Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (436 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(per-am′pa-nel)
Fycompa
Func. class.:
Anticonvulsant
A noncompetitive AMPA-selective receptor antagonist; inhibits calcium influx
Partial onset-seizures with/without secondary generalization
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children <12 yr, geriatric patients, abrupt discontinuation, depression, liver disease, kidney disease, substance abuse, suicidal ideation, driving or operating machinery
Black Box Warning:
Bipolar disorder, psychosis, schizophrenia
Calculator
• Adult/adolescent/child
≥
12 yr receiving enzyme-inducing aeds:
PO
4 mg/day at bedtime, increase dosage every wk by 2 mg/day to 4-12 mg/day at bedtime
• Adult/adolescent/child
≥
12 yr not receiving aeds:
PO
2 mg/day at bedtime, increase dosage every wk by 2 mg/day up to 4-8 mg/day at bedtime
Available forms:
Tabs 2, 4, 6, 8, 10, 12 mg
•
Store at room temperature away from light
CNS:
Drowsiness, confusion, memory impairment, dizziness, fatigue, anxiety,
ataxia, agitation, emotional lability, euphoria, hostility, lethargy, memory impairment, paranoia, paresthesias,
suicidal ideation,
vertigo, depression
CV:
Peripheral edema
EENT:
Blurred vision, diplopia
GI:
Constipation, nausea, vomiting, weight gain
MS:
Myalgia, arthralgia
SYST:
Infection
Protein binding 95%-96%, half-life 105 hr, antagonist of the AMPA receptor
Increase:
perampanel effect—CYP3A4 inducers
Increase:
depression—benzodiazepines
Increase:
CNS depression—alcohol, sedatives, antihistamines, all other CNS depressants
Decrease:
contraception—oral/implant contraceptives with levonorgestrel/estrogen
Decrease:
perampanel effect—CYP3A4 inhibitors
Decrease:
perampanel effect—St. John’s wort
Seizures:
aura, location, duration, activity at onset; institute seizure precautions: padded side rails; move objects that might harm patient
Black Box Warning:
Bipolar disorder, psychosis, schizophrenia:
Hostility, aggression, anger, homicidal ideation can occur
Suicidal ideation:
assess for suicidal thoughts/behaviors as early as 1 wk and any time during treatment
•
Mental status: mood, sensorium, affect, behavioral changes, suicidal thoughts/behaviors; if mental status changes: notify prescriber
Abrupt discontinuation:
can increase seizures
•
Therapeutic response: decreased seizure activity
•
To avoid driving, other activities that require alertness because dizziness, drowsiness can occur
Not to discontinue medication quickly after long-term use; to taper over ≥1 wk because withdrawal-precipitated seizures can occur
To notify prescriber if pregnancy is planned or suspected; to avoid breastfeeding
•
Take once daily at bedtime
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(per-too′zoo-mab)
Perjeta
Func. class.:
Antineoplastic biologic-response modifier
Chem. class.:
Monoclonal antibody, antineoplastic
Blocks liquid-dependent action of human epidermal growth factor-2 (HER2), inhibiting signal pathways
First-line treatment of (HER2) positive metastatic breast cancer with trastuzumab and DOCEtaxel
Black Box Warning:
pregnancy (category D)
Precautions:
Breastfeeding, children, infants, neonates, cardiac arrhythmias, MI, cardiac disease, heart failure, hypertension, infusion-related reactions
Calculator
• Adult:
IV
840 mg over 60 min, then after 3 wk 420 mg over 30-60 min every 3 wk; give with trastuzumab 8 mg/kg IV over 90 min, then after 3 wk 6 mg/kg over 30-90 min every 3 wk and DOCEtaxel 75 mg/m
2
IV every 3 wk; dosage may be escalated to 100 mg/m
2
Available forms:
Solution for inj 420 mg/14 ml
•
Visually inspect for particulate matter and discoloration
•
Withdraw the calculated dose from the vial and add to 250 ml 0.9% sodium chloride to PVC or non-PVC polyolefin infusion bag; do not dilute with dextrose 5% solution
•
Dilute in normal saline only; do not mix or dilute with other drugs or dextrose solutions
•
Mix the diluted solution by gentle inversion; do not shake
•
Administer the diluted solution immediately
•
Do not administer as an IV push or bolus
•
Give the first dose of 840 mg over 60 min and subsequent 420 mg doses over 30–60 min
•
If the diluted solution is not used immediately, store at 2°-8° C for up to 24 hr
•
If time since previous dose is <6 wk, give 420 mg IV (do not wait for next scheduled dose)
•
If time since previous dose is ≥6 wk, give 840 mg IV over 60 min, followed 3 wk later by 420 mg IV over 30–60 min repeated every 3 wk
•
If DOCEtaxel is discontinued, this product and trastuzumab may continue
CNS:
Headache, fever,
peripheral neuropathy
, chills,
fatigue
, asthenia
CV:
Heart failure
EENT:
Lacrimation, stomatitis
GI:
Nausea
, vomiting, diarrhea, dysgeusia
HEMA:
Anemia,
neutropenia
MS:
Myalgia
RESP:
Upper respiratory infection
SYST:
Anaphylaxis,
infection, antibody formation
Median half-life 18 days
•
Testing should be done to identify HER2 overexpression before using this product
Can occur and is increased in those with a history of prior anthracycline use or radiotherapy to the chest; evaluate LVEF at baseline and every 3 mo; withhold therapy ×3 wk if LVEF is <40% or LVEF is 40%-45% with a 10% or greater absolute decrease from baseline; resume therapy if the LVEF is recovered to >45% or to 40%-45% with <10% absolute decrease at reassessment; if the LVEF has not improved or has declined further, consider permanently discontinuing pertuzumab and trastuzumab after a risk/benefit assessment
Assess anaphylactoid reaction, acute infusion reaction, cytokine-release syndrome 60 min after the first infusion, 30 min after other infusions; monitor for pyrexia, chills, fatigue, headache, asthenia, hypersensitivity, and vomiting; if a significant reaction occurs, slow or interrupt the infusion; permanent discontinuation may be needed in severe reactions
Black Box Warning:
Pregnancy: Determine if pregnancy is planned or suspected; patients who become pregnant during therapy should report exposure to the Genentech Adverse Event line at 1-888-835-2555 and enroll in the MOTHER pregnancy registry at 1-800-690-6720
Can occur, but occurs more commonly when trastuzumab is also used
•
Monitor for dyspnea, shortness of breath, fever
•
Decreased size, spread of tumor
Black Box Warning:
Counsel women of childbearing age on the need for contraception during and for 6 mo after therapy; advise patients who suspect pregnancy to contact their health care provider immediately; discontinue breastfeeding