Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (323 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pler-ix′a-fore)
Mozobil
Func. class.:
Biologic modifier
Chem. class.:
Colony-stimulating factor
Competitively inhibits the binding of stromal-derived factors, thereby allowing hematopoietic stem cells to mobilize into peripheral blood
For peripheral blood stem cell (PBSC) mobilization for collection and autologous transplant in patients with non-Hodgkin’s lymphoma, multiple myeloma; used with a granulocyte colony-stimulating factor (G-CSF)
Hypersensitivity, breastfeeding, pregnancy (D)
Precautions:
Children, renal disease, thrombocytopenia
Calculator
• Adult:
SUBCUT
0.24 mg/kg daily about 11 hr prior to initiation of apheresis, give for up to 4 consecutive days; give filgrastim 10 mcg/kg;
SUBCUT
daily each
AM
beginning 4 days prior to the 1st evening dose of plerixafor and on each day of apheresis; give filgrastim before procedure
Available forms:
Inj 300 mcg/ml, 480 mcg/1.6 ml, 480 mcg/0.8 ml, 3000 mcg/0.5 ml
•
Each single-use vial contains 24 mg of plerixafor (1.2 ml of 20 mg/ml sol); volume calculated by multiplying 0.012 by actual body weight (kg)
•
Give 11 hr before apheresis
• Max 40 mg/day or 27 mg/day in patients with renal disease
CNS:
Syncope, dizziness, fatigue, headache, insomnia, malaise, paresthesias
GI:
Nausea
, vomiting, diarrhea, abdominal pain, constipation
HEMA:
Thrombocytopenia,
leukocytosis
INTEG:
Rash, skin irritation, pruritus, inj site reaction, erythema, urticaria
MS:
Musculoskeletal pain
RESP:
Dyspnea, hypoxia
SUBCUT:
30-60 min, peak mobilization 6-9 hr, 58% protein binding, 70% excreted via kidneys (parent drug), terminal half-life 3-5 hr
Increase:
adverse reactions—do not use this product concomitantly with lithium, may increase leukocytosis
•
Blood studies: CBC, differential
•
B/P, respirations, pulse before and during therapy
•
Bone pain; give mild analgesics
•
Storage at room temp
•
Therapeutic response: collection of stem cells
•
About reason for use and expected results
• Pregnancy (D):
notify prescriber if pregnancy is planned or suspected, do not breastfeed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(poe′sa-kon′a-zole)
Noxafil, Posanol
Func. class.:
Antifungal—systemic
Chem. class.:
Triazole derivative
Inhibits a portion of cell-wall synthesis; alters cell membranes and inhibits several fungal enzymes
Prevention of aspergillus, candida infection, oropharyngeal candidiasis in immunocompromised patients, chemotherapy-induced neutropenia, mucocutaneous, candidiasis
Unlabeled uses:
Aspergillosis, cellulitis, coccidioidomycosis, endocarditis, endophthalmitis, esophageal candidiasis, febrile neutropenia, fungal keratitis, fusariosis, histoplasmosis, infectious arthritis, myocarditis, osteomyelitis, pericarditis, sinusitis, tracheobronchitis
Hypersensitivity to this product or other systemic antifungals or azoles; fungal meningitis, onchomycosis or dermatomycosis in cardiac dysfunction
Precautions:
Pregnancy (C), breastfeeding, children, cardiac/hepatic disease
Calculator
• Adult, adolescent:
PO
800 mg/day in 2-4 divided doses
• Child:
PO
100 mg tid
Available forms:
Oral susp 200 mg/5 ml
•
Oral susp:
shake well; use calibrated measuring device; take only with full meal or liquid nutritional supplements such as Ensure; rinse measuring device after each use
CNS:
Headache, dizziness
, insomnia, fever, rigors, weakness, anxiety
CV:
Hypo/hypertension, tachycardia, anemia
GI:
Nausea, vomiting, anorexia, diarrhea
, cramps, abdominal pain, flatulence,
GI bleeding, hepatotoxicity
GU:
Gynecomastia, impotence, decreased libido
INTEG:
Pruritus
, fever,
rash
,
toxic epidermal necrolysis
MISC:
Edema, fatigue
, malaise, hypokalemia, tinnitus,
rhabdomyolysis
Well absorbed, enhanced by food, protein binding 98%-99%, peak 3-5 hr, half-life 35 hr, metabolized in liver, excreted in feces (77% unchanged)
• Do not use with lovastatin, atorvastatin
Increase:
QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β agonists, local anesthetics, tricyclics, haloperidol, chloroquine, droperidol, pentamidine; CYP3A4 inhibitors (amiodarone, clarithromycin, erythromycin, telithromycin, troleandomycin), arsenic trioxide, levomethadyl; CYP3A4 substrates (methadone, pimozide, QUEtiapine, quiNIDine, risperiDONE, ziprasidone)
Increase:
tinnitus, hearing loss—quiNIDine
Increase:
hepatotoxicity—other hepatotoxic products
Increase:
severe hypoglycemia—oral hypoglycemics
Increase:
sedation—triazolam, oral midazolam
Increase:
levels, toxicity—busPIRone, busulfan, calcium-channel blockers, clarithromycin, cycloSPORINE, diazepam, digoxin, felodipine, HMG-CoA reductase inhibitors, indinavir, isradipine, midazolam, niCARdipine, NIFEdipine, niMODipine, phenytoin, quiNIDine, ritonavir, saquinavir, sirolimus, tacrolimus, vinca alkaloids, warfarin
Decrease:
posaconazole level—cimetidine, phenytoin
Decrease:
posaconazole action—antacids, H
2
-receptor antagonists, rifamycin, didanosine
•
Food increases absorption
Infection:
type of, may begin treatment prior to obtaining results; temp, WBC, sputum at baseline and periodically, break-through infections may occur when used with fosamprenavir
• I&O ratio, electrolytes; correct electrolyte imbalances before starting treatment
•
For allergic reaction: rash, photosensitivity, urticaria, dermatitis
Rhabdomyolysis:
muscle pain, increased CPK; weakness, swelling of affected muscles; if these occur and if confirmed by CPK, product should be discontinued
Hepatotoxicity:
nausea, vomiting, jaundice, clay-colored stools, fatigue; hepatic studies (ALT, AST, bilirubin) if patient receiving long-term therapy
QT prolongation:
ECG for QT prolongation, ejection fraction; assess for chest pain, palpitations, dyspnea
•
Storage in tight container in refrigerator; do not freeze
•
Therapeutic response: decreased symptoms of fungal infection, negative C&S for infecting organism
•
That long-term therapy may be needed to clear infection (1 wk-6 mo, depending on infection)
•
To avoid hazardous activities if dizziness occurs
•
To take 2 hr before administration of other products that increase gastric pH (antacids, H
2
-blockers, omeprazole, sucralfate, anticholinergics); to notify health care provider of all medications taken
•
About the importance of compliance with product regimen; to use alternative method of contraception
•
To notify prescriber of GI symptoms, signs of hepatic dysfunction (fatigue, nausea, anorexia, vomiting, dark urine, pale stools)