Mosby's 2014 Nursing Drug Reference (255 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(me-jess′trole)
Megace, Megace ES
Func. class.:
Antineoplastic hormone
Chem. class.:
Progestin
Do not confuse:
Megace
/Reglan
Affects endometrium with antiluteinizing effect; thought to bring about cell death
Breast, endometrial cancer; cachexia, anorexia, weight loss with AIDS
Unlabeled uses:
Hot flashes in women (menopause) or men (prostate cancer), unexplained weight loss in geriatric patients, endometriosis, renal cell cancer (palliative), endometrial cancer, breast cancer (metastatic)
Pregnancy (D) tabs, (X) susp; hypersensitivity
Precautions:
Diabetes, thrombosis, adrenal insufficiency
Calculator
• Adult:
PO
40-320 mg/day in divided doses
• Adult:
PO
40 mg qid or 160 mg/day
• Adult:
PO
800 mg/day (oral susp) or 625 mg/day (ES)
• Adult:
PO
20 mg bid
• Adult:
PO
40-320 mg/day in divided doses × ≥2 mo
Available forms:
Tabs 20, 40 mg; oral susp 40, 125 mg/ml
•
Oral susp for AIDS patients; shake well
•
Tablets for carcinoma
•
Without regard to food
CNS:
Mood swings, insomnia, fever, lethargy, depression
CV:
Thrombophlebitis, thromboembolism,
hypertension
ENDO:
Adrenal insufficiency
GI:
Nausea, vomiting, diarrhea, abdominal cramps, weight gain, flatus, indigestion
GU:
Gynecomastia, fluid retention, hypercalcemia, vaginal bleeding, discharge, impotence, decreased libido, menstruation disorders
INTEG:
Alopecia, rash, pruritus, purpura, itching, sweating
META:
Hyperglycemia
MISC:
Tumor flare
RESP:
Dyspnea
PO:
Half-life 13-105 hr; metabolized in liver; excreted in feces, urine, breast milk; food increases bioavailability of oral sol
•
Do not use with dofetilide
Decrease:
megestrol effect—antidiabetics
Increase:
glucose
•
PSA levels in men (prostate cancer); blood glucose, LFTs, serum calcium, weight
•
Effects of alopecia on body image; feelings about body changes
•
Frequency of stools, characteristics: cramping, acidosis, signs of dehydration (rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness)
•
Anorexia, nausea, vomiting, constipation, weakness, loss of muscle tone
Thrombophlebitis:
Homans’ sign, edema; pain in calf, thigh; notify prescriber immediately
•
Storage in tight container at room temp
•
Therapeutic response: decreased tumor size, spread of malignancy; weight gain in AIDS patients; resolved dysfunctional uterine bleeding
•
To report vaginal bleeding
•
That nonhormonal contraception should be used during and for 4 mo after treatment; pregnancy (D) tabs, (X) susp
•
That gynecomastia, alopecia can occur; reversible after discontinuing treatment
To recognize signs of fluid retention, thromboemboli; to report these immediately
•
To monitor blood glucose if diabetic
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTmelphalan (Rx)
(mel′fa-lan)
Alkeran
Func. class.:
Antineoplastic, alkylating agent
Chem. class.:
Nitrogen mustard
Do not confuse:
melphalan
/Myleran
Responsible for cross-linking DNA strands, thereby leading to cell death; activity is not cell-cycle–phase specific
Multiple myeloma, malignant melanoma, advanced ovarian cancer
Unlabeled uses:
Breast, testicular, prostate carcinoma; osteogenic sarcoma, amyloidosis, chronic myelogenous leukemia, non-Hodgkin’s lymphoma, pediatric rhabdomyosarcoma, stem cell transplant, bone marrow ablation, AML, myelodysplastic syndrome
Pregnancy (D), breastfeeding, other nitrogen mustards
Black Box Warning:
Hypersensitivity to this product
Precautions:
Children, radiation therapy, infections, renal disease
Black Box Warning:
Bone marrow depression, secondary malignancy, radiation therapy; requires an experienced clinician
Calculator
• Adult:
PO
6 mg daily × 2-3 wk, adjust dose based on blood counts or 10 mg daily × 7-10 day
• Adult:
IV INF
16 mg/m
2
, reduce with renal insufficiency, give over 15-20 min, give at 2-wk intervals × 4 doses then at 4-wk intervals
• Adult:
PO
200 mcg/kg/day × 5 days q4-5wk
• Adult:
PO
150 mcg/kg/day × 7 days q4wk; when leukocytes normal, give 50 mcg/kg/day maintenance
• Child:
IV
10-35 mg/m
2
q21-28days
Available forms:
Tabs 2 mg, powder for inj 50 mg
•
Antiemetic 30-60 min before product to prevent vomiting
•
Give on empty stomach
•
Protect from light, store refrigerated
•
Use gloves during administration; if skin exposure occurs, wash immediately with soap and water, use cytotoxic handling procedures
•
Give after reconstituting with 10 ml diluent provided (5 mg/ml); shake, dilute dose with 0.9% NaCl (≤0.45 mg/ml), give within 1 hr, run over ≥15 min; degrading of product occurs rapidly, make sure infusion is completed in time specified
Y-site compatibilities:
Acyclovir, amikacin, aminophylline, ampicillin, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cimetidine, CISplatin, clindamycin, cyclophosphamide, cytarabine, dacarbazine, DACTINomycin, DAUNOrubicin, dexamethasone, diphenhy-drAMINE, DOXOrubicin, doxycycline, droperidol, enalaprilat, etoposide, famotidine, floxuridine, fluconazole, flu-darabine, fluorouracil, furosemide, gallium, ganciclovir, gentamicin, grani-setron, haloperidol, heparin, hydrocortisone, hydrocortisone sodium phosphate, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, LORazepam, mannitol, mechlorethamine, meperidine, mesna, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, miconazole, minocycline, mitoMYcin, mitoXANtrone, morphine, nalbuphine, netilmicin, ondansetron, pentostatin, piperacillin, plicamycin, potassium chloride, prochlorperazine, promethazine, ranitidine, sodium bicarbonate, streptozocin, teniposide, thiotepa, ticarcillin, ticarcillin/clavulanate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vinBLAStine, vinCRIStine, vinorelbine, zidovudine
GI:
Nausea, vomiting
, stomatitis, diarrhea,
hepatitis
GU:
Amenorrhea, hyperuricemia, gonadal suppression, hyperuricemia
HEMA:
Thrombocytopenia, neutropenia, leukopenia,
anemia
INTEG:
Rash, urticaria, alopecia, pruritus
RESP:
Fibrosis, dysplasia,
dyspnea, pneumonitis
SYST:
Anaphylaxis,
allergic reactions,
secondary malignancies,
edema
Metabolized in liver, excreted in urine, half-life 1½ hr, protein binding 80%-90%
•
Avoid administration of sargramostim, GM-CSF, filgrastim, G-CSF 14 hr before or 24 hr after product
Increase:
toxicity—antineoplastics, radiation
Increase:
pulmonary toxicity—carmustine
Increase:
renal failure risk—cycloSPORINE
Increase:
enterocolitis risk—nalidixic acid
Increase:
bleeding risk—NSAIDs, anticoagulants, salicylates, thrombolytics, platelet inhibitors
Decrease:
antibody response—live virus vaccines
Black Box Warning:
Bone marrow depression:
CBC, differential, platelet count weekly; withhold product if WBC is <3000/mm
3
or platelet count is <100,000/mm
3
; notify prescriber; recovery usually occurs in 6 wk
•
Renal studies: BUN, serum uric acid before, during therapy
•
I&O ratio; report fall in urine output to 30 ml/hr
•
Infection:
fever, cough, temp, chills, sore throat; notify prescriber
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed; jaundiced skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea
•
Bleeding:
hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr
•
Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
•
Local irritation, pain, burning, discoloration at inj site
•
Hyperuricemia:
joint pain, edema, increased uric acid, increase fluids to >2 L unless contraindicated
Severe allergic reaction:
rash, pruritus, urticaria, purpuric skin lesions, itching, flushing; assess allergy to chlorambucil; cross-sensitivity may occur
•
Increase fluid intake to 2-3 L/day to prevent urate deposits, calculi formation
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
•
Therapeutic response: decreased tumor size, spread of malignancy
•
That usually sterility, amenorrhea occur; reversible after discontinuing treatment
•
To avoid foods with citric acid, hot or rough texture
•
To report any bleeding, white spots, or ulcerations in mouth to prescriber; to examine mouth daily
•
To report signs of infection: fever, sore throat, flulike symptoms
•
To report suspected pregnancy; to use contraception during treatment; pregnancy (D)
•
To report signs of anemia: fatigue, headache, faintness, SOB, irritability
•
To avoid use of razors, commercial mouthwash
•
To avoid use of aspirin products, NSAIDs, alcohol