Mosby's 2014 Nursing Drug Reference (177 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(fin-gol′i-mod)
Gilenya
Func. class.:
Biologic response modifier
Chem. class.:
Sphingosine 1-phosphate receptor modulator
Binds with high affinity to sphingosine 1-phosphate receptors; blocks lymphocyte egress to lymph nodes, thereby reducing the number of peripheral blood lymphocytes; may reduce lymphocyte migration into the CNS
To reduce frequency of exacerbation, to delay physical disability of relapsing forms of MS
Hypersensitivity
Precautions:
Pregnancy (C), breastfeeding, neonates/infants/children, AIDS, asthma, AV block, bradycardia, cardiac disease, COPD, diabetes mellitus, dysrhythmias, heart failure, hepatic disease, HIV, hypertension, immunosuppression, leukemia, lymphoma, QT prolongation, respiratory insufficiency, sick sinus syndrome, syncope, uveitis
Calculator
• Adult:
PO
0.5 mg/day
• Adult:
PO
Child-Pugh C, total score >10: closely monitor, fingolimod exposure is doubled
Available forms:
Caps 0.5 mg
•
Watch patient for 6 hr after initial dose or if product not given for >2 wk for development of bradycardia
•
Give without regard to food
CNS:
Asthenia, depression, fatigue, headache, dizziness, encephalopathy, migraine, paresthesias,
stroke
CV:
AV block, bradycardia, chest pain, hypertension, palpitations
EENT:
Blurred vision, vision impairment, ocular pain, macular edema
GI:
Abdominal pain, anorexia, diarrhea, jaundice, vomiting, weight loss
HEMA:
Leukopenia, lymphopenia, neutropenia
INTEG:
Alopecia, pruritus
MS:
Back pain
RESP:
Dyspnea, cough
SYST:
Infection, influenza,
secondary malignancy
Protein binding (99.7%), distributed to RBCs (86%), steady state 1-2 months, metabolized by CYP4F2 and CYP2D6 to a lesser extent, terminal half-life 6-9 days, excreted in urine (81% inactive metabolites), peak 12-16 hr
Increase:
immunosuppression—antineoplastics, immunosuppressants, immune modulating therapies
Increase:
fingolimod effect—ketoconazole
Increase:
infection risk—live vaccines
Decrease:
effect of—inactive vaccines, toxoids
Increase:
risk of torsades de pointes—Class Ia/III antidysrhythmics
•
Multiple sclerosis:
improving paresthesia, muscle weakness, clonus, muscle spasms, difficulty with moving, difficulty with coordination of balance, speech, swallowing, vision problems, fatigue; prevention of increasing disability
•
Laboratory monitoring:
obtain before initial dose; CBC, LFTs, serum bilirubin, ophthalmologic exam, antibodies to VZV; if there is no history of chickenpox
or no vaccination, may give VZV vaccination to antibody-negative patient before giving product, postpone for 1 mo after vaccination; obtain ECG for evidence of bradycardia, AV block
•
Storage at room temp, protect from moisture
•
Therapeutic response: improved symptoms of multiple sclerosis and prevention of increasing disability
•
About use of product and expected results; provide med guide to patient
•
That continuing follow-up exams and laboratory tests will be required on a regular basis
•
To report any side effects of therapy
•
To protect product from moisture
•
To report chest pain, palpitations, jaundice
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(flek-ay′nide)
Tambocor
Func. class.:
Antidysrhythmic (Class IC)
Decreases conduction in all parts of the heart, with greatest effect on the His-Purkinje system, which stabilizes cardiac membrane
Life-threatening ventricular dysrhythmias, sustained ventricular tachycardia, supraventricular tachydysrhythmias, paroxysmal atrial fibrillation/flutter associated with disabling symptoms
Unlabeled uses:
Atrial fibrillation, single dose
Hypersensitivity, AV bundle branch block, cardiogenic shock
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, renal/hepatic disease, CHF, respiratory depression, myasthenia gravis, electrolyte abnormalities, atrial fibrillation, sick sinus syndrome, torsades de pointes
Black Box Warning:
MI, cardiac arrhythmias, atrial fibrillation
Calculator
• Adult:
PO
50 mg q12hr; may increase q4days by 50 mg q12hr to desired response, max 300 mg/day
• Adult:
PO
100 mg q12hr; may increase by 50 mg q12hr q4days, max 400 mg/day
• Adult:
PO
CCr <35 ml/min, 100 mg daily or 50 mg bid initially
Available forms:
Tabs 50, 100, 150 mg
•
Reduced dosage as soon as dysrhythmia is controlled
•
May give with meals for GI upset
•
May adjust dose q4days
•
Therapeutic trough serum concentrations for adults range from 200 to 1000 ng/ml (average, 500 ng/ml); toxicity is more common with trough serum concentrations >1000 ng/mL; usual therapeutic range in children is 200–500 ng/mL; in some cases, up to 800 ng/mL is required
•
Adjust dosage at intervals of ≥4 days (approximate plateau effects) following dosage adjustments; however, longer intervals are needed in patients with renal or hepatic impairment
•
Frequent serum drug concentration monitoring is required for patients with severe renal (CrCl <35 ml/min) or hepatic disease and may also be helpful in patients with CHF or in patients with moderate renal disease
•
Monitoring of flecainide serum concentrations is strongly recommended in patients receiving amiodarone therapy
CNS:
Headache, dizziness
, involuntary movement, confusion, psychosis, rest
lessness, irritability, paresthesias, ataxia, flushing, somnolence, depression, anxiety, malaise, fatigue, asthenia, tremors
CV:
Hypotension, bradycardia
, angina, PVCs,
heart block, cardiovascular collapse, arrest,
dysrhythmias,
CHF, fatal ventricular tachycardia,
palpitations,
QT prolongation, torsades de pointes
EENT:
Tinnitus,
blurred vision
, hearing loss, corneal deposits, dry eyes
GI:
Nausea, vomiting, anorexia, constipation, abdominal pain, flatulence, change in taste, diarrhea
GU:
Impotence, decreased libido, polyuria, urinary retention
HEMA:
Leukopenia, thrombocytopenia
INTEG:
Rash, urticaria, edema, swelling
RESP:
Dyspnea,
respiratory depression
Peak 3 hr, half-life 12-27 hr, metabolized by liver, excreted unchanged by kidneys (10%), excreted in breast milk
Increase:
of both products—propranolol
Increase:
CV depressant action—β-blockers, disopyramide, verapamil
Increase:
flecainide level—amiodarone, cimetidine, ritonavir
Increase:
digoxin level—digoxin
Increase or decrease:
effect—urinary, alkalinizing agents, acidifying agents
Increase:
CPK
Black Box Warning:
MI, CHF, cardiogenic shock:
should not be used in these conditions
Black Box Warning:
Atrial fibrillation:
avoid use, risk of ventricular dysrhythmias
Black Box Warning:
Cardiac dysrhythmias:
discontinue in those with prolonged QRS >180 ms or prolonged PR >300 ms
•
Electrolyte imbalances:
hypo/hyperkalemia before administration; correct electrolytes before use
•
CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued
•
Flecainide level:
Monitor level in those with CHF or renal failure; peak, trough
•
Therapeutic response: decreased dysrhythmias
•
To change position slowly from lying or sitting to standing to minimize orthostatic hypotension
•
To take as prescribed; not to skip or double dose
•
To avoid hazardous activities that require alertness until response is known
•
To carry emergency ID with disorder, medications taken
•
To notify all health care providers of treatment
•
To report new or worsening cardiac symptoms
O
2
, artificial ventilation, ECG, DOPamine for circulatory depression, diazepam or thiopental for seizures, treat ventricular dysrhythmias
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert