Mosby's 2014 Nursing Drug Reference (117 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(dar′bee-poh′eh-tin)
Aranesp
Func. class.:
Hematopoietic agent
Chem. class.:
Recombinant human erythropoietin
Stimulates erythropoiesis by the same mechanism as endogenous erythropoietin; in response to hypoxia, erythropoietin is produced in the kidney and released into the bloodstream, where it interacts with progenitor stem cells to increase red-cell production
Anemia associated with chronic renal failure, in patients on and not on dialysis, and anemia in nonmyeloid malignancies for patients receiving coadministered chemotherapy
Hypersensitivity to mammalian-cell–derived products, human albumin, polysorbate 80; uncontrolled hypertension; red-cell aplasia
Precautions:
Pregnancy (C), breastfeeding, children, seizure disorder, porphyria, hypertension, sickle cell disease; vit B
12
, folate deficiency; chronic renal failure, dialysis; latex hypersensitivity, CABG, angina, anemia
Black Box Warning:
Hgb >12 g/dl, neoplastic disease
Calculator
•
Adult: SUBCUT/IV
0.45 mcg/kg as a single inj; every week, titrate max target Hgb of 12 g/dl
•
Adult: SUBCUT
2.25 mcg/kg/wk or 500 mcg q3wk
•
Adult: SUBCUT/IV
(epoetin alfa <2500 units/wk) 6.25 mcg/wk; (epoetin alfa 2500-4999 units/wk) 12.5 mcg/wk; (epoetin alfa 5000-10,999 units/wk) 25 mcg/wk; (epoetin alfa 11,000-17,999 units/wk) 40 mcg/wk; (epoetin alfa 18,000-33,999 units/wk) 60 mcg/wk; (epoetin alfa 34,000-89,999 units/wk) 100 mcg/wk; (epoetin alfa >90,000 units/wk) 200 mcg/wk
Available forms:
Sol for inj 25, 40, 60, 100, 150, 200, 300, 500 mcg/ml
•
Without shaking; check for discoloration, particulate matter, do not use if present; do not dilute, do not mix with other products or sol, discard unused portion, do not pool unused portions
•
Subcut typically used for those not requiring dialysis
•
IV given direct undiluted or bolus into IV tubing or venous line after completion of dialysis; watch for clotting of line
•
Adjust dosage every month or more
•
Store refrigerated, do not freeze; protect from light
CNS:
Seizures
, sweating, headache, dizziness,
stroke
CV:
Hypo/hypertension
,
cardiac arrest,
angina pectoris
,
thrombosis, CHF, acute MI, dysrhythmias,
chest pain, transient ischemic attacks, edema
GI:
Diarrhea, vomiting, nausea, abdominal pain, constipation
HEMA:
Red-cell aplasia
MISC:
Infection, fatigue, fever
,
death,
fluid overload
,
vascular access hemorrhage,
dehydration,
sepsis
MS:
Bone pain, myalgia, limb pain, back pain
RESP:
URI, dyspnea, cough, bronchitis
,
PE
SYST:
Allergic reactions,
anaphylaxis
IV:
Onset of increased reticulocyte count 2-6 wk; distributed to vascular space; absorption slow and rate limiting; terminal half-life 49 hr (SUBCUT), 21 hr (IV); peak concentration at 34 hr; increased Hgb levels not generally observed until 2-6 wk after treatment initiated
Do not use epoetin alfa with product
Increase:
darbepoetin-alfa effect—androgens
Increase:
WBC, platelets
Decrease:
bleeding time
•
Symptoms of anemia: fatigue, dyspnea, pallor
Serious allergic reactions:
rash, urticaria; if anaphylaxis occurs, stop product, administer emergency treatment (rare)
•
Renal studies: urinalysis, protein, blood, BUN, creatinine; monitor dialysis shunts; during dialysis, heparin may need to be increased
Black Box Warning:
Blood studies: ferritin, transferrin monthly; transferrin saturation ≥20%, ferritin ≥100 ng/ml; Hgb 2×/wk until stabilized in target range (30%-33%) then at regular intervals; those with endogenous erythropoietin levels of <500 units/L respond to this agent; iron stores should be corrected before beginning therapy, if there is lack of response, obtain folic acid, iron, B
12
levels
Black Box Warning:
Neoplastic disease: breast, non–small cell lung, head and neck, lymphoid, or cervical cancers, increased tumor progression, use lowest dose to avoid RBC transfusion
•
B/P: check for rising B/P as Hgb rises; antihypertensives may be needed
CV status: hypertension may occur rapidly, leading to
hypertensive encephalopathy;
Hgb >12 g/dl may lead to death, do not administer
•
I&O; report drop in output to <50 ml/hr
•
Seizures:
if Hgb is increased by 4 pts within 2 wk, institute seizure precautions
•
CNS symptoms: sweating, pain in long bones
•
Dialysis patients:
thrill, bruit of shunts, monitor for circulation impairment
•
Therapeutic response: increase in reticulocyte count, Hgb/Hct; increased appetite, enhanced sense of well-being
•
To avoid driving or hazardous activity during beginning of treatment
•
To monitor B/P, Hgb
•
To take iron supplements, vit B
12
, folic acid as directed
•
To report side effects to prescriber; to comply with treatment regimen
•
That menses and fertility may return; to use contraception
•
About home administration procedures, if appropriate
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert