripheral nerve pain, paresthesias, peripheral neuropathy, seizures, dizziness
CV:
Bradycardia, hypotension, cardiac arrest
EENT:
Tinnitus, deafness, diplopia, blurred vision
GI:
Nausea, vomiting, anorexia
, diarrhea, cramps,
hemorrhagic gastroenteritis, acute liver failure
GU:
Hypokalemia
,
azotemia, hyposthenuria,
renal tubular acidosis,
nephrocalcinosis,
permanent renal impairment, anuria, oliguria
HEMA:
Normochromic normocytic anemia, thrombocytopenia, agranulocytosis, leukopenia, eosinophilia,
hyponatremia, hypomagnesemia
INTEG:
Burning, irritation
, pain,
necrosis at inj site with extravasation,
flushing, dermatitis, skin rash (topical route)
MS:
Arthralgia, myalgia, generalized pain, weakness, weight loss
SYST:
Stevens–Johnson syndrome, toxic epidermal neurolysis, exfoliative dermatitis, anaphylaxis
IV:
Peak 1-2 hr; initial half-life (LAmB) mean 4-6 days; metabolized in liver; excreted in urine (metabolites), breast milk; protein binding 90%; poorly penetrates CSF, bronchial secretions, aqueous humor, muscle, bone; terminal half-life mean 4-6 days
Increase:
Nephrotoxicity—other nephrotoxic antibiotics (aminoglycosides, CISplatin, vancomycin, cycloSPORINE, polymyxin B)
Increase:
Hypokalemia—corticosteroids, digoxin, skeletal muscle relaxants, thiazides
•
VS every 15-30 min during first inf; note changes in pulse, B/P
•
I&O ratio; watch for decreasing urinary output, change in specific gravity; discontinue product to prevent permanent damage to renal tubules
•
Blood studies: CBC, potassium, sodium, calcium, magnesium every 2 wk, BUN, creatinine 2-3 ×/wk
•
Weight weekly; if weight increases by more than 2 lb/wk, edema is present; renal damage should be considered
•
For renal toxicity:
increasing BUN, serum creatinine; if BUN is >40 mg/dl or if serum creatinine is >3 mg/dl, product may be discontinued, dosage reduced
•
For hepatotoxicity:
increasing AST, ALT, alk phos, bilirubin
•
For allergic reaction:
dermatitis, rash; product should be discontinued, antihistamines (mild reaction) or EPINEPHrine (severe reaction) administered
•
For hypokalemia:
anorexia, drowsiness, weakness, decreased reflexes, dizziness, increased urinary output, increased thirst, paresthesias
•
For ototoxicity:
tinnitus (ringing, roaring in ears), vertigo, loss of hearing (rare)
•
Therapeutic response: decreased fever, malaise, rash, negative C&S for infecting organism
•
That long-term therapy may be needed to clear infection (2 wk-3 mo, depending on type of infection)
•
To notify prescriber of bleeding, bruising, or soft-tissue swelling