Mosby's 2014 Nursing Drug Reference (111 page)

• Adult:
PO
Initially 1-5 mg/kg over 2-5 days, maintenance is 1-5 mg/kg;
IV
initially 40-50 mg/kg in divided doses over 2-5 days, maintenance 10-15 mg/kg q7-10 days or 3-5 mg/kg q3days

• Child:
PO/IV
2-8 mg/kg or 60-250 mg/m
²
in divided doses for 6 or more days; maintenance 10-15 mg/kg q7-10 days or 30 mg/kg q3-4wk; dose should be reduced by half when bone marrow depression occurs

• Child and infant:
PO
150 mg/m
²
/day, days 1-7 with DOXOrubicin (
IV
35 mg/m
²
on day 8) q21days × 5 cycles

• Child:
IV
70 mg/kg/day with hydration on days 1, 2 with DOXOrubicin and vinCRIStine q21days for courses 1, 2, 4, 6 alternating with CISplatin and etoposide q21days for courses 3, 5, 7

• Adult:
PO
100-200 mg/m
²
/day or 2 mg/kg/day × 4-14 days;
IV
500-1000 mg/m
²
on day 1 in combination with fluorouracil and methotrexate or DOXOrubicin or DOXOrubicin alone, also cyclophosphamide 600 mg/m
²
; may be given dose-dense on day 1 of q14days with DOXOrubicin (60 mg/m
²
) with growth-factor support

• Adult:
IV
500 mg/m
²
with DOXOrubicin (50 mg/m
²
IV
) then docetaxel (75 mg/m
²
)
IV
given 1 hr later q3wk × 6 cycles

• Adult:
PO
2-3 mg/kg/day for up to 12 wk when corticosteroids are unsuccessful

• Adult:
IV
45-50 mg/kg divided over 4 days

• Adult:
PO
1-2 mg/kg/day,
IV
0.5-1 g/m
²

• Adult and child:
PO
1.5-2.5 mg/kg/day

• Adult:
IV
250 mg/m
²
/day on days 1-3 with fludarabine 30 mg/m
²
/day on days 1-3

• 
Use cytotoxic handling procedures

• 
In
AM
so product can be eliminated before bedtime

• 
Fluids IV or PO before chemotherapy to hydrate patient

• 
Antacid before oral agent; give after evening meal, before bedtime

• 
Antiemetic 30-60 min before product and prn

• 
Allopurinol or sodium bicarbonate to maintain uric acid levels, alkalinization of urine

Solution compatibilities:
Amino acids 4.25%/D
₂₅
, D
₅
/0.9% NaCl, D
₅
W, 0.9% NaCl

Syringe compatibilities:
Bleomycin, CISplatin, doxapram, DOXOrubicin, droperidol, fluorouracil, furosemide, heparin, leucovorin, methotrexate, metoclopramide, mitomycin, vinBLAStine, vinCRIStine

Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, azlocillin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamycin, codeine, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, dox
acurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, kanamycin, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANtrone, mivacurium, morphine, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, penicillin G potassium, 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, topotecan, TPN, trastuzumab, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid

Increase:
neuromuscular blockade—succinylcholine

Increase:
cyclophosphamide toxicity—barbiturates

Increase:
action of warfarin

Increase:
bone marrow depression—allopurinol, thiazides

Increase:
hypoglycemia—insulin

Decrease:
digoxin levels—digoxin

Decrease:
cyclophosphamide effect—chloramphenicol, corticosteroids

Decrease:
antibody response—live virus vaccines

• 
Toxicity: St. John’s wort

Increase:
uric acid

False positive:
Pap smear

False negative:
PPD, mumps, trichophytin,
Candida, Trichophyton
, Pap smear

• 
Hemorrhagic cystitis;
renal studies: BUN, serum uric acid, urine CCr before, during therapy; I&O ratio; report fall in urine output <30 ml/hr

• 
Bone marrow depression:
CBC, differential, platelet count baseline, weekly; withhold product if WBC is <2500 or platelet count is <75,000; notify prescriber of results

• 
Pulmonary function tests, chest x-ray films before, during therapy; chest film should be obtained q2wk during treatment

• 
Monitor temp q4hr; elevated temp may indicate beginning infection

• 
Hepatotoxicity:
hepatic studies before, during therapy (bilirubin, AST, ALT, LDH), as needed; jaundice of skin, sclera; dark urine, clay-colored stools; itchy skin; abdominal pain; fever; diarrhea

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

• 
Dyspnea, crackles, unproductive cough, chest pain, tachypnea

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

• 
Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia; obtain prescription for viscous lidocaine (Xylocaine)

 
Symptoms that indicate severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing

• 
Storage in tight container at room temp

• 
Increase fluid intake to 2-3 L/day to prevent urate deposits, calculi formation, reduce incidence of hemorrhagic cystitis

• 
Diet low in purines: organ meats (kidney, liver), dried beans, peas to maintain alkaline urine

• 
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

• 
Warm compresses at inj site for inflammation

• 
To take adequate fluids to eliminate product

• 
Therapeutic response: decreased tumor size, spread of malignancy

• 
That amenorrhea can occur and may last up to 1 yr after therapy but is reversible after stopping treatment

• 
To report any changes in breathing or coughing

• 
That hair may be lost during treatment; a wig or hairpiece may make patient feel better; new hair may be different in color, texture

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

• 
To report signs of infection: increased temp, sore throat, flulike symptoms

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

• 
To report bleeding (bruising, hematuria, petechiae); to avoid use of razors, commercial mouthwash

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

• 
To avoid use of aspirin products, ibuprofen

• 
To avoid vaccinations during therapy

• 
Advise patient on proper handling and disposal of chemotherapy drugs