Mosby's 2014 Nursing Drug Reference (15 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(ah-bak′ah-veer)
Ziagen
Func. class.:
Antiretroviral
Chem. class.:
Nucleoside reverse transcriptase inhibitor (NRTI)
Do not confuse:
abacavir
/amprenavir
Inhibitory action against HIV-1; inhibits replication of the virus by incorporating into cellular DNA by viral reverse transcriptase, thereby terminating the cellular DNA chain
In combination with other antiretroviral agents for HIV-1 infection (not to be used with lamivudine or tenofovir)
Unlabeled uses:
HIV prophylaxis following occupational exposure
Black Box Warning:
Hypersensitivity, moderate severe hepatic disease
Precautions:
Pregnancy (C), breastfeeding, children <3 mo, granulocyte count <1000/mm
3
or Hgb <9.5 g/dl, severe renal disease, impaired hepatic function, HLA B5701
Black Box Warning:
Lactic acidosis
Calculator
• Adult and adolescent ≥16 yr: PO
300 mg bid or 600 mg/day with other antiretrovirals
• Adolescent <16 yr and child ≥3 mo: PO
8 mg/kg bid, max 300 mg bid with other antiretrovirals
• Adult: PO
(Child-Pugh 5-6) (oral sol) 200 mg bid; severe hepatic disease, do not use
• Adult: PO
300 mg bid to be added to the basic 2-drug regimen ×4 wk
Available forms:
Tabs 300 mg; oral sol 20 mg/ml
•
Give in combination with other antiretrovirals with or without food; do not use triple therapy as a beginning treatment, resistance may occur
•
Reduce dose in hepatic disease, use oral sol
CNS:
Fever, headache, malaise, insomnia
, paresthesia
GI:
Nausea, vomiting, diarrhea, anorexia
, cramps, abdominal pain, increased AST, ALT,
hepatotoxicity, hepatomegaly with steatosis
HEMA:
Granulocytopenia, anemia, lymphopenia
INTEG:
Rash
, urticaria, hypersensitivity reactions
META:
Lactic acidosis
OTHER:
Fatal hypersensitivity reactions, MI
RESP:
Dyspnea
Rapid/extensive absorption, distributed to extravascular space then erythrocytes; 50% plasma protein binding; extensively metabolized to inactive metabolites; half-life 1½ hr; excreted in urine, feces (unchanged)
• Do not coadminister with abacavir-containing products
Increase:
possible lactic acidosis—ribavirin
Increase:
abacavir levels—alcohol
Decrease:
abacavir levels—tipranavir
Decrease:
levels of—methadone
Increase:
glucose, triglycerides, GGT
•
Symptoms of HIV and possible infections; increased temp
Lactic acidosis
(elevated lactate levels, increased LFTs), severe hepatomegaly with steatosis, discontinue treatment and do not restart; may have large liver,
elevated AST, ALT, lactate levels, women are at greater chance of lactic acidosis
Black Box Warning:
Fatal hypersensitivity reactions: fever, rash, nausea, vomiting, fatigue, cough, dyspnea, diarrhea, abdominal discomfort; treatment should be discontinued and not restarted; those with HLA B5701 are at great risk for hypersensitivity; obtain genetic testing for HLA B5701 before starting treatment
Blood dyscrasias
(anemia, granulocytopenia): bruising, fatigue, bleeding, poor healing
•
Renal studies: BUN, serum uric acid, CCr before, during therapy; these may be elevated
Black Box Warning:
Hepatic studies before and monthly every 2 wk during therapy: bilirubin, AST, ALT, amylase, alk phos, creatine phosphokinase, creatinine
•
Blood counts; monitor viral load and CD4 counts during treatment; watch for decreasing granulocytes, Hgb; if low, therapy may have to be discontinued and restarted after hematologic recovery; blood transfusions may be required
•
Storage in cool environment; protect from light; oral sol stored at room temperature; do not freeze
•
Therapeutic response: increased CD4 count, decrease viral load
•
That product is not a cure but will control symptoms; patient is still infective, may pass AIDS virus on to others, to carry emergency ID with condition, products taken
To notify prescriber of sore throat, swollen lymph nodes, malaise, fever; other infections may occur; to stop product if skin rash, fever, cough, shortness of breath, GI symptoms, and to notify prescriber immediately; advise all health care providers that allergic reaction has occurred with abacavir
•
That follow-up visits must be continued because serious toxicity may occur; blood counts must be done
•
To use contraception during treatment; if patient is pregnant, register with the Antiretroviral Pregnancy Registry at 1-800-258-4263
•
Give patient Medication Guide and Warning Card, discuss points on guide
•
That other products may be necessary to prevent other infections and that drug is taken with other antiretrovirals
•
Not to drink alcohol while taking this product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(ab-a-ta′sept)
Orencia
Func. class.:
Antirheumatic agent (disease modifying); immunomodulator
A selective costimulation modulator, inhibits T-lymphocytes, inhibits production of tumor necrosis factor (TNF-α), interferon-γ, interleukin-2, which are involved in immune and inflammatory reactions
Polyarticular juvenile rheumatoid arthritis; moderate to severe rheumatoid arthritis; acute, chronic rheumatoid arthritis that has not responded to other disease-modifying agents, may use in combination with DMARDs; do not use with TNF antagonists (adalimumab, etanercept, infliximab), anakinra
Hypersensitivity, TB, viral hepatitis
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, recurrent infections, COPD
Calculator
• Adult:
Subcut 125 mg within 1 day after single IV loading dose, then 125 mg weekly; weekly subcut dose may be initiated without an IV loading dose for those unable to receive an infusion
• Adult >100 kg (220 lb): IV INF
1 g over 30 min, give at 2, 4 wk after first inf, then q4wk
• Adult 60-100 kg (132-220 lb): IV INF
750 mg over 30 min, give at 2, 4 wk after first inf, then q4wk
• Adult <60 kg (132 lb): IV INF
500 mg over 30 min, give at 2, 4 wk after first inf, then q4wk
• Adolescent and child ≥6 yr and >100 kg: IV INF
1 g over 30 min q2wk × 3 doses, then 1 g over 30 min q4wk starting at wk 8
• Adolescent and child ≥6 yr and 75-100 kg: IV INF
750 mg over 30 min q2wk × 2 doses, then 750 mg over 30 min q4wk starting at wk 8
• Adolescent and child ≥6 yr and <75 kg:
IV INF
10 mg/kg over 30 min q2wk × 3 doses then 10 mg/kg q4wk starting at wk 8
Available forms:
Lyophilized powder, single-use vials 250 mg; sol for subcut inj 125 mg/ml
•
To reconstitute, remove plastic flip top from vial and wipe the top with alcohol wipe; insert syringe needle into vial and direct stream of sterile water for inj on the wall of vial; rotate vial until mixed; vent with needle to rid foam after reconstitution (25 mg/ml); further dilute in 100 ml NS from a 100-ml inf bag/bottle; withdraw the needed volume (2 vials remove 20 ml; 3 vials remove 30 ml, 4 vials remove 40 ml); slowly add the reconstituted Orencia sol from each vial into the inf bag/bottle using the same disposable syringe supplied; mix gently, discard unused portions of vials; do not use if particulate is present or discolored; give over 30 min; use non–protein-binding filter (0.2-1.2 microns), protect from light
•
Do not admix with other sol or medications
•
Use prefilled syringe for subcut only (do not use for IV); only those trained should use this system; allow syringe to warm to room temp (30-60 min), do not speed up warming process in any way; the amount of liquid should be between the 2 lines on the barrel, do not use the syringe if there is more or less liquid; inject into fronts of thighs, outer area of upper arm, or abdomen except for 2-inch area around the navel; do not inject into tender, bruised area
•
Gently pinch skin and hold firmly, insert needle at 45-degree angle, inject full amount in 125-mg syringe
•
Rotate injection sites
CNS:
Headache, asthenia, dizziness
CV:
Hypo/hypertension
GI:
Abdominal pain, dyspepsia, nausea
INTEG:
Rash,
inj site reaction
, flushing, urticaria, pruritus
RESP:
Pharyngitis, cough, URI
, non-URI
, rhinitis
, wheezing
SYST:
Anaphylaxis, malignancies, angioedema, serious infections
Terminal half-life IV 13 days, subcut 14.3 days, steady state 60 days; subcut half-life 85 days, clearance increases with increased body weight
•
Do not give concurrently with vaccines; immunizations should be brought up to date before treatment
•
Do not use with TNF antagonists: adalimumab, etanercept, infliximab; anakinra
•
Avoid use with corticosteroids, immunosuppressives, atropine, scopolamine, halothane
•
RA:
pain, stiffness, ROM, swelling of joints during treatment
•
For latent/active TB, viral hepatitis before beginning treatment
•
For inj site pain, swelling
•
Patient’s overall health at each visit; product should not be given with active infections; parenteral product contains maltose, glucose monitoring must be done with glucose-specific testing
Infection:
sinusitis, urinary tract infection, influenza, bronchitis; serious infections have occurred
•
Storage in refrigerator; do not use expired vials, protect from light, do not freeze
•
Therapeutic response: decreased inflammation, pain in joints
•
That product must be continued for prescribed time to be effective
•
To use caution when driving; dizziness may occur
•
Not to have vaccinations while taking this product
•
About patient information included in packaging