Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (307 page)
(pa-kli-tax′el)
albumin-bound (Rx)
Abraxane
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Taxane
Do not confuse:
PACLitaxel
/PARoxetine/Paxil
Inhibits reorganization of microtubule network needed for interphase and mitotic cellular functions; causes abnormal bundles of microtubules during cell cycle and multiple esters of microtubules during mitosis
Taxol:
metastatic carcinoma of the ovary, breast; AIDS-related Kaposi’s sarcoma (2nd-line), non–small-cell lung cancer (1st-line), adjuvant treatment for node-positive breast cancer
Unlabeled uses:
Advanced head, neck, small-cell lung cancer; non-Hodgkin’s lymphoma, adenocarcinoma of the upper GI tract, hormone-refractory prostate cancer, bladder cancer
Pregnancy (D); hypersensitivity to paclitaxel or other products with polyoxyethylated castor oil, albumin
Black Box Warning:
Neutropenia of <1500/mm
3
Precautions:
Breastfeeding, children, females, geriatric patients, cardiovascular/hepatic/renal disease, CNS disorder, bone marrow suppression, dental disease/work, extravasation, herpes, infection, infertility, jaundice, ocular exposure, radiation therapy, thrombocytopenia, vaccination
Black Box Warning:
Taxane hypersensitivity, requires a specialized care setting, requires an experienced clinician
Calculator
• Adult:
IV INF
135 mg/m
2
given over 24 hr q3wk then CISplatin 75 mg/m
2
; or 175 mg/m
2
over 3 hr q3wk; or 175 mg/m
2
over 3 hr
• Adult:
IV/INF
175 mg/m
2
with CISplatin 75 mg/m
2
using a 3-hr regimen q3wk
• Adult:
IV INF
175 mg/m
2
over 3 hr q3wk × 4 courses
• Adult:
IV INF
135 mg/m
2
over 3 hr q3wk or 100 mg/m
2
over 3 hr q2wk
• Adult:
IV INF
135 mg/m
2
/24 hr inf with CISplatin 75 mg/m
2
× 3 wk
• Adult:
for 135 mg/m
2
24-hr IV INF AST/ALT 2-10 × ULN, total bilirubin ≤1.5 mg/dl: 100 mg/m
2
; AST/ALT <10 × ULN, total bilirubin 1.6-7.5 mg/dl: 50 mg/m
2
; AST/ALT ≥10 × ULN or total bilirubin >7.5 mg/dl; avoid use; for 175/m
2
3-hr IV INF AST/ALT <10 × ULN, total bilirubin 1.26-2 × ULN: 135 mg/m
2
; AST/ALT <10 × ULN, total bilirubin 2.01-5 × ULN: 90 mg/m
2
; AST/ALT ≥10 × ULN or total bilirubin >5 × ULN: avoid use
• Adult:
IV
175 mg/m
2
over 3 hr with CARBOplatin
• Adult:
IV
250 mg/m
2
over 24 hr or 175-300 mg/m
2
over 3 hr
• Adult:
IV
250-775 mg/m
2
over 24 hr in combination with other chemotherapy
• Adult:
IV
260 mg/m
2
q3wk
Available forms:
Inj 6 mg/ml, 30 mg/5-ml vial, 100 mg/16.7-ml vial, 150 mg/25-ml vial, 300 mg/50-ml vial; powder for inj, lyophilized 100 mg in single-use vials (Abraxane)
•
CBC, differential, platelet count before treatment and weekly; withhold product if WBC is <1500/mm
3
or platelet count is <100,000/mm
3
; notify prescriber
•
If CISplatin is given, use after taxane
•
Confirmation that dexamethasone was given 12 hr and 6 hr before inf begins
•
Storage of prepared sol up to 27 hr in refrigerator
•
After premedicating with dexamethasone 20 mg PO 12 hr and 6 hr before PACLitaxel, diphenhydrAMINE 50 mg IV 1/2-1 hr before PACLitaxel and cimetidine 300 mg or ranitidine 50 mg IV 1/2-1 hr before PACLitaxel
•
For extravasation if given by regular IV, not port
•
After diluting in 0.9% NaCl, D
5
, D
5
and 0.9% NaCl, D
5
LR (0.3-1.2 mg/ml), chemo dispensing pin or similiar devices with spikes should not be used in vials of Taxol; use in-line filter ≤0.22 micron; may be given as 3-hr or 24-hr inf
•
Using only glass bottles, polypropylene, polyolefin bags and administration sets; do not use PVC inf bags or sets
Y-site compatibilities:
Acyclovir, amikacin, aminophylline, ampicillin/sulbactam, bleomycin, butorphanol, calcium chloride, CARBOplatin, cefepime, cefoTEtan, cefTAZidime, cefTRIAXone, cimetidine, CISplatin, cladribine, cyclophosphamide, cytarabine, dacarbazine, dexamethasone, diphenhydrAMINE, DOXOrubicin, droperidol, etoposide, famotidine, floxuridine, fluconazole, fluorouracil, furosemide, ganciclovir, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, ifosfamide, LORazepam, magnesium sulfate, mannitol, meperidine, mesna, methotrexate, metoclopramide, morphine, nalbuphine, ondansetron, pentostatin, potassium chloride, prochlorperazine, propofol, ranitidine, sodium bicarbonate, thiotepa, vancomycin, vinBLAStine, vinCRIStine, zidovudine
•
Reconstitute vial by injecting 20 ml of 0.9% NaCl; slowly inject 20 ml of 0.9% NaCl over at least 1 min to direct sol flow on wall of vial; do not inject 0.9% NaCl directly onto lyophilized cake (foaming will occur); allow vial to sit for at least 5 min to ensure proper wetting of lyophilized cake; gently swirl or invert vial slowly for ≥2 min until completely dissolved
•
Calculate dose by dosing vol/ml = total dose (mg) ÷ 5 (mg/ml)
CNS:
Peripheral neuropathy
CV:
Bradycardia,
hypotension
, abnormal ECG,
supraventricular tachycardia (SVT)
GI:
Nausea, vomiting, diarrhea, mucositis, stomatitis, increased bilirubin, alk phos, AST
HEMA:
Neutropenia, leukopenia, thrombocytopenia, anemia,
bleeding, infections
INTEG:
Alopecia
,
tissue necrosis,
generalized urticaria,
flushing
MS:
Arthralgia, myalgia
RESP:
Pulmonary embolism,
dyspnea
SYST:
Hypersensitivity reactions
,
anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema
89%-98% of product serum protein bound, metabolized in liver, excreted in bile and urine; terminal half-life 5.3-17.4 hr
Increase:
myelosuppression—other antineoplastics, radiation
Increase:
DOXOrubicin levels—DOXOrubicin
Increase:
toxicity, decrease metabolism—ketoconazole; avoid concurrent use
Increase:
bleeding risk—NSAIDs, anticoagulants
Decrease:
paclitaxel metabolism—verapamil, diazepam, cycloSPORINE, teniposide, etoposide, quiNIDine, dexamethasone, vinCRIStine, testosterone
Decrease:
paclitaxel levels—CYP2C8, CYP2C9 inducers
Decrease:
immune response—live virus vaccines
Increase:
AST/ALT
Decrease:
neutrophils, platelets, WBC, Hgb
Black Box Warning:
Requires a specialized care setting such as a hospital or facility with management of complications; should be used by a clinician experienced in cytotoxic agents
•
Cardiovascular status:
ECG continuously in CV conditions; monitor for hypotension, sinus bradycardia/tachycardia
•
Peripheral neuropathy:
paresthesias, numbness; during inf, use ice packs on extremities to lessen continued neuropathy; may use acupuncture for some relief, use of ice on extremities when infusing
•
Arthralgia, myalgia:
may begin 2-3 days after inf and continue for 4-5 days; may use analgesics
•
Nausea, vomiting:
premedicate with antiemetics; nausea and vomiting occur often
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) prn or monthly, check for jaundiced skin and sclera, dark urine, clay-colored stool, itchy skin, abdominal pain, fever, diarrhea
•
VS during 1st hr of inf, check IV site for signs of infiltration
Hypersensitivity reactions, anaphylaxis:
hypotension, dyspnea, angioedema, generalized urticaria; discontinue inf immediately; keep emergency equipment available, monitor continuously during first 30-60 min then periodically
•
Flush:
for mild to moderate flush, may continue diphenhydrAMINE for ≤48 hr
•
Effects of alopecia on body image; discuss feelings about body changes
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report signs of infection: fever, sore throat, flulike symptoms
•
To report signs of anemia: fatigue, headache, faintness, SOB, irritability
•
To report bleeding; to avoid use of razors, commercial mouthwash; to use soft-bristle toothbrush; to use viscous xylocaine or compounded formula for stomatitis
•
To avoid use of aspirin, ibuprofen
•
To avoid crowds, persons with known infections
•
That hair may be lost during treatment; that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture
•
That pain in muscles and joints 2-5 days after inf is common
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (D), do not breastfeed
•
To avoid receiving vaccinations while taking product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert