Mosby's 2014 Nursing Drug Reference (52 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
Inlyta
Func. class.:
Antineoplastics, biologic response modifiers, signal transduction inhibitors (STIs)
Chem. class.:
Tyrosine kinase inhibitor
Inhibits receptor tyrosine kinases including vascular endothelial growth factor receptors (VEGFR)-1, VEGFR-2, and VEGFR-3; inhibits tumor growth and phosphorylation of VEGFR-2 and VEGF-mediated endothelial cell proliferation
Treatment of advanced renal cell cancer after failure of 1 prior systemic therapy
Pregnancy (D), breastfeeding
Risk for or history of thromboembolic disease, recent bleeding, untreated brain metastasis, recent GI bleeding, GI perforation, fistula, surgery, moderate hepatic disease, uncontrolled hypertension, hyper/hypothyroidism, proteinuria, infertility, end-stage renal disease (CrCl <15 ml/min); not intended for use in adolescents, children, infants, neonates
Calculator
• Adult:
PO 5 mg bid (at 12 hr intervals), may increase to 7 mg bid and then to 10 mg bid in those not receiving antihypertensives who tolerate the lower dosage for at least 2 consecutive wk with no more than grade 2 adverse reactions. Reduce to 3 mg bid if a dose reduction is needed; if further reduction is necessary, reduce to 2 mg bid
• Adult receiving a strong CYP 3A4/5 inhibitor:
Reduce dose by 1/2, adjust as needed
•
Give with or without food; swallow tablet whole with a glass of water
•
If patient vomits or misses a dose, an additional dose should not be taken; the next dose should be taken at the usual time
CNS:
Dizziness, headache,
reversible posterior leukoencephalopathy syndrome (RPLS),
fatigue
CV:
Hypertension,
arterial thromboembolic events (ATE), venous thromboembolic events (VTE)
ENDO:
Hypothyroidism, hyperthyroidism
GI:
Lower GI bleeding/perforation/fistula,
abdominal pain, constipation, diarrhea, dysgeusia, dyspepsia, dysphonia, hemorrhoids, nausea, mucosal inflammation, stomatitis, vomiting, increased ALT/AST
GU:
Proteinuria
HEMA:
Bleeding intracranial bleeding,
anemia, polycythemia, decreased/increased hemoglobin,
lymphopenia thrombocytopenia, neutropenia
INTEG:
Palmar-plantar erythrodysesthesia (hand and foot syndrome) rash, dry skin, pruritus, alopecia, erythema
MISC:
Weight loss dehydration metabolic and electrolyte laboratory abnormalities included
MS:
Asthenia, arthralgia, musculoskeletal pain, myalgia
RESP:
Cough, dyspnea
Absorption: bioavailability 58%; distribution: protein binding >99%; metabolized in liver by CYP3A4/5, CYP1A2, CYP2C19, and UGT1A1; metabolites are carboxylic acid, sulfoxide, and N-glucuronide; excretion 41% in feces and 23% in urine, 12% unchanged; half-life: 2.5-6.1 hr; steady state 2-3 days; onset unknown, peak 2.5-4.1 hr, increased in moderate hepatic disease; duration unknown
Increase:
effect of axitinib—CYP3A4/5 inhibitor, strong, moderate (ketoconazole, boceprevir, chloramphenicol, conivaptan, delavirdine, fosamprenavir, imatinib, indinavir, isoniazid itraconazole, dalfopristin, quinupristin, posaconazole, ritonavir, telithromycin, tipranavir (boosted with ritonavir), darunavir (boosted with ritonavir), aldesleukin, IL-2, amiodarone, aprepitant, fosaprepitant atazanavir, bromocriptine, clarithromycin, crizotinib, danazol, diltiazem, dronedarone, erythromycin, fluvoxaMINE, lanreotide, lapatinib, miconazole, mifepristone, nefazodone, nelfinavir, niCARdipine, octreotide, pantoprazole, saquinavir, tamoxifen, verapamil, voriconazole, grapefruit juice)
Decrease:
effect of axitinib—CYP3A4/5 inducers, strong/moderate (rifampin, carBAMazepine, dexamethasone, phenytoin, PHENobarbital, rifabutin, rifapentine, St. John’s wort, ethanol, bexarotene, bosentan, efavirenz, etravirine, griseofulvin, metyrapone, modafinil, nafcillin, nevirapine, OXcarbazepine, vemurafenib, pioglitazone, topiramate)
Increase or decrease:
effect of axitinib—CYP3A4/5 inhibitor and inducers (quiNINE)
Increase:
creatinine, lipase, amylase, sodium, potassium, glucose
Decrease:
bicarbonate, calcium, albumin, glucose, phosphate, sodium
Increase or decrease:
sodium, glucose
Decrease:
effect of axitinib—St. John’s wort
•
Bleeding:
monitor for GI bleeding or perforation; temporarily discontinue therapy if a patient develops any bleeding that requires treatment
•
Surgery:
discontinue ≥24 hr before surgery, may be resumed after adequate wound healing
•
Hepatic/renal disease:
dosage should be reduced in patients with moderate (Child-Pugh Class B) hepatic disease, monitor liver function tests (ALT, AST, bilirubin) before and periodically during therapy; monitor CCr before and during treatment
•
Hypertension:
B/P should be well controlled before starting treatment; monitor patients for hypertension and administer antihypertensive therapy as needed before and during therapy; dose should be reduced for persistent hypertension; therapy should be discontinued if B/P remains elevated after a dosage reduction or if there is evidence of hypertensive crisis; after discontinuation monitor B/P for hypotension in those receiving antihypertensives
•
Hyper/hypothyroidism:
monitor thyroid function tests before and periodically during therapy; thyroid disease should be treated with thyroid medications
•
Monitor for proteinuria before and periodically during therapy; product may need to be decreased or discontinued if moderate to severe proteinuria occurs
Pregnancy/breastfeeding:
pregnancy category D; determine if the patient is pregnant or breastfeeding before using this product; may also cause infertility
•
Storage at room temperature
•
Decreased spread of malignancy
To use contraception during treatment (pregnancy category D) or to avoid use of this product; to notify prescriber if pregnancy is planned to suspected, not to breastfeed
To notify prescriber of bleeding that is severe or that requires treatment
•
That product will be discontinued ≥24 hr before surgery; may be resumed after adequate wound healing
•
That laboratory testing will be required before and periodically during product use
•
How to monitor B/P and that B/P products should be continued as directed by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert