Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (69 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTbrentuximab
(bren-tuk′see-mab)
Adcetris
Func. class.:
Monoclonal antibody; antineoplastic
The anticancer activity is due to the binding of the ADC to CD30-expressing cells, followed by the internalization and transportation of the ADC-CD30 complex to lysosomes and the release of MMAE via selective proteolytic cleavage. MMAE binds to tubulin and disrupts the microtubule network within the cell, inducing cell cycle arrest and apoptotic death of the cells
For the treatment of Hodgkin’s disease after failure of autologous stem cell transplant (ASCT) or after failure of at least 2 prior multiagent chemotherapy regimens in patients who are not ASCT candidates; for the treatment of non-Hodgkin’s lymphoma (NHL); for the treatment of systemic anaplastic large cell lymphoma (sALCL) after failure of at least 1 prior multiagent chemotherapy regimen
Hypersensitivity, pregnancy (category D)
Precautions:
Breastfeeding, children, infants, neonates, neutropenia, peripheral neuropathy, tumor lysis syndrome (TLS)
Black Box Warning:
Progressive multifocal leukoencephalopathy
Calculator
• Adult: IV
1.8 mg/kg over 30 min every 3 wk until a maximum of 16 cycles, disease progression, or unacceptable toxicity. For patients >100 kg, max weight used for dosage calculation should be 100 kg, which translates to no more than 180 mg/dose
•
For grade <3: no dosage adjustments are recommended; for new or worsening grade 2-3: interrupt treatment until toxicity resolves to grade ≤1; when resuming treatment, reduce dosage to 1.2 mg/kg IV q3wk; for grade 4: discontinue treatment
•
For neutropenia grade <3: no dosage adjustments; for grade 3-4 neutropenia: interrupt treatment until toxicity resolves to baseline or grade ≤2; consider the use of growth factors (CSFs) for subsequent cycles of therapy; for grade 4 neutropenia despite the use of growth factors: discontinue treatment or reduce the dose to 1.2 mg/kg IV q3wk
Available forms:
Powder for inj 50 mg
•
Visually inspect for particulate matter and discoloration whenever sol and container permit
•
Only as an IV inf, do not give as an IV push or bolus
•
Use cytotoxic handling procedures
•
Do not mix, or administer as an infusion, with other IV products
•
Calculate the dose (mg) and the number of vials required. For patients weighing >100 kg, use 100 kg to calculate the dose; reconstitute each 50-mg vial per 10.5 ml of sterile water for inj (5 mg/ml)
•
Direct the stream of sterile water toward the wall of the vial and not directly at the cake or powder; gently swirl the vial to aid in dissolution, do not shake
•
Discard any unused portion left in the vial
•
After reconstitution, dilute immediately with ≥100 ml of 0.9% sodium chloride, 5% dextrose, or lactated ringers solution to a final concentration (0.4 mg/ml-1.8 mg/ml)
•
Infuse over 30 min
CNS:
Headache, dizziness,
fever
, peripheral neuropathy, anxiety, chills, confusion,
fatigue
, paresthesias, insomnia, night sweats
Progressive multifocal leukoencephalopathy
CV:
Peripheral edema, supraventricular arrhythmia
GI:
Abdominal pain, nausea, vomiting
, constipation,
diarrhea
, weight loss
INTEG:
Rash
, pruritus, alopecia, xerosis
RESP:
Pneumothorax, pneumonitis, pulmonary embolism,
dyspnea,
cough
SYST:
Anaphylaxis, tumor lysis syndrome, antibody formation, Stevens-Johnson Syndrome
HEMA:
Anemia, neutropenia, thrombocytopenia
Protein binding is 68%-82%, only a small amount is metabolized; potent inhibitors or inducers of CYP3A4 may alter action; ADC peak at end of infusion; MME peak 1-3 days; terminal half-life is 4–6 days; 3 components are released: MMAE (monomethyl auristatin E), ADC, and the total antibody; the half-life of MMAE a component is 3.43-3.6 days
Increase:
brentuximab component action: ketoconazole, boceprevir, delavirdine, isoniazid, indinavir, itraconazole, dalfopristin; quinupristin, telithromycin, tipranavir, rifampin, ritonavir
Increase noninfectious pulmonary toxicity:
bleomycin, do not use together
•
Increased brentuximab component action: St. John’s Wort
•
Tumor lysis syndrome (TLS):
assess for hyperkalemia, hypophosphatemia, hypocalcemia; may develop renal failure may use allopurinol or rasburicase to prevent TLS; monitor serum BUN/creatinine
•
Pregnancy: determine if pregnancy is planned or suspected, pregnancy category D
•
Peripheral neuropathy: Progressive multifocal leukoencephalopathy:
Assess for weakness, or paralysis, vision loss, impaired speech, and cognitive deterioration; often fatal
•
Monitor CBC, and differential
•
Use the diluted sol immediately or store in refrigerator for ≤24 hr after reconstitution; do not freeze
•
Decreasing symptoms of Hodgkin’s disease (increased lymph nodes, night sweats, weight loss, splenomegaly, hepatomegaly)
•
To report immediately weakness, change in vision, impaired speech
•
To use reliable contraception (pregnancy D); to avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ophthalmic)
(bri-moe′ni-deen)
Alphagan P
Func. class.:
Antiglaucoma
Chem. class.:
Selective alpha-2 agonist
Do not confuse:
brimonidine
/bimatoprost
Decrease aqueous humor and increase outflows
Treatment of chronic open-angle glaucoma and ocular hypertension
Hypersensitivity, AV block, heart failure, bradycardia, sick sinus syndrome, within 14 days of MAOIs therapy
Precautions:
Breastfeeding, depression, cerebrovascular disease, hepatic/renal impairment, Raynaud’s phenomenon, orthostatic hypotension, thromboangiitis obliterans
Calculator
• Adult/child >2 yr:
Instill 1 drop in the affected eye(s) tid
Available forms:
Ophthalmic solution 0.1%, 0.15%, 0.2%
CNS:
Headache, dizziness, somnolence
CV:
Hyper/hypotension
EENT:
Eye stinging/burning, tearing, photophobia, change in vision, sinus infection
Peak ½-2 hr, half-life 2 hr
Increase:
intraocular pressure reduction—apraclonidine, dorzolamide, pilocarpine, timolol
Increase:
effects of—CNS depressants
Decrease:
B/P—beta blockers, antihypertensives
Decrease:
brimonidine effect—tricyclic antidepressants, may cause HTN crisis MAOIs, linezolid
•
Glaucoma: Monitor intraocular pressure
•
Decreasing intraocular pressure
•
That drug is for ophthalmic use only
•
Not to touch the tip of the dropper to the eye, fingertips, or other surface to prevent contamination
•
To wash hands before and after use. Tilt the head back slightly and pull the lower eyelid down with the index finger to form a pouch. Squeeze the prescribed number of drops into the pouch. Close eyes to spread drops. To avoid excessive systemic absorption, apply finger pressure on the lacrimal sac for 1–2 min following use
•
That if more than one topical ophthalmic drug product is being used, the drugs should be administered at least 5 minutes apart
•
To avoid contamination or the spread of infection, do not use dropper for more than one person