Mosby's 2014 Nursing Drug Reference (199 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
glycerin (
OTC
)
(gli′ser-in)
Sani-Supp
Func. class.:
Laxative, hyperosmotic
Constipation
Hypersensitivity
Calculator
• Adult and child >6 yr:
RECT SUPP
3 g;
ENEMA
5-15 ml
• Child <6 yr:
RECT SUPP
1-1.8 g;
ENEMA
2-5 ml
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(goal-lim′yu-mab)
Simponi
Func. class.:
Antirheumatic agent (disease modifying), immunomodulator
Chem. class.:
Monoclonal antibody, DMARD, tumor necrosis factor (TNF-α) modifier
Monoclonal antibody specific for human tumor necrosis factor (TNF); elevated levels of TNF are found in patients with rheumatoid arthritis
Rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis
Hypersensitivity, active infections
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, CNS demyelinating disease, Guillain-Barré syndrome, CHF, hepatitis B carriers, blood dyscrasias, surgery, MS, neurologic disease, diabetes, immunosuppression
Black Box Warning:
Neoplastic disease, TB; fungal, bacterial, viral infections
Calculator
• Adult:
SUBCUT
50 mg q month; for RA, give with methotrexate
Available form:
Inj 50 mg/0.5 ml prefilled syringe, SmartJect Auto Injector
•
Visually inspect sol for particulate or discoloration, sol should be clear to slightly opalescent and colorless to slightly yellow, there may be tiny white particles; do not shake; rotate injection sites
•
SmartJect autoinjector:
Allow to reach room temp for 30 min before use; remove cap, and inject within 5 min of removing cap, do not put cap back on, place open end against the inj site at a 90-degree angle without pushing button, push the injector firmly against the skin, press the button once and release, listen for the first click, wait for the second click or 15 sec, then remove injector; do not rub site
•
Prefilled syringe:
Allow to warm to room temp for 30 min, remove needle cover by pulling straight off, do not twist or recap, inject within 5 min of needle cover removal, hold syringe in one hand like a pencil and use other hand to pinch the skin, inject needle at a 45-degree angle, push plunger down as far as it will go, keep pressure on plunger head and remove needle from skin, remove pres
sure from plunger head, needle guard will cover needle; do not rub site
CNS:
Dizziness, paresthesia,
CNS demyelinating disorder,
weakness
CV:
Hypertension,
CHF
GI:
Hepatitis
HEMA:
Agranulocytosis, aplastic anemia, leukopenia, polycythemia, thrombocytopenia, pancytopenia
INTEG:
Psoriasis
MISC:
Increased cancer risk,
antibody development to this drug;
risk for infection (TB, invasive fungal infections, other opportunistic infections), may be fatal,
inj site reactions
Terminal half-life 2 wk, lower
•
Do not give concurrently with vaccines; immunizations should be brought up to date before treatment
•
Dosage change may be needed: warfarin, cycloSPORINE, theophylline
Increase:
infection—abatacept, etanercept, rilonacept, riTUXimab, adalimumab, anakinra, immunosuppressants, inFLIXimab
•
Pain,
stiffness, ROM, swelling of joints during treatment
•
Inj site pain, swelling; usually occur after 2 inj (4-5 days)
Black Box Warning:
TB: obtain TB skin test before starting treatment, treat latent TB before starting therapy
Blood dyscrasias:
CBC, differential prior to and periodically during treatment
Black Box Warning:
Infection:
fever, flulike symptoms, dyspnea, change in urination, redness/swelling around any wounds; stop treatment if present; some serious infections including sepsis may occur, may be fatal; patients with active infections should not be started on this product; obtain a chest x-ray, fungal serology, TB testing before starting treatment
•
LFTs; hepatitis B serology, may reactivate HBV
•
CHF:
B/P, pulse, edema, SOB
•
Psoriasis:
may occur or worsen
Black Box Warning:
Neoplastic disease: may occur in those <18 yr, avoid use in those with known malignancies
•
Refrigerate, do not freeze; allow to warm to room temp before using
•
Therapeutic response: decreased inflammation, pain in joints, decreased joint destruction
•
About self-administration if appropriate: inj should be made in thigh, abdomen, upper arm; rotate sites at least 1 inch from old site, do not inject in areas that are bruised, red, hard
•
That, if medication not taken when due, to inject next dose as soon as remembered and then the following dose as scheduled
•
Not to receive any live virus vaccines during treatment
Black Box Warning:
To report signs, symptoms of infection, allergic reaction, or lupuslike syndrome
•
To notify prescriber if pregnancy is planned or suspected, not to breastfeed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(goe′se-rel-lin)
Zoladex
Func. class.:
Gonadotropin-releasing hormone, antineoplastic (hormone)
Chem. class.:
Synthetic decapeptide analog of LHRH