Mosby's 2014 Nursing Drug Reference (16 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 ALERTabciximab (Rx)
(ab-six′i-mab)
ReoPro
Func. class.:
Platelet aggregation inhibitor
Used with heparin and aspirin to prevent acute cardiac ischemia after percutaneous transluminal coronary angioplasty in patients with NSTEMI or UA when percutaneous coronary intervention (PCI) is planned within 24 hr
Unlabeled uses:
Acute MI, Kawasaki disease (child)
Hypersensitivity to this product or murine protein; GI, GU bleeding; CVA within 2 yr, bleeding disorders, intracranial neoplasm, intracranial arteriovenous malformations, intracranial aneurysm, platelet count <100,000/mm
3
, recent surgery, aneurysm, uncontrolled severe hypertension, vasculitis, coagulopathy
Calculator
• Adult: IV BOL
250 mcg (0.25 mg)/kg 10-60 min before PCI followed by 0.125 mcg/kg/min
CONT INF
for 12 hr
• Adult:
IV BOL
0.25 mg/kg over 5 min, then 0.125 mcg/kg/min (max 10 mcg/min);
IV INF
for 12 hr unless complications
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(a′bir-a′ter-one)
Zytiga
Func. class.:
Androgen inhibitor
Converted to abiraterone which inhibits CYP17, the enzyme required for androgen biosynthesis; androgen-sensitive prostate cancer responds to treatment that decreases androgens
Metastatic castration-resistant prostate cancer in combination with predniSONE for patients who have received prior chemotherapy containing docetaxel
Pregnancy (X), women, children
Precautions:
Adrenal insufficiency, cardiac disease, MI, heart failure, hepatic disease, hypertension, hypokalemia, infection, surgery, ventricular dysrhythmia
Calculator
• Adult males: PO
1000 mg/day with predniSONE 5 mg bid
• Adult males (Child-pugh B, 7-9): PO
250 mg/day with predniSONE; (Child-Pugh C, >10) do not use
Tabs 250 mg
•
Give whole, on empty stomach 2 hr before or 1 hr after meals with full glass of water
Women who are pregnant or may become pregnant should not touch tabs without gloves
CV:
Angina, dysrhythmia exacerbation,
atrial flutter/fibrillation/tachycardia, AV block,
chest pain, edema, heart failure,
MI,
hypertension,
QT prolongation,
sinus tachycardia,
supraventricular tachycardia, ventricular tachycardia
ENDO:
Hot flashes
GI:
Diarrhea, dyspepsia
GU:
Increased urinary frequency, nocturia, urinary tract infection
META:
Adrenocortical insufficiency, hyperbilirubinemia, hypertriglyceridemia, hypokalemia, hypophosphatemia
MS:
Arthralgia, myalgia
RESP:
Cough, upper respiratory infection
SYST:
Infection
99% protein binding, converted to abiraterone (active metabolite), mean terminal half-life 7-17 hr; excreted 88% in feces, 5% in urine; high-fat food increases effect, give on empty stomach; increased effect in hepatic disease
Avoid use with: CYP3A4 inhibitors (clarithromycin, atazanavir, nefazodone, saquinavir, telithromycin, ritonavir, indinavir, nelfinavir, voriconazole, ketoconazole, itraconazole); loperamide, guinine, naprosen, pioglitazone, pitavastin, repaglinide, rosiglitazone
Avoid use with: CYP3A4 inducers (carBAMazepine, phenytoin, rifampin, rifabutin, rifapentine, PHENobarbital)
Increase action of CYP2D6 substrate—dextromethorphan, thioridazine; dose of these products should be reduced
Increase:
abiraterone action—must be taken on an empty stomach
•
Prostate cancer:
monitor prostate specific antigen (PSA), serum potassium
Hepatotoxicity:
monitor liver function tests (AST/ALT) at baseline, every 2 wk for 3 mo, monthly thereafter in patients with no known hepatic disease; interrupt treatment in patients without known hepatic disease at baseline who develop ALT/AST >5 × ULN or total bilirubin >3 × ULN; patients with moderate hepatic disease at baseline, measure ALT, AST, bilirubin before the start of treatment, every wk for 1 month, every 2 wk for the following 2 mo, monthly thereafter; if elevations in ALT and/or AST >5 × ULN or total bilirubin >3 × ULN occur in patients with moderate hepatic impairment at baseline, discontinue and do NOT restart; measure serum total bilirubin, AST/ALT if hepatotoxicity is suspected; elevations of AST, ALT, bilirubin from baseline should prompt more frequent monitoring.
•
Musculoskeletal pain, joint swelling, discomfort: arthritis, arthralgia, joint swelling, and joint stiffness, some severe; muscle discomfort that included muscle spasms, musculoskeletal pain, myalgia, musculoskeletal discomfort, and musculoskeletal stiffness may be relieved with analgesics
•
Signs, symptoms of adrenocorticoid insufficiency; monthly for hypertension, hypokalemia, fluid retention
QT prolongation:
Monitor ECG for QT prolongation, ejection fraction in patients with cardiac disease, small increases in the QTc interval such as <10 ms have occurred; monitor for arrhythmia exacer
bation such as sinus tachycardia, atrial fibrillation, supraventricular tachycardia (SVT), atrial tachycardia, ventricular tachycardia, atrial flutter, bradycardia, AV block complete, conduction disorder, bradyarrhythmia
•
Storage of tabs at room temp
That women must not come in contact with tabs; wear gloves if product needs to be handled, pregnancy (X)
•
To report chest pain, swelling of joints, burning/pain when urinating