Mosby's 2014 Nursing Drug Reference (80 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 ALERT(kar-boe-pla′-tin)
Func. class.:
Antineoplastic alkylating agent
Chem. class.:
Platinum coordination compound
Do not confuse:
CARBOplatin
/CISplatin
Produces interstrand DNA cross-links and, to a lesser extent, DNA-protein cross-links; activity is not cell-cycle–phase specific
Initial treatment of advanced ovarian cancer in combination with other agents; palliative treatment of ovarian carcinoma recurrent after treatment with other antineoplastic agents
Unlabeled uses:
Acute lymphocytic leukemia (ALL), acute myelogenous leukemia (AML), bladder/breast/head/neck/lung/testicular cancer, bone marrow ablation, malignant glioma, neuroblastoma, non-Hodgkin’s lymphoma, osteogenic sarcoma, soft-tissue sarcoma, stem-cell transplant preparation, Wilms’ tumor, stage I seminoma
Pregnancy (D), breastfeeding, hypersensitivity, significant bleeding, aluminum products used to prepare or administer CARBOplatin
Black Box Warning:
Severe bone marrow depression, platinum compound hypersensitivity
Precautions:
Geriatric patients, radiation therapy within 1 mo, other cancer chemotherapy within 1 mo, renal/hepatic disease
Black Box Warning:
Anemia, infection
Calculator
• Adult:
The total CARBOplatin dose in mg for adults may be calculated using the Calvert equation:
Total dose (mg) = target AUC × (GFR + 25)
• Children:
Calculate CARBOplatin dosage (mg/m
2
) in children:
Total dose (mg/m
2
) = target AUC × [(0.93 × GFR) + 15]
• Adult (single agent):
IV INF
initially 300 mg/m
2
on day 1 with cyclophosphamide, 600 mg/m
2
IV
on day 1, repeat q4wk × 6 cycles; refractory tumors 360 mg/m
2
single dose, may repeat q4wk as needed, do not repeat until neutrophils >2000/mm
3
and platelets >100,000/mm
3
• Adult (single agent):
IV INF
CCr 41-59 ml/min, 250 mg/m
2
, CCr 16-40 ml/min, 200 mg/m
2
, do not use if CCr <15 ml/min
• Adult <21 yr/adolescent/child:
IV
635 mg/m
2
on day 3 with ifosfamide, mesna, etoposide
• Child:
IV
400 mg/m
2
× 2 days with etoposide, ifosfamide
• Adult/adolescent/child:
IV
560 mg/m
2
on day 1 with ifosfamide 2.65 g/m
2
/day
IV
on days 1-3
• Child:
IV
300-600 mg/m
2
q4wk or 400 mg/m
2
/day for 2 days q4wk or 160 mg/m
2
/day × 5 days q4wk
Available forms:
Lyophilized powder for inj 50-, 150-, 450-mg vials; aqueous sol for inj 50 mg/5-ml vial, 150 mg/15-ml vial, 450 mg/45-ml vial, 600 mg/60-ml vial
•
Antiemetic 30-60 min before product and prn for vomiting
•
Do not use needles or IV administration sets that contain aluminum; may cause precipitate or loss of potency
•
Use cytotoxic handling procedures
•
Storage protected from light at room temp; reconstituted vials stable for 24 hr at room temp, Paraplatin multidose (10 mg/ml) vials stable for up to 14 days after entry into vial
•
Reconstitute
CARBOplatin 50, 150, or 450 mg with 5, 15, or 45 ml, respectively, of sterile water for inj, D
5
W, or NaCl (10 mg/ml); then further
dilute
with the same sol to 0.5-4 mg/ml;
give
over 15 min or more (intermittent INF)
•
Continuous IV INF
over 24 hr; max dose based on (GFR=125 mg/ml)
Solution compatibilities:
D
5
/0.2% NaCl, D
5
/0.45% NaCl, D
5
/0.9% NaCl, 0.9% NaCl, D
5
W, sterile water for inj
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, caspofungin, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamycin, codeine, cyclophosphamide, cycloSPORINE, cytarabine, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, insulin (regular),
irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin, levorphanol, lidocaine, linezolid injection, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, minocycline, mitoXANtrone, mivacurium, morphine, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, pentamidine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride, potassium phosphates, prochlorperazine, promethazine, propofol, propranolol, ranitidine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, topotecan, TPN, trastuzumab, trimethobenzamide, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine
CNS:
Seizures, central neurotoxicity,
peripheral neuropathy
, dizziness, confusion
CV:
Cardiac abnormalities (fatal CV events), stroke
EENT:
Tinnitus, hearing loss,
vestibular toxicity
, visual changes
GI:
Severe nausea, vomiting
, diarrhea, weight loss, mucositis, anorexia, constipation, taste change
HEMA:
Thrombocytopenia, leukopenia, pancytopenia, neutropenia, anemia,
bleeding
INTEG:
Alopecia
, dermatitis, rash, erythema, pruritus, urticaria
META:
Hypomagnesemia, hypocalcemia, hypokalemia, hyponatremia, hyperuremia
SYST:
Anaphylaxis
Initial half-life 1-2 hr, postdistribution half-life 2½-6 hr, not bound to plasma proteins, excreted by the kidneys
Increase:
nephrotoxicity or ototoxicity—aminoglycosides, amphotericin B
Increase:
bleeding risk—aspirin, NSAIDs, thrombolytics, anticoagulants, platelet inhibitors
Increase:
toxicity—radiation, bone marrow suppressants
Increase:
myelosuppression—myelosuppressives
Decrease:
phenytoin levels, monitor levels
Increase:
AST, BUN, alk phos, bilirubin, creatinine
Decrease:
platelets, neutrophils, WBC, RBC, Hgb/HCT, calcium, potassium, magnesium, phosphate
Black Box Warning:
To only be used by person experienced in the use of Chemotherapeutic products, in a specialized care setting
Black Box Warning:
Bone marrow depression:
CBC, differential, platelet count weekly; withhold product if neutrophil count is <2000/mm
3
or platelet count is <100,000/mm
3
; notify prescriber of results; calcium, magnesium, phosphate, potassium, sodium, uric acid, CCR, bilirubin; CCr <60 ml/min may be responsible for increased bone marrow suppression; assess frequently for infection
•
Renal studies: BUN, creatinine, serum uric acid; urine CCr before, during therapy; I&O ratio; report fall in urine output to <30 ml/hr
•
Monitor temp q4hr (may indicate beginning infection)
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly; jaundice of skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
Anaphylaxis:
hypotension, rash, pruritus, wheezing, tachycardia may occur within a few mins of use; notify prescriber after discontinuing product; resuscitation equipment should be available
•
Delay dental work until blood counts have returned to normal; regular toothbrushes, dental floss, and toothpicks should not be used, use soft bristle toothbrush
•
Peripheral neuropathy:
may be increased in geriatric patients
•
Bleeding;
hematuria, stool guaiac, bruising, petechiae, mucosa or orifices; avoid all IM injections if platelets <50,000/mm
3
•
Effects of alopecia on body image; discuss feelings about body changes
•
Therapeutic response: decreasing size of tumor, spread of malignancy
•
To report ringing/roaring in the ears; numbness, tingling in face, extremities; weight gain
•
That impotence or amenorrhea can occur; that this is reversible after treatment is discontinued; to notify prescriber if pregnancy is suspected or planned; pregnancy (D), that contraception should be used if patient is fertile
•
Not to breastfeed during treatment
•
To avoid OTC products with aspirin, NSAIDs, alcohol; not to receive vaccinations during treatment
To notify prescriber immediately of fever, fatigue, sore throat, bleeding, bruising, chills, back pain, blood in stools, dyspnea
•
That hair may be lost during treatment; that a wig or hairpiece may make the patient feel better; that new hair may be different in color, texture
•
To avoid crowds, persons with known infections; to avoid the use of razors, stiff-bristle toothbrushes