Mosby's 2014 Nursing Drug Reference (234 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Reversibly binds tyrosine kinase of both the epidermal growth factor receptor (ERbB1) and the human epidermal receptor type 2 (HER2) (ERbB2), blocking downstream signaling for cell proliferation
Advanced metastatic breast cancer patients with tumor that overexpresses HER2 protein and who have received previous chemotherapy
Pregnancy (D), breastfeeding, hypersensitivity
Precautions:
Geriatric patients, cardiac disease, bradycardia, hypertension, hypokalemia, hypomagnesemia, QT prolongation, pneumonitis, interstitial lung disease
Black Box Warning:
Hepatic disease
Calculator
• Adult:
PO
1250 mg (5 tabs)/day 1 hr before or after food on days 1-21 plus capecitabine 2000 mg/m
2
/day in 2 divided doses on days 1-14 in a repeating 21-day cycle; continue until therapeutic response or toxicity occurs
• Adult:
PO
1500 mg (6 tabs) 1 hr before food with letrozole 2.5 mg/day
• Adult:
PO
(Child-Pugh C) 750 mg/day (with capecitabine); 1000 mg/day (with letrozole)
Available forms:
Tabs 250 mg
•
Once a day with water on an empty stomach, 1 hr before or after food
•
Do not use with grapefruit products
CNS:
Fatigue, insomnia,
palmar-plantar erythrodysesthesia (hand/foot syndrome)
CV:
Heart failure,
palpitations,
QT prolongation
GI:
Anorexia, diarrhea, dyspepsia, mouth ulcerations, nausea, vomiting, xerosis
HEMA:
Anemia, neutropenia, thrombocytopenia
INTEG:
Rash
RESP:
Dyspnea, pneumonitis
Bioavailability incomplete; peak 4 hr; >99% protein bound; extensively metabolized in the liver by P450 enzymes CYP3A4, CYP3A5; elimination half-life 24 hr; steady state 6-7 days; increased half-life in hepatic disease
Increase:
effect of lapatinib—CYP3A4 inhibitors (amiodarone, amprenavir, aprepitant, atazanavir, chloramphenicol, clar
ithromycin, conivaptan, dalfopristin, danazol, darunavir, delavirdine, diltiazem, efavirenz, erythromycin, estradiol, fluconazole, fluvoxaMINE, imatinib, indinavir, isoniazid, itraconazole, ketoconazole, miconazole, mifepristone, nefazodone, nelfinavir, propoxyphene, quinupristin, ritonavir, RU-486, saquinavir, telithromycin, troleandomycin, verapamil, voriconazole, zafirlukast); avoid concurrent use
Increase:
QT prolongation—CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin); class IA/III antidysrhythmics, arsenic trioxide, chlorproMAZINE, chloroquine, haloperidol, levomethadyl, mesoridazine, pentamine, thioridazine, CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, terfenadine, ziprasidone)
•
Cardiac status:
ECG for QT prolongation, ejection fraction; chest pain, palpitations, dyspnea
•
Hepatic status:
liver function tests; jaundice of sclera, skin; dose should be reduced in hepatic disease
Skin toxicities
NCI CTC grade ≥2 discontinue use in those with decreased left ventricular ejection fraction (LVEF) or for a LVEF that drops below institution’s lower limit of normal; product may be restarted after 2 wk if LVEF recovers to normal at 1000 mg/day; restart at 1250 mg/day when toxicity improves to grade 1 or better
•
Storage at room temp, away from heat
•
Therapeutic response: decrease in breast cancer progression
•
To take with a full glass of water, once a day, 1 hr before or after food; not to take with food or grapefruit products
•
To take as directed only; if a dose is missed, to take as soon as remembered; if it is close to the next dose, to take only that dose; not to double
To report chest pain, difficulty breathing, fever, chills, sore throat, bleeding, bruising, yellow skin or eyes, severe fatigue, dizziness, palpitations to prescriber
•
That other side effects that may occur, but do not need to be reported: nausea, diarrhea, heartburn, mouth sores, rash, numbness/pain in hands/feet
To use adequate contraception because the fetus could be damaged by this product (D)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ophthalmic)
(lah-tan′oh-prost)
Xalatan
Func. class.:
Antiglaucoma agent
Chem. class.:
Prostaglandin agonist
Do not confuse:
latanoprost/
bimatoprost
Increases aqueous humor outflow
Increased intraocular pressure in those who have open-angle glaucoma/ocular hypertension and who do not respond to other IOP-lowering products
Hypersensitivity to this product, benzalkonium chloride
Precautions:
Eye infections, angle-closure glaucoma, renal/hepatic function impairment, children
Calculator
• Adult:
OPHTH
Instill 1 drop in each affected eye (conjunctival sac) every night
Available forms:
Ophthalmic solution 0.005%
•
Wash hands before and after use; contact lenses should be removed before using the product, reinsert 15 min after use; contains benzalkonium chloride,
which may be absorbed by soft contact lenses
•
Tilt the head back slightly and pull the lower eyelid down with the index finger to form a pouch; squeeze the prescribed number of drops into the pouch and gently close the eyes for 1–2 min; do not blink; to avoid contamination, do not touch the tip of the dropper to the eye, fingertips, or other surface
•
The solution may be used concomitantly with other topical ophthalmic drug products to lower IOP; if more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 min apart
•
Store unopened bottle refrigerated; once opened, it may be stored at room temperature, protected from light, for up to 6 wk
EENT:
Conjunctival hyperemia, iris color change, ocular pruritus
, xerophthalmia, visual disturbance, ocular irritation burning, foreign body sensation, ocular pain, blepharitis, cataracts, and superficial punctate keratitis
INTEG:
Rash
MISC:
Flulike symptoms
Ophthalmic: Onset 3-4 hr, peak 8-12 hr; half-life 3 hr
•
Intraocular pressure:
in those with on-going increased IOP
•
Decreasing IOP
•
To wash hands before and after use; that contact lenses should be removed before using product, reinsert 15 min after use; contains benzalkonium chloride, which may be absorbed by soft contact lenses
•
To tilt the head back slightly and pull the lower eyelid down with the index finger to form a pouch; squeeze the prescribed number of drops into the pouch and gently close the eyes for 1–2 min; not to blink; to avoid contamination, do not touch the tip of the dropper to the eye, fingertips, or other surface
•
That the solution may be used concomitantly with other topical ophthalmic drug products to lower IOP; if more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart
•
To store unopened bottle refrigerated; that once opened, it may be stored at room temperature, protected from light, for up to 6 wk
