A



A



abacavir


a-bak-a-veer


(Ziagen)


BLACK BOX ALERT Serious, sometimes fatal hypersensitivity reactions, lactic acidosis, severe hepatomegaly with steatosis (fatty liver) have occurred.
















Nursing considerations


Baseline assessment


Question for possibility of pregnancy. Obtain baseline laboratory testing, esp. CBC, hepatic function tests, before beginning therapy and at periodic intervals during therapy. Increased risk of sensitivity (cutaneous, GI, pulmonary) in those with positive HLA-B 5701 genotype status. Offer emotional support.





abataceptimage


a-bay-ta-sept


(Orencia)


Do not confuse Orencia with Oracea.











Administration/handling


imageIV


Reconstitution • Reconstitute powder in each vial with 10 ml Sterile Water for Injection using the silicone-free syringe provided with each vial and an 18- to 21-gauge needle. • Rotate solution gently to prevent foaming until powder is completely dissolved. • From a 100-ml 0.9% NaCl infusion bag, withdraw and discard an amount equal to the volume of the reconstituted vials (for 2 vials remove 20 ml, for 3 vials remove 30 ml, for 4 vials remove 40 ml). • Slowly add the reconstituted solution from each vial into the infusion bag using the same syringe provided with each vial. • Concentration in the infusion bag will be 10 mg/ml or less abatacept.


Rate of Administration • Infuse over 30 min using a 0.2- to 1.2-micron low protein-binding filter.


Storage • Store vials in refrigerator. • Any reconstitution that has been prepared by using siliconized syringes will develop translucent particles and must be discarded. • Solution should appear clear and colorless to pale yellow. Discard if solution is discolored or contains precipitate. • Solution is stable for up to 24 hrs after reconstitution. • Reconstituted solution may be stored at room temperature or refrigerated.





Indications/routes/dosage


Rheumatoid arthritis (RA)


IV: BODY WEIGHT 101 KG OR MORE: 1 g (4 vials) given as a 30-min infusion. Following initial therapy, give at 2 wks and 4 wks after first infusion, then q4wks thereafter. BODY WEIGHT 60–100 KG: 750 mg (3 vials) given as a 30-min infusion. Following initial therapy, give at 2 wks and 4 wks after first infusion, then q4wks thereafter. BODY WEIGHT 59 KG OR LESS: 500 mg (2 vials) given as a 30-min infusion. Following initial therapy, give at 2 wks and 4 wks after first infusion, then q4wks thereafter.


Subcutaneous: Following a single IV infusion, 125 mg given within a day, then 125 mg once a week.







abciximabimage


ab-sik-si-mab


(c7E3 Fab, ReoPro)







Precautions


Contraindications: Active internal bleeding, arteriovenous malformation or aneurysm, CVA with residual neurologic deficit, history of CVA (within the past 2 yrs) or oral anticoagulant use within the past 7 days unless PT is less than 1.2× control, history of vasculitis, hypersensitivity to murine proteins, intracranial neoplasm, prior IV dextran use before or during percutaneous transluminal coronary angioplasty (PTCA), recent surgery or trauma (within the past 6 wks), recent GI or GU bleeding (within the past 6 wks), thrombocytopenia (less than 100,000 cells/mcl), and severe uncontrolled hypertension. Concomitant use of another glycoprotein IIb/IIIa inhibitor. Cautions: Pts who weigh less than 75 kg; those older than 65 yrs; those with history of GI disease; those receiving thrombolytics; PTCA in less than 12 hrs of onset of symptoms for acute MI; prolonged PTCA (longer than 70 min); failed PTCA.






Administration/handling


imageIV


Reconstitution • Bolus dose: Withdraw bolus dose into syringe using a 0.2- or 0.5-micron low protein-binding filter. • Continuous infusion: Withdraw dose through a 0.2- or 0.5-micron low protein-binding filter and further dilute into 250 ml D5W or 0.9% NaCl.


Rate of Administration • Bolus given over 1 min.


Administration Precautions • Give in separate IV line; do not add any other medication to infusion. • For bolus injection and continuous infusion, use sterile, nonpyrogenic, low protein-binding 0.2- or 0.22-micron filter. • While vascular sheath is in position, maintain pt on complete bed rest with head of bed elevated at 30°. • Maintain affected limb in straight position. • After sheath removal, apply femoral pressure for 30 min, either manually or mechanically, then apply pressure dressing.


Storage • Store vials in refrigerator. • Solution appears clear, colorless. • Do not shake. • Prepared solution is stable for 12 hrs. Discard any unused portion left in vial or if preparation contains any opaque particles.








Nursing considerations


Baseline assessment


Heparin should be discontinued 4 hrs before arterial sheath removal. Maintain pt on bed rest for 6–8 hrs following sheath removal or drug discontinuation, whichever is later. Check platelet count, PT, aPTT, PFA, before infusion (assess for preexisting blood abnormalities), 2–4 hrs following treatment, and at 24 hrs or before discharge, whichever is first. Check insertion site, distal pulse of affected limb while femoral artery sheath is in place, and then routinely for 6 hrs following femoral artery sheath removal. Minimize need for injections, blood draws, catheters, other invasive procedures.





abiraterone


a-bir-a-ter-one


(Zytiga)


Do not confuse Zytiga with Zetia or Zyrtec.










Availability (Rx)


image Tablets: 250 mg.




Indications/routes/dosage


◀ ALERT ▶ Consider increased dosage of prednisone during unusual stress or infection. Interrupting prednisone therapy may induce adrenocorticoid insufficiency.





Hepatic enzymes greater than upper limit of normal (ULN)














Lab Values Recommendation
AST, ALT elevations greater than 5 × ULN or bilirubin greater than 3 × ULN with 1,000 mg Interrupt treatment and restart at 750 mg once AST, ALT less than 2.5 × ULN or bilirubin less than 1.5 × ULN.
AST, ALT elevations greater than 5 × ULN or bilirubin greater than 3 × ULN with 750 mg Interrupt treatment and restart at 500 mg once AST, ALT less than 2.5 × ULN or bilirubin less than 1.5 × ULN.


If hepatotoxicity occurs at reduced dose of 500 mg daily, discontinue treatment. Mild hepatic impairment: No dosage adjustment necessary. Moderate hepatic impairment: Reduce dose to 250 mg daily. Discontinue if AST/ALT greater than 5 times ULN or bilirubin greater than 3 times ULN. Severe hepatic impairment: Contraindicated.





Nursing considerations


Baseline assessment


Evaluate history of heart failure, myocardial infarction, arrhythmias, angina pectoris, peripheral edema, hepatic impairment, adrenal or pituitary abnormalities, left ventricular ejection fraction if applicable. Obtain baseline ALT/AST, alkaline phosphatase, bilirubin, BMP. Question possibility of pregnancy before treatment (Pregnancy Category X). Question history of corticosteroid intolerance if applicable.



Intervention/evaluation


Assess for peripheral edema behind medial malleolus (sacral area in bedridden patients). Monitor BMP, hepatic function. Monitor for mineralocorticoid excess (hypokalemia, hypertension, fluid retention) at least once monthly. Assess for cardiac arrhythmia if hypokalemia occurs. Obtain EKG for palpitations, dyspnea, dizziness. Monitor for signs and symptoms of adrenocortical insufficiency during prednisone interruption, periods of stress, infection. Measure AST/ALT, alkaline phosphatase, bilirubin every 2 wks for 3 mos, then monthly. If hepatotoxicity occurs, dosage modification will be necessary. Pts with moderate hepatic impairment must have hepatic function tests every wk for first month, then every 2 wks for 2 mos, then monthly. If AST/ALT above 5 times ULN or bilirubin above 3 times ULN, treatment should be discontinued.



Patient/family teaching


• Must be taken on empty stomach (no food 2 hrs before and 1 hr after dose). • If taken with food, toxic levels may result. • Sexually active men must wear condom during treatment and for 1 wk after treatment. • Women who are pregnant or are planning pregnancy may not touch medication without gloves. • Dizziness, palpitations, headache, confusion, muscle weakness, leg swelling/discomfort may become more apparent during periods of unusual stress, infection, or interruption of prednisone therapy. • Blood test will be performed routinely. • Report signs of liver problems (yellowing of skin, bruising, light-colored stool, right upper quadrant pain), chest pain, palpitations. • An increase in urinary frequency or nocturia is expected as treatment becomes therapeutic.



acetaminophenimage


a-seet-a-min-oh-fen


(Abenol image, Acephen, Apo-Acetaminophen image, Atasol image, Feverall, Mapap, Ofirmev, Tempra image, Tylenol, Tylenol Arthritis Pain, Tylenol Children’s Meltaways, Tylenol Junior Meltaways, Tylenol Extra Strength)


BLACK BOX ALERT Potential for severe liver injury.


Do not confuse Acephen with Aciphex, Feverall with Fiberall, Fioricet with Fiorinal, Percocet with Percodan, Tylenol with atenolol, timolol, Tylenol PM, or Tylox, or Vicodin with Hycodan.



Fixed-combination(s)


Note: The amount of acetaminophen in combination products will be limited to no more than 325 mg per FDA mandate.


Capital with Codeine, Tylenol with Codeine: acetaminophen/codeine: 120 mg/12 mg per 5 ml. Endocet: acetaminophen/oxycodone: 325 mg/5 mg, 325 mg/7.5 mg, 325 mg/10 mg, 500 mg/7.5 mg, 650 mg/10 mg. Fioricet: acetaminophen/caffeine/butalbital: 325 mg/40 mg/50 mg. Hycet: acetaminophen/hydrocodone: 325 mg/7.5 mg per 15 ml. Lortab: acetaminophen/hydrocodone: 500 mg/5 mg, 500 mg/7.5 mg. Lortab Elixir: acetaminophen/hydrocodone: 167 mg/2.5 mg per 5 ml. Norco: acetaminophen/hydrocodone: 325 mg/5 mg, 325 mg/7.5 mg, 325 mg/10 mg. Percocet, Roxicet: acetaminophen/oxycodone: 325 mg/5 mg. Tylenol with Codeine: acetaminophen/codeine: 300 mg/15 mg, 300 mg/30 mg, 300 mg/60 mg. Tylox: acetaminophen/oxycodone: 500 mg/5 mg. Ultracet: acetaminophen/tramadol: 325 mg/37.5 mg. Vicodin: acetaminophen/hydrocodone: 300 mg/5 mg. Vicodin ES: acetaminophen/hydrocodone: 300 mg/7.5 mg. Vicodin HP: acetaminophen/hydrocodone: 300 mg/10 mg. Xodol: acetaminophen/hydrocodone: 300 mg/5 mg, 300 mg/7.5 mg, 300 mg/10 mg. Zydone: acetaminophen/hydrocodone: 400 mg/5 mg, 400 mg/7.5 mg, 400 mg/10 mg.

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