Mosby's 2014 Nursing Drug Reference (420 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTvinBLAStine (VLB) (Rx)
(vin-blast′een)
Func. class.:
Antineoplastic
Chem. class.:
Vinca alkaloid
Do not confuse:
vinBLAStine
/vinCRIStine/vinorelbine
Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant
Breast, testicular cancer, lymphomas, neuroblastoma; Hodgkin’s/non-Hodgkin’s lymphoma; mycosis fungoides, histiocytosis, Kaposi’s sarcoma, Langerhans cell histiocytosis
Unlabeled uses:
Lung, bladder, prostate cancer; desmoid tumor, malignant melanoma
Pregnancy (D), breastfeeding, infants, hypersensitivity, leukopenia, granulocytopenia, bone marrow suppression, infection
Black Box Warning:
Intrathecal use
Precautions:
Renal/hepatic disease, tumor lysis syndrome
Black Box Warning:
Extravasation
Calculator
• Adult:
IV
4.5 mg/m
2
on day 1 of every 21 days in combination with DOXOrubicin and thiotepa
• Adult:
IV
6 mg/m
2
on days 1 and 15 of every 28 days with DOXOrubicin, bleomycin, dacarbazine (ABVD regimen)
• Child:
IV
2.5-6 mg/m
2
/day once q1-2wk × 3-6 wk, max weekly dose 12.5 mg/m
2
Available forms:
Inj, powder 10 mg for 10 ml IV; sol for inj 1 mg/ml
•
Antiemetic 30-60 min before product and prn to prevent vomiting
Black Box Warning:
Hyaluronidase 150 units/ml in 1 ml NaCl, warm compress for extravasation for vesicant activity treatment
Black Box Warning:
Do not administer intrathecally; fatal
•
After diluting 10 mg/10 ml NaCl; give through
Y
-tube or 3-way stopcock or directly over 1 min
•
Further dilute in 50-100 ml of NS, infuse over 15-30 min
Additive compatibilities:
Bleomycin
Syringe compatibilities:
Bleomycin, CISplatin, cyclophosphamide, droperidol, fluorouracil, leucovorin, methotrexate, metoclopramide, mitoMYcin, vinCRIStine
Y-site compatibilities:
Allopurinol, amifostine, amphotericin B cholesteryl, aztreonam, bleomycin, CISplatin, cyclophosphamide, DOXOrubicin, DOXOrubicin liposome, droperidol, filgrastim, fludarabine, fluorouracil, granisetron, heparin, leucovorin, melphalan, methotrexate, metoclopramide, mitoMYcin, ondansetron, PACLitaxel, piperacillin/tazobactam, sargramostim, teniposide, thiotepa, vinCRIStine, vinorelbine
CNS:
Paresthesias, peripheral neuropathy, depression, headache,
seizures,
malaise
CV:
Tachycardia, orthostatic hypo/hypertension
GI:
Nausea, vomiting
, ileus,
anorexia, stomatitis, constipation
, abdominal pain,
GI/rectal bleeding, hepatotoxicity,
pharyngitis
GU:
Urinary retention,
renal failure,
hyperuricemia
HEMA:
Thrombocytopenia, leukopenia, myelosuppression,
agranulocytosis, granulocytosis, aplastic anemia, neutropenia, pancytopenia
INTEG:
Rash, alopecia
, photosensitivity,
extravasation, tissue necrosis
META:
SIADH
RESP:
Fibrosis, pulmonary infiltrate, bronchospasm
SYST:
Tumor lysis syndrome (TLS)
Half-life (triphasic) <5 min, 50-155 min, 23-85 hr; metabolized in liver; excreted in urine, feces; crosses blood-brain barrier
Increase:
Synergism: bleomycin
Increase:
Bronchospasm: mitoMYcin
•
Do not use with radiation
Increase:
bleeding risk—NSAIDs, anticoagulants, thrombolytics, antiplatelets
Increase:
toxicity, bone marrow suppression—antineoplastics
Increase:
action of methotrexate
Increase:
adverse reactions—live virus vaccines
Increase:
toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole
)
Decrease:
vinBLAStine effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)
•
Avoid use with St. John’s wort
Increase:
uric acid, bilirubin
Decrease:
Hgb, platelets, WBC
CBC, differential, platelet count weekly; withhold product if WBC is <2000/mm
3
or platelet count is <75,000/mm
3
; notify prescriber; RBC, Hct, Hgb may be decreased, nadir occurs on days 4-10 and continues for another 1-2 wk
•
Tumor lysis syndrome:
monitor for hyperkalemia, hyperphosphatemia, hyperuricemia; usually occurs with leukemia, lymphoma; alkalinization of the urine, allopurinol should be used to prevent urate nephrophy; monitor electrolytes and renal function (BUN, uric acid, urine CCR)
•
Hepatitis: transient hepatitis may occur with continuous IV
•
Bleeding: hematuria, guaiac, bruising, petechiae, mucosa or orifices
•
Bronchospasm:
can be life-threatening; usually occurs when giving mitoMYcin
•
Effects of alopecia on body image; discuss feelings about body changes
•
Sensitivity of feet/hands, which precedes neuropathy
•
Jaundiced skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
•
Buccal cavity q8hr for dryness, sores, ulcerations, white patches, oral pain, bleeding, dysphagia
Black Box Warning:
Local irritation, pain, burning, discoloration at inj site, extravasation
•
Symptoms indicating severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
•
Increased fluid intake to 2-3 L/day to prevent urate deposits, calculi formation
•
Brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report any complaints or side effects to nurse or prescriber
•
To report any changes in breathing or coughing; to avoid exposure to persons with infection
•
That hair may be lost during treatment, that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture
•
To report change in gait or numbness in extremities; may indicate neuropathy
•
To avoid foods with citric acid, hot or rough texture
•
To report any bleeding, white spots, ulcerations in mouth to prescriber; to examine mouth daily
•
To wear sunscreen, protective clothing, sunglasses
•
To avoid receiving vaccinations
Pregnancy:
pregnancy (D); to avoid breastfeeding; that product may cause male infertility
•
To notify prescriber if pregnancy is planned or suspected; avoid persons with known infections
•
Infection:
to report sore throat, flulike symptoms