Mosby's 2014 Nursing Drug Reference (347 page)

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

rasburicase (Rx)

(rass-burr′i-case)

Elitek, Fasturtec

Func. class.:
Enzyme

Chem. class.:
Recombinant urate-oxidase enzyme

ACTION:

Catalyzes enzymatic oxidation of uric acid into an inactive and soluble metabolite (allantoin)

USES:

To reduce uric acid levels in children with leukemia, lymphoma, solid tumor malignancies who are receiving chemotherapy

CONTRAINDICATIONS:

Hypersensitivity

Black Box Warning:

G6PD deficiency (Mediterranean, African descendants), hemolytic reactions, methemoglobinemia reactions to product

Precautions:
Pregnancy (C), breastfeeding, children <2 yr, anemia

Black Box Warning:

Acute bronchospasm, angina, angioedema, atony, African-American and Mediterranean patients, hypotension, urticaria

DOSAGE AND ROUTES
Calculator

• Adult/adolescent/infant:
IV INF
0.2 mg/kg as single daily dose given as
IV INF
over 1/2 hr × 5 days

Available forms:
Powder for inj 1.5, 7.5 mg/vial

Administer:

Intermittent IV INF route

•
Reconstitute with diluent provided, add 1 ml of diluent/each vial, swirl, withdraw amount needed, mix with NS to final volume of 50 ml, use within 24 hr, give over 30 min, do not use filter, use different line; if not possible, flush with ≥15 ml of saline before, after use

•
Chemotherapy started 4-24 hr after 1st dose

SIDE EFFECTS

CNS:
Headache
, fever

CV:
Chest pain, hypotension

GI:
Nausea, vomiting, anorexia, diarrhea, abdominal pain, constipation, dyspepsia, mucositis

HEMA:
Neutropenia with fever, hemolysis, methemoglobinemia

INTEG:
Rash

MISC:
Edema

RESP:
Bronchospasm,
wheezing, dyspnea

SYST:
Anaphylaxis, hemolysis, methemoglobinemia, sepsis

PHARMACOKINETICS

Elimination half-life 16-21 hr

INTERACTIONS

Increase:
toxicity—allopurinol

NURSING CONSIDERATIONS

Assess:

•
Blood studies: BUN, serum uric acid, urine creatinine clearance, electrolytes, CBC with differential before, during therapy

•
Monitor temp; fever may indicate beginning infection; no rectal temps

Anaphylaxis:
dyspnea, urticaria, flushing, wheezing, swelling of lips, tongue, throat; have emergency equipment nearby

G6PD deficiency, hemolytic reactions, methemoglobinemia;
these patients should not be given this product; screen patients who are at higher risk for these disorders

•
GI symptoms: frequency of stools, cramping; if severe diarrhea occurs, fluid, electrolytes may need to be given

Evaluate:

•
Therapeutic response: decreased uric acid levels in children when antineoplastics causing high uric acid levels used

Teach patient/family:

•
About the reason for therapy, expected results

To report trouble breathing, jaundice, chest pain

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