Mosby's 2014 Nursing Drug Reference (429 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Selected new drugs
(al′oh-glip′tin)
Nesina
Func. class.:
Antidiabetic
Chem. class.:
Dipeptidyl peptidase-4 (DPP-4) inhibitor
A dipeptidyl-peptidase-IV (DDP-IV) inhibitor for the treatment of type 2 diabetes mellitus (monotherapy or in combination with other antidiabetic agents), potentiates the effects of the incretin hormones by inhibiting their breakdown by DDP-IV
Type 2 diabetes mellitus (T2DM)
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, hepatic disease, burns, ketoacidosis, diarrhea, fever, GI obstruction, hyper/hypoglycemia, hyper/hypothyroidism, type 1 diabetes, hypercortisolism, children, ileus, malnutrition, pancreatitis, surgery, trauma, vomiting, kidney disease, adrenal insufficiency
Black Box Warning:
Angioedema
Calculator
• Adult:
PO
25 mg/day; when used in combination, a lower dose of the other antidiabetic may be needed
• Adult:
PO
CCr 30–59 ml/min: 12.5 mg q day; CCr <30 ml/min: 6.25 mg q day; intermittent hemodialysis: 6.25 mg q day; give without regard to the timing of hemodialysis
Available forms:
Tab 6.25, 12.5, 25
•
Without regard to food
CNS:
Headache
GI:
Pancreatitis
META:
Hypoglycemia
RESP:
Upper respiratory infection, nasopharyngitis
SYST:
Rash, hypersensitivity,
angioedema, Stevens–Johnson syndrome
20% protein binding, excreted unchanged (urine), peak 1-2 hr, effect decreased in liver disease and increased in kidney disease
Increase:
LFTs
•
Diabetes:
monitor blood glucose, glycosylated hemoglobin A1c (A1c), LFTs, serum creatinine/BUN
Pancreatitis:
Can occur during use
Hypersensitivity reactions:
angioedema, Stevens–Johnson syndrome; product should be discontinued
•
Positive therapeutic response: Decrease in polyuria, polydipsia, polyphagia, clear sensorium, absence of dizziness, improvement in A1c, daily blood glucose monitoring
•
That diabetes is a life-long condition, product does not cure disease
•
That all food in diet plan must be eaten to prevent hypoglycemia; to continue with weight control, dietary medical nutrition therapy, physical activity, hygiene
•
To carry emergency ID with prescriber, medications, and condition listed
•
To test blood glucose using a blood glucose meter
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(boe-sue′ti-nib)
Bosulif
Func. class.:
Antineoplastic biologic response modifiers
Chem. class.:
Signal transduction inhibitors (STIs), tyrosine kinase inhibitor
Inhibits bcr-abl tyrosine kinase created in patients with chronic myeloid leukemia (CML)
Treatment of CML; Philadelphia-chromosome–positive patients in blast-cell crisis
Pregnancy (D), hypersensitivity
Precautions:
Breastfeeding, children, diarrhea, geriatric patients, hepatic disease, bone marrow suppression, infection, thrombocytopenia, neutropenia, immunosuppression
Calculator
• Adult:
PO
500 mg daily with food, may increase to 600 mg/day in those who have not developed grade 3 toxicity or in patients who do not reach complete hematological response by wk 8 or complete cytogenic response (CCyR) by wk 12
• Adult:
PO
Any baseline hepatic impairment: Start at 200 mg/day; liver transaminase >5 × ULN, hold dose until levels are ≤2.5 × ULN, then resume at 400 mg/day; liver transaminase level ≥3 × ULN and bilirubin >2 × ULN and alk phos <2 × ULN, discontinue
ANC
<
1000
×
10
6
/L or platelet count
<
50,000
×
10
6
/L:
hold dose until ANC is ≥1000 × 10
6
/L and platelets are ≥50,000 × 10
6
/L; if recovery within 2 wk, resume therapy at the same dosage; if blood counts remain low after 2 wk, upon recovery, resume at 100 mg/day less than the previous dosage
Grade 3 or 4 diarrhea (
≥
7 stools/day compared with baseline):
hold therapy until recovery to grade 1 toxicity or lower; resume therapy at 400 mg/day
Significant or moderate or severe toxicity:
hold therapy until toxicity resolves; resume therapy at 400 mg/day
Available forms:
Tabs 100, 500 mg
•
Give with food; swallow whole
•
If dose is missed, take within 12 hr of missed dose; if >12 hr have passed, skip dose
•
Follow cytotoxic handling procedures
CNS:
Headache, dizziness
GI:
Nausea, vomiting, anorexia, abdominal pain, diarrhea
HEMA:
Neutropenia, thrombocytopenia, bleeding
INTEG:
Rash, pruritus
MS:
Arthralgia, myalgia
RESP:
Cough, dyspnea, pleural effusion, edema
OTHER:
Elevated LFTs
Protein binding 96%; metabolized by CYP3A4; half-life 22.5 hr
Increase:
bosutinib concentrations—CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin)
Increase:
plasma concentrations of simvastatin, calcium channel blockers, ergots
Decrease:
bosutinib concentrations—CYP3A4 inducers (dexamethasone, phenytoin, carBAMazepine, rifampin, PHENobarbital), antacids, proton-pump inhibitors
Increase:
increase bosutinib effect—grapefruit juice; avoid use while taking product
Decrease:
bosutinib concentration—St. John’s wort
Myelosuppression: anemia, thrombocytopenia, neutropenia; obtain a CBC weekly × 1 mo, then monthly as needed
•
LFTs every mo × 3 mo, then as clinically indicated
•
Therapeutic response: decrease in leukemic cells or size of tumor
•
To report adverse reactions immediately, bleeding
•
About reason for treatment, expected results
•
To use effective contraception during treatment and up to 30 days after discontinuing treatment