Mosby's 2014 Nursing Drug Reference (198 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(glu-car-pie′dase)
Voraxaze
Func. class.:
Recombinant bacterial enzyme
A recombinant bacterial enzyme that hydrolyzes glutamate residue from methotrexate and provides an alternate nonrenal pathway for methotrexate elimination in patients with renal dysfunction during high-dose methotrexate treatment. As a result of its enzymatic action, converts methotrexate to its inactive metabolites
The treatment of methotrexate toxicity (methotrexate plasma concentration >1 micromole/liter) in those with delayed methotrexate clearance due to impaired renal function
Precautions:
Pregnancy (C), breastfeeding
Calculator
• Adult/adolescent/child:
IV
50 units/kg over 5min; continue to give leucovorin, IV hydration, urinary alkalinization as needed
Available forms:
Sol for IV
•
Visually inspect parenteral products for particulate matter and discoloration prior to administration
•
Reconstitution: add 1 ml of sterile saline for injection to vial, roll and tilt the vial gently to mix; do not shake; flush the IV line then inject as a bolus inj over 5 min; flush the IV line again
•
Do not administer to patients who exhibit the expected clearance of methotrexate (plasma methotrexate concentrations within 2 standard deviations of the mean methotrexate excretion curve specific for the dose of methotrexate administered)
•
Do not administer to patients with normal or mildly impaired renal function because of the potential risk of subtherapeutic exposure to methotrexate
•
Continue to administer leucovorin after glucarpidase, but do not administer leucovorin within 2 hr before or after a glucarpidase. For the first 48 hr after glucarpidase administration, administer the same leucovorin dose as given before glucarpidase. After 48 hr after glucarpidase, administer leucovorin based on the measured methotrexate concentration. Do not discontinue therapy with leucovorin based on the determination of a single methotrexate concentration below the leucovorin treatment threshold. Continue leucovorin until the methotrexate concentration has been maintained below the leucovorin treatment threshold for a minimum of 3 days; use of a chromatographic method to determine methotrexate concentrations is needed for the first 48 hr after glucarpidase receipt
•
Continue hydration and alkalinization of the urine as needed
CNS:
Paresthesias, headache
CV:
Hypo/hypertension
EENT:
Throat irritation or tightness
GI:
Nausea, vomiting
INTEG:
Flushing, hot, burning sensation; rash, hypersensitivity, serious allergic reactions
SYST:
Antibody formation
Elimination half-life of 5.6 hr, methotrexate concentration reduced 97% within 15 min
Decrease:
elucarpidase level—PEMEtrexed, PRALAtrexate; avoid concurrent use
•
Continue monitoring of methotrexate blood levels, renal status (creatinine/BUN) after glucarpidase is given. Methotrexate concentrations within 48 hr of glucarpidase are only reliable measure by a chromatographic method. Leucovorin receipt is needed until methotrexate level has been maintained below leucovorin treatment threshold for a minimum of 3 days
•
Storage of reconstituted solution refrigerated ≤4 hr; discard any unused product, no preservative is present
•
For resolution of methotrexate toxicity
•
To immediately report any infusion-related reactions: fever, chills, flushing, feeling hot, rash, hives, itching, throat tightness or breathing problems, tingling, numbness, or headache
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(glye′byoor-ide)
DiaBeta, Glynase PresTab
Func. class.:
Antidiabetic
Chem. class.:
Sulfonylurea (2nd generation)
Do not confuse:
glyBURIDE
/Glucotrol/glipiZIDE
DiaBeta
/Zebeta
Causes functioning β cells in pancreas to release insulin, thereby leading to a drop in blood glucose levels; may improve insulin binding to insulin receptors and increase number of insulin receptors with prolonged administration; may also reduce basal hepatic glucose secretion; not effective if patient lacks functioning β cells
Type 2 diabetes mellitus
Unlabeled use:
Gestational diabetes not controlled by diet
Hypersensitivity to sulfonylureas, type 1 diabetes, diabetic ketoacidosis, renal failure
Precautions:
Pregnancy (B) Glynase; (C) Diabeta, geriatric patients, cardiac/thyroid disease, severe renal/hepatic disease, severe hypoglycemic reactions, sulfonamide/sulfonylurea hypersensitivity, G6PD deficiency
Calculator
• Adult:
PO
1.25-5 mg initially then increase to desired response at weekly intervals up to 20 mg/day; may be given as a single or divided dose
• Geriatric:
PO
1.25 mg initially then increase to desired response; max 20 mg/day, maintenance 1.25-20 mg/day
• Adult:
PO
1.5-3 mg/day initially, may increase by 1.5 mg/wk, max 12 mg/day
• Geriatric:
PO
0.75-3 mg/day, may increase by 1.5 mg/wk
• Adult (pregnant female):
PO
2.5 mg/day titrated up to 20 mg/day (conventional glyBURIDE)
Available forms:
Tabs (DiaBeta) 1.25, 2.5, 5 mg (nonmicronized); (Glynase PresTab) 1.5, 3, 6 mg (micronized)
•
With breakfast as single or divided dose, hold dose if patient NPO to avoid hypoglycemia, take at same time each day
•
Gradual conversion from other oral hypoglycemics to product is not needed; insulin ≥20 units/day; convert using 25% reduction in insulin dose every day
•
Micronized glyBURIDE/nonmicronized glyBURIDE are not equivalent
CNS:
Headache, weakness
, paresthesia, tinnitus, fatigue, vertigo
EENT:
Blurred vision
ENDO:
Hypoglycemia
GI:
Nausea, fullness, heartburn,
hepatotoxicity, cholestatic jaundice,
vomiting, diarrhea,
hepatic failure
HEMA:
Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia (rare),
increased AST, ALT, alk phos
INTEG:
Rash, allergic reactions, pruritus, urticaria, eczema, photosensitivity, erythema
MISC:
Angioedema
MS:
Joint pain
PO:
Completely absorbed by GI route; onset 2 hr; peak 2-4 hr; duration 24 hr; half-life 10 hr; metabolized in liver; excreted in urine, feces (metabolites); crosses placenta; 99% plasma-protein bound
Increase:
masking symptoms of hypoglycemia—β-blockers
Increase:
level—digoxin
Increase:
hypoglycemic effects—insulin, MAOIs, oral anticoagulants, chloramphenicol, guanethidine, methyldopa, NSAIDs, salicylates, probenecid, androgens, fenfluramine, fluconazole, gemfibrozil, histamine H
2
antagonists, magnesium salts, phenylbutazone, sulfinpyrazone, sulfonamides, tricyclics, urinary acidifiers, β-blockers, clarithromycin
Increase:
LFTs—bosentan; avoid concurrent use
Increase:
triglyceride levels—colesevelam
Increase:
action of—cycloSPORINE
Decrease:
both products’ effects—diazoxide
Decrease:
glyBURIDE action—thiazide diuretics, rifampin, isoniazid, cholestyramine, hydantoins, urinary alkalinizers, charcoal, corticosteroids, phenothiazines; oral contraceptives, estrogens, thyroid, voriconazole
Increase:
antidiabetic effect—garlic, horse chestnut
Decrease:
hypoglycemic effect—green tea
Increase:
AST, ALT, LDH, BUN, creatinine
Decrease:
Hgb, sodium, glucose
•
Hypo/hyperglycemic reaction that can occur soon after meals; for severe hypoglycemia, give IV D
50
W then IV dextrose sol
•
Blood glucose; A1c levels during treatment
Blood dyscrasias:
CBC at baseline, throughout treatment; report decreased blood counts
•
Storage in tight container in cool environment
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; improved serum glucose, A1c
•
To check for symptoms of cholestatic jaundice: dark urine, pruritus, jaundiced sclera; if these occur, notify prescriber
•
To use a blood glucose meter for testing while taking this product
•
About the symptoms of hypo/hyperglycemia, what to do about each
•
That product must be continued on a daily basis; about consequences of discontinuing product abruptly; that in times of stress, infection, surgery, trauma, a higher dose may be needed
•
To take product in morning to prevent hypoglycemic reactions at night if taking once a day
•
To avoid OTC medications unless ordered by prescriber
•
To report bleeding, bruising, weight gain, edema, shortness of breath, weakness, sore throat
•
That diabetes is a lifelong illness; that product will not cure disease
•
That all food included in diet plan must be eaten to prevent hypoglycemia;
to have glucagon emergency kit, sugar packets always available
•
To use sunscreen or stay out of the sun, wear protective clothing (photosensitivity)
•
To carry an emergency ID with prescriber and medication information
Glucose 25 g IV via dextrose 50% sol, 50 ml, 1 mg glucagon, or carbohydrate depending on severity