Mosby's 2014 Nursing Drug Reference (45 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Hypersensitivity, breastfeeding, history of serious pancreatitis, bleeding, or serious thrombosis with prior L-asparaginase therapy
Pregnancy (C), children <2 yr, hepatic disease, diabetes mellitus
Calculator
• Adult, adolescent, child ≥2 yr (substitute for pegaspargase): IM
25,000 IU/m
2
3 ×/wk (Monday/Wednesday/Friday) × 6 doses for each planned dose of pegaspargase within a treatment
• Adult (substitute for L-asparaginase
E. coli
): IM
25,000 IU/m
2
for each scheduled dose of native
E. coli
asparaginase within a treatment
Powder for inj 10,000 Units
•
Slowly inject 1 or 2 ml of preservative-free sterile sodium chloride (0.9%) inj against inner vial wall; do not forcefully inject sol directly onto or into powder; if 1 ml of NS is used, conc is 10,000 IU/ml; if 2 ml of NS is used, conc is 5000 IU/ ml; dissolve contents by gentle mixing or swirling; do not shake or invert vial
•
Reconstituted sol should be clear and colorless; discard if any visible particles or protein aggregates are present
•
Calculate the volume needed to obtain dose; withdraw volume containing calculated dose from vial into polypropylene syringe within 15 min of reconstitution
Administer dose by IM inj within 4 hr of reconstitution; limit volume to 2 ml per inj site; multiple inj sites may be needed
ENDO:
Hyperglycemia
GI:
Pancreatitis
HEMA:
Bleeding,
serious thrombosis
INTEG:
Local inj site reaction
MISC:
Hyperammonemia
(seizure, headache),
neurotoxicity,
elevated hepatic enzymes, hyperbilirubinemia
SYST:
Anaphylaxis
Achieved serum trough asparaginase activity concentrations ≥0.1 IU/ml by 72 hr after dose 3
Synergistic or antagonistic action of:
methotrexate
Increase:
neurotoxicity—vinCRIStine
Increase:
pancreatitis risk—cytarabine
Increase:
hyperglycemia—corticosteroids
Increase:
bleeding risk—NSAIDs, thrombolytics, salicylates, anticoagulants, platelet inhibitors
Increase:
liver function tests, ammonia
Decrease:
fibrinogen, protein C activity, protein S activity, anti-thrombin III
•
Anaphylaxis:
give only with resuscitation equipment and other agents necessary to treat anaphylaxis; if a serious hypersensitivity reaction occurs, discontinue product
•
Bleeding:
identify if NSAIDs, salicylates, thrombolytics, platelet inhibitors, anticoagulants have been used; grade 1 or 2 bleeding or coagulation abnormalities may occur (serious thrombosis, sagittal sinus thrombosis); discontinue for a thrombotic or hemorrhagic event until symptoms resolve; after resolution, treatment may be resumed; coagulation proteins were decreased in most patients after a 2-wk course: fibrinogen, protein C activity, protein S activity, antithrombin III
Pancreatitis:
discontinue for severe or hemorrhagic pancreatitis (abdominal pain >72 hr and amylase elevation ≥2 × upper limit of normal); mild pancreatitis, hold until the signs, symptoms subside and amylase concentrations return to normal, then resume
•
Hyperglycemia:
glucose intolerance that is irreversible in some cases; monitor baseline and periodic glucose concentration; administer insulin therapy as needed
Hyperammonemia/neurotoxicity:
seizures, headache; asparagine rescue may be used to treat acute CNS toxicity; doses of asparagine used were 1-2 mmol/kg/day continuous IV inf × 5 days
Monitor liver function tests and for hyperbilirubinemia
Local injection site reaction: no more than 2 ml of the reconstituted product is to be administered at a single injection site
•
Do not freeze or refrigerate the reconstituted solution; discard any unused portions
•
Decreased spread of malignancy
To get immediate medical advice if they experience abdominal pain, nausea, vomiting, diarrhea; pancreatitis may occur
To get immediate medical advice if experiencing anaphylactic reactions
•
To contact provider if patient experiences excessive thirst or any increase in volume or frequency of urination; hyperglycemia may occur
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
OTC
)
(as′pir-in)
APC-ASA Coated Aspirin
, A.S.A., Ascriptin Enteric, Aspergum, Aspirin, Aspir-Low, Aspir-trin, Bayer Aspirin, Bayer Children’s Aspirin, Bufferin, Ecotrin, Equaline, Good Sense Aspirin, Halfprin, PMS-ASA, St. Joseph Children’s, St. Joseph’s Adult, Walgreens Aspirin Adult
Func. class.:
Nonopioid analgesic, nonsteroidal antiinflammatory, antipyretic, antiplatelet
Chem. class.:
Salicylate