Mosby's 2014 Nursing Drug Reference (420 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

HIGH ALERT
vinBLAStine (VLB) (Rx)

(vin-blast′een)

Func. class.:
Antineoplastic

Chem. class.:
Vinca alkaloid

Do not confuse:
vinBLAStine
/vinCRIStine/vinorelbine

ACTION:

Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant

USES:

Breast, testicular cancer, lymphomas, neuroblastoma; Hodgkin’s/non-Hodgkin’s lymphoma; mycosis fungoides, histiocytosis, Kaposi’s sarcoma, Langerhans cell histiocytosis

Unlabeled uses:
Lung, bladder, prostate cancer; desmoid tumor, malignant melanoma

CONTRAINDICATIONS:

Pregnancy (D), breastfeeding, infants, hypersensitivity, leukopenia, granulocytopenia, bone marrow suppression, infection

 

Black Box Warning:

Intrathecal use

Precautions:
Renal/hepatic disease, tumor lysis syndrome

 

Black Box Warning:

Extravasation

DOSAGE AND ROUTES
Calculator
Breast cancer

• Adult:
IV
4.5 mg/m
2
on day 1 of every 21 days in combination with DOXOrubicin and thiotepa

Hodgkins disease

• Adult:
IV
6 mg/m
2
on days 1 and 15 of every 28 days with DOXOrubicin, bleomycin, dacarbazine (ABVD regimen)

• Child:
IV
2.5-6 mg/m
2
/day once q1-2wk × 3-6 wk, max weekly dose 12.5 mg/m
2

Available forms:
Inj, powder 10 mg for 10 ml IV; sol for inj 1 mg/ml

Administer:

• 
Antiemetic 30-60 min before product and prn to prevent vomiting

 

Black Box Warning:

Hyaluronidase 150 units/ml in 1 ml NaCl, warm compress for extravasation for vesicant activity treatment

 

Black Box Warning:

Do not administer intrathecally; fatal

IV inj route

• 
After diluting 10 mg/10 ml NaCl; give through
Y
-tube or 3-way stopcock or directly over 1 min

Intermittent IV INF route

• 
Further dilute in 50-100 ml of NS, infuse over 15-30 min

Additive compatibilities:
Bleomycin

Syringe compatibilities:
Bleomycin, CISplatin, cyclophosphamide, droperidol, fluorouracil, leucovorin, methotrexate, metoclopramide, mitoMYcin, vinCRIStine

Y-site compatibilities:
Allopurinol, amifostine, amphotericin B cholesteryl, aztreonam, bleomycin, CISplatin, cyclophosphamide, DOXOrubicin, DOXOrubicin liposome, droperidol, filgrastim, fludarabine, fluorouracil, granisetron, heparin, leucovorin, melphalan, methotrexate, metoclopramide, mitoMYcin, ondansetron, PACLitaxel, piperacillin/tazobactam, sargramostim, teniposide, thiotepa, vinCRIStine, vinorelbine

SIDE EFFECTS

CNS:
Paresthesias, peripheral neuropathy, depression, headache,
seizures,
malaise

CV:
Tachycardia, orthostatic hypo/hypertension

GI:
Nausea, vomiting
, ileus,
anorexia, stomatitis, constipation
, abdominal pain,
GI/rectal bleeding, hepatotoxicity,
pharyngitis

GU:
Urinary retention,
renal failure,
hyperuricemia

HEMA:
Thrombocytopenia, leukopenia, myelosuppression,
agranulocytosis, granulocytosis, aplastic anemia, neutropenia, pancytopenia

INTEG:
Rash, alopecia
, photosensitivity,
extravasation, tissue necrosis

META:
SIADH

RESP:
Fibrosis, pulmonary infiltrate, bronchospasm

SYST:
Tumor lysis syndrome (TLS)

PHARMACOKINETICS

Half-life (triphasic) <5 min, 50-155 min, 23-85 hr; metabolized in liver; excreted in urine, feces; crosses blood-brain barrier

INTERACTIONS

Increase:

Synergism: bleomycin

Increase:

Bronchospasm: mitoMYcin

• 
Do not use with radiation

Increase:
bleeding risk—NSAIDs, anticoagulants, thrombolytics, antiplatelets

Increase:
toxicity, bone marrow suppression—antineoplastics

Increase:
action of methotrexate

Increase:
adverse reactions—live virus vaccines

 
Increase:
toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole
)

Decrease:
vinBLAStine effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)

Drug/Herb

• 
Avoid use with St. John’s wort

Drug/Lab Test

Increase:
uric acid, bilirubin

Decrease:
Hgb, platelets, WBC

NURSING CONSIDERATIONS
Assess:

 
CBC, differential, platelet count weekly; withhold product if WBC is <2000/mm
3
or platelet count is <75,000/mm
3
; notify prescriber; RBC, Hct, Hgb may be decreased, nadir occurs on days 4-10 and continues for another 1-2 wk

• 
Tumor lysis syndrome:
monitor for hyperkalemia, hyperphosphatemia, hyperuricemia; usually occurs with leukemia, lymphoma; alkalinization of the urine, allopurinol should be used to prevent urate nephrophy; monitor electrolytes and renal function (BUN, uric acid, urine CCR)

• 
Hepatitis: transient hepatitis may occur with continuous IV

• 
Bleeding: hematuria, guaiac, bruising, petechiae, mucosa or orifices

• 
Bronchospasm:
can be life-threatening; usually occurs when giving mitoMYcin

• 
Effects of alopecia on body image; discuss feelings about body changes

• 
Sensitivity of feet/hands, which precedes neuropathy

• 
Jaundiced skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea

• 
Buccal cavity q8hr for dryness, sores, ulcerations, white patches, oral pain, bleeding, dysphagia

 

Black Box Warning:

Local irritation, pain, burning, discoloration at inj site, extravasation

• 
Symptoms indicating severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing

Perform/provide:

• 
Increased fluid intake to 2-3 L/day to prevent urate deposits, calculi formation

• 
Brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss

Evaluate:

• 
Therapeutic response: decreased tumor size, spread of malignancy

Teach patient/family:

• 
To report any complaints or side effects to nurse or prescriber

• 
To report any changes in breathing or coughing; to avoid exposure to persons with infection

• 
That hair may be lost during treatment, that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture

• 
To report change in gait or numbness in extremities; may indicate neuropathy

• 
To avoid foods with citric acid, hot or rough texture

• 
To report any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily

• 
To wear sunscreen, protective clothing, sunglasses

• 
To avoid receiving vaccinations

 
Pregnancy:
pregnancy (D); to avoid breastfeeding; that product may cause male infertility

• 
To notify prescriber if pregnancy is planned or suspected; avoid persons with known infections

• 
Infection:
to report sore throat, flulike symptoms

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