Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (378 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tak-row′lim-us)
Prograf
Protopic
Func. class.:
Immunosuppressant
Chem. class.:
Macrolide
Produces immunosuppression by inhibiting T-lymphocytes
Organ transplants to prevent rejection;
topical:
atopic dermatitis
Unlabeled uses:
Severe recalcitrant psoriasis, contact dermatitis, GVHD prophylaxis/disease, pancreas/heart/kidney/liver/lung/small bowel transplant rejection, uveitis, ulcerative colitis, nephrotic syndrome, lichen sclerosus
Children <2 yr (topical); hypersensitivity to this product or to some kinds of castor oil (IV); long-term use (topical)
Precautions:
Pregnancy (C), breastfeeding, severe renal/hepatic disease; diabetes mellitus, hyperkalemia, hyperuricemia, hypertension, acute bronchospasm, African American patients, heart failure, seizures, QT prolongation
Black Box Warning:
Children <12, lymphomas, infection, neoplastic disease, neonates, infants, requires a specialized setting, requires an experienced clinician
Calculator
• Adult:
IV
0.03-0.05 mg/kg/day as
CONT INF,
give no sooner than 6 hr after transplantation
• Adult:
PO
0.10-0.15 mg/kg/day in 2 divided doses q12hr, give no sooner than 6 hr after transplantation;
IV
0.03-0.05 mg/kg/day as
CONT INF,
give no sooner than 6 hr after transplantation
• Adult:
PO
0.075 mg/kg/day in 2 divided doses q12hr, give no sooner than 6 hr after transplantation;
IV
0.01 mg/kg/day as
CONT INF,
give no sooner than 6 hr after transplantation
• Adult:
TOP
use 0.03% or 0.1% ointment, apply bid × 7 days after clearing of signs
• Child ≥ 2-15 yr:
TOP
0.03% ointment, apply bid × 7 days after clearing of signs
• Adult and adolescent:
IV
0.1 mg/kg/day in 2 divided doses given with other immunosuppressants or
PO
0.3 mg/kg/day in 2 divided doses
• Child:
CONT IV INF
0.1 mg/kg/day
• Adult:
CONT IV INF
0.03 mg/kg/day starting 1-2 days before bone marrow transplant;
PO
0.12 mg/kg/day in 2 divided doses
• Adolescent and child:
PO
0.12 mg/kg/day in 2 divided doses
• Adult:
IV
0.05 mg/kg/day or
PO
0.2-0.3 mg/kg/day in 2 divided doses; adjust to maintain whole blood conc 7-15 ng/ml
• Adult:
PO
0.15 mg/kg/day, maintain 12-hr trough, whole blood conc 1-1.5 ng/ml
• Adult:
IV
0.1-0.15 mg/kg/day then
PO
0.3 mg/kg/day in divided doses
• Adult:
TOP
0.1% ointment, apply bid × 8 wk
Available forms:
Inj 5 mg/ml; caps 0.5, 1, 5 mg; ointment 0.03%, 0.1%
•
Give on empty stomach, food decreases absorption
•
For several days before transplant surgery, patients should be placed in protective isolation
•
Apply thin layers to affected skin only, rub in gently
•
Do not use occlusive dressings
•
Use on small area of skin
•
Topical ointment has risk of developing cancer, use only when other options have failed
•
After diluting in 0.9% NaCl or D
5
W to 0.004 to 0.02 mg/ml as continuous inf over 24 hr
Y-site compatibilities:
Alemtuzumab, alfentanil, amifostine, amikacin, aminophylline, amiodarone, amphotericin B colloidal, amphotericin B liposome, anidulafungin, argatroban, atracurium, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium acetate/chloride/gluconate, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, DOXOrubicin hydrochloride, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, foscarnet, fosphenytoin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, imipenem/cilastatin, inamrinone, insulin, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, mitoMYcin, mitoXANtrone, mivacurium, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pancuronium, PEMEtrexed, penicillin G, pentamidine, pentazocine, perphenazine, phentolamine, phenylephrine, piperacillin/tazobactam, potassium chloride/phosphates, procainamide, prochlorper
azine, promethazine, propranolol, quinapristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
CNS:
Tremors, headache
, insomnia, paresthesia, chills, fever,
seizures,
posterior reversible encephalopathy syndrome, BK-virus–associated nephropathy
CV:
Hypertension, myocardial hypertrophy,
prolonged QTc,
cardiomyopathy
EENT:
Blurred vision, photophobia
GI:
Nausea, vomiting, diarrhea, constipation,
GI bleeding
GU:
UTIs,
albuminuria, hematuria, proteinuria, renal failure, hemolytic uremic syndrome
HEMA:
Anemia, leukocytosis, thrombocytopenia, purpura
INTEG:
Rash, flushing, itching, alopecia
META:
Hirsutism, hyperglycemia, hyperuricemia, hypo/hyperkalemia, hypomagnesemia
MS:
Back pain, muscle spasms
RESP:
Pleural effusion, atelectasis, dyspnea, interstitial lung disease
SYST:
Anaphylaxis,
infection, malignancy
PO:
Extensively metabolized, half-life 10 hr, 75% protein binding
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, QUEtia-pine, quiNIDine, risperiDONE, ziprasidone); do not use together
Increase:
toxicity—aminoglycosides, CISplatin, cycloSPORINE
Increase:
blood levels—antifungals, calcium channel blockers, cimetidine, danazol, mycophenolate, mofetil
Decrease:
blood levels—carBAMazepine, PHENobarbital, phenytoin, rifamycin
Decrease:
effect of live-virus vaccines
Decrease:
immunosuppression—astragalus, echinacea, melatonin
Decrease:
effect—ginseng, St. John’s wort
Increase:
effect—grapefruit juice
Decreased absorption:
food
Increase:
glucose, BUN, creatinine
Increase or decrease:
LFTs, potassium
Decrease:
magnesium, Hgb, platelets
•
Blood studies: Hgb, WBC, platelets during treatment monthly; if leukocytes <3000/mm
3
or platelets <100,000/mm
3
, product should be discontinued or reduced; decreased hemoglobulin level may indicate bone marrow suppression
•
Hepatic studies: alk phos, AST, ALT, amylase, bilirubin; for hepatotoxicity: dark urine, jaundice, itching, light-colored stools; product should be discontinued
•
Serum creatinine/BUN, serum electrolytes, lipid profile, serum tacrolimus conc
Anaphylaxis:
rash, pruritus, wheezing, laryngeal edema; stop infusion, initiate emergency procedures
•
QT prolongation:
ECG, ejection fraction; assess for chest pain, palpitations, dyspnea
•
Therapeutic response: absence of graft rejection; immunosuppression in patients with autoimmune disorders
•
To report fever, rash, severe diarrhea, chills, sore throat, fatigue; that serious infections may occur; to report clay-colored stools, cramping
(hepatotoxicity), nephrotoxicity,
signs of diabetes mellitus
•
To avoid crowds, persons with known infections to reduce risk for infection; to avoid eating raw shellfish
•
To avoid exposure to natural or artificial sunlight
•
Not to breastfeed while taking product
•
That repeated lab tests will be needed during treatment
•
To avoid vaccines
•
Not to use with alcohol, grapefruit
•
To report if pregnancy is planned or suspected
Black Box Warning:
To report symptoms of lymphoma