Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (96 page)
HIGH ALERTCISplatin (Rx)
(sis′pla-tin)
Func. class.:
Antineoplastic alkylating agent
Chem. class.:
Platinum complex
Do not confuse:
CISplatin
/CARBOplatin
Alkylates DNA, RNA; inhibits enzymes that allow for the synthesis of amino acids in proteins; activity not cell-cycle–phase specific
Advanced bladder cancer; adjunct in metastatic testicular cancer; osteosarcoma; soft-tissue sarcomas; adjunct in metastatic ovarian cancer; head, neck cancer; esophagus, prostate, lung, cervical cancer; lymphoma
Unlabeled uses:
Astrocytoma; breast, gastric, head, neck, hepatocellular, lung, penile cancer; carcinoid, desmoid tumor; Hodgkin’s disease, malignant glioma, malignant melanoma, neuroblastoma, non-Hodgkin’s lymphoma (NHL), osteogenic sarcoma
Pregnancy (D), breastfeeding
Black Box Warning:
Preexisting hearing impairment, bone marrow suppression, platinum compound hypersensitivity, renal disease/failure
Precautions:
Geriatric patients, vaccination
Calculator
Dosage protocols may vary
• Adult:
IV
20 mg/m
2
/day × 5 days, repeat q3wk for 2 cycles or more, depending on response
• Adult:
IV
50-70 mg/m
2
q3-4wk
• Adult:
IV
100 mg/m
2
q4wk or 75-100 mg/m
2
q3wk with cyclophosphamide
• Adult and child:
IV INF
100 mg/m
2
24 hr continuous inf day 1 of 4-day regimen with cytarabine/dexamethasone q3-4wk
• Adult:
IV
75 mg/m
2
on day 1 with docetaxel 75 mg/m
2
and fluorouracil 750 mg/m
2
on days 1-5, q21days
Available forms:
Inj 0.5
, 1 mg/ml
•
Do not use aluminum equipment during any preparation or administration, will form precipitate; do not refrigerate unopened powder or solution; protect from sunlight
•
Prepare in biologic cabinet using gown, gloves, mask; do not allow product to come in contact with skin; use soap and water if contact occurs; use cytotoxic handling procedures
•
Hydrate patient with 0.9% NaCl over 8-12 hr before treatment
•
EPINEPHrine, antihistamines, corticosteroids for hypersensitivity reaction
•
Antiemetic 30-60 min before product and prn; allopurinol to maintain uric acid levels, alkalinization of urine; diuretic (furosemide 40 mg IV) or mannitol after INF
•
Dilute
10 mg/10 ml or 50 mg/50 ml sterile water for inj, withdraw prescribed dose;
dilute
1/2 dose with 1000 ml D
5
0.2 NaCl, D
5
0.45 NaCl with 37.5 g mannitol; IV INF is
given
over 3-4 hr; use a 0.45-μm filter; total dose 2 L over 6-8 hr; check site for irritation, phlebitis
•
Give
over 24 hr × 5 days
Additive compatibilities:
CARBOplatin, cyclophosphamide, floxuridine, hydrOXYzine, ifosfamide, leucovorin, mag
nesium sulfate, mannitol, ondansetron, potassium chloride
Solution compatibilities:
D
5
/0.225% NaCl, D
5
/0.45% NaCl, D
5
/0.9% NaCl, D
5
/0.45% NaCl with mannitol 1.875%, D
5
/0.33% NaCl with KCl 20 mEq and mannitol 1.875%, 0.9% NaCl, 0.45% NaCl, 0.3% NaCl, 0.225% NaCl
Syringe compatibilities:
Bleomycin, cyclophosphamide, doxapram, droperidol, fluorouracil, furosemide, heparin, leucovorin, methotrexate, metoclopramide, vinBLAStine, vinCRIStine
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amikacin, aminophylline, amiodarone, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, carmustine, caspofungin, ceFAZolin, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, cladribine, clindamycin, codeine, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, docetaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, indomethacin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, methohexital, methotrexate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANtrone, mivacurium, nafcillin, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, phenytoin, piperacillin, polymyxin B, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propofol, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, riTUXimab, sargramostim, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, topotecan, trastuzumab, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Seizures,
peripheral neuropathy
CV:
Cardiac abnormalities
EENT:
Tinnitus, hearing loss, vestibular toxicity
, blurred vision, altered color perception
GI:
Severe nausea, vomiting, diarrhea, weight loss
GU:
Renal tubular damage,
renal insufficiency
, impotence, sterility, amenorrhea, gynecomastia, hyperuremia
HEMA:
Thrombocytopenia, leukopenia, pancytopenia
INTEG:
Alopecia
, dermatitis
META:
Hypomagnesemia
, hypocalcemia, hypokalemia, hypophosphatemia
RESP:
Fibrosis
SYST:
Anaphylaxis
Absorption complete, metabolized in liver, excreted in urine, half-life 20 min
first phase, 48-70 min second phase, 24 hr terminal phase, accumulates in body tissues for several months, enters breast milk
Increase:
bleeding risk—aspirin, NSAIDs, alcohol
Increase:
ototoxicity—bumetanide, ethacrynic acid, furosemide
Increase:
myelosuppression—myelosuppressive agents, radiation
Increase:
nephrotoxicity—aminoglycosides, loop diuretics, salicylates
Decrease:
effects of phenytoin
Decrease:
antibody response—live virus vaccines
Increase:
uric acid, BUN, creatinine
Decrease:
CCr, calcium, phosphate, potassium, magnesium
Positive:
Coombs’ test
Black Box Warning
Bone marrow depression:
CBC, differential, platelet count weekly; withhold product if WBC is <4000 or platelet count is <100,000; notify prescriber of results
Black Box Warning:
Renal toxicity:
BUN, creatinine, serum uric acid, urine CCr before, electrolytes during therapy; dose should not be given if BUN <25 mg/dl; creatinine <1.5 mg/dl; I&O ratio; report fall in urine output of <30 ml/hr
Anaphylaxis:
wheezing, tachycardia, facial swelling, fainting; discontinue product, report to prescriber; resuscitation equipment should be nearby, may occur within minutes; often EPINEPHrine, corticosteroids, antihistamines may alleviate symptoms
•
Monitor temp q4hr; may indicate beginning infection
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed
Bleeding:
hematuria, guaiac, bruising, petechiae, mucosa or orifices q8hr; obtain prescription for viscous lidocaine (Xylocaine)
Black Box Warning:
Ototoxicity:
More common in genetic variants TPMT 3B and 3C in children, use audiometric testing baseline and before each dose
•
Effects of alopecia on body image; discuss feelings about body changes
•
Comprehensive oral hygiene
•
All medications PO, if possible; avoid IM inj when platelets <100,000/mm
3
•
Hyperuricemia:
Increase fluid intake to 2-3 L/day to prevent urate deposits, calculi formation; promote elimination of product, usually occurs between 3-5 days after a dose, may use allopurinol
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report signs of infection: increased temp, sore throat, flulike symptoms
•
To report signs of anemia: fatigue, headache, faintness, SOB, irritability
•
To report bleeding, bruising, petechiae; to avoid use of razors, commercial mouthwash; to avoid aspirin, ibuprofen, NSAIDs, alcohol; may cause GI bleeding
•
That impotence or amenorrhea can occur but is reversible after discontinuing treatment
Black Box Warning:
Ototoxicity:
To report loss of hearing, ringing or roaring in the ears
•
To maintain adequate fluids; report decreased urine output, flank pain
•
That hair may be lost during treatment; a wig or hairpiece may make patient feel better; new hair may be different in color, texture
•
To report numbness, tingling in face or extremities; poor hearing; joint pain, swelling
•
Not to receive vaccinations during treatment
•
To use contraception during treatment and for 4 mo after (pregnancy D); product may cause infertility; to avoid breastfeeding