Mosby's 2014 Nursing Drug Reference (120 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
deferasirox (Rx)
(def-a′sir-ox)
Exjade
Func. class.:
Heavy metal chelating agent
Chronic iron overload, transfusion hemosiderosis
Breastfeeding, children, hypersensitivity, severe renal/hepatic disease, GI hemorrhage
Calculator
•
Adult and child >2 yr: PO
20-30 mg/kg/day; oral dispersion tablet is dissolved in water <1 g in 3.5 oz; >1 g in 7 oz or more; give on empty stomach at least 30 min before meals
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(day-gah-rel′iks)
Firmagon
Func. class.:
Antineoplastic
Chem. class.:
GnRH-receptor antagonist
Reduces gonadotropins release and testicular steroidogenesis by reversibly binding to GnRH receptors
Advanced prostate cancer
Hypersensitivity
Precautions:
Hypersensitivity
Calculator
• Adult (male): SUBCUT
240 mg given as two 120 mg injections; (40 mg/ml concentration) maintenance 80 mg (20 mg/ml concentration) every 28 days, starting 28 days after first dose
Available forms:
Injection 80, 120 mg vial
•
Do not give IV, subcut only
•
Use gloves, aseptic technique during preparation and administration
•
Keep vials vertical at all times; do
not
shake the vials; give reconstituted drug within 1 hr after addition of sterile water for injection
only
):
•
To achieve a 240-mg dose, two 120-mg vials of degarelix must be used. Repeat for each 120 mg vial: draw up exactly 3 ml of sterile water for injection with a 2-inch, 21-G needle; do not use bacteriostatic water for injection; inject the sterile water slowly into vial containing 120 mg; to maintain sterility, do not remove the syringe or the needle from the vial; keep the vial in an upright position and swirl gently until clear; avoid shaking; reconstitution can take up to 15 min; tilt the vial slightly and withdraw 3 ml (40 mg/ml), avoid turning the vial upside down; repeat with a new vial, needle, and syringe for the second 120-mg dose (total dose = 240 mg)
•
Draw up 4.2 ml of sterile water for injection with a 2-inch, 21-G needle; do not use bacteriostatic water for injection; inject the sterile water slowly into vial containing 80 mg; do not remove the syringe or the needle from the vial; keep the vial upright, swirl gently until clear; avoid shaking; reconstitution can take up to 15 min; tilt vial slightly and withdraw 4 ml (20 mg/ml); avoid turning upside down during withdrawal
•
Exchange the reconstitution needle with a 1.25-inch, 27-G needle; remove air bubbles; give in the abdominal region; rotate injection site periodically; use area not exposed to pressure; grasp the skin of abdomen, elevate the subcutaneous tissue, and insert the needle deeply at an angle ≥45 degrees; aspirate before injection; inject the dose subcut; when giving the loading dose of two 120 mg doses, the second dose should be injected at a different site
CNS:
Chills, dizziness, fatigue, fever, headache, insomnia
CV:
Increased QT prolongation,
hypotension, hot flashes
GI:
Diarrhea, constipation, nausea
GU:
ED, UTI, gynecomastia
INTEG:
Injection site reactions,
pain at site, redness, swelling
MS:
Back pain, decreased bone density
Peak 2 days, duration 50 days, half-life 53 days
Increase:
QT prolongation—Class IA/III antidysrhythmics
Increase:
PSA, LFTs
Decrease:
bone density test
QT prolongation:
More common in those taking Class IA/III antidysrhythmics, heart failure, congenital long QT syndrome; monitor cardiac status at baseline and often thereafter
•
Liver function studies, PSA, GGT that may be elevated; bone density that may be decreased; electrolytes
•
Decreasing spread, size of tumor
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To notify all prescribers of cardiac disease or use of cardiac products
•
Injection technique if patient/family will be giving product (provide patient information)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(de-la-veer′deen)
Rescriptor
Func. class.:
Antiretroviral
Chem. class.:
Nonnucleoside reverse transcriptase inhibitor (NNRTI)
Binds directly to reverse transcriptase; blocks RNA-, DNA-dependent polymerase activities, causing a disruption of the enzyme’s site
HIV-1 in combination with at least 2 other antiretrovirals
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, children, hepatic disease, achlorhydria, antimicrobial resistance, exfoliative dermatitis, hepatitis, immune reconstitution syndrome
Calculator
•
Adult and adolescent ≥16 yr: PO
400 mg tid, max 1200 mg/day
Available forms:
Tabs 100, 200 mg
•
100-mg tab: dispersion by adding 4 tab/3-4 oz water, let stand, stir, swallow, rinse glass, swallow; use only 100-mg tabs for dispersion; 200-mg tab take as intact tab
•
Do not give within 1 hr of antacids or didanosine
•
Always use as combination therapy; this product is not recommended for initial treatment; due to inferior, virologic effect, it is no longer listed as part of any preferred regimens
CNS:
Headache, fatigue, anxiety, insomnia, fever
GI:
Diarrhea, abdominal pain, nausea, anorexia, vomiting, dyspepsia,
hepatotoxicity
GU:
Nephrotoxicity
HEMA:
Neutropenia, leukopenia, thrombocytopenia, anemia, granulocytopenia
INTEG:
Rash, pruritus
MISC:
Cough
MS:
Pain, myalgia
SYST:
Stevens-Johnson syndrome; immune reconstitution syndrome (combination therapy)
98% protein bound, half-life 5.8 hr, peak 1 hr, duration 8 hr, extensively metabolized by CYP3A4, excreted in urine, feces
Do not coadminister with nevirapine, efavirenz, rilpivirine, combined use not beneficial
Serious life-threatening adverse reaction: amphetamines, ergots, benzodiazepines, calcium channel blockers, sedative/hypnotics, antidysrhythmics, sildenafil, pimozide, cisapride, ALPRAZolam, astemizole, midazolam, terfenadine, opiates, triazolam
Increase:
levels of ALPRAZolam, clarithromycin, dapsone, ergots, felodipine, midazolam, NIFEdipine, indinavir, saquinavir, lovastatin, simvastatin, atorvastatin, other CYP3A4, 2D6 inhibitors
Increase:
delavirdine levels—FLUoxetine, ketoconazole
Increase:
levels of both products—quiNIDine, warfarin, clarithromycin
Decrease:
delavirdine levels—antacids, anticonvulsants, rifamycins, protease inhibitors, didanosine
Decrease:
action of oral contraceptives, didanosine
Decrease:
delavirdine level—St. John’s wort
•
HIV:
obtain hepatitis B virus (HBV) screening to ensure proper treatment, if coinfected, a fully suppressive antiretroviral regimen with products against both; CBC, blood chemistry, plasma HIV RNA,
absolute CD41/CD81/cell counts/%, serum β-2 microglobulin, serum ICD124 antigen levels
•
Immune reconstitution syndrome:
when treated with combination therapy; development of opportunistic infections (
Mycobacterium avium complex
[MAC], cytomegalovirus [CMV],
Pneumocystis carinii
pneumonia [PCP], TB)
•
Signs of infection, anemia
•
Hepatic studies: ALT, AST; renal studies
•
Bowel pattern before, during treatment; if severe abdominal pain with bleeding occurs, product should be discontinued; monitor hydration
•
Allergies before treatment, reaction to each medication; place allergies on chart
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Plasma delavirdine concentrations (trough 10 micromolar)
•
Toxicity:
severe nausea/vomiting, maculopapular rash
•
Serious skin reactions:
Stevens-Johnson syndrome; rash may occur within 1-3 wk of beginning treatment; if rash is not severe, manage with diphenhydrAMINE, hydrOXYzine, topical corticosteroids
•
Therapeutic response: increased CD4 cell count, decreased viral load, improvement in symptoms of HIV
•
To take as prescribed; if dose is missed, to take as soon as remembered up to 1 hr before next dose; not to double dose
•
That tabs may be dissolved in 1/2 cup of water; to stir; when dissolved, drink right away; to rinse cup with water and drink to get all medication
•
To make sure health care provider knows about all medications being taken
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That if severe rash, mouth sores, swelling, aching muscles/joints, or eye redness occur, to notify health care provider
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Not to breastfeed if taking this product
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That this product is not a cure, only controls symptoms