Mosby's 2014 Nursing Drug Reference (165 page)

Black Box Warning:

Bone marrow depression, infection, bleeding, requires an experienced clinician

• Adult:
IV
100 mg/m
²
/day on days 1, 2 in combination with methotrexate, leucovorin, actinomycin D, cyclophosphamide and vinCRIStine (EMA-CO regimen) q2-3wk or 1-5 with bleomycin, CISplatin (BEP regimen) or 100 mg/m
²
/day on days 1, 3, 5, repeat q3-4wk

• Adult:
IV
CCr 45-60 ml/min, reduce dose by 15%; CCr 30-44 ml/min, reduce dose by 20%; CCr <30 ml/min, reduce dose by 25%

• Adult:
IV/PO
total bilirubin 1.5-3 mg/dl reduce dose by 50% total bilirubin 3-5 mg/dl: reduce dose by 75%; total bilirubin >5 mg/dl: hold

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

• 
Urate nephropathy:
Allopurinol, aggressive alkalinization to maintain uric acid levels

• 
Antispasmodic, EPINEPHrine, corticosteroids, antihistamines for reactions

Additive compatibilities:
CARBOplatin, cytarabine, floxuridine, fluorouracil, hydrOXYzine, ifosfamide, ondansetron

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

Y-site compatibilities:
Acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium acetate/chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, codeine, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, HCL/
liposome, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, famotidine, fenoldopam, fentaNYL, floxuridine, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, mivacurium, morphine, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, plicamycin, polymyxin B, potassium chloride/phosphates, procainamide, promethazine, propranolol, quiNIDine, quinupristin-dalfopristin, ranitidine, remifentanil, riTUXimab, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid

Increase:
bone marrow depression—other antineoplastics, radiation, immunosuppressives

Increase:
adverse reactions—live virus vaccines, toxoids

Increase:
effect of etoposide, toxicity—voriconazole, conivaptan, cycloSPORINE, imatinib, nilotinib, etravirine, telithromycin

Increase:
risk of bleeding—anticoagulants, NSAIDs, platelet inhibitors, thrombolytics, salicylate

Decrease:
etoposide effect—sargramostim, filgrastim, separate by ≥24 hr

• 
Decreased oral etoposide—grapefruit juice

Decrease:
platelets, RBC, WBC, neutrophils, Hgb, calcium, phosphate

Increase:
uric acid, potassium

Black Box Warning:

Bone marrow depression:
CBC, differential, platelet count weekly; withhold product if WBC is <500 or platelet count is <50,000; notify prescriber, treatment should be delayed

• 
Nephrotoxicity:
BUN; serum uric acid; urine CCr; electrolytes before, during therapy; I&O ratio; report fall in urine output to <30 ml/hr; check B/P bid, report any significant decrease

Black Box Warning:

Infection:
Monitor temp; fever may indicate beginning infection, treat active infection before treatment

Black Box Warning:

Infection:
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly

Black Box Warning:

Bleeding:
hematuria, guaiac stools, bruising or petechiae, mucosa or orifices q8hr

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

• 
Hepatotoxicity:
Jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea

• 
B/P q15min during inf; if systolic reading <90 mm Hg, discontinue inf, notify prescriber

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

• 
Injection site reaction:
monitor site closely for infiltration

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

 
Symptoms indicating severe allergic reaction:
rash, pruritus, urticaria, purpuric skin lesions, itching, flushing, restlessness, coughing, difficulty breathing

• 
Frequency of stools, characteristics:
cramping, acidosis;
signs of dehydration:
rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness

• 
Geriatric patients:
increased alopecia, GI effects, infection, nephrotoxicity, myelosuppression

Black Box Warning:

An experienced clinician knowledgable in the use of cytotoxic products

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

• 
Refrigerate oral product, do not freeze

• 
Therapeutic response: decreased tumor size, spread of malignancy

• 
To report any changes in breathing or coughing

• 
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

• 
That metallic taste may occur

Black Box Warning:

Infection:
To report symptoms of infection (fever, sore throat); to avoid crowds, persons with known infections

• 
To avoid immunizations

• 
Pregnancy:
To notify prescriber if pregnancy is planned or suspected pregnancy (D); to use reliable contraception during and for several months after therapy; to avoid breastfeeding

• 
To take as prescribed (PO), not to double dose

• 
To report signs of infection (flu-like symptoms, fever, fatigue, sore throat)

• 
To take B/P often, hypotension occurs