Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (78 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(cap-eh-sit′ah-bean)
Xeloda
Func. class.:
Antineoplastic, antimetabolite
Chem. class.:
Fluoropyrimidine carbamate
Do not confuse:
Xeloda
/Xenical
Competes with physiologic substrate of DNA synthesis, thereby interfering with cell replication in the S phase of cell cycle (before mitosis); also inter
feres with RNA and protein synthesis; product is converted to 5-FU
Monotherapy for PACLitaxel; anthracycline-resistant, metastatic breast, colorectal cancer when 5-FU monotherapy is preferred; treatment of colorectal cancer patients who have undergone complete resection of their primary tumors
Unlabeled uses:
Biliary tract, ovarian cancer
Pregnancy (D), hypersensitivity to 5-FU, infants, severe renal impairment (CCr <30 ml/min), DPD deficiency
Precautions:
Breastfeeding, children, geriatric patients, renal/hepatic disease
Calculator
• Adult:
PO
2500 mg/m
2
/day divided q12hr after a meal × 2 wk, repeat q3wk
• Adult:
PO
2500 mg/m
2
/day divided q12hr after a meal on days 1-14, with docetaxel 75 mg/m
2
IV on day 1
• Adult:
PO
2000 mg/m
2
/day divided q12hr after a meal on days 1-14 with lapatinib 1250 mg/day on days 1-21, repeat q21days
• Adult:
PO
2000 mg/m
2
/day divided q12hr on days 1-14 with ixabepilone 40 mg/m
2
IV over 3 hr, repeat q3wk
• Adult:
PO
2500 mg/m
2
/day divided q12hr within 30 min of a meal × 2 wk, repeat q3wk for 8 cycles
• Adult:
PO
2500 mg/m
2
/day divided q12hr after a meal × 2 wk, repeat q3wk
• Adult:
PO
2000 mg/m
2
/day divided q12hr after a meal on days 1-14 with oxaliplatin on day 1, repeat q3wk
• Adult:
PO
2000 mg/m
2
/day divided q12hr on days 1-14 and oxaliplatin 130 mg/m
2
IV on day 1, repeat q3wk
• Adult:
PO
2500 mg/m
2
divided q12hr on days 1-14, then 7-day rest period; given with CISplatin 60 mg/m
2
IV over 1 hr on day 1, repeat q21days
• Adult:
PO
CCr 30-50 ml/min, decrease initial dose to 75% of usual dose; CCr <30 ml/min, contraindicated
Available forms:
Tabs 150, 500 mg
•
Dosage adjustments of capecitabine monotherapy based on most severe toxicity OR when used in combination with ixabepilone based on nonhematologic toxicity: Grade 1 toxicity:
maintain current dosage;
Grade 2 toxicity (1st appearance):
interrupt therapy until toxicity is resolved to grade 0–1; do not replace missed doses, begin the next cycle with 100% of the starting dose;
Grade 2 toxicity (2nd appearance):
interrupt therapy until toxicity is resolved to grade 0–1; do not replace missed doses, begin the next cycle with 75% of the starting dose;
Grade 2 toxicity (3rd appearance):
interrupt therapy until toxicity is resolved to grade 0–1; do not replace missed doses, begin the next cycle with 50% of the starting dose;
Grade 2 toxicity (4th appearance):
discontinue treatment permanently;
Grade 3 toxicity (1st appearance):
interrupt therapy until toxicity is resolved to grade 0–1
CNS:
Dizziness,
headache, paresthesia, fatigue
, insomnia
CV:
Venous thrombosis
GI:
Nausea, vomiting, anorexia, diarrhea, stomatitis, abdominal pain, constipation, dyspepsia
,
intestinal obstruction, necrotizing enterocolitis,
hyperbilirubinemia,
hepatic failure
HEMA:
Neutropenia, lymphopenia, thrombocytopenia,
anemia
INTEG:
Hand and foot syndrome, dermatitis
, nail disorders
OTHER:
Eye irritation, edema, myalgia
, limb pain,
pyrexia
, dehydration
RESP:
Cough, dyspnea
,
pulmonary embolism
Readily absorbed, peak 1½ hr, food decreases absorption, extensively metabolized in the liver, elimination half-life 45 min
Increase:
toxicity—leucovorin
Increase:
capecitabine levels—antacids (aluminum, magnesium)
Increase:
phenytoin level—phenytoin
Black Box Warning:
Increase:
bleeding risk—anticoagulants
Increase:
absorption; give within 30 min of a meal
Increase:
bilirubin
Decrease:
Hgb/HcT/RBC, neutrophils, platelets, WBC
•
Bone marrow suppression,
CBC (RBC, Hct, Hgb), differential, platelet count weekly; withhold product if WBC is <4000/mm
3
, platelet count is <75,000/mm
3
, or RBC, Hct, Hgb low; notify prescriber of these results; frequently monitor INR in those receiving warfarin concurrently
•
Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy
•
Monitor temp q4hr; fever may indicate beginning infection; no rectal temps
•
Hepatic studies before, during therapy: bilirubin, ALT, AST, alk phos as needed or monthly
Black Box Warning:
Bleeding:
hematuria, heme-positive stools, bruising or petechiae of mucosa or orifices q8hr, monitor INR and PT in those taking anticoagulants
•
Dyspnea, crackles, unproductive cough, chest pain, tachypnea, fatigue, increased pulse, pallor, lethargy; personality changes with high doses
•
Hand and foot syndrome:
paresthesia, tingling, painful/painless swelling, blistering, erythema with severe pain of hands or feet
•
Toxicity:
severe diarrhea (multiple times/day or at night), nausea, vomiting, stomatitis, fever
•
Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
•
GI symptoms:
frequency of stools, cramping; if severe diarrhea occurs, fluid, electrolytes may need to be given
•
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To avoid foods with citric acid, hot or rough texture if stomatitis is present; take with water within 30 min of end of meal
•
To notify prescriber if pregnancy is planned or suspected, pregnancy (D); to avoid pregnancy while taking this product; not to breastfeed
•
Not to double dose if dose is missed
To immediately report severe diarrhea, vomiting, stomatitis, fever of more than 100° F (37.8° C), hand and foot syndrome, anorexia
•
To report signs of
infection:
increased temp, sore throat, flulike symptoms; signs of
anemia:
fatigue, headache, faintness, shortness of breath, irritability;
bleeding;
to avoid use of razors, commercial mouthwash
•
OTC antidiarrheals for mild diarrhea (4-6 stools/day or diarrhea at night)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert