Mosby's 2014 Nursing Drug Reference (435 page)

Black Box Warning:

Hepatic disease

• Adult:
PO
800 mg/day without food (1 hr before, 2 hr after a meal), may decrease to 400 mg/day if not tolerated (renal cell cancer); or adjust in 200-mg increments based on toxicity (soft-tissue sarcoma)

• 
Give on an empty stomach (1 hr before or 2 hr after a meal); separate doses by ∼24 hr

• 
Do not crush tablets owing to the potential for an increased rate of absorption, which can affect systemic exposure; only intact, whole tablets should be used

• 
If a dose is missed, it should not be taken if it is <12 hr until the next dose

• 
Store at 77°F (25°C)

Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl; CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)

Increase:
pazopanib concentrations—CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin)

Increase:
plasma concentrations of simvastatin, calcium-channel blockers, ergots

Increase:
plasma concentration of warfarin; avoid use with warfarin; use low-molecular-weight anticoagulants instead

Decrease:
pazopanib concentrations—CYP3A4 inducers (dexamethasone, phenytoin, carBAMazepine, rifampin, PHENobarbital)

Increase:
pazopanib effect—grapefruit juice; avoid use while taking product

Decrease:
pazopanib concentration—St. John’s wort

Black Box Warning:

Hepatic disease: fatal hepatotoxicity can occur; obtain LFTs baseline and at least every 2 wk × 2 mo, then monthly

 
Fatal Bleeding:
from GI, respiratory, GU tracts, permanently discontinue in those with severe bleeding

 
Palmar-plantar erythrodysesthesia (hand-foot syndrome):
more common in those previously treated; reddening swelling, numbness, desquamation on palms and soles

 
GI perforation/fistula:
discontinue if this occurs, assess for pain in epigastric area, dyspepsia, flatulence, fever, chills

 
Hypertension/hypertensive crisis:
hypertension usually occurs in the first cycle; in those with preexisting hypertension, do not start treatment until B/P is controlled; monitor B/P every wk × 6 wk, then at start of each cycle or more often if needed, temporarily or permanently discontinue for severe uncontrolled hypertension

• 
Therapeutic response: decreased in size, spread of tumor

• 
To report adverse reactions immediately: bleeding

• 
About reason for treatment, expected results

• 
That effect on male fertility is unknown

Black Box Warning:

Hgb >11 g/dl, surgery, neoplastic disease

• Adult:
SUBCUT/IV
0.04 mg/kg monthly for those not receiving erythropoiesis-stimulating agent (ESA)

• Adult:
SUBCUT/IV
2 mg/mo for epoetin <2500 units/wk or darbepoetin <12 mcg/wk; 3 mg/mo for epoetin 2500 to <4300 units/wk or darbepoetin 12 to <18 mcg/wk; 4 mg/mo for epoetin 4300 to <6500 units/wk or darbepoetin 12 to <25 mcg/wk; 5 mg/mo for epoetin 6500 to <8900 units/wk or darbepoetin 25 to <35 mcg/wk; 6 mg/mo for epoetin 8900 to <13,000 units/wk or darbepoetin 35 to <45 mcg/wk; 8 mg/mo for epoetin 13,000 to <19,000 units/wk or darbepoetin 45 to <60 mcg/wk; 10 mg/mo for epoetin 19,000 to <33,000 units/wk or darbepoetin 60 to <95 mcg/wk; 15 mg/mo for epoetin 33,000 to <68,000 units/wk or darbepoetin 95 to <175 mcg/wk; 20 mg/mo for epoetin ≥68,000 units/wk or darbepoetin ≥175 mcg/wk

• 
Administer IV or SUBCUT

• 
Single-use vials and single-use prefilled syringes do not contain preservatives; use only one time and discard unused portion

• 
Do not dilute and do not administer with other drugs

• 
Adjustments in dialysis prescriptions and anticoagulation regimens may be required after initiation

• 
Visually inspect for particulate matter and discoloration before use; solution should be colorless to slightly yellow

Increase:
WBC, platelets

Decrease:
bleeding time

• 
Anemia
: fatigue, dyspnea, pallor

 
Serious allergic reactions:
rash, urticaria; if anaphylaxis occurs, stop product, administer emergency treatment

• 
Renal studies: urinalysis, protein, blood, BUN, creatinine; monitor dialysis shunts; during dialysis, heparin may need to be increased

Black Box Warning:

HGB ≥11 g/dl B/P: check for rising B/P as Hgb rises; antihypertensives may be needed

 
CV status:
hypertension can occur rapidly, leading to hypertensive encephalopathy; Hgb 12 g/dl can lead to death, do not administer

• 
I&O; report drop in output to 50 ml/hr

• 
Seizures
: Monitor B/P; neurologic symptoms should be closely monitored

• 
Dialysis patients: thrill, bruit of shunts, monitor for circulation impairment

 
Before and during therapy, monitor iron status (transferrin saturation and serum ferritin); most patients require supplemental iron during therapy; monitor Hgb up to every 2 wk until stable, then at least monthly thereafter; consider rate of Hgb rise and fall, responsiveness to therapy, and Hgb variability when adjusting the peginesatide dose; a single Hgb concentration outside of the therapeutic range might not necessitate a dosage change

 
Do not initiate therapy until Hgb is <10 g/dl

 
Do not increase the dosage more than q4wk

 
If Hgb rises rapidly (eg, >1 g/dl in the 2 wk before the dose or >2 g/dl in 4 wk), reduce the dosage by 25% or more as needed to reduce rapid responses

 
If Hgb approaches or exceeds 11 g/dl, reduce or interrupt the dose. After a dose has been withheld and the Hgb begins to decrease, product may be restarted at a dosage 25% less than previous dosage

 
For those whose response is inadequate, if Hgb has not increased >1 g/dl after 4 wk of therapy, increase the dosage by 25%

 
For those who do not respond adequately over a 12-wk escalation period, increasing the dosage further is unlikely to improve response and can increase risks

• 
Therapeutic response: increase in reticulocyte count, Hgb/Hct; increased appetite, enhanced sense of well-being

• 
To avoid driving or hazardous activity, to report changes that can indicate seizures during beginning of treatment

• 
That lab testing (Hgb) and blood pressure monitoring are required