Mosby's 2014 Nursing Drug Reference (200 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Inhibitor of pituitary gonadotropin secretion; initially increases LH and FSH, with increases in testoster
one, reduction in sex steroid levels (substitute serum testosterone levels)
Advanced and locally confined prostate cancer stage B2-C (10.8 mg), endometriosis, advanced breast cancer, endometrial thinning (3.6 mg)
Hypersensitivity; pregnancy D (breast cancer), X (endometriosis); breastfeeding, children, nondiagnosed vaginal bleeding; hypersensitivity to LHRH, LHRH-agonist analogs; 10.8 mg dose contraindicated in women
Precautions:
Spinal cord decompression, renal disease, bone mineral density loss, hyperglycemia, diabetes mellitus, CV disease
Calculator
• Adult:
SUBCUT
3.6 mg q28days or 10.8 mg q12wk
• Adult:
SUBCUT
3.6 mg 1-2 depot inj, usually 1 depot, surgery performed at 4 wk; if 2 depots, surgery performed 2-4 wk after 2nd depot
Available forms:
Depot inj 3.6, 10.8 mg
•
SUBCUT using implant, inserted by qualified person into upper subcutaneous tissue in abdominal wall q28days or q12wk (10.8 mg); do not attempt to remove air bubbles from syringe
CNS:
Headaches
,
spinal cord compression,
anxiety, depression, dizziness, insomnia, lethargy
, hot flashes, emotional lability
CV:
Dysrhythmia, cerebrovascular accident,
hypertension, chest pain,
CHF;
MI, sudden cardiac death, stroke (men),
peripheral edema
ENDO:
Gynecomastia, breast tenderness, breast enlargement,
hot flashes;
hyperglycemia, diabetes (men)
GI:
Nausea
, vomiting, constipation, diarrhea, ulcer
GU:
Spotting, breakthrough bleeding, decreased libido
, renal insufficiency, urinary obstruction, urinary tract infection,
impotence
INTEG:
Rash, pain on inj, diaphoresis
MS:
Osteoneuralgia
RESP:
COPD, URI
Peak 12-15 days, half-life 4½ hr, 30% protein bound
Increase:
alk phos, estradiol, FSH, LH, testosterone levels, triglycerides
Decrease:
testosterone levels, progesterone
•
Reproductive studies:
pelvic ultrasound, pelvic exam, PSA, serum estradiol/testosterone, pregnancy test prior to therapy
•
I&O ratios; palpate bladder for distention in urinary obstruction
•
Cancer metastases:
for relief of bone pain (back pain), change in motor function
•
Blood studies: lipid profile, acid phosphatase; calcium; hypercalcemia may occur
•
Therapeutic response: more normal levels of PSA, acid phosphatase, alk phos; testosterone level of <25 ng/dl; thinning of endometrial lining
•
To continue with appointments monthly
•
That hyperglycemia may occur in diabetic patients
•
That gynecomastia and postmenopausal symptoms may occur but will decrease when treatment is discontinued
•
That bone pain may increase then decrease
•
To notify prescriber of difficulty urinating, hot flashes
•
Not to breastfeed; to use effective nonhormonal contraception; to notify prescriber if menstrual period continues
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(grane-iss′e-tron)
Granisol, Kytril, Sancuso
Func. class.:
Antiemetic
Chem. class.:
5-HT
3
receptor antagonist
Prevents nausea, vomiting by blocking serotonin peripherally, centrally, and in the small intestine
Prevention of nausea, vomiting associated with cancer chemotherapy, including high-dose CISplatin, radiation
Unlabeled uses:
Acute nausea, vomiting after surgery
Hypersensitivity to this product, benzyl alcohol
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, ondansetron/palonosetron/dolasetron hypersensitivity, cardiac dysrhythmias, cardiac/hepatic disease, electrolyte imbalances
Calculator
• Adult and child ≥2 yr:
IV
10 mcg/kg over 5 min, 30 min before the start of cancer chemotherapy;
TD
apply 1 patch (3.1 mg/24 hr) to upper outer arm 24-48 hr before chemotherapy, patch may be worn up to 7 days
• Adult:
PO
1 mg bid, give 1st dose 1 hr before chemotherapy and next dose 12 hr after 1st or 2 mg as a single dose anytime within 1 hr prior to chemotherapy
• Adult:
PO
2 mg/day 1 hr before radiation
Available forms:
Inj 1 mg/ml; tab 1 mg; oral sol 2 mg/10 ml; patch TD 3.1 mg/24 hr
•
Chemotherapy/radiation: given on day of chemotherapy or radiation
•
Give dose 1 hr before chemotherapy/radiation and another 12 hr after 1st dose
•
May give undiluted over 30 sec via
Y
-site
•
Dilute in 0.9% NaCl for inj or D
5
W (20-50 ml); give over 5-15 min 30 min before chemotherapy
Additive compatibilities:
Dexamethasone, methylPREDNISolone
Solution compatibilities:
D
5
W, 0.9% NaCl
Y-site compatibilities:
Acyclovir, allopurinol, amifostine, amikacin, aminophylline, amphotericin B cholesteryl, ampicillin, ampicillin/sulbactam, amsacrine, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefepime, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, ciprofloxacin, CISplatin, cladribine, clindamycin, cyclophosphamide, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin, dexamethasone, diphenhydrAMINE, DOBUTamine, DOPamine, DOXOrubicin, DOXOrubicin liposome, doxycycline, droperidol, enalaprilat, etoposide, famotidine, filgrastim, fluconazole, fluorouracil, floxuridine, fludarabine, furosemide, gallium, ganciclovir, gentamicin,
haloperidol, heparin hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, leucovorin, LORazepam, magnesium sulfate, melphalan, meperidine, mesna, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, mezlocillin, miconazole, minocycline, mitoMYcin, mitoXANtrone, morphine, nalbuphine, netilmicin, ofloxacin, PACLitaxel, piperacillin, piperacillin/tazobactam, plicamycin, potassium chloride, prochlorperazine, promethazine, propofol, ranitidine, sargramostim, sodium bicarbonate, streptozocin, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vinBLAStine, vinCRIStine, vinorelbine, zidovudine
•
Apply to dry, clean, intact skin of upper outer arm 24-48 hr before chemotherapy, firmly press on skin, keep on during chemotherapy; can bathe, avoid swimming, whirlpool; remove ≥24 hr after chemotherapy completion, do not cut patch
CNS:
Headache, asthenia
, anxiety, dizziness
CV:
Hypertension,
QT prolongation
GI:
Diarrhea,
constipation
, increased AST, ALT,
nausea
HEMA:
Leukopenia,
anemia,
thrombocytopenia
MISC:
Rash,
bronchospasm
Metabolized in liver to an active metabolite, half-life 10-12 hr, protein binding 65%
Increase:
EPS—antipsychotics
Increase:
QT prolongation—amoxapine, β-blockers, chloroquine, class IA, III antidysrhythmics, clozapine, dasatinib, dolasetron, dronedarone, droperidol, erythromycin, flecainide, halogenated/local anesthetics, haloperidol, lapatinib, maprotiline, methadone, octreotide, ondansetron, palonosetron, pentamidine, phenothiazines, pimozide, propafenone, ranolazine, risperiDONE, sertindole, SUNItinib, tacrolimus, telithromycin, tricyclics, troleandomycin, vardenafil, vorinostat, ziprasidone
•
For absence of nausea, vomiting during chemotherapy
•
Hypersensitivity reaction:
rash, bronchospasm
•
Storage at room temp for 24 hr after dilution
•
Therapeutic response: absence of nausea, vomiting during cancer chemotherapy
•
To report diarrhea, constipation, rash, changes in respirations
•
That headache requiring an analgesic is common
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert