Mosby's 2014 Nursing Drug Reference (223 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(ear-een-oh-tee′kan)
Camptosar
Func. class.:
Antineoplastic
Chem. class.:
Camptothecin analog
Cytotoxic by producing damage to single-strand DNA during DNA synthesis; binds to topoisomerase I
Metastatic carcinoma of the colon or rectum or 1st-line treatment in combination with 5-FU and leucovorin for metastatic colon or rectal carcinomas
Unlabeled uses:
Cervical, gastric, lung, ovarian, pancreatic cancer, malignant glioma, rhabdomyosarcoma
Pregnancy (D), hypersensitivity
Precautions:
Breastfeeding, children, geriatric patients, irradiation, hepatic disease
Black Box Warning:
Myelosuppression, diarrhea
Calculator
• Adult: IV
125 mg/m
2
over 90 min followed by leucovorin 20 mg/m
2
IV bolus and then 5-FU 500 mg/m
2
IV bolus on days 1, 8, 15, and 22; the next course begins on day 43 or when toxicity has recovered to NCI grade 1 or less
• Adult: IV
180 mg/m
2
over 90 min followed by leucovorin 200 mg/m
2
IV over 2 hr then 5-FU bolus and continuous infusion 400 mg/m
2
IV bolus, then 600 mg/m
2
IV infusion over 22 hr on days 1, 15, and leucovorin and 5-FU are given on days 1, 2, 15, 16, 29, and 30; the next course begins on day 43 or when toxicity has recovered to NCI grade 1 or less
• Adult: IV
125 mg/m
2
over 90 min weekly × 4 wk, every 6 wk
• Adult: IV
350 mg/m
2
over 90 min every 3 wk
Available forms:
Inj 20 mg/ml
•
Use cytotoxic handling precautions
•
Premedicate with antiemetic dexamethasone 10 mg plus another antiemetic agent, such as a 5-HT
3
blocker, given at least 30 min before use
•
Before beginning a course of therapy, the granulocyte count should be ≥1500, the platelet count should be ≥100,000, and treatment-related diarrhea should be fully resolved
•
Dilute appropriate dose in D
5
W (preferred) or NS injection to a final concentration of 0.12–2.8 mg/ml
•
Store up to 24 hr at room temperature and room lighting; however, because of possible microbial contamination during preparation, an admixture prepared with D
5
W or NS should be used within 6 hr, solutions prepared with D
5
W, refrigerated, protected from light must be used within 48 hr; avoid refrigeration if prepared with NS
•
Infuse intravenously over 90 min
CNS:
Fever, headache, chills, dizziness
CV:
Vasodilation, edema,
thromboembolism
GI:
Severe diarrhea,
nausea, vomiting
, anorexia, constipation, cramps, flatus, stomatitis, dyspepsia,
hepatotoxicity
HEMA:
Leukopenia, anemia, neutropenia
INTEG:
Irritation at site, rash, sweating, alopecia
MISC:
Edema, asthenia, weight loss, back pain
RESP:
Dyspnea, increased cough, rhinitis
Rapidly and completely absorbed, excreted in urine and bile as metabolites, half-life 6-12 hr, bound to plasma proteins 30%-68%, increased risk for toxicity in patients homozygous for UGT1A1 28
Increase:
toxicity—fluorouracil
Increase:
bleeding risk—NSAIDs, anticoagulants
Increase:
irinotecan levels—some CYP3A4 inhibitors (ketoconazole)
Increase:
myelosuppression, diarrhea—other antineoplastics, radiation
Increase:
lymphocytopenia, hyperglycemia—dexamethasone
Increase:
akathisia—prochlorperazine
Increase:
dehydration—diuretics
Decrease:
irinotecan levels—CYP3A4 inducers (phenytoin, carBAMazepine, PHENobarbital)
Decrease:
product level—St. John’s wort; avoid concurrent use
Increase:
alk phos, LFTs, bilirubin
Decrease:
platelets, WBC, neutrophils, Hgb/HcT
•
CNS symptoms: fever, headache, chills, dizziness
Black Box Warning:
CBC, differential, platelet count weekly; use colony-stimulating factor if WBC <2000/mm
3
or platelet count <100,000/mm
3
, Hgb ≤9 g/dl, neutrophil ≤1000/mm
3
; notify prescriber of results; product should be discontinued and colony-stimulating factor given
•
Buccal cavity for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia
Black Box Warning:
GI symptoms: frequency of stools; cramping; severe, life-threatening diarrhea may occur with fluid and electrolyte imbalances, treat diarrhea within 24 hr of use with 0.25-1 mg atropine IV; treat diarrhea >24 hr of use with loperamide, diarrhea >24 hr (late diarrhea) can be fatal
•
Signs of dehydration: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
•
Bone marrow depression: bruising, bleeding, blood in stools, urine, sputum, emesis
•
Increased fluid intake to 2-3 L/day to prevent dehydration unless contraindicated
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss
•
Therapeutic response: decrease in tumor size, spread of cancer
•
To avoid foods with citric acid or hot or rough texture if stomatitis is present; to drink adequate fluids
•
To report stomatitis; any bleeding, white spots, ulcerations in mouth; to examine mouth daily, report symptoms
•
To report signs of anemia: fatigue, headache, faintness, SOB, irritability, infection, rash
•
To use contraception during therapy
•
To report if pregnancy is planned or suspected pregnancy (D)
•
To avoid salicylates, NSAIDs, alcohol because bleeding may occur; to avoid all products unless approved by prescriber
•
About alopecia; that, when hair grows back, it will be different texture, thickness
•
To avoid vaccinations while taking this product
To report diarrhea that occurs 24 hr after administration; severe dehydration can occur rapidly
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert