Mosby's 2014 Nursing Drug Reference (274 page)

Black Box Warning:

Secondary malignancy, neutropenia, intrathecal administration, extravasation, heart failure

• Adult:
IV INF
12 mg/m
²
/day on days 1-3 and 100 mg/m
²
cytarabine × 7 days as continuous 24-hr inf

• Adult:
IV
12 mg/m
²
given as short 5- to 15-min inf for 2 days with cytarabine × 5 days

• Adult:
IV
12-14 mg/m
²
as single dose or short inf q21days

• Adult:
IV INF
12 mg/m
²
as 5- to 15-min inf q3mo, cumulative lifetime dose 140 mg/m
²

• 
Other medications by oral route if possible; avoid IM, SUBCUT, IV routes

• 
Antiemetic 30-60 min before product to prevent vomiting

Y-site compatibilities:
Acyclovir, alemtuzumab, alfentanil, allopurinol, amikacin, aminocaproic acid, aminophylline, amiodarone, anidulafungin, argatroban, atracurium, bivalirudin, bleomycin, bretylium, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, CARBOplatin, carmustine, caspofungin, cefoTEtan, ceftizoxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, codeine, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOrubicin citrate liposome, dexmedetomidine, dexrazoxane, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, hydrALAZINE, hydrocortisone sodium succinate, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem-cilastatin, inamrinone, insulin regular, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, mesna, metaraminol, methohexital, methotrexate, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mivacurium, morphine sulfate, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, palonosetron, pamidronate, pancuronium, pentamidine, pentazocine, PENTObarbital, PHENObarbital, phentolamine, phenylephrine, polymyxin b, potassium acetate, potassium chloride, procainamide, prochlorperazine, promethazine hydrochloride, propranolol, quiNIDine gluconate, quinupristin-dalfopristin, ranitidine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, zidovudine, zoledronic acid

Increase:
bone marrow depression toxicity—radiation, other antineoplastics

Increase:
adverse reactions—live virus vaccines, trastuzumab

Increase:
bleeding risk—NSAIDs, anticoagulants

Increase:
mitoXANtrone effects of—digoxin, phenytoin

Increase:
LFTs, uric acid

Decrease:
HcT/Hgb, platelets, WBC

• 
CBC, differential, platelet count weekly; withhold product if WBC is <1500/mm
³
; leukopenia, neutropenia, thrombocytopenia are expected, leukocyte nadir 10-14 days, recovers in 2-3 wk

• 
Hepatotoxicity:
hepatic studies before, during therapy: bilirubin, AST, ALT, alk phos prn or monthly; dose reduction needed with hepatic disease; jaundiced skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea

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

• 
Bleeding, hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr

Black Box Warning:

ECG, ECHO, chest x-ray, MUGA, RAI angiography; assess ejection fraction before and during treatment; cardiotoxic may develop during treatment or months to years after treatment; use vigilant cardiac monitoring in MS

Black Box Warning:

Secondary acute myelogenous leukemia (AML) that can develop after taking this product

Black Box Warning:

Multiple sclerosis:
obtain MUGA, LVEF baselines; repeat LVEF if symptoms of CHF occur or if cumulative dose is >100 mg/m
²
; do not administer to patients who have received lifetime dose of ≥140 mg/m
²
or if LVEF <50% or significant LVEF

• 
Obtain pregnancy test for all women of childbearing age, even if birth control is used

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

• 
Increased fluids to 2-3 L/day unless contraindicated

• 
Therapeutic response: decreased tumor size, spread of malignancy

• 
To immediately report bleeding, dyspnea, possible infections, seizure, jaundice, fever, cough, or dyspnea

• 
To avoid hot foods or those with citric acid, rough texture

• 
To report any bleeding, white spots, ulcerations in mouth; to examine mouth daily

• 
To avoid crowds, persons with infections

• 
That sclera, urine may turn blue or green; that hair loss may occur

Black Box Warning:

To notify prescriber if pregnancy is suspected or planned; to use effective contraception