Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (89 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(se-tux′i-mab)
Erbitux
Func. class.:
Antineoplastic—miscellaneous, monoclonal antibody
Chem. class.:
Epidermal growth factor receptor inhibitor
Not fully understood; binds to epidermal growth factor receptors (EGFRs); inhibits phosphorylation and activation of receptor-associated kinase, thereby resulting in inhibition of cell growth
Alone or in combination with irinotecan for EGFRs expressing metastatic colorectal carcinoma, head/neck cancer
Unlabeled uses:
Front-line use for non–small-cell lung cancer in combination with CISplatin and vinorelbine
Hypersensitivity to this product, murine proteins
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients; CV/renal/hepatic disease; ocular, pulmonary disorders
Black Box Warning:
Arrhythmias, CAD, infusion-related reactions, radiation, cardiac, respiratory arrest
Calculator
• Adult:
IV INF
400 mg/m
2
loading dose given over 120 min, max inf rate 5 ml/min; weekly maintenance dose (all other inf) is 250 mg/m
2
given over 60 min, max inf rate 5 ml/min (10 mg/min); premedicate with an H
1
-antagonist (diphenhydrAMINE 50 mg IV); dosage adjustments made for inf reactions or dermatologic toxicity; other protocols used
• Adult:
IV
400 mg/m
2
over 120 min (max 5 ml/min) week 1 with weekly inf of 250 mg/m
2
over 60 min (max 5 ml/min) with CISplatin 80 mg/m
2
on day 1 and vinorelbine 25 mg/m
2
on days 1, 8
Available forms:
Sol for inj 100 mg/50 ml, 200 mg/100 ml
•
Use cytoxic handling procedures
•
By IV inf only; do not give by IV push or bolus; do not shake or dilute
•
Do not dilute with other products
•
Storage refrigerated at 36° F-46° F, discard unused portions
•
Inf pump:
draw up volume of vial using appropriate syringe/needle (vented spike or other appropriate transfer device); fill Erbitux into sterile evacuated container/bag, repeat until calculated volume put into the container; use new needle for each vial; give through in-line filter (low protein binding 0.22 micrometer); affix inf line and prime before starting inf, max rate 5 ml/min; flush line at end of inf with 0.9% NaCl, use a low protein binding 0.22-micrometer in-line filter
•
Syringe pump:
draw up volume of vial using appropriate syringe/needle (vented spike); place syringe into syringe driver of syringe pump and set rate; use in-line filter (low protein binding 0.22-micrometer); connect inf line, start inf after priming; repeat until calculated volume given
•
Use new needle and filter for each vial, max 5 ml/min rate; use 0.9% NaCl to flush line after inf
•
Do not piggyback to patient inf line
•
Observe patient for adverse reactions for 1 hr after inf
Black Box Warning:
Inf reactions: if mild (grade 1 or 2), reduce all doses by 50%; if severe (grade 3 or 4), permanently discontinue
CNS:
Headache, insomnia, depression
,
aseptic meningitis
CV:
Cardiac arrest
GI:
Nausea, diarrhea, vomiting, anorexia, mouth ulceration, dehydration, constipation, abdominal pain
HEMA:
Leukopenia, anemia
INTEG:
Rash, pruritus, acne, dry skin,
toxic epidermal necrolysis, angioedema,
blepharitis, cheilitis, cellulitis, cysts, alopecia, skin/nail disorder
,
acute infusion reactions, other skin toxicities
MISC:
Conjunctivitis, asthma, malaise, fever
,
renal failure,
hypomagnesemia
MS:
Back pain
RESP:
Interstitial lung disease,
cough, dyspnea
,
pulmonary embolus,
peripheral edema
,
respiratory arrest
SYST:
Anaphylaxis, sepsis, infection
Half-life 114 hr, steady state by 3rd wkly inf, peak 168-235 g/ml, trough 41-85 g/ml
Increase:
LFTs
Black Box Warning:
Pulmonary changes:
lung sounds, cough, dyspnea; interstitial lung disease may occur, may be fatal; discontinue therapy if confirmed
•
Cardiac arrest: monitor electrolytes, in those undergoing radiation therapy, electrolytes may be decreased
Serious hypersensitivity reactions:
toxic epidermal necrosis, angioedema, anaphylaxis
•
GI symptoms: frequency of stools, dehydration, abdominal pain, stomatitis
•
K-RAS mutations
with metastatic colorectal carcinoma; if K-RAS mutation on codon 12 or 13 detected, patient should not receive anti-EGFR antibody therapy
•
Therapeutic response: decreased growth, spread of EGFR-expressing metastatic colorectal, head/neck carcinoma
Black Box Warning:
To report adverse reactions immediately: shortness of breath, severe abdominal pain, skin eruptions
•
About the reason for treatment, expected results
Black Box Warning:
To use contraception during treatment (pregnancy [C]), not to breastfeed
•
To wear sunscreen and hats to limit sun exposure; sun exposure can exacerbate any skin reactions
•
To avoid crowds, persons with known infections
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(klor-dye-az-e-pox′ide)
Librium
Func. class.:
Antianxiety
Chem. class.:
Benzodiazepine, long-acting
Do not confuse:
Librium
/Librax
Potentiates the actions of GABA, especially in the limbic system, reticular formation
Short-term management of anxiety, acute alcohol withdrawal, preoperatively for relaxation
Pregnancy (D), breastfeeding, children <6 yr, hypersensitivity to benzodiazepines, closed-angle glaucoma, psychosis
Precautions:
Geriatric patients, debilitated, renal/hepatic disease, suicidal ideation, abrupt discontinuation
Calculator
• Adult:
PO
5-10 mg tid-qid
• Geriatric:
PO
5 mg bid initially, increase as needed
• Child >6 yr:
PO
5 mg bid-qid, max 10 mg bid-tid
• Adult:
PO
25-50 mg tid-qid
• Adult:
PO
5-10 mg tid-qid on day before surgery
• Adult:
PO
50-100 mg q4-6hr prn, max 300 mg/day
• Adult:
PO
CCr <10 ml/min, give 50% dose
Available forms:
Caps 5, 10, 25 mg
•
With food or milk for GI symptoms
CNS:
Dizziness, drowsiness
, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations
CV:
Orthostatic hypotension
, edema,
ECG changes, tachycardia,
hypotension
EENT:
Blurred vision
, tinnitus, mydriasis
GI:
Constipation, dry mouth, nausea, vomiting, anorexia, diarrhea
GU:
Irregular periods, decreased libido
HEMA:
Agranulocytosis
INTEG:
Rash, dermatitis, itching
PO:
Onset 30 min, peak within 2 hr, duration 4-6 hr, metabolized by liver, excreted by kidneys, crosses placenta, excreted in breast milk, half-life 5-30 hr (increased in geriatric patients)
Increase:
CNS depression—CNS depressants, alcohol
Increase:
chlordiazePOXIDE—cimetidine, disulfiram, FLUoxetine, isoniazid, ketoconazole, metoprolol, oral contraceptives, propranolol, valproic acid
Decrease:
action of levodopa
Decrease:
action of chlordiazePOXIDE—CYP3A4 inhibitors (protease inhibitors, barbiturates, rifamycins)
Increase:
LFTs
False increase:
17-OHCS
False positive:
pregnancy test (some methods)
•
B/P (lying, standing), pulse; if systolic B/P drops 20 mm Hg, hold product, notify prescriber
•
Blood studies: CBC during long-term therapy;
blood dyscrasias
have occurred rarely
•
Hepatic studies: AST, ALT, bilirubin, creatinine, LDH, alk phos during long-term therapy
•
For ataxia, oversedation of geriatric patients, debilitated patients
•
Physical dependency, withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness after long-term use
•
Mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness; suicidal tendencies; paradoxic reactions such as excitement, stimulation, acute rage
•
For pregnancy; product should not be used during pregnancy (D)
•
Assistance with ambulation during beginning therapy because drowsiness, dizziness occur
•
Check to confirm that PO medication has been swallowed if patient is depressed, suicidal
•
Sugarless gum, hard candy, frequent sips of water for dry mouth
•
Therapeutic response: decreased anxiety, restlessness, sleeplessness
•
That product may be taken with food
•
Not to use product for everyday stress or use for more than 4 mo unless directed by prescriber
•
Not to take more than prescribed amount; may be habit forming
•
To avoid OTC preparations unless approved by prescriber
•
To avoid driving, activities that require alertness because drowsiness may occur
•
To avoid alcohol ingestion, other psychotropic medications unless directed by prescriber
•
Not to discontinue medication abruptly after long-term use because this may precipitate seizures
•
To rise slowly because fainting may occur, especially among geriatric patients
•
That drowsiness may be worse at beginning of treatment
•
To notify prescriber if pregnancy is suspected or planned
•
To immediately report suicidal thoughts/behaviors
Lavage, VS, supportive care, give flumazenil