Mosby's 2014 Nursing Drug Reference (220 page)

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Premedicate with acetaminophen or ibuprofen and give at bedtime to lessen flulike symptoms

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Interferon β1a (Avonex) 30 mcg is equivalent to 6 million IU

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If a dose is missed, give it as soon as possible; continue the regular schedule but do not give 2 injections within 2 days of each other; all products are for single-use only; do not reuse needles, syringes, prefilled syringes, or autoinjectors

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Injection sites should be rotated to minimize the likelihood of injection site reactions

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Do not inject into an area of the body where skin is irritated, reddened, bruised, infected, or scarred

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The injection site should be checked after 2 hr for redness, edema, or tenderness

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The manufacturer of Avonex offers free training on IM use for patients and health care partners; contact MS ActiveSource for more information (800-456-2255)

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Use appropriate aseptic technique for preparation of solution

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Sites for injection include the thigh or upper arm

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Slowly add 1.1 ml sterile water for injection, USP, preservative-free (supplied by manufacturer) to the vial; rapid addition of the diluent can cause foaming, making it difficult to withdraw the solution

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Gently swirl the vial to aid in dissolution; do not shake; final concentration should be 30 mcg/ml (6 million IU/ml)

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The reconstituted solution should be clear to slightly yellow without particles; discard if the reconstituted product contains particulate matter or is discolored

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Withdraw 1 ml of reconstituted solution into a syringe; attach the sterile needle and inject IM

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A 25-G 1-inch needle for intramuscular injection may be substituted for the 23-G 1¼-inch needle provided by the manufacturer, if needed

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Storage:
Use within 6 hr of reconstitution; store reconstituted solution in refrigerator;
do not freeze;
discard any unused solution; both drug and diluent vials are single-use only

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Patients may self-inject only if provider determines that it is appropriate, and with medical follow-up, and after proper training in IM injection technique

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The first injection should be performed under the supervision of an appropriately qualified person

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If self-injecting, rotate injection site between thighs; with help from another person, may rotate injection site between thighs and upper arms

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Wash hands before handling the Dose Pack

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Remove prefilled syringe from the refrigerator to warm to room temperature (usually 30 min before use); do not use external heat sources such as hot water to warm the syringe

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Hold the syringe so the cap is facing down and the 0.5 ml mark is at eye level; be sure the amount of liquid in the syringe is the same or very close to the 0.5 ml mark; if the syringe does not contain the correct amount of liquid, do not use it and call the pharmacist

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Hold syringe upright so that the rubber cap faces up; remove the cap by bending it at a 90 degree angle until it snaps free

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Attach the needle by pressing it onto the syringe and turning it clockwise until it locks in place; be careful not to push the plunger while attaching the needle

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Use the alcohol wipe to clean the skin at the injection site you choose; then, pull the protective cover straight off the needle; do not twist the cover off

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Inject intramuscularly at a 90-degree angle into the thigh or upper arm as directed by the provider

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Use gauze pad to apply pressure for a few seconds after the injection

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Dispose of used needles and syringes in a puncture-resistant container and discard appropriately

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Instruct patients to contact the health care provider if a skin reaction occurs that does not resolve in a few days

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A 25-G 1-inch needle for intramuscular injection may be substituted for the 23-G 1¼-inch needle provided by the manufacturer, if deemed appropriate by the physician

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Refer to the Patient Medication Guide for detailed instructions for preparing and giving a dose

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Storage:
Store refrigerated; if refrigeration is unavailable, may store at 77° F or less for up to 7 days; after removing from refrigerator, do not store product above 25° C; if the product has been exposed to conditions other than recommended, discard the product; do not expose to high temperatures; do not freeze; protect from light

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Patients may self-inject only if their provider determines that it is appropriate, and with medical follow-up, and after proper training in IM technique

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The first injection should be performed under the supervision of provider

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Remove one Administration Dose Pack from the refrigerator to warm to room temperature (about 30 min before use); do not use external heat sources such as hot water to warm the syringe Dose Pack

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Wash hands before handling Dose Pack contents

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Ensure tamper-evident cap has not been removed or is loose; then grasp the cap and bend it at a 90-degree angle until it snaps off; pull off the sterile foil from the needle cover

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Hold the Avonex Pen with the glass syringe tip pointing up; press the needle onto the glass syringe tip; gently turn the needle clockwise until firmly attached; do not remove plastic cover from the needle

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Hold Pen with one hand and, using other hand, hold onto the injector shield (grooved area) tightly and quickly pull up on the injector shield until the injector shield covers the needle all the way; the plastic needle cover will pop off after the injector shield has been fully extended

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When the injector shield is extended the right way, there will be a small blue rectangular area next to the oval medication display window; check the display window and make sure the Avonex is clear and colorless

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Do not use the injection if the liquid is colored, cloudy, or has lumps or particles; air bubbles will not affect the dose

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Do not push down on the injector shield and the blue activation button at the same time until you are ready to give injection

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Avonex Pen should be injected into the upper outer thigh

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Use the alcohol wipe to clean the skin at the injection site and allow it to dry before injection

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Hold Pen at 90-degree angle to the injection site; firmly push the body of the pen down against the thigh to release the
safety lock; safety lock is released when blue rectangle area above the oval medication display window is gone, push down on blue activation button with thumb and count to 10, you will hear a click if the injection is given the right way

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After counting to 10, pull the Pen straight out of the skin, use gauze pad to apply pressure for a few seconds

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The circular display window on the Pen is yellow if the full dose is received

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Cover exposed needle with Pen cover; do not hold the Pen cover with your hands while inserting the needle

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Dispose of used needles and syringes in a puncture-resistant container and discard appropriately

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Instruct patients to contact the health care provider if a skin reaction occurs that does not resolve in a few days

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Refer to the Patient Medication Guide for detailed instructions for preparing and giving a dose

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Storage:
Store at 36°–46° F (2°–8° C); if refrigeration is unavailable, may store at 77° F or less for up to 7 days; after removing from refrigerator, do not store product above 25° C; if the product has been exposed to conditions other than recommended, discard the product and do not use; do not expose to high temperatures; do not freeze; protect from light

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Give at the same time (preferably late in the afternoon or evening) on the same days of the week at least 48 hours apart

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Do not give on two consecutive days; if a dose is missed, administer the dose as soon as possible, then skip the following day; return to the regular schedule the following week

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Premedication with acetaminophen or ibuprofen can lessen the severity of flulike symptoms

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Interferon β1a (Rebif) 44 mcg is equivalent to 12 million IU

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Rotate injection sites; appropriate injection sites include thigh, outer surface of upper arm, stomach, or buttocks; do not inject into an area where the skin is irritated, reddened, bruised, or infected

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A Starter Pack containing a lower dose of Rebif syringes is available for the initial titration period; patients and/or their caregivers should be trained and understand appropriate preparation and administration

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The manufacturer offers complimentary services including injection training and reimbursement support; contact MS LifeLines at 877-44-REBIF

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Interferon β1a (Rebif) is available in a prefilled syringe with a 29-G needle

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Inject subcutaneously into the outer surface of the upper arm, abdomen, thigh, or buttock do not inject the area near the navel or waistline; take care not to inject intradermally

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Discard any unused solution; prefilled syringes do not contain preservatives and are single-use only

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The manufacturers of Betaseron and of Extavia offer materials to assist with training on subcut use, call 1-800-788-1467 (Betaseron), 1-888-669-6682 (Extavia)

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Premedication with acetaminophen or ibuprofen and use of product at bedtime can lessen the severity of flulike symptoms

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Visually inspect parenteral products for particulate matter and discoloration before use; do not use if particulate matter is present

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Add 1.2 ml of 0.54% sodium chloride injection (supplied by the manufacturer) to the vial by using the vial adapter to attach the prefilled syringe that contains the diluent; keep the plunger depressed, and gently swirl, do not shake; if you take your thumb off the plunger, the solution can come back into the syringe before the product is fully reconstituted; if foaming occurs, allow the vial to sit until the foam settles; final concentration (250
mcg interferon β1b/ml, which corresponds to 8 million IU/ml)

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If not used immediately, store in the refrigerator for up to 3 hr; do not freeze; discard any unused portion after 3 hr

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Withdraw the desired amount of the reconstituted solution into the syringe by turning the vial and syringe to get the vial on top; pull the plunger back to get the desired amount of product; turn the syringe to point the needle upward, and tap the syringe and release any air bubbles; twist the vial adapter to remove it and the vial

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Choose an injection site on the upper back arm; abdomen; buttock; or front thigh; do not inject within 2 in of the navel or in a site where the skin is red, bruised, infected, broken, painful, uneven, or scabbed; rotate injection sites to minimize injection site reactions such as necrosis or localized infection

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Inject subcutaneously; take care not to inject intradermally