Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (422 page)
HIGH ALERTvinorelbine (Rx)
(vi-nor′el-bine)
Navelbine
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Semisynthetic vinca alkaloid
Inhibits mitotic spindle activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant
Unresectable advanced non–small-cell lung cancer (NSCLC) stage IV;
may be used alone or in combination with CISplatin for stage III or IV NSCLC
Unlabeled uses:
Hodgkin’s disease, breast/ovarian/head/neck cancer, desmoid tumor
Pregnancy (D), breastfeeding, infants, hypersensitivity, granulocyte count <1000 cells/mm
3
pretreatment
Black Box Warning:
Severe neutropenia, intrathecal administration
Precautions:
Children, geriatric patients, renal/hepatic/pulmonary/neurologic disease, anemia, bone marrow suppression
Black Box Warning:
Extravasation
Calculator
• Adult:
IV
30 mg/m
2
/wk
Give 50% of dose; <1000, hold dose; <1000 × 3 wk, discontinue
• Adult:
IV
total bilirubin 2.1-3 mg/dl 15 mg/m
2
/wk; total bilirubin ≥3 mg/dl 7.5 mg/m
2
/day
Available forms:
Inj 10 mg/ml
Black Box Warning:
Do not give intrathecally; fatal
•
Antiemetic 30-60 min before product and prn to prevent vomiting
•
Dilute to 0.5-2 mg/ml with 0.9% NaCl, 0.45% NaCl, D
5
W, D
5
/0.45% NaCl, LR, Ringer’s sol, give over 6-10 min into
Y
-site or central line, flush line
Black Box Warning:
Hyaluronidase 150 units/ml in 1 ml NaCl, warm compress for extravasation for vesicant activity treatment
•
40 mg/m
2
q3wk after IV bol of 8 mg/m
2
; may be given in combination with DOXOrubicin, fluorouracil, CISplatin
Y-site compatibilities:
Amikacin, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, carmustine, cefotaxime, cefTAZidime, ceftizoxime, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin, dexamethasone, diphenhydrAMINE, DOXOrubicin, DOXOrubicin liposome, doxycycline, droperidol, enalaprilat, etoposide, famotidine, filgrastim, floxuridine, fluconazole, fludarabine, gallium, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, LORazepam, mannitol, mechlorethamine, melphalan, meperidine, mesna, methotrexate, metoclopramide, metroNIDAZOLE, minocycline, mitoXANtrone, morphine, nalbuphine, netilmicin, ondansetron, plicamycin, streptozocin, teniposide, ticarcillin, ticarcillin-clavulanate, tobramycin, vancomycin, vinBLAStine, vinCRIStine, zidovudine
CNS:
Paresthesias, peripheral neuropathy, depression, headache,
seizures,
weakness, jaw pain, asthenia
CV:
Chest pain
GI:
Nausea, vomiting
, ileus,
anorexia, stomatitis
, constipation, abdominal pain,
diarrhea
,
hepatotoxicity, GI obstruction/perforation
HEMA:
Neutropenia, anemia, thrombocytopenia, granulocytopenia
INTEG:
Rash, alopecia
, photosensitivity, inj site reaction, necrosis
META:
SIADH
MS:
Myalgia
RESP:
SOB,
dyspnea, pulmonary edema, acute bronchospasm, acute respiratory distress syndrome (ARDS)
Half-life 27-43 hr; peak 1-2 hr; highly bound to platelets, lymphocytes; metabolized in liver; excreted in feces; small amount unchanged in kidneys
Increase:
bleeding risk—NSAIDs, anticoagulants
Increase:
toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole)
Decrease:
vinorelbine effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)
•
Avoid use with St. John’s wort
Increase:
LFTs, bilirubin
Decrease:
Hgb, WBC, platelets
•
B/P (baseline, q15min) during administration
Black Box Warning:
CBC, differential, platelet count before each dose; withhold product if WBC is <4000/mm
3
or platelet count is <75,000/mm
3
; notify prescriber of results; recovery will take 3 wk
•
Bronchospasm:
more common with mitoMYcin; also dyspnea, wheezing; may be treated with oxygen, bronchodilators, corticosteroids, especially if there is underlying pulmonary disease
•
Respiratory status: dyspnea, crackles, unproductive cough, chest pain, tachypnea
•
Renal studies: BUN, serum uric acid, urine CCr before, during therapy; I&O ratio; report fall in urine output to <30 ml/hr; decreased hyperuricemia
•
Infection,
cold, fever, sore throat; notify prescriber if these occur; effects of alopecia on body image
•
Bleeding:
hematuria, guaiac, bruising, petechiae, mucosa or orifices, no rectal temps; avoid IM inj; apply pressure to venipuncture sites
•
Hepatic function tests: AST, ALT, bilirubin, LDH
Severe allergic reactions:
rash, pruritus, urticaria, itching, flushing, bronchospasm, hypotension; EPINEPHrine and crash cart should be nearby
•
Neurologic status: numbness, pain, tingling, loss of Achilles reflex, weakness, palsies
•
Brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; unwaxed dental floss
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report change in gait or numbness in extremities, continuing constipation; may indicate neurotoxicity
•
To examine mouth daily for bleeding, white spots, ulcerations; to notify prescriber
•
Infection:
report sore throat, fever, flulike symptoms
•
To avoid crowds, people with infections, vaccinations, OTC products
Pregnancy:
notify prescriber if pregnancy is planned or suspected; to use effective contraception during treatment and for ≥2 mo after product is discontinued, pregnancy (D); to avoid breastfeeding
•
That hair may be lost; that hair will grow back but with different texture, color
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert