Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (438 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(fil-gras′tim)
Neutrophil
Func. class.:
Biologic modifier
Chem. class.:
Short-acting granulocyte colony-stimulating factor (G-CSF)
Stimulates proliferation and differentiation of neutrophils by binding to G-CSF receptors
Chemotherapy-induced neutropenia prophylaxis to reduce the duration of severe neutropenia in nonmyeloid malignancies
Hypersensitivity
Precautions:
pregnancy (C), breastfeeding, children, sickle cell disease, chemotherapy, neoplastic disease
Calculator
• Adult:
SUBCUT
5 mcg/kg/day
Available forms:
Solution for injection 300 mcg/0.5 ml, 480 mcg/0.8 ml
•
Visually inspect for particulate matter and discoloration before use, the solution should be clear; do not shake
•
Injection sites include the front of the middle thighs, the upper outer areas of the buttocks, the upper back portion of the upper arms, or the abdomen except for the 2 inches around the navel; vary sites daily
•
After removing the needle shield, expel unneeded volume based on the needed dose, discard unused portions
•
Inject SUBCUT, avoiding any area that is tender, red, bruised, or hard or that has stretch marks or scars; push the plunger as far as it will go, because injection of the entire contents is necessary to activate the needle guard
•
Remove needle from skin while keeping plunger depressed; slowly let the plunger go to allow the empty syringe to move inside the device and guard the needle
CNS:
Fever, headache
GI:
Nausea, vomiting, diarrhea, anorexia, abdominal pain
HEMA:
Excessive leukocytosis
INTEG:
Alopecia
RESP:
Acute respiratory distress syndrome (ARDS)
SYST:
Anaphylaxis, angioedema, sickle-cell crisis, splenic rupture
Half-life 3.2-3.8 hr
Increase:
adverse reactions—do not use this product concomitantly with antineoplastics, lithium
•
Blood studies: CBC, platelet count before treatment and twice weekly; neutrophil counts may be increased for 2 days after therapy
•
B/P, respirations, pulse before and during therapy
•
Bone pain; give mild analgesics
•
Absence of severe neutropenia in cancer chemotherapy
•
About the technique for self-administration: dose, side effects, disposal of containers and needles; provide instruction sheet
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ter′i-floo′noe-mide)
Aubagio
Func. class.:
Multiple sclerosis agent
Chem. class.:
Pyrimidine synthesis inhibitor
Antiproliferative effects including peripheral T- and B-lymphocytes, might reduce inflammatory demyelination
Reduction of the frequency of relapses or remitting MS
Hypersensitivity
Black Box Warning:
Pregnancy: X
Precautions:
Breastfeeding, alcoholism, diabetes mellitus, eosinophilic pneumonia, hepatitis, jaundice, male-mediated teratogenicity, pneumonitis, pulmonary disease/fibrosis, sarcoidosis, TB, vaccination
Black Box Warning:
Hepatic disease
Calculator
• Adult:
PO
7 or 14 mg/day
Available forms:
Tabs 7, 14 mg
•
May be taken without regard to food
CNS:
Anxiety, headache
CV:
Palpitations, hypertension,
MI
EENT:
Blurred vision, conjunctivitis, sinusitis
GI:
Nausea, vomiting, diarrhea, cystitis
HEMA:
Leukopenia, lymphopenia, neutropenia
INTEG:
Acne vulgaris, alopecia, pruritus
META:
Weight loss
MISC:
Infection, cystitis
Protein binding >99%, median half-life 18-19 days, peak 1-4 hr
•
Do not use with leflunomide, live virus vaccines
Increase:
teriflunomide effect—cycloSPORINE, eltrombopag, gefitinib
Increase:
hepatotoxicity—methotrexate, HMG-CoA reductase inhibitors
Increase:
hematologic toxicity—zidovudine
Increase:
effect of—oral contraceptives, repaglinide, pioglitazone, rosiglitazone, PACLitaxel, naproxen, topotecan, bosentan, furosemide
Decrease:
effect of—warfarin, alosetron, DULoxetine, theophylline, tiZANidine, quiNINE, tamoxifen, bendamustine, rasagiline, rOPINIRole, selegiline, propafenone, mexiletine, lidocaine, anagrelide, cloZAPine, cinacalcet, caffeine, monitor closely
Decrease:
effect of teriflunomide—cholestyramine, activated charcoal
•
CNS symptoms: anxiety, confusion, vertigo
•
GI status: diarrhea, vomiting, abdominal pain
•
Cardiac status: tachycardia, palpitations, vasodilation, chest pain
•
Therapeutic response: decreased symptoms of MS
•
That blurred vision can occur
•
To notify prescriber if pregnancy is planned or suspected
•
Not to change dosing or stop taking without advice of prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(toe′fa-sye′ti-nib)
Xeljanz
Func. class.:
Antirheumatic agent (disease modifying), immunomodulator/biologic DMARD
Chem. class.:
Janus kinase inhibitor
Affects the signaling pathway of Janus kinase
Rheumatoid arthritis (moderately to severely active) in those who have taken methotrexate with inadequate response or intolerance
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, neonates, infants, children, geriatric patients, neoplastic disease, ulcerative colitis, neutropenia, peptic ulcer disease
Active infections, risk of lymphomas/leukemias, TB, posttransplant lymphoproliferative disorder (PTLD), kidney disease, diabetes mellitus, HIV, hypercholesterolemia
Black Box Warning:
Infection, secondary malignancy
Calculator
• Adult:
PO
5 mg/day with or without methotrexate or other nonbiologic DMARDs
Available forms:
Tabs 5 mg
•
Without regard to food
CNS:
Headache, paresthesias, insomnia, fatigue
CV:
Hypertension
GI:
Abdominal pain, nausea,
liver damage,
dyspepsia, vomiting, diarrhea, gastritis,
GI perforation, steatosis
HEMA:
Anemia,
lymphocytosis, lymphopenia,
neutropenia
INTEG:
Rash, pruritus
MISC:
Increased cancer risk, risk of infection (TB, invasive fungal infections, other opportunistic infections), may be fatal, posttransplant lymphoproliferative disorder (PTLD)
Bioavailability 70%, protein binding 40% (albumin), metabolism mediated by CYP3A4, half-life 3 hr, peak 0.5-1 hr
•
Do not use with TNF modifiers, vaccines, potent immunosuppressants, other biologic DMARDS
Increase:
tofacinib effect—CYP3A4 inhibitors (amprenavir, boceprevir, delavirdine, ketoconazole, indinavir, itraconazole, dalfopristin/quinupristin, ritonavir, tipranavir, fluconazole, isoniazid, miconazole)
Decrease:
tofacinib effect—CYP3A4 inducers (rifampin, rifapentine, rifabutin, primidone, phenytoin, PHENobarbital, nevirapine, nafcillin, modafinil, griseofulvin, etravirine, efavirenz, barbiturates, bexarotene, bosentan, carBAMazepine, enzalutamide, dexamethasone)
Increase:
LFTs, cholesterol
Decrease:
neutrophils, lymphocytes, Hct, Hgb
•
Monitor lipid profile, Hct/Hgb WBC, LFTs
•
RA:
Pain, stiffness, ROM, swelling of joints before, during treatment
Black Box Warning:
Active infection, including localized infection:
evaluate and test patients for latent or active TB before use; treat with antimycobacterials before use of product; this product increases the risk of serious including fatal infections (pulmonary or extrapulmonary TB; invasive fungal infections; and bacterial, viral, and opportunistic infections); during and after use, monitor for infection including TB in those who tested negative for latent TB before use; if a serious infection develops, interrupt receipt until the infection is controlled
Black Box Warning:
Secondary malignancy:
lymphoma and other malignancies have been noted with product use
Epstein–Barr virus–associated posttransplant lymphoproliferative disorder (PTLD):
in kidney transplant patients when used with this product and immunosupressives
•
Liver disease:
not recommended in severe liver disease, impairment; dose modification is needed with moderate liver impairment, monitor LFTs
GI perforation:
assess in those with diverticulitis, peptic ulcer disease, or ulcerative colitis
Immunosuppression:
obtain neutrophil and lymphocyte counts before use, do not start the product in lymphocyte count <500 cells/mm
3
or ANC <1000 cells/mm
3
; for ANC >1000 cells/mm
3
, monitor neutrophil counts after 4–8 wk and every 3 mo thereafter; lymphocyte count >500 cells/mm
3
, monitor lymphocyte counts every 3 mo
Anemia:
determine Hgb, do not start in Hgb <9 g/dl; in Hgb ≥9 g/dl, monitor Hgb after 4–8 wk and every 3 mo thereafter
Pregnancy (C)/breastfeeding:
use during pregnancy only if the potential benefit justifies the potential risk to the fetus; if pregnancy occurs, enrollment in the pregnancy registry is encouraged by calling 1–877–311–8972; discontinue product or breastfeeding, serious adverse reactions can occur in nursing infants
Black Box Warning:
Neoplastic disease (lymphomas/leukemias)
•
Therapeutic response: decreased inflammation, pain in joints, decreased joint destruction
•
Not to have vaccines while taking this product
•
Not to take any live virus vaccines during treatment
•
To report signs of infection, allergic reaction
Pregnancy C:
teach patient to report if pregnancy is planned or suspected, do not breastfeed