Mosby's 2014 Nursing Drug Reference (421 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTvinCRIStine (
VCR
) (Rx)
(vin-kris′teen)
Vincasar PFS
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Vinca alkaloid
Do not confuse:
vinCRIStine
/vinBLAStine/vinorelbine
Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant
Lymphomas, neuroblastoma, Hodgkin’s disease, acute lymphoblastic and other leukemias, rhabdomyosarcoma, Wilms’ tumor, non-Hodgkin’s lymphoma, malignant glioma, soft-tissue sarcoma
Unlabeled uses:
Lung, breast, colorectal, head/neck, osteogenic sarcomas; small-cell lung cancer, trophoblastic disease
Pregnancy (D), breastfeeding, infants, hypersensitivity, radiation therapy
Black Box Warning:
Intrathecal use
Precautions:
Renal/hepatic disease, hypertension, neuromuscular disease
Black Box Warning:
Extravasation
Calculator
• Adult:
IV
0.4-1.4 mg/m
2
/wk, max 2 mg
• Child:
IV
1-2 mg/m
2
/wk, max 2 mg
Available forms:
Inj 1 mg/ml; powder for inj 5 mg/vial
•
Antiemetic 30-60 min before product and prn
•
Antispasmodic for GI symptoms
Black Box Warning:
Do not give intrathecally; fatal
•
After diluting with diluent provided or 1 mg/10 ml sterile water or NaCl; give through
Y
-tube or 3-way stopcock or directly over 1 min; do not use 5-mg vial for single doses
Black Box Warning:
Hyaluronidase 150 units/ml in 1 ml NaCl; apply warm compress for extravasation
Additive compatibilities:
Bleomycin, cytarabine, fluorouracil, methotrexate
Syringe compatibilities:
Bleomycin, CISplatin, cyclophosphamide, doxapram, DOXOrubicin, droperidol, fluorouracil, heparin, leucovorin, methotrexate, metoclopramide, mitomycin, vinBLAStine
Y-site compatibilities:
Allopurinol, amifostine, amphotericin B cholesteryl, aztreonam, bleomycin, CISplatin, cladribine, cyclophosphamide, DOXOrubicin, DOXOrubicin liposome, droperidol, filgrastim, fludarabine, fluorouracil, granisetron, heparin, leucovorin, melphalan, methotrexate, metoclopramide, mitoMYcin, ondansetron, PACLitaxel, piperacillin/tazobactam, sargramostim, teniposide, thiotepa, vinBLAStine, vinorelbine
CNS:
Decreased reflexes, numbness, weakness, motor difficulties
, CNS depression, cranial nerve paralysis,
seizures,
peripheral neuropathy
CV:
Orthostatic hypotension
EENT:
Diplopia
GI:
Nausea, vomiting, anorexia, stomatitis, constipation
,
paralytic ileus,
abdominal pain
,
hepatotoxicity
GU:
Renal tubular obstruction
HEMA:
Thrombocytopenia, leukopenia, myelosuppression, anemia
INTEG:
Alopecia
, extravasation
SYST:
Tumor lysis syndrome (TLS)
Half-life (triphasic) <5 min, 50-155 min, 23-85 hr; metabolized in liver; excreted in bile, feces; crosses placental, blood-brain barrier
Decrease:
immune response—vaccines, toxoids
Decrease:
digoxin level—digoxin
Decrease:
vinCRIStine effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)
Increase:
Neurotoxicity: peripheral nervous system products
•
Do not use with radiation
•
Acute pulmonary reactions: mitoMYcin c
Increase:
toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole)
•
Avoid use with St. John’s wort
Increase:
uric acid
Decrease:
Hgb, WBC, platelets, sodium
•
CBC, differential, platelet count before each dose; withhold product if WBC is <4000/mm
3
or platelet count is <75,000/mm
3
; notify prescriber; RBC, Hct, Hgb; may be decreased
•
Bronchospasm:
more common with mitoMYcin
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly
•
Sensitivity of feet/hands, which precedes neuropathy
•
Tumor lysis syndrome:
hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; more common in leukemia, lymphoma; use alkalinization of urine with allopurinol, monitor electrolytes, renal function (BUN, urine, CCR, uric acid)
Black Box Warning:
Extravasation:
pain, swelling, poor blood return; if extravasation occurs, local inj of hyaluronidase and moderate heat to area may help disperse product
•
Bleeding:
hematuria, guaiac, bruising, petechiae, mucosa or orifices q8hr
•
Effects of alopecia on body image; discuss feelings about body changes
•
Buccal cavity q8hr for dryness, sores, ulcerations, white patches, oral pain, bleeding, dysphagia
•
Symptoms indicating severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
•
Brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To report change in gait or numbness in extremities; may indicate neuropathy
•
To report any bleeding, white spots or ulcerations in mouth to prescriber; to examine mouth daily
•
To increase bulk, fluids, exercise to prevent constipation
•
Infection:
to report sore throat, fever, flulike symptoms; avoid persons with known infection
•
To avoid vaccinations
•
That hair may be lost; that hair will grow back but with different texture, color
•
Pregnancy (D):
to notify prescriber if pregnancy is planned or suspected
To use effective contraception during and for 2 mo after therapy, pregnancy (D), to avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert