Mosby's 2014 Nursing Drug Reference (16 page)

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

RARELY USED
HIGH ALERT
abciximab (Rx)

(ab-six′i-mab)

ReoPro

Func. class.:
Platelet aggregation inhibitor

USES:

Used with heparin and aspirin to prevent acute cardiac ischemia after percutaneous transluminal coronary angioplasty in patients with NSTEMI or UA when percutaneous coronary intervention (PCI) is planned within 24 hr

Unlabeled uses:
Acute MI, Kawasaki disease (child)

CONTRAINDICATIONS:

Hypersensitivity to this product or murine protein; GI, GU bleeding; CVA within 2 yr, bleeding disorders, intracranial neoplasm, intracranial arteriovenous malformations, intracranial aneurysm, platelet count <100,000/mm
3
, recent surgery, aneurysm, uncontrolled severe hypertension, vasculitis, coagulopathy

DOSAGE AND ROUTES
Calculator
PCI

• Adult: IV BOL
250 mcg (0.25 mg)/kg 10-60 min before PCI followed by 0.125 mcg/kg/min
CONT INF
for 12 hr

MI (unlabeled)

• Adult:
IV BOL
0.25 mg/kg over 5 min, then 0.125 mcg/kg/min (max 10 mcg/min);
IV INF
for 12 hr unless complications

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

abiraterone

(a′bir-a′ter-one)

Zytiga

Func. class.:
Androgen inhibitor

ACTION:

Converted to abiraterone which inhibits CYP17, the enzyme required for androgen biosynthesis; androgen-sensitive prostate cancer responds to treatment that decreases androgens

USES:

Metastatic castration-resistant prostate cancer in combination with predniSONE for patients who have received prior chemotherapy containing docetaxel

CONTRAINDICATIONS:

Pregnancy (X), women, children

Precautions:
Adrenal insufficiency, cardiac disease, MI, heart failure, hepatic disease, hypertension, hypokalemia, infection, surgery, ventricular dysrhythmia

DOSAGE AND ROUTES
Calculator

• Adult males: PO
1000 mg/day with predniSONE 5 mg bid

Hepatic dose

• Adult males (Child-pugh B, 7-9): PO
250 mg/day with predniSONE; (Child-Pugh C, >10) do not use

Available forms:

Tabs 250 mg

Administer:
PO route

• 
Give whole, on empty stomach 2 hr before or 1 hr after meals with full glass of water

 
Women who are pregnant or may become pregnant should not touch tabs without gloves

SIDE EFFECTS

CV:
Angina, dysrhythmia exacerbation,
atrial flutter/fibrillation/tachycardia, AV block,
chest pain, edema, heart failure,
MI,
hypertension,
QT prolongation,
sinus tachycardia,
supraventricular tachycardia, ventricular tachycardia

ENDO:
Hot flashes

GI:
Diarrhea, dyspepsia

GU:
Increased urinary frequency, nocturia, urinary tract infection

META:
Adrenocortical insufficiency, hyperbilirubinemia, hypertriglyceridemia, hypokalemia, hypophosphatemia

MS:
Arthralgia, myalgia

RESP:
Cough, upper respiratory infection

SYST:
Infection

PHARMACOKINETICS

99% protein binding, converted to abiraterone (active metabolite), mean terminal half-life 7-17 hr; excreted 88% in feces, 5% in urine; high-fat food increases effect, give on empty stomach; increased effect in hepatic disease

INTERACTIONS

Avoid use with: CYP3A4 inhibitors (clarithromycin, atazanavir, nefazodone, saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole, ketoconazole, itraconazole); loperamide, guinine, naprosen, pioglitazone, pitavastin, repaglinide, rosiglitazone

Avoid use with: CYP3A4 inducers (carBAMazepine, phenytoin, rifampin, rifabutin, rifapentine, PHENobarbital)

Increase action of CYP2D6 substrate—dextromethorphan, thioridazine; dose of these products should be reduced

Drug/Food

Increase:
abiraterone action—must be taken on an empty stomach

NURSING CONSIDERATIONS
Assess:

• 
Prostate cancer:
monitor prostate specific antigen (PSA), serum potassium

 
Hepatotoxicity:
monitor liver function tests (AST/ALT) at baseline, every 2 wk for 3 mo, monthly thereafter in patients with no known hepatic disease; interrupt treatment in patients without known hepatic disease at baseline who develop ALT/AST >5 × ULN or total bilirubin >3 × ULN; patients with moderate hepatic disease at baseline, measure ALT, AST, bilirubin before the start of treatment, every wk for 1 month, every 2 wk for the following 2 mo, monthly thereafter; if elevations in ALT and/or AST >5 × ULN or total bilirubin >3 × ULN occur in patients with moderate hepatic impairment at baseline, discontinue and do NOT restart; measure serum total bilirubin, AST/ALT if hepatotoxicity is suspected; elevations of AST, ALT, bilirubin from baseline should prompt more frequent monitoring.

• 
Musculoskeletal pain, joint swelling, discomfort: arthritis, arthralgia, joint swelling, and joint stiffness, some severe; muscle discomfort that included muscle spasms, musculoskeletal pain, myalgia, musculoskeletal discomfort, and musculoskeletal stiffness may be relieved with analgesics

• 
Signs, symptoms of adrenocorticoid insufficiency; monthly for hypertension, hypokalemia, fluid retention

 
QT prolongation:
Monitor ECG for QT prolongation, ejection fraction in patients with cardiac disease, small increases in the QTc interval such as <10 ms have occurred; monitor for arrhythmia exacer
bation such as sinus tachycardia, atrial fibrillation, supraventricular tachycardia (SVT), atrial tachycardia, ventricular tachycardia, atrial flutter, bradycardia, AV block complete, conduction disorder, bradyarrhythmia

Perform/provide:

• 
Storage of tabs at room temp

Teach patient/family:

 
That women must not come in contact with tabs; wear gloves if product needs to be handled, pregnancy (X)

• 
To report chest pain, swelling of joints, burning/pain when urinating

Other books

The Duke's Dilemma by Fenella J Miller
Trickster by Laurie Halse Anderson
03 - God King by Graham McNeill - (ebook by Undead)
Edge of Moonlight by Stephanie Julian
Remember by Mihai, Cristian
Blue Hour by Carolyn Forche