B

baclofen

(Apo-Baclofen , Lioresal, Novo-Baclofen , Nu-Baclo )

BLACK BOX ALERT Abrupt withdrawal of intrathecal form has resulted in severe hyperpyrexia, obtundation, rebound or exaggerated spasticity, muscle rigidity, leading to organ failure, death.

Do not confuse baclofen with Bactroban or Beclovent, or Lioresal with lisinopril or Lotensin.

Administration/handling

PO

• Give with food or milk. • Tablets may be crushed.

Intrathecal

• For screening, a 50 mcg/ml concentration should be used for injection. • For maintenance therapy, solution should be diluted for pts who require concentrations other than 500 mcg/ml or 2,000 mcg/ml.

Indications/routes/dosage

◀ ALERT ▶ Avoid abrupt withdrawal.

Spasticity

PO: ADULTS: Initially, 5 mg 3 times a day. May increase by 15 mg/day (5 mg/dose) at 3-day intervals. Range: 40–80 mg/day. Maximum: 80 mg/day. ELDERLY: Initially, 5 mg 2–3 times a day. May gradually increase dosage. CHILDREN 8 YRS AND OLDER: 30–40 mg/day in divided doses q8h. May increase dose by 5–15 mg/day q3days. Maximum: 120 mg/day. CHILDREN 2–7 YRS: 20–30 mg/day in divided doses q8h. May increase dose by 5–15 mg/day q3days. Maximum: 60 mg/day. CHILDREN YOUNGER THAN 2 YRS: 10–20 mg/day in divided doses q8h. May increase dose by 5–15 mg/day. Maximum: 40 mg/day.

Intrathecal dose

ADULTS, ELDERLY, CHILDREN: Test dose: 50–100 mcg. Dose greater than 50 mcg given in 25-mcg increments, separated by 24 hrs. Following positive response to test dose, maintenance infusion can be given via implanted intrathecal pump. Initial dose is twice the test dose.

Side effects

Frequent (greater than 10%): Transient drowsiness, asthenia (loss of strength, energy), dizziness, light-headedness, nausea, vomiting. Occasional (10%–2%): Headache, paresthesia, constipation, anorexia, hypotension, confusion, nasal congestion. Rare (less than 1%): Paradoxical CNS excitement or restlessness, slurred speech, tremor, dry mouth, diarrhea, nocturia, impotence.

Adverse effects/toxic reactions

Abrupt discontinuation may produce hallucinations, seizures. Overdose results in blurred vision, seizures, myosis, mydriasis, severe muscle weakness, strabismus, respiratory depression, vomiting.

Nursing considerations

Baseline assessment

Record onset, type, location, duration of muscular spasm. Check for immobility, stiffness, swelling.

Intervention/evaluation

Assess for paradoxical reaction. Observe for drowsiness, dizziness, ataxia. Assist with ambulation at all times. For those on long-term therapy, hepatic/renal function tests, blood counts should be performed periodically. Evaluate for therapeutic response: decreased intensity of skeletal muscle spasm, pain.

Patient/family teaching

• Drowsiness usually diminishes with continued therapy. • Avoid tasks that require alertness, motor skills until response to drug is established. • Do not abruptly withdraw medication after long-term therapy (may result in muscle rigidity, rebound spasticity, high fever, altered mental status). • Avoid alcohol, CNS depressants.

basiliximab

ba-si-lik-si-mab

(Simulect)

BLACK BOX ALERT Must be prescribed by a physician experienced in immunosuppression therapy and organ transplant management.

Do not confuse basiliximab with daclizumab.

classification

PHARMACOTHERAPEUTIC: Monoclonal antibody. CLINICAL: Immunosuppressive (see p. 123C).

Action

Binds to and blocks receptor of interleukin-2, a protein that stimulates proliferation of T-lymphocytes, which play a major role in organ transplant rejection. Therapeutic Effect: Prevents lymphocytic activity, impairs response of immune system to antigens, prevents acute renal transplant rejection.

Pharmacokinetics

Half-life: 4–10 days (adults); 5–17 days (children).

Uses

Adjunct with cyclosporine, corticosteroids in prevention of acute organ rejection in pts receiving renal transplant. OFF-LABEL: Treatment of refractory graft-vs-host disease, prevention of liver or cardiac transplant rejection.

Precautions

Contraindications: Hypersensitivity to basiliximab. Cautions: Anemia, HF, chronic wounds, diabetes mellitus, dehydration, electrolyte imbalance, generalized/peripheral edema, HTN.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Breastfeeding not recommended. Pregnancy Category B. Children/Elderly: No age-related precautions noted.

Interactions

DRUG: Tacrolimus (topical), trastuzumab may increase concentration. HERBAL: Echinacea may decrease therapeutic effect. Bilberry, garlic, ginger, ginseng may increase hypoglycemic effect. FOOD: None known. LAB VALUES: May alter serum calcium, glucose, potassium, Hgb, Hct. May increases serum cholesterol, BUN, creatinine, uric acid. May decrease serum magnesium, phosphate, platelet count.

Availability (Rx)

Injection, Powder for Reconstitution: 10 mg, 20 mg.

Administration/handling

IV

Reconstitution • Reconstitute 10-mg vial with 2.5 ml or 20-mg vial with 5 ml Sterile Water for Injection. • Shake gently to dissolve. • May further dilute with 25–50 ml 0.9% NaCl or D₅W to a final concentration of 0.4 mg/ml. • Gently invert to avoid foaming. • Do not shake.

Rate of Administration • IV bolus over 10 min. • IV infusion over 20–30 min.

Storage • Refrigerate unused vials. • After reconstitution, use within 4 hrs (24 hrs if refrigerated). • Discard if precipitate forms.

IV incompatibilities

Specific information not available. Do not add other medications simultaneously through same IV line.

Indications/routes/dosage

Prophylaxis of organ rejection

IV: ADULTS, ELDERLY, CHILDREN WEIGHING 35 KG OR MORE: 20 mg within 2 hrs before transplant surgery and 20 mg 4 days after transplant. CHILDREN WEIGHING LESS THAN 35 KG: 10 mg within 2 hrs before transplant surgery and 10 mg 4 days after transplant.

Side effects

Frequent (greater than 10%): GI disturbances (constipation, diarrhea, dyspepsia), CNS effects (dizziness, headache, insomnia, tremor), respiratory tract infection, dysuria, acne, leg or back pain, peripheral edema, hypertension. Occasional (10%–3%): Angina, neuropathy, abdominal distention, tachycardia, rash, hypotension, urinary disturbances (urinary frequency, genital edema, hematuria), arthralgia, hirsutism, myalgia.

Adverse effects/toxic reactions

Severe, acute hypersensitivity reactions including anaphylaxis characterized by hypotension, tachycardia, cardiac failure, dyspnea, wheezing, bronchospasm, pulmonary edema, respiratory failure, urticaria, rash, pruritus, sneezing, as well as capillary leak syndrome and cytokine release syndrome, have been reported.

Nursing considerations

Baseline assessment

Obtain baseline BUN, serum creatinine, potassium, uric acid, glucose, calcium, phosphatase levels and vital signs, particularly B/P, pulse rate. Breastfeeding not recommended.

Intervention/evaluation

Diligently monitor CBC, serum chemistry results. Assess B/P for hypertension/hypotension; pulse for evidence of tachycardia. Question for GI disturbances, CNS effects, urinary changes. Monitor for presence of wound infection, signs of infection (fever, sore throat, unusual bleeding/bruising), hypersensitivity reaction.

Patient/family teaching

• Report difficulty in breathing or swallowing, palpitations, bruising/bleeding, rash, itching, swelling of lower extremities, weakness. • Female pts should take measures to avoid pregnancy; avoid breast-feeding.

beclomethasone

be-kloe-meth-a-sone

(Apo-Beclomethasone , Beconase AQ, QNASL, QVAR, Rivanase AQ )

Do not confuse Beconase with baclofen.

classification

PHARMACOTHERAPEUTIC: Adreno-corticosteroid. CLINICAL: Anti-inflammatory, immunosuppressant (see pp. 2C, 77C, 99C).

Action

Controls or prevents inflammation by altering rate of protein synthesis; migration of polymorphonuclear leukocytes, fibroblasts; reverses capillary permeability. Therapeutic Effect: Inhalation: Inhibits bronchoconstriction, produces smooth muscle relaxation, decreases mucus secretion. Intranasal: Decreases response to seasonal, perennial rhinitis.

Pharmacokinetics

Rapidly absorbed from pulmonary, nasal, GI tissue. Hydrolyzed by pulmonary esterase prior to absorption. Metabolized in liver. Protein binding: 87%. Primarily eliminated in feces. Half-life: 15 hrs.

Uses

Inhalation: Long-term control of bronchial asthma. Reduces need for oral corticosteroid therapy for asthma. Intranasal: Relief of seasonal/perennial rhinitis; prevention of nasal polyp recurrence after surgical removal; treatment of nonallergic rhinitis. QNASL: Treatment of seasonal and perennial allergic rhinitis in adults and adolescents 12 yrs and older. OFF-LABEL: Prevention of seasonal rhinitis (nasal form).

Precautions

Contraindications: Hypersensitivity to beclomethasone, acute exacerbation of asthma, status asthmaticus. Cautions: Thyroid disease, hepatic impairment, renal impairment, cardiovascular disease, diabetes, glaucoma, cataracts, myasthenia gravis, seizures, risk for osteoporosis, peptic ulcer, ulcerative colitis, following acute MI, elderly. Avoid use in pts with untreated viral, fungal, or bacterial systemic infections.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Pregnancy Category C. Children: Prolonged treatment/high dosages may decrease short-term growth rate, cortisol secretion. Elderly: No age-related precautions noted.

Interactions

DRUG: May decrease effect of anti-diabetic agents. HERBAL: Echinacea may decrease effects. FOOD: None known. LAB VALUES: None significant.

Availability (Rx)

Inhalation, Oral (Qvar): 40 mcg/inhalation, 80 mcg/inhalation. QNASL: 80 mcg/actuation. Nasal Inhalation (Beconase AQ): 42 mcg/inhalation.

Administration/handling

Inhalation

• Shake container well. • Instruct pt to exhale completely, place mouthpiece between lips, inhale, hold breath as long as possible before exhaling. • Allow at least 1 min between inhalations. • Rinsing mouth after each use decreases dry mouth, hoarseness, thrush.

Intranasal

• Instruct pt to clear nasal passages as much as possible before use. • Tilt pt’s head slightly forward. • Insert spray tip into nostril, pointing toward nasal passages, away from nasal septum. • Spray into one nostril while pt holds the other nostril closed, concurrently inhaling through nose to permit medication as high into nasal passages as possible.

Indications/routes/dosage

Long-term control of bronchial asthma

Oral Inhalation (QVAR): ADULTS, ELDERLY, CHILDREN 12 YRS AND OLDER: 40–160 mcg twice a day. Maximum: 320 mcg twice a day. CHILDREN 5–11 YRS: 40 mcg twice a day. Maximum: 80 mcg twice a day.

Rhinitis, prevention of recurrence of nasal polyps

Nasal Inhalation (QVAR): ADULTS, ELDERLY, CHILDREN 6 YRS AND OLDER: 1–2 sprays in each nostril twice a day.

Allergic rhinitis

Oral Inhalation (QNASL): ADULTS, ELDERLY, CHILDREN 12 YRS AND OLDER: 2 sprays in each nostril daily.

Side effects

Frequent: Inhalation (14%–4%): Throat irritation, dry mouth, hoarseness, cough. Intranasal: Nasal burning, mucosal dryness. Occasional: Inhalation (3%–2%): Localized fungal infection (thrush). Intranasal: Nasal-crusting epistaxis, sore throat, ulceration of nasal mucosa. Rare: Inhalation: Transient bronchospasm, esophageal candidiasis. Intranasal: Nasal and pharyngeal candidiasis, eye pain.

Adverse effects/toxic reactions

Acute hypersensitivity reaction (urticaria, angioedema, severe bronchospasm) occurs rarely. Change from systemic to local steroid therapy may unmask previously suppressed bronchial asthma condition.

Nursing considerations

Baseline assessment

Establish baseline history for asthma, rhinitis. Question for hypersensitivity to any corticosteroids.

Intervention/evaluation

Monitor respiratory status, lung sounds; observe for signs of oral candidiasis. In those receiving bronchodilators by inhalation concomitantly with inhaled steroid therapy, advise to use bronchodilator several minutes before corticosteroid aerosol (enhances penetration of steroid into bronchial tree).

Patient/family teaching

• Do not change dose schedule or stop taking drug; must taper off gradually under medical supervision. • Inhalation: Maintain diligent oral hygiene. • Rinse mouth with water immediately after inhalation (prevents mouth/throat dryness, fungal infection of mouth). • Contact physician if sore throat or mouth occurs. • Intranasal: Contact physician if symptoms do not improve or sneezing, nasal irritation occurs. • Clear nasal passages prior to use. • Improvement noted after several days.

bedaquiline

bed-ak-wi-leen

(Sirturo)

Do not confuse bedaquiline with quinidine or quetiapine.

BLACK BOX ALERT QT prolongation may occur. Concurrent use with other drugs that prolong QT interval may produce additive QT prolongation. To be used only when current treatment regimen is ineffective. Placebo-controlled trial: increased risk of death (11.4% bedaquiline vs. 2.5% placebo).

classification

PHARMACOTHERAPEUTIC: Diarylquinoline antimycobacterial. CLINICAL: Antitubercular.

Action

Inhibits mycobacterial adenosine triphosphate (ATP) synthase, an enzyme essential for generation of energy in mycobacterium tuberculosum. Therapeutic Effect: Treatment of multidrug-resistant mycobacterium tuberculosis (TB).

Pharmacokinetics

Absorbed from GI tract. Peak plasma concentration: 5 hrs. Metabolized in liver. Mainly excreted in feces. Protein binding: 99.9%. Half-life: 5.5 mos.

Uses

Treatment of pulmonary multidrug-resistant TB in adults 18 yrs and older when other alterations are not available. Not recommended for pts with extrapulmonary TB (e.g., central nervous system), latent or drug-sensitive TB.

Precautions

Contraindications: None known. Cautions: Severe hepatic/renal impairment, history of or risk of QT prolongation (e.g., torsades de pointes, bradyarrhythmias, hypothyroidism).

Lifespan considerations

Pregnancy/Lactation: Unknown if distributed in breast milk. Pregnancy Category B. Children: Safety and efficacy not established in those younger than 18 yrs. Elderly: No age-related precautions noted.

Interactions

DRUG: CYP3A4 inducers (e.g., carbamazepine, rifampin) may reduce concentration/effect. CYP3A4 inhibitors (e.g., ketoconazole) may increase concentration/effect. Macrolide antibacterial (e.g., clarithromycin), fluoroquinolones (e.g., levofloxacin), clofazimine may increase risk of prolonged QT interval. HERBAL: St. John’s wort decreases concentration/effect. FOOD: Food enhances bioavailability. LAB VALUES: May increase serum ALT, AST, alkaline phosphatase, amylase.

Availability (Rx)

Tablets: 100 mg.

Administration/handling

PO

• Give with food (increases bioavailability). • Swallow tablet whole with water.

Indications/routes/dosage

Tuberculosis

PO: ADULTS 18 YRS AND OLDER, ELDERLY: Note: Initiate medication with at least 3 other antitubercular drugs.

Weeks 1–2: 400 mg (4 tablets of 100 mg) once daily with food. Weeks 3–24: 200 mg (2 tablets of 100 mg) 3 times per week with food (at least 48 hrs between doses) for a total dose of 600 mg per wk. Total duration of treatment: 24 wks.

Side effects

Frequent (33%–28%): Arthralgia, nausea, headache. Occasional (9%–8%): Anorexia, rash.

Adverse effects/toxic reactions

Hemoptysis, chest pain occur in 18% and 11%, respectively. May prolong QT interval.

Nursing considerations

Baseline assessment

Obtain baseline laboratory results prior to initiation of treatment, particularly serum potassium, calcium, magnesium (may alter QT interval), ALT, AST, alkaline phosphatase, bilirubin and correct if abnormal. Obtain EKG and assess for prolonged QT. Test for viral hepatitis.

Intervention/evaluation

Follow-up monitoring of electrolytes should be performed if QT prolongation is detected. If baseline EKG presents with prolonged QT interval, monitor EKG frequently to confirm QT interval has returned to baseline (monitor for syncope). Monitor serum chemistries monthly while on treatment. Aminotransferase 3 × the ULN or higher should be followed by repeat testing within 48 hrs. Diligently monitor for any signs or symptoms of bleeding, fatigue, anorexia, nausea, jaundice, melanuria, hepatic tenderness, hepatomegaly.

Patient/family teaching

• Avoid alcohol. • Report fatigue, loss of appetite, nausea, yellowing of skin or eyes, change in urine color, abdominal tenderness. • Strict compliance with drug regimen is essential.

belatacept

bel-at-a-sept

(Nulojix)

BLACK BOX ALERT Must be administered by personnel trained in administration/handling of therapy at appropriate medical facility. Increased risk of malignancies, tuberculosis, and opportunistic infection. Test for tuberculosis prior to and during treatment, regardless of initial result. Increased risk of post-transplant lymphoproliferative disorder (PTLD), mainly in central nervous system. JC virus-associated progressive multifocal leukoencephalopathy (PML) and polyoma virus nephropathy may lead to graft loss, deteriorated renal function, or death. Pts who are Epstein-Barr virus (EBV) antibody negative are at increased risk of developing PTLD. Cytomegalovirus and pneumocystitis prophylaxis are recommended after transplantation. Not recommended for hepatic transplants due to increased risk of graft loss, death.

classification

PHARMACOTHERAPEUTIC: Selective T-cell costimulation blocker. CLINICAL: Immunosuppressive agent.

Action

Inhibits T-lymphocyte proliferation and production of cytokines including interleukin-2 (IL-2), interferon-γ, interleukin-4 (IL-4), TNF-α; a critical pathway in cellular immune response involved in allograft rejection. Therapeutic Effect: Prevents renal transplant rejection. Decreases production of antidonor antibodies.

Pharmacokinetics

Half-life: 8–10 days.

Uses

Prevention of acute organ rejection in pts receiving renal transplants (in combination with basiliximab induction, mycophenolate mofetil, corticosteroids). For use in Epstein-Barr virus (EBV) seropositive renal transplant recipients.

Precautions

Contraindications: Transplant pts who are Epstein-Barr virus (EBV) seronegative or unknown sero-status. Cautions: History of opportunistic infections: bacterial, mycobacterial, invasive fungal, viral, protozoal, (histoplasmosis, aspergillosis, candidiasis, coccidioidomycosis, listeriosis, HIV, tuberculosis, pneumocystosis). Recent open wounds, ulcerations. Not recommended in liver transplants. Avoid use of live vaccines.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Must either discontinue breastfeeding or discontinue drug. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: No age-related precautions noted.

Interactions

DRUG: May increase concentration/effects of belimumab, mycophenolate. Pimecrolimus, tacrolimus (topical) may increase belatacept concentration. Live vaccines not recommended. HERBAL: Echinacea may reduce belatacept effects. FOOD: None known. LAB VALUES: May increase serum potassium, cholesterol, uric acid, urine protein, glucose. May decrease serum phosphate, potassium, calcium, magnesium, WBC, Hgb, Hct.

Availability (Rx)

Lyophilized Powder for Injection: 250 mg per vial.

Administration/handling

◀ ALERT ▶ Use only silicone-free disposable syringe provided. Using different syringe may produce translucent particles. Must infuse with sterile, nonpyrogenic, low protein-binding filter (pore size 0.2–1.2 μm). Administer with dedicated line only.

IV

Reconstitution • Calculate number of vials needed for injection (solution will equal 25 mg/ml after mixing). • Reconstitute vial with 10.5 ml of suitable diluent (0.9% NaCl, D₅W, or Sterile Water for Injection) using provided syringe, 18- to 20-gauge needle. • Direct stream to glass wall (avoids foaming). • Swirl gently (do not shake). • Discard if opaque particles, discoloration, or foreign particles are present. • Infusion bag must match diluent (0.9% NaCl with 0.9% NaCl, D₅W with D₅W, Sterile Water for Injection with NaCl or D₅W). • To mix infusion bag, withdraw and discard volume equal to the volume of reconstituted solution. • Using same silicone-free disposable syringe, gently inject reconstituted solution into 100- to 250-ml bag (based on concentration). • Final concentration of infusion bag should range from 2 mg/ml to 10 mg/ml. • IV infusion stable for 24 hrs at room temperature.

Rate of Administration • Infuse over 30 min.

Storage • Solution should be clear to slightly opalescent and colorless to slightly yellow. • May refrigerate solution up to 24 hrs. • Discard if reconstituted solution remains at room temperature longer than 24 hrs.

Indications/routes/dosage

Prophylaxis of acute renal transplant rejection (in combination with an immunosuppressant)

IV: ADULTS, ELDERLY: 10 mg/kg on day 1 (day of transplantation, prior to implantation), day 5, end of wk 2, 4, 8, and 12 after transplantation. 5 mg/kg end of wk 16 and q4wks thereafter. Dosage Modification: Infusion is based on actual body weight at the time of transplantation; modify dose for weight changes greater than 10% during treatment. Prescribed dose must be evenly divisible by 12.5 to match closest increment (0, 12.5, 25, 37.5, 50, 62.5, 75, 87.5, 100) in mg. For example, the actual dose for a 64-kg pt is 637.5 mg, not 640 mg.

Side effects

Frequent (45%–20%): Anemia, diarrhea, UTI, peripheral edema, constipation, hypertension, pyrexia, nausea, cough, vomiting, headache. Occasional (19%–5%): Abdominal pain, hypotension, arthralgia, hematuria, upper respiratory infection, insomnia, nasopharyngitis, back pain, dyspnea, influenza, dysuria, bronchitis, stomatitis, anxiety, dizziness, abdominal pain, muscle tremor, acne, alopecia, hyperhidrosis.

Adverse effects/toxic reactions

Serious conditions including malignancies (esp. skin cancer), progressive multifocal leukoencephalopathy (caused by JC virus), cytomegalovirus, polyoma virus nephropathy, viral reactivation (herpes zoster, hepatitis). Other opportunistic infections such as bacterial, fungal, viral, protozoal may cause tuberculosis, cryptococcal meningitis, Chagas’ disease, West Nile encephalitis, Guillain-Barré syndrome, cerebral aspergillosis. Additional complications including chronic allograft nephropathy, renal tubular necrosis, renal artery necrosis, atrial fibrillation, hematoma at incision site, wound dehiscence, lymphocele, arteriovenous fistula thrombosis, hydronephrosis, urinary incontinence, anti-belatacept antibody formation have been reported.

Nursing considerations

Baseline assessment

Evaluate pt for active tuberculosis or latent infection prior to initiating treatment and periodically during therapy. Induration of 5 mm or greater with tuberculin skin test should be considered a positive result when assessing whether treatment for latent tuberculosis is necessary. Assess baseline mental status to compare any worsening cognitive symptoms. Obtain Epstein-Barr virus (EBV) serology prior to treatment (contraindicated in pts who are EBV seronegative). Note any skin discoloration, ulcers, excoriation, lesions. Question history of hypertension/hypotension, arrhythmia, diabetes, HIV, hepatitis, home medications. Question possibility of pregnancy. Obtain baseline CBC, serum chemistries, renal function, glomerular filtration rate (GFR), magnesium, ionized calcium, phosphate, lipid panel, urinalysis, urine pregnancy if applicable.

Intervention/evaluation

Monitor B/P, vital signs, I&O, weight. Diligently monitor CBC, renal function, serum electrolytes (hypokalemia may result in changes in muscle strength, muscle cramps, altered mental status, cardiac arrhythmias). Routinely monitor serum glucose levels for new-onset diabetes after transplantation, corticosteroid use. Monitor for fever, tenderness over transplantation site, skin lesions, changing characteristics of moles, neurologic deterioration related to PTLD or PML.

Patient/family teaching

• Inform pt that therapy may increase risk of malignancies and life-threatening infections. • Detail concomitant immunosuppressive therapy with basiliximab induction, corticosteroids. • Report history of HIV, opportunistic infections, hepatitis, coughing of blood, or close relatives with active tuberculosis. • Avoid sunlight, sunlamps. • Seek immediate attention if adverse reactions occur. • Do not receive live vaccines. • Notify physician if pregnant or plan on becoming pregnant. • Pt must adhere to strict dosing schedule. • Report any chest pain, palpitations, edema, fever, night sweats, weight loss, swollen glands, flu-like symptoms, stomach pain, vomiting, diarrhea, weakness, or urinary changes (color, frequency, odor, concentration, burning, blood).

belimumab

be-lim-oo-mab

(Benlysta)

Do not confuse belimumab with bevacizumab.

classification

PHARMACOTHERAPEUTIC: Monoclonal antibody. CLINICAL: Immunosuppressant, Anti-Lupus agent.

Action

Inhibits binding of B-lymphocyte stimulator (BLYS) to B-cell receptors. Inhibits survival of B cells, including autoreactive B cells, and reduces differentiation into immunoglobulin-producing plasma cells. Therapeutic Effect: Limits lupus erythematosus disease activity.

Pharmacokinetics

Half-life: 19 days.

Uses

Treatment for active, autoantibody-positive, systemic lupus erythematosus, in addition to standard therapy.

Precautions

Contraindications: Prior anaphylaxis with belimumab. Cautions: Severe, active infections. Depression, pts at risk for suicide, other mood changes. Avoid live vaccines.

Lifespan considerations

Pregnancy/Lactation: Not recommended in pregnancy unless benefits outweigh risks. Unknown if crosses placenta or distributed in breast milk. Contraception should be considered during therapy and for at least 4 wks after final treatment. Pregnancy Category C. Children: Safety and efficacy not established. Elderly: No age-related precautions noted.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Tags: Saunders Nursing Drug Handbook 2015

Mar 8, 2017 | Posted by admin in NURSING | Comments Off

Fastest Nurse Insight Engine

B

B

Share this:

Related

Related posts:

Stay updated, free articles. Join our Telegram channel

Full access? Get Clinical Tree