Mosby's 2014 Nursing Drug Reference (400 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
See
Appendix B
(toe′si-liz′oo-mab)
Actemra
Func. class.:
DMARDs (disease-modifying antirheumatoid drugs)/tumor necrosis factor (TNF) modifier
Interleukin-6 (IL-6) receptor inhibiting monoclonal antibody
Rheumatoid arthritis, active systemic juvenile idiopathic arthritis
Hypersensitivity
Precautions:
Breastfeeding, pregnancy (C); risk for GI perforation, active hepatic disease, severe neutropenia/ thrombocytopenia, demyelinating disorders
Black Box Warning:
Invasive fungal infection, active TB
Calculator
• Adult:
IV
4 mg/kg over 1 hr q4wk, may increase to 8 mg/kg q4wk based on clinical response, max dose 800 mg/inf; do not initiate if ANC >2000, platelets <100,000
• Child ≥2 yr/adolescent ≥30 kg:
IV
8 mg/kg over 1 hr q2wk
• Child ≥2 yr/adolescent <30 kg:
IV
12 mg/kg over 1 hr
Available forms:
Sol for inj 80 mg/4 ml, 200 mg/10 ml, 400 mg/20 ml
•
Visually inspect for particulate matter, discoloration before administration whenever sol and container permit; colorless to pale yellow liquid
•
From 100-ml inf bag or bottle, withdraw vol of 0.9% sodium chloride inj equal to vol of tocilizumab sol required for patient’s dose
•
Slowly add tocilizumab from each vial into inf bag or bottle; gently invert bag to avoid foaming; fully diluted sols are compatible with polypropylene, polyethylene, polyvinyl chloride inf bags and polypropylene, polyethylene, glass inf bottles
•
Fully diluted sol for infusion may be stored refrigerated or at room temp for ≤24 hr and should be protected from light; do not use unused product remaining in vials; no preservatives
•
Allow the fully diluted sol to reach room temp before inf
•
Give over 60 minutes with inf set; do not administer as IV push or bolus
•
Do not infuse concomitantly in same IV line with other drugs
CNS:
Headache, dizziness
CV:
Hypertension
GI:
Perforation,
abdominal pain, gastritis, mouth ulcerations
HEMA:
Neutropenia, thrombocytopenia
INTEG:
Rash, inf reactions
RESP:
Upper respiratory infections, nasopharyngitis, bronchitis
SYST:
Serious infections, anaphylaxis,
infusion-related reactions, antitocilizumab antibody formation
Decrease:
product level—cycloSPORINE, theophylline warfarin
Decreased:
level of CYP3A4 substrates (hormonal contraceptives, omeprazole, atorvastatin, simvastatin)
•
Do not give with live virus vaccines
•
Avoid use with TNF modifiers, DMARDs, immunosuppressives due to increased risk of infection
Half-life approx 6 days with single dose, approx 11 days with multiple (steady-state) doses
•
Rheumatoid arthritis:
ROM, pain, stiffness at baseline q1-2wk
•
Blood studies: CBC with differential, LFTs, platelet count, serum lipid profile at baseline and periodically
•
Infection
before treatment and periodically; obtain TB screening before beginning treatment, invasive fungal infections, discontinue if infection occurs during administration, may use antituberculosis therapy before tocilizumab in past history of latent or active TB when adequate course of treatment cannot be confirmed and those with a negative TB with risk factors for infections
•
Therapeutic response: ability to move more easily with less pain
•
That this treatment must continue unless safety or effectiveness is an issue
•
About reason for use and expected results
•
To avoid live vaccines, bring immunizations up to date before treatment
Black Box Warning:
To report signs, symptoms of infection, including TB and hepatitis B
•
To notify prescriber if pregnancy or suspected pregnancy (C), do not use if breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(toll′cah′pone)
Tasmar
Func. class.:
Antiparkinson agent
Chem. class.:
COMT inhibitor
Inhibits COMT; used as adjunct to levodopa/carbidopa therapy
Parkinson’s disease
Hypersensitivity, rhabdomyolysis
Black Box Warning:
Hepatic disease
Precautions:
Pregnancy (C), breastfeeding, cardiac/renal disease, hypertension, asthma, history of rhabdomyolysis
Calculator
• Adult:
PO
100-200 mg tid with levodopa/carbidopa therapy; max 600 mg/day, discontinue if no benefit after 3 wk
Available forms:
Tabs 100, 200 mg
•
Only to be used if levodopa/carbidopa does not provide satisfactory results
•
Give without regard to food
CNS:
Dystonia, dyskinesia, dreaming,
fatigue, headache, confusion
, psychosis, hallucination, dizziness, sleep disorders
CV:
Orthostatic hypotension
, chest pain, hypotension
EENT:
Cataract, eye inflammation
GI:
Nausea, vomiting, anorexia, abdominal distress
, diarrhea, constipation,
fatal hepatic failure,
increased LFTs
GU:
UTI, urine discoloration, uterine tumor, micturition disorder, hematuria
HEMA:
Hemolytic anemia, leukopenia, agranulocytosis
INTEG:
Sweating, alopecia
MS:
Rhabdomyolysis
Rapidly absorbed, peak 2 hr, protein binding 99%, extensively metabolized, half-life 2-3 hr, excreted in urine (60%)/feces (40%)
Increase:
CNS depression—CNS depressants
•
May influence pharmacokinetics of α-methyldopa, DOBUTamine, apomorphine, isoproterenol
•
Inhibition of normal catecholamine metabolism: MAOIs, MAO-B inhibitor may be used
Black Box Warning:
Hepatic disease:
AST, ALT, alk phos, LDH, bilirubin, CBC; monitor ALT, AST q2wk × 1 yr, then q4wk × 6 mo, then q8wk thereafter; if LFTs elevated, product should not be used
•
Involuntary movements of parkinsonism: akinesia, tremors, staggering gait, muscle rigidity, drooling
•
B/P, respiration during initial treatment; hypo/hypertension should be reported
•
Mental status: affect, mood, behavioral changes
•
Therapeutic response: decrease in akathisia, increased mood
•
To change positions slowly to prevent orthostatic hypotension
•
That urine, sweat may change color
•
That food taken within 1 hr before meals or 2 hr after meals decreases action of product by 20%, may be taken without regard to food
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (C)
•
That CNS changes may occur, hallucinations, involuntary movement
•
To avoid hazardous activities until reaction is known, dizziness may occur
•
That nausea and diarrhea are common
Black Box Warning:
To report signs of hepatic injury:
clay-colored stools, jaundice, fatigue, appetite loss, lethargy, fatigue, itching, right upper abdominal pain
•
To report nausea, vomiting, anorexia; that nausea may occur at beginning of treatment
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B
(toll-tehr′oh-deen)
Detrol, Detrol LA
Func. class.:
Overactive bladder product
Chem. class.:
Muscarinic receptor antagonist