Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (68 page)
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Appendix B
HIGH ALERTbortezomib (Rx)
(bor-tez′oh-mib)
Velcade
Func. class.:
Antineoplastic—miscellaneous
Chem. class.:
Proteasome inhibitor
Reversible inhibitor of chymotrypsin-like activity in mammalian cells; causes delay in tumor growth by disrupting normal homeostatic mechanisms
Multiple myeloma previously untreated or when at least 2 other treatments have failed; mantle cell lymphoma who have received ≥1 prior therapy
Unlabeled uses:
Non-Hodgkin’s lymphoma (NHL)
Pregnancy (D), breastfeeding; hypersensitivity to product, boron, mannitol
Precautions:
Children, geriatric patients, peripheral neuropathy, renal/hepatic disease, hypotension, tumor lysis syndrome, thrombocytopenia, infection, diabetes mellitus, bone marrow suppression
Calculator
• Adult: IV BOL/SUBCUT
Give for nine 6-wk cycles; cycles 1-4, 1.3 mg/m
2
/dose given on days 1, 4, 8, 11, then a 10-day rest period (days 12-21), then give again on days 22, 25, 29, 32, then a 10-day rest period (days 33-42); given with melphalan (9 mg/m
2
/day on days 1-4) and predniSONE (60 mg/m
2
/day on days 1-4); during cycles 5-9, give bortezomib 1.3 mg/m
2
/dose on days 1, 8, 22, 29 with melphalan (9 mg/m
2
/day on days 1-4) and predniSONE (60 mg/m
2
/day on days 1-4); this 6-wk cycle is considered 1 course; at least 72 hr should elapse between consecutive doses
• Adult: IV BOL/SUBCUT
1.3 mg/m
2
/dose on days 1, 4, 8, 11 followed by a 10-day rest period (days 12 to 21); max 8 cycles
• Adult: IV
bilirubin >1.5 × ULN, reduce to 0.7 mg/m
2
during cycle 1; consider dose escalation to 1 mg/m
2
or further reduction to 0.5 mg/m
2
during next cycles based on tolerability
• Adult: IV BOL
1.3 mg/m
2
on days 1, 4, 8, 11 repeated every 21 days
Available forms:
Lyophilized powder for inj 3.5 mg
•
Reconstitute
each vial with 3.5 ml of 0.9% NaCl (1 mg/ml); sol should be clear/colorless;
inj
as bolus over 3-5 sec
•
Store unopened product at room temperature, protect from light
•
Wear protective clothing during han
dling, preparation; avoid contact with skin
CNS:
Anxiety, insomnia, dizziness, headache,
peripheral neuropathy
, rigors, paresthesia, fever
CV:
Hypotension
, edema,
CHF
GI:
Abdominal pain,
constipation, diarrhea
, dyspepsia,
nausea, vomiting
, anorexia
HEMA:
Anemia
,
neutropenia, thrombocytopenia
MISC:
Dehydration, weight loss, herpes zoster,
rash
, pruritus, blurred vision
MS:
Fatigue, malaise, weakness
, arthralgia, bone pain, muscle cramps, myalgia, back pain,
tumor lysis syndrome
RESP:
Cough, pneumonia, dyspnea, URI
Half-life 9-15 hr, protein binding 83%, metabolized by CYP450 enzymes (3A4, 2D6, 2C19, 2C9, 1A2)
•
Do not use hematopoietic progenitor cells (sargramostim, filgrastim) within 24 hr of chemotherapy
•
Oral hypoglycemics: may result in hypo/hyperglycemia
Increase:
risk for bleeding—anticoagulants, NSAIDs, platelet inhibitors, salicylates, thrombolytics
Increase:
hypotension—antihypertensives
Increase:
peripheral neuropathy—amiodarone, antivirals (amprenavir; atazanavir; didanosine, lamiVUDine, 3TC; ritonavir; stavudine, zidovudine), chloramphenicol, CISplatin, colchicine, cycloSPORINE, dapsone, disulfiram, DOCEtaxel, gold salts, HMG-CoA reductase inhibitors, iodoquinol, INH, metroNIDAZOLE, nitrofurantoin, oxaliplatin, PACLitaxel, penicillamine, phenytoin, sulfaSALAzine, thalidomide, vinBLAStine, vinCRIStine, zalcitabine ddc, isoniazid, statins, others
Increase:
toxicity or decrease efficacy when administered with products that induce or inhibit CYP3A4
Increase:
toxicity or decrease efficacy—St. John’s wort
•
Hematologic status: platelets, CBC throughout treatment; platelets ≥70 × 10
9
/L and ANC ≥1.0 × 10
9
/L before any cycle; nonhematologic toxicities should be grade 1 or baseline before any cycle
•
For extravasation at inj site
•
B/P, fluid status, peripheral neuropathy symptoms
•
Therapeutic response: improvement of multiple myeloma symptoms
•
To use contraception while taking this product (pregnancy [D]); to avoid breastfeeding
•
To monitor blood glucose levels if diabetic
•
To contact prescriber about new or worsening peripheral neuropathy, severe vomiting, diarrhea, easy bruising, bleeding, infection
•
To avoid driving, operating machinery until effect is known
•
To avoid using other medications unless approved by prescriber
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(boh′sen-tan)
Tracleer
Func. class.:
Vasodilator
Chem. class.:
Endothelin receptor antagonist
Peripheral vasodilation occurs via the antagonism of the effect of endothelin on endothelium and vascular smooth muscle
Pulmonary arterial hypertension with WHO class III, IV symptoms
Unlabeled uses:
Septic shock to improve microcirculatory blood flow, functional class II pulmonary arterial hypertension
Hypersensitivity, CVA, CAD
Black Box Warning:
Pregnancy X
Precautions:
Breastfeeding, children, geriatric patients, mitral stenosis
Black Box Warning:
Hepatic disease
Calculator
• Adult and adolescent >40 kg: PO
62.5 mg bid × 4 wk then 125 mg bid
• Adult and adolescent <40 kg: PO
62.5 mg bid
Available forms:
Tabs 62.5, 125 mg
•
Give without regard to meals
•
Only available through the TAP program; 866-228-3546
•
Do not stop product abruptly; taper
CNS:
Headache, flushing, fatigue, fever
CV:
Hypo/hypertension
, palpitations, edema of lower limbs, fluid retention
GI:
Abnormal hepatic function, diarrhea, dyspepsia,
hepatotoxicity
HEMA:
Anemia, leukopenia, neutropenia, lymphopenia, thrombocytopenia
INTEG:
Pruritus,
anaphylaxis,
rash,
Stevens-Johnson syndrome, toxic epidermal necrolysis
MISC:
Oligospermia,
tumor lysis syndrome
SYST:
Secondary malignancy
Metabolized by inducer of CYP2C9, CYP3A4, possibly CYP2C19; metabolized by the liver; terminal half-life 5 hr; steady state 3-5 days
•
Do not coadminister cycloSPORINE with bosentan; bosentan is increased, cycloSPORINE is decreased
•
Do not coadminister glyBURIDE with bosentan; glyBURIDE is decreased significantly, bosentan is also decreased, hepatic enzymes may be increased
Increase:
bosentan effects—CYP2C9, CYP3A4 inhibitors
Increase:
bosentan level—ketoconazole
Decrease:
effects of warfarin, hormonal contraceptives, statins
Increase:
ALT, AST
Decrease:
Hgb, Hct
•
Serious skin toxicities:
Angioedema occurring 8-21 days after initiating therapy
•
B/P, pulse during treatment until stable
•
Blood studies: Hct, Hgb after 1 month, 3 months, then every 3 months may be decreased
•
Pulmonary hypertension/CHF: Fluid retention, weight gain, increased leg edema; may occur within weeks
Black Box Warning:
Hepatic toxicity:
vomiting, jaundice; product should be discontinued; hepatic studies: AST, ALT, bilirubin; hepatic enzymes may increase; if ALT/AST >3× and ≤5× ULN, decrease dose or interrupt treatment and monitor AST/ALT q2wk; if bilirubin >2× ULN or signs of hepatitis or hepatic disease are present, stop treatment
•
Storage at room temp
•
Therapeutic response: decrease in pulmonary hypertension
•
To report jaundice, dark urine, joint pain, fatigue, malaise, bruising, easy bleeding
Black Box Warning:
Pregnancy (X), monitor pregnancy test monthly
•
To avoid pregnancy; to use nonhormonal form of contraception, hormonal contraceptives may not be effective
•
That lab work will be required periodically
•
To take without regard to food