Mosby's 2014 Nursing Drug Reference (53 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
HIGH ALERTazaCITIDine (Rx)
(a-za-sie-ti′deen)
Vidaza
Func. class.:
Antineoplastic-nucleoside analog
Chem. class.:
DNA demethylation agent
Do not confuse:
azaCITIDine
/azaTHIOprine
Cytotoxic by producing damage to double-strand DNA during DNA synthesis
Myelodysplastic syndrome (MDS)
Unlabeled uses:
Acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML)
Pregnancy (D), hypersensitivity to product or mannitol, advanced malignant hepatic tumors
Precautions:
Breastfeeding, children, geriatric patients, renal/hepatic disease, baseline albumin <30 g/L; a man should not father a child while taking product
Calculator
• Adult: SUBCUT/IV
75 mg/m
2
/day × 7 days q4wk, dose may be increased to 100 mg/m
2
if no response seen after 2 treatment cycles; minimum treatment, 4 cycles
Available forms:
Powder for inj 100 mg
•
Use cytotoxic handling procedures
•
Reconstitute
with 4 ml sterile water for inj (25 mg/ml), inject diluents slowly
into vial, invert vial 2-3 times, gently rotate; sol will be cloudy, use immediately; divide doses >4 ml into 2 syringes; invert contents 2-3 times, gently roll syringe between the palms for 30 sec immediately before administration, rotate inj site
•
Reconstitute
each vial with 10 ml sterile water for inj, shake well until all solids are dissolved, withdraw sol (10 mg/ml), inject in 50-100 NS or LR inf run over 10-40 min
CNS:
Anxiety, depression, dizziness, fatigue, headache, fever, insomnia
CV:
Cardiac murmur, hypotension, tachycardia, peripheral edema,
chest pain
GI:
Diarrhea, nausea, vomiting
, anorexia,
constipation
, abdominal pain, distention, tenderness, hemorrhoids, mouth hemorrhage, tongue ulceration, stomatitis, dyspepsia,
hepatotoxicity, hepatic coma
GU:
Renal failure, renal tubular acidosis,
dysuria, UTI
HEMA:
Leukopenia, anemia, thrombocytopenia, neutropenia, febrile neutropenia,
ecchymosis, petechiae
INTEG:
Irritation at site, rash
, sweating, pyrexia, pruritus
META:
Hypokalemia
MS:
Weakness, arthralgia, muscle cramps, myalgia, back pain
RESP:
Cough,
dyspnea, pharyngitis
,
pleural effusion
Rapidly absorbed, peak 1/2 hr, metabolized in the liver, half-life 4 hr, excreted in urine
Increase:
bone marrow depression—other antineoplastics
•
For CNS symptoms: fever, headache, chills, dizziness
•
Bone marrow suppression/hematologic response:
CBC with differential, baseline WBC ≥3000/mm
3
, absolute neutrophil count (ANC) ≥1500/mm
3
, platelets >7500/mm
3
, adjust dose based on nadir; ANC <500/mm
3
, platelets <25,000/mm
3
, give 50% dose next course; ANC 500-1500/mm
3
, platelets 25,000-50,000/mm
3
, give 67% next course; bruising, bleeding, blood in stools, urine, sputum, emesis; myelodysplastic syndrome (MDS), splenomegaly
•
Buccal cavity q8hr for dryness, sores, or ulceration, white patches, oral pain, bleeding, dysphagia
•
Myelodysplastic syndrome:
severe anemia, cytopenias, splenomegaly
•
Blood studies: BUN, bicarbonate, creatine, LFTs
•
Increased fluid intake to 2-3 L/day to prevent dehydration unless contraindicated
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss
•
Nutritious diet with iron, vitamin supplement, low fiber, few dairy products
•
Therapeutic response: improvement in blood counts with refractory anemia or refractory anemia with excess blasts
•
To avoid crowds, persons with known infections; not to receive immunizations
•
To avoid foods with citric acid or hot or rough texture if stomatitis is present; to drink adequate fluids
•
To report stomatitis; any bleeding, white spots, ulcerations in mouth; to examine mouth daily, report symptoms, infection site reactions, pruritus, fever
•
To use contraception during and for several months after therapy (pregnancy [D]); not to breastfeed; not to father a child while receiving product
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ay-za-thye′oh-preen)
Azasan, Imuran
Func. class.:
Immunosuppressant
Chem. class.:
Purine antagonist
Do not confuse:
Imuran
/Imferon/Elmiron/IMDUR/Enduron/Tenormin
azaTHIOprine
/azaCITIDine
Produces immunosuppression by inhibiting purine synthesis in cells
Renal transplants to prevent graft rejection, refractory rheumatoid arthritis
Unlabeled uses:
Myasthenia gravis, chronic ulcerative colitis, Crohn’s disease, Behçet’s disease, autoimmune hepatitis, dermatomyositis, thrombocytopenic purpura, lupus nephritis, polymyositis, pulmonary fibrosis, systemic lupus erythematosus (SLE), Wegener’s granulomatosis, vasculitis, atopic dermatitis
Pregnancy (D), hypersensitivity, breastfeeding
Precautions:
Severe renal/hepatic disease, geriatric patients, thiopurine methyltransferase deficiency, infection
Black Box Warning:
Bone marrow suppression, neoplastic disease, must be used by experienced clinician
Calculator
• Adult and child: IV
3-5 mg/kg/day then maintenance
(PO)
of ≥ 1-3 mg/kg/day
• Adult: PO
1 mg/kg/day, may increase dose after 2 mo by 0.5 mg/kg/day and then q4wk, max 2.5 mg/kg/day
• Adult: PO
2-3 mg/kg/day
• Adult/adolescent ≥16 yr: PO
2.5 mg/kg/day
Available forms:
Tabs 50, 75, 100 mg; inj 100 mg
•
For several days before transplant surgery
•
All medications PO if possible; avoid IM inj because bleeding may occur
•
With meals to reduce GI upset
•
Prepare in biologic cabinet with gown, gloves, mask
•
Dilute
to 10 mg/ml with 0.9% NaCl, 0.45% NaCl, D
5
W,
give
over 5 min
•
Reconstitute
100 mg/10 ml of sterile water for inj; rotate to dissolve;
further dilute
with 50 ml or more saline or glucose in saline,
give
over 1/2-1 hr
Y-site compatibilities:
Alfentanil, atracurium, atropine, benztropine, calcium gluconate, cycloSPORINE, enalaprilat, epoetin alfa, erythromycin, fentaNYL, fluconazole, folic acid, furosemide, glycopyrrolate, heparin, insulin, mannitol, mechlorethamine, metoprolol, naloxone, nitroglycerin, oxytocin, penicillin G, potassium chloride, propranolol, protamine, SUFentanil, trimetaphan, vasopressin
Solution compatibilities:
D
5
W, NaCl 0.9%, NaCl 0.45%
GI:
Nausea, vomiting
, stomatitis, esophagitis,
pancreatitis, hepatotoxicity, jaundice, hepatic veno-occlusive disease
HEMA:
Leukopenia, thrombocytopenia, anemia, pancytopenia, bleeding
INTEG:
Rash, alopecia
MISC:
Serum sickness,
Raynaud’s symptoms,
secondary malignancy, infection
MS:
Arthralgia, muscle wasting
Metabolized in liver, excreted in urine (active metabolite), crosses placenta, half-life 3 hr
Increase:
leukopenia—ACE inhibitors, sulfamethoxazole-trimethoprim
Increase:
myelosuppression—cycloSPORINE, mercaptopurine
Increase:
action of azaTHIOprine—allopurinol
Decrease:
immune response—vaccines, toxoids
Decrease:
action of warfarin—warfarin
•
Do not admix with other products
Increase:
LFTs
Decrease:
uric acid
Interference:
CBC, differential count
•
For infection:
increased temp, WBC; sputum, urine
•
I&O, weight daily, report decreasing urine output; toxicity may occur