Mosby's 2014 Nursing Drug Reference (300 page)

omalizumab (Rx)

(oh-mah-lye-zoo′mab)

Xolair

Func. class.:
Antiasthmatic

Chem. class.:
Monoclonal antibody

ACTION:

Recombinant DNA-derived humanized IgG murine monoclonal antibody that selectively binds to IgE to limit the release of mediators in the allergic response

USES:

Moderate to severe persistent asthma

Unlabeled uses:
Seasonal allergic rhinitis, food allergy

CONTRAINDICATIONS:

Hypersensitivity to hamster protein

 

Black Box Warning:

Hypersensitivity to this product

Precautions:
Pregnancy (B), breastfeeding, children <12 yr, acute attacks of asthma, lymphoma, nephrotic disease, bronchospasm, neoplastic disease, status asthmatics

DOSAGE AND ROUTES
Calculator

• Adult/adolescent/child ≥12 yr:
SUBCUT
150-375 mg × 2-4 wk, divide inj into 2 sites if dose >150 mg; dose is adjusted based on IgE levels, significant changes in body weight

Available forms:
Powder for inj, lyophilized 202.5 mg (150 mg/1.2 ml after reconstitution)

Administer:
SUBCUT route

• 
Reconstitute using 1.4 ml sterile water for inj (150 mg/1.2 ml or 125 mg/ml); gently swirl to dissolve; allow vial to stand and q5min gently swirl for 5-10 sec to dissolve, some vials may take ≥20 min, do not use if contents do not dissolve within 40 min, should be clear or slightly opalescent; use large-bore needle to withdraw medication; replace needle with small-bore needle

• 
Given q2-4wk; product is viscous; if >150 mg is given, divide into 2 sites; inj may take 5-10 sec to administer

SIDE EFFECTS

CV:
Heart failure,
cardiomyopathy, hypotension

HEMA:
Serious systemic eosinophilia

INTEG:
Pruritus, dermatitis, inj site reactions, rash

MISC:
Earache, dizziness, fatigue, pain,
malignancies
, viral infections,
anaphylaxis, thrombocytopenia,
headache

MS:
Arthralgia, fracture, leg, arm pain

RESP:
Sinusitis, upper respiratory infections, pharyngitis, pulmonary hypertension,
bronchospasm

PHARMACOKINETICS

Slowly absorbed, peak 7-8 days, half-life 26 days, degradation by liver, excretion in bile

INTERACTIONS

• 
Use cautiously with live virus vaccines

Drug/Lab Test

Increase:
IgE

NURSING CONSIDERATIONS
Assess:

• 
Asthma:
respiratory rate, rhythm, depth; auscultate lung fields bilaterally; notify prescriber of abnormalities; monitor pulmonary function tests; serum IgE (may increase and continue for 1 year)

• 
Inj site reactions:
inflammation, edema, redness, warmth at site; may occur within 60 min of inj, may decrease with repeated dosing

 

Black Box Warning:

Anaphylaxis, allergic reactions:
rash, urticaria, inability to breathe, edema of throat; product should be discontinued; have emergency equipment available, observe for 2 hr, reaction can occur ≤24 hr

Evaluate:

• 
Therapeutic response: ability to breathe more easily

Teach patient/family:

• 
That improvement will not be immediate

• 
Not to stop taking or decrease current asthma medications unless instructed by prescriber

• 
To avoid live virus vaccines while taking this product

 

Black Box Warning:

To report signs of allergic reaction

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

omeprazole (
OTC
, Rx)

(oh-mep′ray-zole)

Good Sense Omeprazole, Losec
, PriLOSEC, PriLOSEC OTC

Func. class.:
Antiulcer, proton pump inhibitor

Chem. class.:
Benzimidazole

Do not confuse:
PriLOSEC
/Prinivil/PROzac/predniSONE

ACTION:

Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cells; characterized as gastric acid pump inhibitor because it blocks the final step of acid production

USES:

Gastroesophageal reflux disease (GERD), severe erosive esophagitis, poorly responsive systemic GERD, pathologic hypersecretory conditions (Zollinger-Ellison syndrome, systemic mastocytosis, multiple endocrine adenomas); treatment of active duodenal ulcers with/without antiinfectives for
Helicobacter pylori

Unlabeled uses:
NSAID-induced ulcer prophylaxis, stress gastritis prophylaxis

CONTRAINDICATIONS:

Hypersensitivity

Precautions:
Pregnancy (C), breastfeeding, children

DOSAGE AND ROUTES
Calculator
Active duodenal ulcers

• Adult:
PO
20 mg/day × 4-8 wk; associated with
H. pylori
40 mg q
AM
and clarithromycin 500 mg tid on days 1-14 then 20 mg/day on days 15-28

Severe erosive esophagitis/poorly responsive GERD

• Adult:
PO
(del rel cap/del rel susp) 20 mg/day × 4-8 wk

Pathologic hypersecretory conditions

• Adult:
PO
60 mg/day; may increase to 120 mg tid; daily doses >80 mg should be divided

Gastric ulcer

• Adult:
PO
40 mg/day 4-8 wk

• Geriatric:
PO
≤20 mg/day

Heartburn (OTC)

• Adult:
PO
1 del rel tab (20 mg)/day before
AM
meal with glass of water

Available forms:
Del rel caps 10, 20, 40 mg; del rel tabs 20 mg; granules for oral susp 2.5, 10 mg (del rel)

Administer:

• 
Swallow caps whole; do not crush or chew; caps may be opened and sprinkled over applesauce

• 
Before eating, usually in the
AM
, separate with other medications

• 
Oral susp powder:
give on empty stomach ≥1 hr before food; if there is NG or enteral feeding tube, do not feed 3 hr before or 1 hr after giving product: contents of packet should be mixed with 1-2 tbls water, add 20 ml water for NG tube; for oral, stir well, drink, add more water, and drink

SIDE EFFECTS

CNS:
Headache, dizziness, asthenia

CV:
Chest pain, angina, tachycardia, bradycardia, palpitations, peripheral edema,
heart failure

EENT:
Tinnitus, taste perversion

GI:
Diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid regurgitation
, abdominal swelling, anorexia, irritable colon, esophageal candidiasis, dry mouth,
hepatic failure

GU:
UTI, urinary frequency, increased creatinine,
proteinuria, hematuria,
testicular pain, glycosuria

HEMA:
Pancytopenia, thrombocytopenia, neutropenia, leukocytosis,
anemia

INTEG:
Rash
, dry skin, urticaria, pruritus, alopecia

META:
Hypoglycemia, increased hepatic enzymes, weight gain, hypomagnesemia, hyponatremia, vit B12 deficiency

MISC:
Back pain
, fever, fatigue, malaise

RESP:
Upper respiratory infections, cough
, epistaxis,
pneumonia

SYST:
Angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis

PHARMACOKINETICS

Bioavailabity 30%-40%; peak 1/2-3½ hr; half-life 1/2-1 hr; protein binding 95%; eliminated in urine as metabolites and in feces; in geriatric patients, elimination rate decreased, bioavailability increased; metabolized by CYP2C19 enzyme system

INTERACTIONS

Increase:
bleeding—warfarin

Increase:
serum levels of diazepam, phenytoin, flurazepam, triazolam, cycloSPORINE, disulfiram, digoxin

Decrease:
effect of iron salts, ketoconazole, cyanocobalamin, calcium carbonate, ampicillin, indinavir, gefitinib

Drug/Lab Test

Increase:
alk phos, AST, ALT, bilirubin, gastrin

NURSING CONSIDERATIONS
Assess:

• 
GI system:
bowel sounds q8hr, abdomen for pain, swelling, anorexia, blood in stools

• 
Electrolyte imbalances:
hyponatremia; hypomagnesemia in patients using product (3 mo-1 yr); if hypomagnesemia occurs, use of magnesium supplements may be sufficient, if severe, discontinue product

• 
Hepatic enzymes:
AST, ALT, alk phos during treatment;
blood studies:
CBC, differential during treatment, blood dyscrasias may occur; vit B12 in long-term treatment

 
Serious skin reactions:
toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, exfoliative dermatitis; fever, sore throat, fatigue, thin ulcers, lesions in mouth, lips; discontinue product, some serious skin disorders may be fatal

Evaluate:

• 
Therapeutic response: absence of epigastric pain, swelling, fullness, bleeding: decreased GERD, esophagitis symptoms

Teach patient/family:

• 
To report severe diarrhea; black, tarry stools; abdominal cramps/pain; or continuing headache; product may have to be discontinued

• 
That, if diabetic, hypoglycemia may occur

• 
To avoid hazardous activities because dizziness may occur

• 
To avoid alcohol, salicylates, NSAIDs; may cause GI irritation

• 
To take as directed, even if feeling better; to take missed dose as soon as remembered; not to double; PriLOSEC OTC takes up to 4 days for full effect

Other books

Velocity by Steve Worland
Dead of Night by Lynn Viehl
Council of Evil by Andy Briggs
Damned If You Do by Marie Sexton
The Rebellion by Isobelle Carmody