Mosby's 2014 Nursing Drug Reference (194 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(jem-sit′a-been)
Gemzar
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Nucleoside analog
Do not confuse:
Gemzar
/Zinecard
Exhibits antitumor activity by killing cells undergoing DNA synthesis (S phase) and blocking G1/S-phase boundary
Adenocarcinoma of the pancreas (nonresectable stage II, III, or metastatic stage IV); in combination with CISplatin for inoperable, advanced, or metastatic non–small-cell lung cancer; advanced breast cancer in combination with PACLitaxel; with CARBOplatin for ovarian cancer
Unlabeled uses:
Bladder cancer, mesothelioma, adjuvant treatment of pancreatic cancer, ovarian cancer single agent, biliary tract cancer, advanced T-cell lymphoma
Pregnancy (D), breastfeeding, hypersensitivity
Precautions:
Children, geriatric patients, myelosuppression, radiation therapy, renal/hepatic disease, accidental exposure, alcoholism, dental disease, infection
Calculator
• Adult:
IV
1000 mg/m
2
given over 30 min/wk up to 7 wk then 1 wk rest period; subsequent cycles should be infused 1×/wk × 3 wk out of every 4 wk depending on hematologic toxicity
• Adult:
IV
(4-wk schedule) 1000 mg/m
2
given over 30 min on days 1, 8, 15, of
each 28-day cycle; give CISplatin
IV
100 mg/m
2
on day 1 after gemcitabine; 3-wk schedule: 1250 mg/m
2
given over 30 min on days 1, 8 of each 21-day cycle; give CISplatin
IV
100 mg/m
2
after the inf of gemcitabine on day 1
• Adult:
IV
1250 mg/m
2
over 30 min on days 1 and 8 of 21-day cycle; give with PACLitaxel 175 mg/m
2
over 3 hr before gemcitabine on day 1
• Adult:
IV
1 g/m
2
, days 1, 8, 15 of 28-day cycle
Available forms:
Lyophilized powder for inj 20 mg/ml (10-, 50-ml vials)
•
Prepare in biologic cabinet using gown, mask, gloves; use cytotoxic handling procedures
•
After reconstituting with 0.9% NaCl 5 ml/200-mg vial of product or 25 ml/1-g vial of product (38 mg/ml) shake; may be further diluted with 0.9% NaCl to conc as low as 0.1 mg/ml; discard unused portions, give over 30 min, do not admix
•
Diluted solution stable at room temp for 24 hr, do not refrigerate
•
Infusions longer than 60 min increase toxicity
•
Bone marrow depression:
CBC, differential, platelet count before each dose; single agent: absolute granulocyte count >1000 and platelets >100,000, give complete dose; absolute granulocyte count 500-999, platelets 50,000-99,999, give 75%; absolute granulocyte count <500 or platelets <50,000, do not give; combination with PACLitaxel for breast cancer: absolute granulocyte count >1200 and platelets >75,000, give complete dose; absolute granulocyte count 1000-1199 or platelets 50,000-75,000, give 75%; absolute granulocyte 700-999 or platelets ≥50,000, give 50%; granulocyte count <700 or platelet <50,000, do not give; combination with CARBOplatin for ovarian cancer: absolute granulocyte count >1500 and platelet count >100,000, give complete dose; absolute granulocyte count 1000-1499 or platelets 75,000-99,000, give 75%; absolute granulocyte count <1000 or platelets <75,000, do not give
Y-site compatibilities:
Amifostine, amikacin, aminophylline, ampicillin, aztreonam, bleomycin, bumetanide, butorphanol, calcium gluconate, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, chlorproMAZINE, cimetidine, ciprofloxacin, CISplatin, clindamycin, cyclophosphamide, cytarabine, DACTINomycin, DAUNOrubicin, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin, droperidol, enalaprilat, etoposide, famotidine, floxuridine, fluconazole, fludarabine, fluorouracil, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifosfamide, leucovorin, linezolid, LORazepam, mannitol, meperidine, mesna, metoclopramide, metroNIDAZOLE, minocycline, mitoXANtrone, morphine, nalbuphine, ondansetron, PACLitaxel, promethazine, ranitidine, streptozocin, teniposide, thiotepa, ticarcillin, tobramycin, topotecan, trimethoprim/sulfamethoxazole, vancomycin, vinBLAStine, vinCRIStine, vinorelbine, zidovudine, zoledronic acid
ENDO:
Hyperglycemia
GI:
Diarrhea,
nausea, vomiting
, anorexia, constipation, stomatitis
GU:
Proteinuria
, hematuria
HEMA:
Leukopenia, anemia, neutropenia, thrombocytopenia
INTEG:
Irritation at site,
rash, alopecia
META:
Hypocalcemia, hypokalemia, hypomagnesemia
OTHER:
Dyspnea,
fever
,
hemorrhage,
infection, flulike symptoms, paresthesia,
peripheral edema
, myalgia
Half-life 42-379 min, crosses placenta, excretion: renal, 92%-98%
Increase:
bleeding—NSAIDs, alcohol, salicylates, anticoagulants
Increase:
myelosuppression, diarrhea—other antineoplastics, radiation
Decrease:
antibody response—live virus vaccines
Increase:
BUN, AST, ALT, alk phos, bilirubin, creatinine
Decrease:
Hgb, WBC, neutrophils, platelets
•
Blood dyscrasias:
bruising, bleeding, petechiae
•
I&O, nutritional intake; food preferences: list likes, dislikes
•
Renal, hepatic studies before and during treatment; may increase AST, ALT, alk phos, bilirubin, BUN, creatinine, calcium, potassium, glucose, magnesium, urine protein
•
Buccal cavity for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
•
GI symptoms: frequency of stools, cramping
•
Signs of dehydration: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
•
Increased fluid intake to 2-3 L/day to prevent dehydration unless contraindicated
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss
•
Antiemetic agents
•
Therapeutic response: decrease in tumor size; decrease in spread of cancer; symptom relief
•
To avoid foods with citric acid or hot or rough texture if stomatitis is present; to drink adequate fluids; to avoid use with NSAIDs, alcohol, salicylates
•
To report stomatitis and any bleeding, white spots, ulcerations in mouth; to examine mouth daily, report symptoms
•
To report signs of anemia: fatigue, headache, faintness, SOB, irritability; hematuria, dysuria
•
To use contraception during therapy and for 4 mo after; pregnancy (D), do not breastfeed
•
Not to receive vaccinations during treatment
•
About possible hair loss and what can be done
•
To report flulike symptoms, swelling of feet/legs
•
To report bruising, bleeding: gums, blood in urine, stool, emesis
•
To avoid crowds, persons with known upper-respiratory infections
•
To avoid use of hard-bristle toothbrush, electric razor
•
Infection: to report sore throat, fever, flulike symptoms immediately
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(jem-fi′broe-zil)
Lopid
Func. class.:
Antilipemic
Chem. class.:
Fibric acid derivative
Do not confuse:
Lopid
/Levbid/Slo-bid
Inhibits biosynthesis of VLDL, decreases triglycerides, increases HDL
Type IIb, IV, V hyperlipidemia as adjunct with diet therapy, hypertriglyceridemia
Severe renal/hepatic disease, preexisting gallbladder disease, primary biliary cirrhosis, hypersensitivity
Precautions:
Pregnancy (C), breastfeeding; monitor hematologic and hepatic function
Calculator
• Adult:
PO
600 mg bid 30 min before
AM
,
PM
meal
•
Avoid use
Available forms:
Tabs 600 mg; caps 300 mg
•
Should not be used with repaglinide or itraconazole
•
30 min before
AM
,
PM
meals
•
Discontinue product if response does not occur within 3 mo
CNS:
Fatigue, vertigo, headache, paresthesia, dizziness, somnolence
GI:
Dyspepsia, diarrhea, abdominal pain
, nausea, vomiting
HEMA:
Leukopenia, anemia, eosinophilia, thrombocytopenia
INTEG:
Rash, urticaria, pruritus
MISC:
Taste perversion
MS:
Myopathy, rhabdomyolysis
SYST:
Angioedema, exfoliative dermatitis
Peak 1-2 hr; plasma protein binding >90%; half-life 1½ hr; 70% excreted in urine mostly unchanged; metabolized in liver (minimal)
Increase:
hypoglycemic effect—sulfonylureas, repaglinide
Increase:
anticoagulant properties—warfarin
Increase:
risk of myositis, myalgia—HMG-CoA reductase inhibitors
Decrease:
effect of cycloSPORINE
Decrease:
effect of gemfibrozil—bile acid sequestrants, separate by >2 hr
Increase:
LFTs, CK
Decrease:
Hgb, Hct, WBC, potassium, eosinophils, platelets
•
Hyperlipidemia: diet history: fats, triglycerides, cholesterol; if lipids increase, product should be discontinued; LDL, VLDL baseline and periodically
•
Myopathy, rhabdomyolysis:
For muscle pain, tenderness; obtain baseline CPK; if elevated or if these occur, product should be discontinued; at greater risk if combined with HMG-Co-A reductase inhibitors
•
Renal, hepatic studies, CBC, blood glucose if patient is receiving long-term therapy; if LFTs increase, therapy should be discontinued
•
Bowel pattern daily; watch for increasing diarrhea (common)
•
Therapeutic response: decreased cholesterol, triglyceride levels; HDL, cholesterol ratios improved
•
That compliance is needed for positive results; not to double or skip dose
•
That risk factors should be decreased: high-fat diet, smoking, alcohol consumption, absence of exercise
•
To notify prescriber of diarrhea, nausea, vomiting, chills, fever, sore throat, muscle cramps, abdominal cramps, severe flatulence, tendon pain
•
To avoid driving, hazardous activities if dizziness, blurred vision occur