Mosby's 2014 Nursing Drug Reference (113 page)

Black Box Warning:

Bone marrow suppression

• Adult:
CONT IV INF
100 mg/m
²
/day × 7 days q2wk as single agent or 2-6 mg/kg/day (100-200 mg/m
²
/day) as a single dose or 2-3 divided doses for 5-10 days until remission, used in combination; maintenance 70-200 mg/m
²
/day for 2-5 days monthly;
SUBCUT/IM
maintenance 100 mg/m
²
/day × 5 days q28days

• Adult/child:
INTRATHECAL
5-70 mg/m
²
variable daily × 4 days to q2-7days

• Adult/child:
IV
2 g/m
²
/day; on day 5 q21days, with etoposide, methylPREDNISolone, and CISplatin

• Adult:
IT
50 mg over 1-5 min q14days, during induction and consolidation wk 1, 3, 5, 7, 9, give another 50 mg
IT
wk 13; maintenance 50 mg q28days on wk 17, 21, 25, 29 use with dexamethasone 4 mg
PO/IV
× 5 day on each day of cytarabine

• Adult CCR ≤60 ml/min, serum creatinine 1.5-1.9 mg/dl or increase of 0.5-1.2 mg/dl from baseline during treatment:
reduce to 1 g/m
²
/dose;
serum creatinine ≥2 mg/dl or change from baseline serum creatinine was 1.2 mg/dl:
reduce to 100 mg/m
²
/day

• 
Antiemetic 30-60 min before product and prn

• 
Allopurinol to maintain uric acid levels and alkalinization of the urine

• 
Topical or systemic analgesics for pain

Additive compatibilities:
Corticotropin, DAUNOrubicin with etoposide, etoposide, hydrOXYzine, lincomycin, mitoXANtrone, ondansetron, potassium chloride, prednisoLONE, sodium bicarbonate, vinCRIStine

Solution compatibilities:
Amino acids, D
₅
/LR, D
₅
/0.2% NaCl, D
₅
/0.9% NaCl, D
₁₀
/0.9% NaCl, D
₅
W, invert sugar 10% in electrolyte #1, Ringer’s, LR, 0.9% NaCl, sodium lactate 1/6 mol/L, TPN #57

Syringe compatibilities:
Metoclopramide

Y-site compatibilities:
Acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, amsacrine, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamycin, codeine, cyclophosphamide, cycloSPORINE, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, foscarnet, fosphenytoin, furosemide, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, mivacurium, morphine, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, pentamidine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propofol, propranolol, quinupristin-dalfopristin, ranitidine, rapacuronium, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid

Increase:
toxicity—immunosuppressants, methotrexate, flucytosine, radiation, or other antineoplastics

Increase:
bleeding risk—anticoagulants, platelet inhibitors, salicylates, thrombolytics, NSAIDs

Decrease:
effects of oral digoxin, gentamicin

Black Box Warning:

Bone marrow suppression:
CBC (RBC, Hct, Hgb), differential, platelet count weekly; withhold product if WBC is <1000/mm
³
, platelet count is <50,000/mm
³
, or RBC, Hct, Hgb low; notify prescriber of these results

• 
Renal studies: BUN, serum uric acid, urine CCr, electrolytes before and during therapy

• 
I&O ratio; report fall in urine output to <30 ml/hr

• 
Monitor temp, fever may indicate beginning infection; no rectal temps

• 
Hepatotoxicity:
hepatic studies before and during therapy: bilirubin, ALT, AST, alk phos, as needed or monthly; check for jaundice of skin, sclera; dark urine; clay-colored stools; pruritus; abdominal pain; fever; diarrhea

• 
Blood uric acid during therapy

 
For anaphylaxis:
rash, pruritus, facial swelling, dyspnea; resuscitation equipment should be nearby

 
Chemical arachnoiditis (IT):
headache, nausea, vomiting, fever; neck rigidity pain, meningism, CSF pleocytosis; may be decreased by dexamethasone

• 
Cytarabine syndrome 6-12 hr after inf: fever, myalgia, bone pain, chest pain, rash, conjunctivitis, malaise; corticosteroids may be ordered

• 
Bleeding: hematuria, heme-positive stools, bruising or petechiae, mucosa or orifices q8hr

 
Dyspnea, crackles, unproductive cough, chest pain, tachypnea, fatigue, increased pulse, pallor, lethargy; personality changes, with high doses; pulmonary edema may be fatal (rare)

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

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

• 
GI symptoms: frequency of stools, cramping; antispasmodic may be used

• 
Acidosis, signs of dehydration: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness

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

• 
Diet low in purines: absence of organ meats (kidney, liver), dried beans, peas to prevent increased urate deposits

• 
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss

• 
Therapeutic response: improvement of hematologic parameters

• 
To report any coughing, chest pain, changes in breathing; may indicate beginning
pneumonia, pulmonary edema

• 
To avoid foods with citric acid, spicy or rough texture if stomatitis is present, use sponge brush and rinse with water after each meal; to report stomatitis: any bleeding, white spots, ulcerations in mouth; to examine mouth daily, report any symptoms

• 
To report signs of
infection:
increased temp, sore throat, flulike symptoms; to avoid crowds, persons with infections

• 
To report signs of
anemia:
fatigue, headache, faintness, SOB, irritability

• 
To report bleeding; to avoid use of razors, commercial mouthwash, salicylates, NSAIDs, anticoagulants

• 
To use thrombocytopenia precautions

• 
To take fluids to 3 L/day to prevent renal damage

• 
To use reliable contraception during treatment and for 4 mo thereafter; not to breastfeed

• 
To avoid receiving vaccines during treatment

• 
That fever, headache, nausea, vomiting likely to occur