Mosby's 2014 Nursing Drug Reference (221 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
β-1a:
Onset ≤12 hr, peak 48 hr, duration 4 days, half-life 8.6 hr
β-1b:
Onset rapid, peak 2-8 hr, duration unknown, half-life 8 min-4.3 hr
Increase:
hepatic damage—antiretrovirals (NNRTIs, NRTIs, protease inhibitors)
Increase:
myelosuppression—antineoplastics
Decrease:
clearance of zidovudine
•
Change in immunomodulation: astragalus, echinacea, melatonin
Interference:
vaccines, toxoids; avoid concurrent use
Increase:
LFTs
•
Blood, hepatic studies: CBC, differential, platelet counts, BUN, creatinine ALT, urinalysis; if absolute neutrophil count <750/mm
3
or if AST/ALT is 10× normal, discontinue product
•
CNS symptoms: headache, fatigue, depression
•
GI status: diarrhea or constipation, vomiting, abdominal pain
•
Cardiac status: increased B/P, tachycardia
•
Mental status: depression, depersonalization,
suicidal thoughts,
insomnia
•
Multiple sclerosis symptoms
•
Storage in refrigerator; do not freeze
•
Therapeutic response: decreased symptoms of multiple sclerosis
•
With written, detailed information about product
•
That blurred vision, sweating may occur
•
That female patients may experience irregular menses, dysmenorrhea or metrorrhagia, breast pain
•
To use sunscreen to prevent photosensitivity
•
To notify prescriber if pregnancy is suspected
•
About inj technique, care of equipment
•
To notify prescriber of increased temp, chills, muscle soreness, fatigue, depression, symptoms of hepatotoxicity
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(in-ter-feer′on)
Actimmune
Func. class.:
Biologic response modifier
Chem. class.:
Lymphokine, interleukin type
Species-specific protein synthesized in response to viruses, effects; can mediate killing of
Staphylococcus aureus, Toxoplasma gondii, Leishmania donovani, Listeria monocytogenes, Mycobacterium avium intracellulare;
enhances oxidative metabolism of macrophages, enhances antibody-dependent cellular cytotoxicity
Serious infections associated with chronic granulomatous disease, osteopetrosis
Unlabeled uses:
Mycobacterium avium
complex (MAC), pulmonary fibrosis
Hypersensitivity to interferon-γ,
Escherichia coli
–derived products
Precautions:
Pregnancy (C), breastfeeding, children <1 yr, cardiac disease, seizure disorders, CNS disorders, myelosuppression
Calculator
• Adult: SUBCUT
50 mcg/m
2
(1.5 million units/m
2
) for patients with surface area >0.5 m
2
; 1.5 mcg/kg/dose for patients with surface area <0.5 m
2
; give Monday, Wednesday, Friday for 3×/wk dosing
Available forms:
Inj 100 mcg (2 million units)/single-dose vial
•
At bedtime to minimize adverse reactions; give acetaminophen for fever, headache
•
50% of dose if severe reactions occur or discontinue treatment until reactions subside
•
In right and left deltoid and anterior thigh
•
Warm to room temp before use; do not leave at room temp >12 hr (unopened vial)
CNS:
Headache, fatigue
, depression, fever, chills
GI:
Nausea, anorexia
, abdominal pain, weight loss, diarrhea, vomiting, colitis
HEMA:
Leukopenia, thrombocytopenia, neutropenia
INTEG:
Rash, pain at inj site,
Stevens-Johnson syndrome
MS:
Myalgia, arthralgia
SUBCUT:
Dose absorbed 89%, elimination half-life 5.9 hr, peak 7 hr
Increase:
myelosuppression—other myelosuppressive agents
Increase:
level of theophylline, aminophylline
Increase:
liver toxicity—protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs)
•
Blood, renal, hepatic studies: CBC, differential, platelet counts, BUN, creatinine, ALT, urinalysis
•
CNS symptoms: headache, fatigue, depression
•
Storage in refrigerator upon receipt; do not freeze; do not shake
•
Therapeutic response: decreased serious infections; improvement in existing infections and inflammatory conditions
•
About the method of administration if family members will be giving medication
•
With written, detailed information about product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ip-i-lim′ue-mab)
Yervoy
Func. class.:
Antineoplastic; biologic response modifier
A recombinant, human monoclonal antibody that binds to the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4); action is indirect, possibly through T-cell–mediated anti-tumor immune responses
Treatment of unresectable or metastatic malignant melanoma
Hyper-sensitivity
Precautions:
Pregnancy, breastfeeding, Crohn’s disease, hepatitis, immunosuppression, inflammatory bowel disease, iritis, ocular disease, organ transplant, pancreatitis, renal disease, rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, thyroid disease, ulcerative colitis, uveitis
Black Box Warning:
Adrenal insufficiency, diarrhea, Guillain-Barré syndrome, hepatic disease, myasthenia gravis, hypo/hyperthyroidism, hypopituitarism, peripheral neuropathy, serious rash
Calculator
• Adult/geriatric: IV
3 mg/kg over 90 min q3wk × 4 doses; permanently discontinue if the full treatment course is not completed within 16 wk from 1st dose or for severe or life-threatening adverse reactions; withhold a dose for any moderate endocrine or immune-mediated adverse reactions; if the moderate adverse reaction completely or partially resolves (Grade 0-1) and if the patient is receiving <7.5 mg predniSONE or equivalent/day, resume at a dose of 3 mg/kg IV q3wk until all 4 planned doses or 16 wk from 1st dose, whichever occurs earlier; if moderate adverse reactions are persistent or if the corticosteroid dose cannot be reduced to 7.5 mg predniSONE or equivalent/day, permanently discontinue
Available forms:
Sol for inj 50 mg/10 ml, 200 mg/40 ml
•
Visually inspect parenteral products for particulate matter and discoloration before using whenever sol and container permit; sol may have a pale yellow color and have translucent to white, amorphous particles; discard the vial if sol is cloudy, if there is pronounced discoloration, or if particulate matter is present
•
Allow vials to stand at room temperature for 5 min before inf preparation; withdraw the required volume and transfer into an IV bag; discard partially used vials or empty vials; dilute with 0.9% sodium chloride injection or 5% dextrose injection to a final conc (1-2 mg/ml); mix diluted sol by gentle inversion; do not admix
•
Give inf over 90 min through an IV line with a low-protein binding in-line filter, do not give with other products; after each inf, flush the line with 0.9% sodium chloride injection or 0.5% dextrose injection
CNS:
Severe and fatal immune-mediated neuropathies, fatigue, headache, fever
EENT:
Uveitis, iritis, episcleritis
ENDO:
Severe and fatal immune-mediated endocrinopathies
GI:
Severe and fatal immune-mediated enterocolitis, hepatitis, pancreatitis, abdominal pain, nausea, diarrhea, appetite decreased, vomiting, constipation, colitis
INTEG:
Severe and fatal immune-mediated dermatitis pruritus, rash, urticaria
MISC:
Cough, dyspnea, anemia, eosinophilia, nephritis
SYST:
Antibody formation, Stevens-Johnson syndrome, toxic epidermal necrolysis
Steady state by 3rd dose; terminal half-life 14.7 days
•
Serious skin disorders: Stevens-Johnson syndrome, toxic epidermal necrolysis:
permanently discontinue in these or rash complicated by full thickness dermal ulceration or necrotic, bullous, or hemorrhagic manifestations like bullous rash; give systemic corticosteroids at a dose of 1-2 mg/kg/day of predniSONE or equivalent; when dermatitis is controlled, taper corticosteroids over a period of at least 1 mo, withhold in patients with moderate to severe reactions; for mild to moderate dermatitis (localized rash and pruritus), give topical or systemic corticosteroids
•
Hepatotoxicity:
monitor liver functions tests baseline and before each dose to rule out infectious or malignant causes, increase the frequency of liver function test monitoring until resolution, permanently discontinue in patients with Grade 3-5 toxicity, give systemic corticosteroids at a dose of 1-2 mg/kg/day of predniSONE or equivalent
•
Neuropathy:
monitor for motor or sensory neuropathy (unilateral or bilateral weakness, sensory alterations, or paresthesias) before each dose; permanently discontinue if severe neuropathy (interfering with daily activities), such as Guillain-Barré–like syndromes, occur
•
Endocrinopathy:
monitor thyroid function tests at baseline and before each dose; monitor hypophysitis, adrenal insufficiency, adrenal crisis, hypo/hyperthyroidism (fatigue, headache, mental status changes, abdominal pain, unusual bowel habits, hypotension, or nonspecific symptoms that may resemble other causes)
•
Storage once diluted for no more than 24 hr refrigerated or at room temperature
Evaluate:
Decreasing spread of malignant melanoma
•
To immediately report allergic reactions, skin rash, severe abdominal pain, yellowing of skin or eyes, tingling of extremities, change in bowel habits
•
About the reason for treatment and expected results
