Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (434 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
ocriplasmin
(ok-ri-plas′min)
Jetrea
Func. class.:
Ophthalmic agent
Symptomatic vitreomacular adhesion
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• Adult:
Intravitreal INJ
0.125 mg (0.1 ml of diluted solution) by intravitreal injection to the affected eye once as a single dose
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(oh′ma-set-ax′een)
Synribo
Func. class.:
Antineoplastic-miscellaneous
Chem. class.:
Cephalotaxine ester (derived from the Evergreen tree:
Cephalotaxus harringtonia)
Inhibits protein synthesis by binding to site of large ribosome subunit, it reduces Bcr-Abl and Mcl-1 independent of direct Bcr-Abl binding, inducing apoptosis
Chronic or accelerated phase chronic myelogenous leukemia (CML) with resistance or/and intolerance to 2 or more tyrosine kinase inhibitors
Pregnancy (D), breastfeeding, hypersensitivity
Precautions:
Children, bleeding, diabetes mellitus, female patients, geriatric patients, hyperglycemia, hyperosmolar hyperglycemic state (HHS), infection, anemia, neutropenia, thrombocytopenia
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• Adult:
SUBCUT
1.25 mg/m
2
bid × 14 days every 28 days
Grade 4 neutropenia (absolute neutrophil count [ANC]
<
0.5
×
109/L) or grade 3 thrombocytopenia (platelet count
<
50
×
109/L):
Do not start the next cycle until the ANC is ≥1 × 10
9
/L and platelets are ≥50 × 10
9
/L; when therapy is resumed, reduce the number of dosing days by 2 days/cycle (initial cycles, from 14 to 12 days; maintenance cycles, from 7 to 5 days)
Available forms:
Powder for injection 3.5 mg
•
Reconstitution:
Add 1 ml of 0.9% saline for injection/vial to 3.5 mg/ml, gently swirl until the solution is clear and completely dissolved, visually inspect for particulate matter and discoloration before use, protect from light
•
Administration:
Calculate dose, withdraw into a syringe, and give as a SUBCUT injection; discard unused portion, use ≤12 hr at room temperature, ≤24 hr when refrigerated
CNS:
Seizures,
weakness, agitation, anxiety, chills, fever, confession, depression, dizziness, fatigue, headache, insomnia, lethargy, night sweats, tremor
CV:
Hypotension, peripheral edema,
sinus tachycardia
EENT:
Blurred vision, change in taste (dysgeusia)
GI:
Nausea, vomiting, diarrhea, abdominal pain, stomatitis
HEMA:
Neutropenia, leukopenia, thrombocytopenia, anemia, bleeding
INTEG:
Alopecia, rash, skin hyperpigmentation, stomatitis, skin ulcer, purpura, petechiae, pruritus
MISC:
Fever
MS:
Arthralgia, gout, myalgia, back pain
RESP:
Dyspnea, cough, rales, sinus congestion
SYST:
Infections
Protein binding ≤50%, half-life 6 hr, peak 30 min
Increase:
Bleeding risk—anticoagulants, salicylates, NSAIDs, avoid use when platelets are <50,000 cells/mL
Black Box Warning:
CBC, differential, platelet count before treatment and weekly, during induction/maintenance, then every 2 wk as needed
Pregnancy D:
assess for pregnancy before starting treatment
Infection:
monitor temp every 4 hr; fever might indicate beginning of infection
•
CV status: B/P, edema, flushing
•
CNS changes: confusion, paresthesias, dysesthesia, pain, weakness
Hypersensitive reactions, anaphylaxis:
hypotension, dyspnea, angioedema, generalized urticaria; discontinue infusion immediately
Bone marrow depression/bleeding:
hematuria, guaiac, bruising or petechiae, mucosa or orifices every 8 hr; obtain prescription for viscous lidocaine (Xylocaine); avoid invasive procedures
•
Effects of alopecia on body image; discuss feelings about body changes
•
Diabetes mellitus:
avoid in poorly controlled disease, monitor blood glucose levels frequently
•
Therapeutic response: decreased CML, positive hematologic response
•
To report signs of infection: fever, sore throat, flulike symptoms
•
To report signs of anemia: fatigue, headache, faintness, SOB, irritability
•
To report bleeding; to avoid use of razors, commercial mouthwash
•
To avoid use of aspirin, ibuprofen
•
That hair may be lost during treatment; that a wig or hairpiece might make patient feel better; that new hair may be different in color and texture
•
That pain in muscles and joints 2-5 days after infusion is common
To use barrier contraception during and for several mo after treatment, pregnancy (D); to avoid breastfeeding
•
To avoid receiving vaccinations while taking product