Mosby's 2014 Nursing Drug Reference (21 page)

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

adalimumab (Rx)

(add-a-lim′yu-mab)

Humira

Func. class.:
Antirheumatic agent (disease modifying), immunomodulator, anti-TNF

Chem. class.:
Recombinant human IgG1 monoclonal antibody, DMARD

Do not confuse:
Humira
/Humulin/Humalog

ACTION:

A form of human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF); elevated levels of TNF are found in patients with rheumatoid arthritis

USES:

Reduction of signs and symptoms and inhibition of progression of structural damage in patients with moderate to severe active rheumatoid arthritis who are ≥18 years of age and who have not responded to other disease-modifying agents, juvenile rheumatoid arthritis (JRA), psoriatic arthritis, Crohn’s disease, moderate to severe plaque psoriasis, ankylosing spondylitis, ulcerative colitis

CONTRAINDICATIONS:

Hypersensitivity

Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, CNS
demyelinating disease, lymphoma, CHF, hepatitis B carriers, manitol hypersensitivity, latex allergy, neoplastic disease

 

Black Box Warning:

Active infections, risk of lymphomas/leukemias, TB

DOSAGE AND ROUTES
Calculator
Rheumatoid arthritis/ankylosing spondylitis/psoriatic arthritis

• Adult:SUBCUT
40 mg every other wk or every wk if not combined with methotrexate;
IV
(unlabeled) 0.25-3 mg/kg q2-4wk

Juvenile rheumatoid arthritis

• Child

4 yr/adolescent

30 kg: SUBCUT
40 mg every other wk

• Child ≥4 yr/adolescent ≥15 kg to <30 kg: SUBCUT
20 mg every other wk

• Child

4 yr/adolescent
<
15 kg: SUBCUT
24 mg/m
2
BSA (up to 40 mg total) every other wk, then 20 mg every other wk

Crohn’s disease/ulcerative colitis

• Adult:SUBCUT
160 mg given as 4 inj on day 1 or 2 inj each on days 1 and 2, then 80 mg at wk 2 and 40 mg every other wk starting at wk 4

Plaque psoriasis

• Adult:SUBCUT
80 mg baseline as 2 inj then 40 mg every other wk starting 1 wk after initial dose × 16 wk

Available form:
Inj 40 mg/0.8 ml; 20 mg/0.4 ml (pediatric)

Administer:
SUBCUT route

• 
Do not admix with other sol or medications; do not use filter; protect from light; give at 45-degree angle using abdomen, thighs; rotate inj sites; discard unused portions

SIDE EFFECTS

CNS:
Headache

CV:
Hypertension

EENT:
Sinusitis

GI:
Abdominal pain, nausea, hepatic damage

HEMA:
Leukopenia pancytopenia, aplastic anemia, agranulocytopenia

INTEG:
Rash, inj site reaction

MISC:
Flulike symptoms, UTI, back pain, lupus-like syndrome,
increased cancer risk,
antibody development to this drug;
risk of infection (TB, invasive fungal infections, other opportunistic infections), may be fatal, Stevens-Johnson syndrome, anaphylaxis

RESP:
URI
,
pulmonary fibrosis, bronchitis

PHARMACOKINETICS

Absorption 65%, terminal half-life 2 wk, lower clearance with advancing age (40-75 yr), high RA factor

INTERACTIONS

Increase:
serious infections—other TNF blockers, rilonacept

• 
Do not use with anakinra, serious infections may occur

• 
Do not give concurrently with vaccines; immunizations should be brought up to date before treatment

Drug/Lab Test

Increase:
ALT, cholesterol

NURSING CONSIDERATIONS
Assess:

• 
RA:
pain, stiffness, ROM, swelling of joints before, during treatment

• 
For inj site pain, swelling, redness; usually occur after 2 inj (4-5 days), use cold compress to relieve pain/swelling

 

Black Box Warning:

For infections (fever, flulike symptoms, dyspnea, change in urination, redness/swelling around any wounds), stop treatment if present; some serious infections including sepsis may occur, may be fatal; patients with active infections should not be started on this product

• 
May reactivate hepatitis B in chronic carriers, may be fatal

 

Black Box Warning:

Latent TB before therapy, treat before starting this product

• 
Anaphylaxis, latex allergy:
stop therapy if lupuslike syndrome develops


 
Blood dyscrasias:
CBC, differential periodically

 

Black Box Warning:

For neoplastic disease (lymphomas/leukemia) in children, adolescents, hepatosplenic T-cell lymphoma is more likely in adolescent males with Crohn’s disease or ulcerative colitis

Evaluate:

• 
Therapeutic response: decreased inflammation, pain in joints, decreased joint destruction

Teach patient/family:

• 
About self-administration if appropriate: inj should be made in thigh, abdomen, upper arm; rotate sites at least 1 inch from old site; do not inject in areas that are bruised, red, hard

• 
That if medication is not taken when due, inject next dose as soon as remembered and inject next dose as scheduled

• 
Not to take any live virus vaccines during treatment

• 
To report signs of infection, allergic reaction, or lupuslike syndrome, immediately

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

adefovir (Rx)

(add-ee-foh′veer)

Hepsera

Func. class.:
Antiviral

Chem. class.:
Adenosine monophosphate analog

ACTION:

Inhibits hepatitis B virus DNA polymerase by competing with natural substrates and by causing DNA termination after its incorporation into viral DNA; causes viral DNA death

USES:

Chronic hepatitis B

CONTRAINDICATIONS:

Hypersensitivity

Precautions:
Pregnancy (C), labor, breastfeeding, children, geriatric patients, dialysis, females, obesity, organ transplant

 

Black Box Warning:

Severe renal disease, impaired hepatic function, lactic acidosis, HIV

DOSAGE AND ROUTES
Calculator

• Adult/adolescent: PO
10 mg/day, optimal duration unknown

Renal dose

• Adult: PO
CCr ≥50 ml/min 10 mg q24hr; CCr 30-49 ml/min 10 mg q48hr; CCr 10-29 ml/min 10 mg q72hr; hemodialysis 10 mg q7days after dialysis

Available forms:
Tabs 10 mg

Administer:

• 
By mouth without regard for food

• 
Take with full glass of water

SIDE EFFECTS

CNS:
Headache

GI:
Dyspepsia
, abdominal pain, nausea, vomiting, diarrhea, hepatomegaly, flatulence,
pancreatitis

GU:
Hematuria, glycosuria,
nephrotoxicity, Fanconi syndrome, renal failure

MISC:
Fever, rash, weight loss, cough

PHARMACOKINETICS

PO:
Rapidly absorbed from GI tract, peak 1
3
/
4
hr, excreted by kidneys 45%, terminal half-life 7.48 hr

INTERACTIONS

• 
Do not use in combination with emtricitabine/tenofovir, emtricitabine/rilpivirine, emtricitabine/efavirenz/tenofovir

Increase:
serum conc and possible toxicity—aminoglycosides, memantine, emtricitabine, efavirenz, dofetilide, digoxin, cyclosporine, amiloride, quiNINE, quiNIDine, procainamide, pemetrexed, midodrine, metFORMIN, NSAIDs, vancomycin, trospium, triamterene, tenofovir, tacrolimus, ranitidine, cimetidine, morphine

 

Black Box Warning:

Increase:
lactic acidosis, severe hepatomegaly, NNRTIs, NRTIs, antiretroviral protease inhibitors

Drug/Lab Test

Increase:
ALT, AST, amylase, creatine kinase

NURSING CONSIDERATIONS
Assess:

 

Black Box Warning:

Nephrotoxicity: increasing CCr, BUN

 

Black Box Warning:

HIV antibody testing before beginning treatment, HIV resistance may occur in chronic hepatitis B patients

 

Black Box Warning:

For lactic acidosis, severe hepatomegaly with stenosis; for use of NNRTIs, NRTIs, antiretroviral protease inhibitors (PIs), lactic acidosis with severe hepatomegaly is more common in females, obese patients, and with prolonged nucleoside use

• 
Geriatric patients more carefully; may develop renal, cardiac symptoms more rapidly

 

Black Box Warning:

For exacerbations of hepatitis after discontinuing treatment, monitor LFTs, hepatitis B serology

• 
Pregnancy: If planned or suspected; if pregnant call the Pregnancy Registry 800-258-4263

Perform/provide:

• 
Storage in cool environment; protect from light

Evaluate:

• 
Therapeutic response: decreased symptoms of chronic hepatitis B, improving LFTs

Teach patient/family:

• 
That optimal duration of treatment is unknown, that product is not a cure, that transmission may still occur

• 
To avoid use with other medications unless approved by prescriber

• 
To notify prescriber of decreased urinary output

• 
Not to stop abruptly unless directed, worsening of hepatitis may occur

• 
To report immediately dyspnea, nausea, vomiting, abdominal pain, weakness, dizziness, cold extremities

• 
To notify prescriber if pregnancy is planned or suspected, avoid breastfeeding

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