Mosby's 2014 Nursing Drug Reference (384 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(tem-oh-zole′oh-mide)
Temodar
Func. class.:
Antineoplastic-alkylating agent
Chem. class.:
Imidazotetrazine derivative
Prodrug that undergoes conversion to MTIC; MTIC action prevents DNA transcription
Anaplastic astrocytoma with relapse, glioblastoma multiforme, malignant glioma
Unlabeled uses:
Metastatic melanoma
Pregnancy (D), breastfeeding; hypersensitivity to this product, carbazine, or gelatin
Precautions:
Geriatric patients, radiation therapy, renal/hepatic disease, bone marrow suppression, infection, myelosuppression
Calculator
• Adult:
PO
adjust dose based on nadir neutrophil and platelet counts 150 mg/m
2
/day × 5 days during a 28-day cycle
• Adult:
PO/IV
75 mg/m
2
/day × 42 days with focal radiotherapy then maintenance of 6 cycles
• Adult:
IV
150 mg/m
2
/day over 90 min on days 1-5 q28days, may increase to 200 mg/m
2
/day on days 1-5 q28days if hematologic parameters permit
Available forms:
Caps 5, 20, 100, 140, 180, 250 mg; powder for inj 100 mg
•
Do not break, crush, chew, open caps
•
Antiemetic 30-60 min before product to prevent vomiting
•
Caps 1 at a time with 8 oz of water at same time of day
•
Fluids IV or PO before chemotherapy to hydrate patient
•
If caps accidentally damaged, do not allow contact with skin or inhale
•
Use proper procedures for handling/disposing of chemotherapy products
•
Give on empty stomach at bedtime to prevent nausea/vomiting
•
Bring vial to room temp, discard if cloudy
•
Inject 41 ml sterile water for inj into vial (2.5 mg/ml)
•
Gently swirl, do not shake
•
Withdraw up to 40 ml from each vial to make total dose, transfer to empty 250-ml PVC inf bag, flush before and after inf
•
Run over 90 min
•
Use reconstituted sol within 14 hr, including inf time
•
Do not admix
CNS:
Seizures,
hemiparesis, dizziness, poor coordination, amnesia, insomnia, paresthesia, somnolence, paresis, ataxia, anxiety, dysphagia, depression, confusion
GI:
Nausea, anorexia, vomiting
, abdominal pain, constipation
GU:
Urinary incontinence, UTI, frequency
HEMA:
Thrombocytopenia, leukopenia,
anemia,
myelosuppression, neutropenia
INTEG:
Rash, pruritus
MISC:
Headache, fatigue, asthenia, fever, edema, back pain, weight increase, diplopia
RESP:
URI, pharyngitis, sinusitis, coughing
SYST:
Anaphylaxis, secondary malignancy
Absorption complete, rapid; crosses blood-brain barrier; excreted in urine, feces; half-life 1.8 hr; peak 1 hr
•
Do not use within 24 hr of sargramostim, filgrastim, G-CSF
Increase:
myelosuppression—radiation, other antineoplastics
Increase:
bleeding risk—NSAIDs, anticoagulants, platelet inhibitors, thrombolytics
Decrease:
antibody reaction—live virus vaccines, toxoids
Decrease:
action of digoxin
Decrease:
drug absorption
Decrease:
Hgb, platelets, WBC, neutrophils
•
Tumor response during treatment
•
CBC on day 22 (21 days after 1st dose), CBC weekly until recovery if ANC is <1.5 × 10
9
/L and platelets <100 × 10
9
/L, do not administer to patients who do not tolerate 100 mg/m
2
, myelosuppression usually occurs late during the treatment cycle
•
Seizures throughout treatment; mental status
•
Monitor temp; may indicate beginning infection
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH), as needed or monthly
•
Bleeding: hematuria, guaiac, bruising, petechiae, mucosa or orifices
•
Storage in light-resistant container in a dry area
•
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 notify prescriber if pregnancy is planned or suspected, pregnancy (D); not to breastfeed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tem-sir-oh′li-mus)
Torisel
Func. class.:
Biologic response modifier
Chem. class.:
Kinase inhibitor, mTOR antagonist
Inhibits mammalian target of rapamycin (mTOR), a protein kinase
Renal cell carcinoma
Unlabeled uses:
Mantle cell lymphoma, relapsed/refractory high-grade malignant gliomas, neuroblastoma, rhabdomyosarcoma in children
Pregnancy (D), breastfeeding; hypersensitivity to this product or to sirolimus; polysorbate 80
Precautions:
Children <13 yr, females, severe pulmonary/renal/hepatic disease (bilirubin >1-1.5×ULN or AST >ULN but bilirubin ≤ULN), diabetes mellitus, hyperkalemia, hyperuricemia, hypertension, bone marrow suppression, hypertriglyceridemia/hyperlipidemia, surgery, brain tumors
Calculator
• Adult:
IV
25 mg over 30-60 min weekly; treat until disease progression or severe toxicity occurs
• Adult:
IV
(mild impairment) bilirubin >1-1.5×ULN or AST >ULN but bilirubin ≤ULN; reduce to 15 mg/wk; (moderate or severe impairment, do not use)
Available forms:
25 mg/ml sol for inj kit
•
Using in-line filter ≤5 microns and inf pump
•
Premedicate with 25-50 mg diphenhydrAMINE IV 30 min before dose; if reaction occurs, stop for 1/2-1 hr, may resume at slower rate
•
Over 30-60 min, complete inf within 6 hr
•
Dilute product with 1.8 ml provided diluent, result is 3 ml (10 mg/ml); invert to mix well; withdraw required amount and inject rapidly into 250 ml of NS; do not use PVC inf bags/sets
•
Protect from light during preparation, use only glass
CNS:
Headache
,
seizures
CV:
Hypertension,
thrombophlebitis
ENDO:
Hypertriglyceridemia, hyperlipidemia, hyperglycemia
GI:
Nausea, vomiting, diarrhea, constipation,
bowel perforation
GU:
UTIs,
albuminuria, hematuria, proteinuria, renal failure,
mucositis
HEMA:
Anemia, leukopenia, thrombocytopenia
INTEG:
Rash
, pruritus
META:
Metabolic acidosis, hyperglycemia, hyperlipidemia
RESP:
Interstitial lung disease
SYST:
Lymphoma
Rapidly absorbed, peak 0.5-2 hr, extensively metabolized via liver by P450 3A4, eliminated via feces
Increase:
blood levels—CYP3A4 inhibitors, antifungals, calcium channel blockers, cimetidine, clarithromycin, danazol, erythromycin, cycloSPORINE, metoclopramide, bromocriptine, HIV-protease inhibitors, benzodiazepines, HMG-CoA reductase inhibitors
Increase:
toxicity—SUNItinib
Decrease:
blood levels—CYP3A4 inducers, carBAMazepine, dexamethasone, PHENobarbital, phenytoin, rifamycin, rifapentine
Decrease:
effect of vaccines—avoid with vaccines
Decrease:
sirolimus effect—St. John’s wort
Increase:
effect—ginseng, maitake, mistletoe
Decrease:
immunosuppression—astragalus, echinacea, melatonin
•
Alters bioavailability; use consistently with/without food; do not use with grapefruit juice
•
Cardiac status: B/P, heart rate
•
Interstitial lung disease
•
Hypersensitivity reactions: anaphylaxis
•
Lipid profile: cholesterol, triglycerides; lipid-lowering agent may be needed; blood glucose
Infection and development of lymphoma
Blood studies: Hgb, WBC, platelets during treatment monthly
•
Renal studies: BUN, creatinine, phosphate potassium; proteinuria, hematuria, albuminemia may indicate renal failure
•
Hepatic disease:
monitor liver function tests at baseline and periodically
•
Therapeutic response: decreased time of progression of renal cell carcinoma
•
To report fever, rash, severe diarrhea, chills, sore throat, fatigue; that serious infections may occur; to report clay-colored stools, cramping
(hepatotoxicity),
excessive thirst, urinary frequency, new or worsening breathing problems, blood in stool, abdominal pain
•
To avoid crowds, persons with known infections to reduce risk of infection
To use contraception before, during, for 12 wk after product discontinued; to avoid breastfeeding; that men should also use reliable contraception during and for 12 wk after cessation of product, pregnancy (D)