Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (439 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(vis′moe-deg′ib)
Erivedge
Func. class.:
Antineoplastic biologic response modifier
Chem. class.:
Signal transduction inhibitor (STI)
A hedgehog (Hh) signaling pathway inhibitor
Patients who have metastatic basal cell carcinoma, locally advanced, that has recurred after surgery and who are not candidates for surgery/radiation
Hypersensitivity, breastfeeding
Black Box Warning:
Intrauterine fetal death, male-mediated teratogenicity, Pregnancy (D)
Precautions:
Children, blood donation
Calculator
• Adult:
PO
150 mg/day
Available forms:
Cap 150 mg
•
Give without regard to food
•
Swallow whole, do not open or crush caps
•
If a dose is missed, do not take additional dose, take at usual time
•
Store at 77°F (25°C)
GI:
Nausea, vomiting, dysgeusia
GU:
Amenorrhea, azotemia
INTEG:
Alopecia
META:
Hyponatremia
MISC:
Fatigue, decreased weight
MS:
Arthralgia
Protein binding >99%, elimination half-life 4 days
Increase:
effect of each product—Pgp inhibitors (amiodarone, clarithromycin, cycloSPORINE, diltiazem, erythromycin, indinavir, itraconazole, ketoconazole, nelfinavir, niCARdipine, propafenone, quiNIDine, ritonavir, saquinavir, tacrolimus, tamoxifen, verapamil); CYP2C19 substrates (amitriptyline, clomiPRAMINE, imipramine, citalopram, diazepam, phenytoin, PHENobarbital, lansoprazole, omeprazole, pantoprazole, RABEprazole, esomeprazole, clopidogrel, proguanil, propranolol, carisoprodol, chloramphenicol, cyclophosphamide, indomethacin, nelfinavir, nilutamide, progesterone, teniposide, warfarin)
Black Box Warning:
Pregnancy D: Verify pregnancy status of all women within 7 days before starting therapy; effective contraception is needed during and for 7 mo after treatment; men receiving this product should use condoms with spermicide (even after vasectomy) during sexual intercourse with female partners and for 2 mo after the last dose; report exposure during pregnancy to the Genentech Adverse Event Line
•
Therapeutic response: decreased spread of tumor
Black Box Warning:
Pregnancy D: Teach patient to notify their provider immediately if pregnancy is suspected (or in a female partner for male patients); effective contraception is needed during and for 7 mo after treatment; men receiving this product should use condoms with spermicide (even after vasectomy) during sexual intercourse with female partners and for 2 mo after the last dose; if product is used during pregnancy or if the patient becomes pregnant during use, the woman (or female partner for male patients) should be apprised of the potential hazard to the fetus; encourage exposed women (either directly or through seminal fluid) to participate in the ERIVEDGE pregnancy pharmacovigilance program
•
About reason for treatment, expected results
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ziv-a-flih′ber-sept)
Zaltrap
Func. class.:
Antineoplastic biologic response modifier
Chem. class.:
Signal transduction inhibitor (STI)
An angiogenesis inhibitor, a fusion protein that binds to vascular endothelial growth factors (VEGF-A, VEGF-B) and placental growth factor 1 and 2
Metastatic colorectal cancer that is resistant or has progressed after an Oxaliplatin-containing regimen in combination with 5-fluorouracil, leucovorin, irinotecan (FOLFIRI)
Hypersensitivity
Precautions:
infertility, male-mediated teratogenicity, encephalopathy, hypertension, dental work, breastfeeding, children, neonates, geriatric patients, infection, neutropenia, pregnancy C
Black Box Warning:
Bleeding, GI bleeding/perforation, intracranial bleeding, surgery
Calculator
• Adult:
IV
4 mg/kg over 1 hr on day 1 every 2 wk in combination with the FOLFIRI regimen (irinotecan 180 mg/m
2
over 90 min on day 1 with dl-racemic leucovorin 400 mg/m
2
over 2 hr) (infused at the same time, in same Y-line; then on day 1 by 5-fluorouracil 400 mg/m
2
as a bolus, then 2400 mg/m
2
as a 46-hr cont IV inf)
Available forms:
Solution for injection 100 mg/4 ml; 200 mg/8 ml
•
Give before FOLFIRI chemotherapy; visually inspect for particulate matter and discoloration before use
•
Withdraw the calculated dose, add to 0.9% sodium chloride or dextrose 5% solution to 0.6–8 mg/mL; use polyvinyl chloride (PVC) infusion bags containing bis (2-ethylhexyl) phthalate (DHEP) or polyolefin infusion bags; do not re-enter the vial after first puncture; discard any unused portion; do not mix or combine with other drugs in the same infusion bag; the diluted solution may be stored refrigerated for ≤4 hr; discard any unused portion in the infusion bag
•
Give diluted solution over 1 hr using a 0.2 micron polyethersulfone filter; do not use nylon or polyvinylidene fluoride (PVDF) filters; do not give IV push or bolus; do not mix or combine with other drugs in the same IV line; give using an infusion set made of one of the following: PVC containing DEHP, DEHP-free PVC containing trioctyl-trimellitate (TOTM), polypropylene, polyethylene-lined PVC, or polyurethane
Hold until B/P is controlled and then permanently reduce dose to 2 mg/kg; discontinue in hypertensive crisis or hypertensive encephalopathy
Hold until proteinuria is <2 g/24 hr; if proteinuria recurs, hold therapy until proteinuria is <2 g/24 hr, then reduce to 2 mg/kg; discontinue in nephrotic syndrome or thrombotic microangiopathy
CNS:
Intracranial bleeding,
headache, dizziness
CV:
Hypertensive crisis,
hypertension,
stroke
GI:
Nausea,
hepatotoxicity,
dyspepsia,
GI hemorrhage,
abdominal pain,
GI perforation
GU:
Proteinuria, hematuria
HEMA:
Neutropenia, leukopenia
INTEG:
Rash, pruritus, alopecia, hypersensitivity
MISC:
Fatigue, epistaxis, night sweats, decreased weight, flulike symptoms, infection
RESP:
Dyspnea,
pulmonary embolism
Elimination half-life 6 days
Severe bleeding:
GI bleeding, intracranial bleeding, and pulmonary hemorrhage/hemoptysis may be fatal; monitor patients for signs and symptoms of bleeding
GI perforation:
some cases are fatal; monitor patients for signs and symptoms of GI perforation; discontinue therapy if GI perforation develops
•
Poor wound healing
: hold ≥4 wk before elective surgery; after major surgery, do not restart for ≥4 wk and until the surgical wound is entirely healed
Severe hypertension/hypertensive crisis:
usually occurs within the first 2 cycles (grade 3 or 4 hypertension); monitor B/P every 2 wk or more often if needed; treatment with antihypertensives may be needed; product may need to be discontinued
Severe proteinuria/nephrotic syndrome/thrombotic microangiopathy (TMA):
monitor urine protein by dipstick analysis and urinary protein–to–creatinine ratio (UPCR); obtain a 24-hr urine collection for a UPCR >1; for proteinuria of 2 g/24 hr, temporarily hold doses until proteinuria is <2 g/24 hr; if proteinuria recurs, hold doses until proteinuria is <2 g/24 hr, then permanently reduce; discontinue in nephrotic syndrome or TMA
Febrile neutropenia, neutropenic infection/sepsis:
monitor CBC with differential at baseline and before each cycle, hold FOLFIRI until the neutrophil count is ≥1.5 × 10
9
/L
Geriatric toxicity:
assess for diarrhea, dizziness, asthenia, weight loss, and dehydration that can indicate toxicity
Pregnancy C/Breastfeeding:
highly effective contraception during and up to 3 mo after the last dose is needed for all patients of reproductive potential because infertility and male-mediated teratogenicity can occur; infertility can occur but is reversible within 18 wk after stopping product: do not breastfeed
•
Therapeutic response: decrease in spread of size of tumor
That highly effective contraception should be used during and up to 3 mo after the last dose in all patients of reproductive potential, infertility and male-mediated teratogenicity can occur; infertility is reversible within 18 wk after stopping product; do not breastfeed
•
About reason for treatment, expected results
Notify prescriber immediately of bleeding, severe abdominal pain, poor wound healing
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert