Mosby's 2014 Nursing Drug Reference (40 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(an-ah-kin′rah)
Kineret
Func. class.:
Antirheumatic (DMARD), immunomodulator
Chem. class.:
Recombinant form of human interleukin-1 receptor antagonist (IL-1Ra)
Do not confuse:
Anakinra
/amikacin
A form of human interleukin-1 receptor antagonist (IL-1Ra) produced by DNA technology; blocks activity of IL-1, thereby resulting in decreased inflammation, cartilage degradation, bone resorption
Reduction in signs and symptoms of moderate to severe active rheumatoid arthritis in patients ≥18 yr who have not responded to other disease-modifying agents
Unlabeled uses:
Cryopyrin-associated periodic syndromes
Hypersensitivity to
Escherichia-coli
–derived proteins, product, latex; sepsis
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, renal impairment, active infections, immunosuppression, neoplastic disease, asthma
Calculator
• Adult:SUBCUT
100 mg/day
• Adult:
CCr <30 ml/min
SUBCUT
100 mg every other day
Available form:
Inj 100 mg/0.67 ml prefilled glass syringe
•
Do not use if cloudy, discolored, if particulate is present; protect from light
•
Do not admix with other sol or medications; do not use filter; give at same time each day
•
Apply cold compress before, after inj, allow sol to warm to room temp before use
•
Use middle thigh, abdomen (outside 2 inches from navel), upper outer buttocks, upper outer area of arm; rotate sites, give inj at least 1 inch from old site; do not give in skin that is bruised, red, tender, hard; remove needle cover immediately before use, pull gently back on plunger, if no blood appears, inject entire contents of prefilled syringe; discard any unused portion
CNS:
Headache
CV:
Cardiac arrest
EENT:
Sinusitis
GI:
Abdominal pain, nausea, diarrhea
HEMA:
Neutropenia
INTEG:
Rash,
inj site reaction
, allergic reaction
MISC:
Flulike symptoms, infection
MS:
Worsening of RA, arthralgia
RESP:
URI
Terminal half-life 4-6 hr; eliminated renally
•
Do not use rilonacept
Increase:
risk for severe infection—TNF-blocking agents, do not use together
Decrease:
antibody reactions—vaccines, avoid concurrent use
•
Rheumatoid arthritis:
pain, stiffness, ROM, swelling of joints, baseline, periodically during treatment
•
For inj site pain, swelling; usually occurs after 2 inj (4-5 days)
•
For infections (increased WBC, fever, flulike symptoms); stop treatment if present, do not start if patient has active infection
•
CBC with differential, neutrophil counts before treatment, monthly × 3 mo, quarterly for up to 1 yr thereafter
•
For allergic reactions (rash, dyspnea); discontinue if severe
•
For urinary status: decreasing urinary output
•
Therapeutic response: decreased inflammation, pain in joints
•
Not to receive vaccines while taking this product; to update vaccines before treatment
•
About self-administration, if appropriate: inj should be made in thigh, abdomen, upper arm; rotate sites at least 1 inch from old site; give at same time of day, store in refrigerator, do not freeze
•
To notify prescriber if pregnancy is planned, suspected, to avoid breastfeeding; to notify prescriber of allergic reaction, decreasing urine output, signs/symptoms of infection
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERT(an-a-stroh′zole)
Arimidex
Func. class.:
Antineoplastic
Chem. class.:
Aromatase inhibitor
Highly selective nonsteroidal aromatase inhibitor that lowers serum estradiol concentrations; many breast cancers have strong estrogen receptors
Advanced breast carcinoma not responsive to other therapy in estrogen-receptor–positive patients (postmenopausal); patients with advanced disease taking tamoxifen, adjunct therapy for early breast cancer
Unlabeled uses:
Uterine leiomyomata, breast cancer (in those who have received tamoxifen for 2-3 yr)
Pregnancy (X), breastfeeding, hypersensitivity
Precautions:
Children, geriatric patients, premenopausal women, osteoporosis, hepatic/cardiac disease
Calculator
• Adult: PO
1 mg/day
Available forms:
Tabs 1 mg
•
Give without regard to meals at same time of day
CNS:
Hot flashes, headache, light-headedness
, depression, dizziness, confusion, insomnia, anxiety, fatigue, mood changes
CV:
Chest pain,
hypertension
,
thrombophlebitis,
edema
, angina,
MI, cerebral infarct, CVA,
vasodilation
GI:
Nausea, vomiting
, altered taste leading to anorexia, diarrhea, constipation, abdominal pain, dry mouth
GU:
Vaginal bleeding, vaginal dryness, pelvic pain, pruritus vulvae, UTI
HEMA:
Leukopenia
INTEG:
Rash
,
Stevens-Johnson syndrome,
anemia
MISC:
Hypercholesterolemia
MS:
Bone pain, myalgia,
asthenia
, bone loss/osteoporosis, arthralgia, fractures
RESP:
Cough, sinusitis, dyspnea,
pulmonary embolism
Peak 2 hr; half-life 50 hr; excreted in feces, urine, terminal half-life 50 hr
•
Do not use with oral contraceptives, estrogen, tamoxifen, androstenedione, DHEA
Increase:
GGT, AST, ALT, alk phos, cholesterol, LDL
•
Bone mineral density, cholesterol, lipid panel, periodically
Serious skin reactions:
Stevens-Johnson syndrome
•
Not effective in hormone-receptor–negative disease, use only in postmenopausal women
•
Storage in light-resistant container at room temp
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report any complaints, side effects to prescriber
•
That vaginal bleeding, pruritus, hot flashes reversible after discontinuing treatment
•
To report continued vaginal bleeding immediately
•
That
tumor flare
—increase in size of tumor, increased bone pain—may occur and will subside rapidly; may take analgesics for pain
•
To take adequate calcium and vitamin D due to risk for bone loss/fractures
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert