Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (377 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(soo-nit′-in-ib)
Sutent
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Protein-tyrosine kinase inhibitor
Inhibits multiple receptor tyrosine kinases (RTKs); some are responsible for tumor growth
Gastrointesitnal stromal tumors (GIST) after disease progression or intolerance to imatinib; advanced renal carcinoma, pancreatic neuroendocrine tumors (pNET) in patients with unresectable locally advanced/metastatic disease
Pregnancy (D), breastfeeding, hypersensitivity
Precautions:
Children, geriatric patients, active infections, QT prolongation, torsades de pointes, stroke, heart failure
Black Box Warning:
Hepatic disease
Calculator
• Adult:
PO
50 mg/day × 4 wk then 2 wk off; may increase or decrease dose by 12.5 mg; if administered with CYP3A4 inducers, give 87.5 mg/day; if given with CYP3A4 inhibitors, give 37.5 mg/day
• Adult:
PO
37.5 mg daily continuously, increase or decrease by 12.5 mg based on tolerance, avoid potent CYP3A4 inhibitors/inducers; if used with CYP3A4 inhibitors, decrease SUNItinib dose to
minimum of 25 mg/day; if used with CYP3A4 inducers, increase SUNItinib to max 62.5 mg/day
Available forms:
Caps 12.5, 25, 50 mg
•
With meal and large glass of water to decrease GI symptoms
CNS:
CNS hemorrhage
, headache, dizziness, insomnia,
seizures,
fatigue
CV:
Hypertension,
left ventricular dysfunction, QT prolongation, cardiotoxicity, torsades de pointes, thrombotic microangiopathy, cardiac arrest, thromboembolism
ENDO:
Hypo/hyperthyroidism
GI:
Nausea
,
hepatotoxicity, vomiting, dyspepsia,
anorexia, abdominal pain
, altered taste,
constipation
, stomatitis, mucositis,
pancreatitis,
diarrhea,
GI bleeding/perforation
GU:
Nephrotic syndrome
HEMA:
Neutropenia, thrombocytopenia, hemolytic anemia, leukopenia
INTEG:
Rash, yellow skin discoloration
, depigmentation of hair or skin, alopecia,
necrotizing fasciitis, pyoderma gangrenosum
MS:
Pain, arthralgia, myalgia,
myopathy, rhabdomyolysis
RESP:
Cough, dyspnea,
pulmonary embolism
SYST:
Bleeding,
electrolyte abnormalities, hand-foot syndrome,
serious infection
Protein binding 95%; metabolized by CYP3A4; excreted in feces, small amount in urine; peak plasma levels 6-12 hr; terminal half-life 40-60 hr (SUNItinib); active metabolite 80-110 hr
Increase:
microangiopathic hemolytic anemia—bevacizumab; avoid concurrent use
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl; CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
Increase:
hepatotoxicity—acetaminophen
Increase:
plasma concentrations of simvastatin, calcium channel blockers; warfarin; avoid use with warfarin, use low-molecular-weight anticoagulants instead
Decrease:
SUNItinib concentrations—dexamethasone, phenytoin, carBAMazepine, rifampin, PHENobarbital
Decrease:
SUNItinib concentration—St. John’s wort
Increase:
plasma concentrations—grapefruit juice
ANC and platelets; if ANC <1 × 10
9
/L and/or platelets <50 × 10
9
/L, stop until ANC >1.5 × 10
9
/L and platelets >75 × 10
9
/L; if ANC <0.5 × 10
9
/L and/or platelets <10 × 10
9
/L, reduce dosage by 200 mg; if cytopenia continues, reduce dosage by another 100 mg; if cytopenia continues for 4 wk, stop product until ANC ≥1 × 10
9
/L
CV status:
hypertension, QT prolongation can occur; monitor left ventricular ejection fraction (LVEF), (MUGA) at baseline, periodically; ECG
Renal toxicity:
if bilirubin >3 × IULN, withhold SUNItinib until bilirubin levels return to <1.5 × IULN; electrolytes
Hepatotoxicity:
monitor LFTs before treatment, monthly; if liver transaminases >5 × IULN, withhold SUNItinib until transaminase levels return to <2.5 × IULN
•
CHF:
adrenal insufficiency in those experiencing trauma
•
Bleeding: epistaxis; rectal, gingival,
upper GI, genital, wound bleeding; tumor-related hemorrhage may occur rapidly
•
Nutritious diet with iron, vitamin supplement, low fiber, few dairy products
•
Storage at 25° C (77° F)
•
Therapeutic response: decrease in size of tumor
•
To report adverse reactions immediately: SOB, bleeding
•
About reason for treatment, expected result
•
That many adverse reactions may occur: high B/P, bleeding, mouth swelling, taste change, skin discoloration, depigmentation of hair/skin
•
To avoid persons with known upper respiratory infections; that immunosuppression is common
•
To avoid grapefruit juice
To report if pregnancy is planned or suspected, pregnancy (D)