I

ibandronate

Administration/handling

PO

• Give 60 min before first food, beverage of the day, on an empty stomach with 6–8 oz plain water (not mineral water) while pt is standing or sitting in upright position. • Pt cannot lie down for 60 min following drug administration. • Instruct pt to swallow whole; do not chew, suck tablet (potential for oropharyngeal ulceration).

IV

• Give over 15–30 sec.

Indications/routes/dosage

Osteoporosis

PO (Prevention/Treatment): ADULTS, ELDERLY: 150 mg once monthly.

IV (Treatment): ADULTS, ELDERLY: 3 mg q3mos.

Dosage in renal impairment

Not recommended for pts with creatinine clearance less than 30 ml/min.

Side effects

Frequent (13%–6%): Back pain, dyspepsia (epigastric distress, heartburn), peripheral discomfort, diarrhea, headache, myalgia. IV: Abdominal pain, dyspepsia, constipation, nausea, diarrhea. Occasional (4%–3%): Dizziness, arthralgia, asthenia (loss of strength, energy). Rare (2% or less): Vomiting, hypersensitivity reaction.

Adverse effects/toxic reactions

Upper respiratory infection occurs occasionally. Overdose results in hypocalcemia, hypophosphatemia, significant GI disturbances.

Nursing considerations

Baseline assessment

Hypocalcemia, vitamin D deficiency must be corrected before beginning therapy. Obtain laboratory baselines, esp. serum chemistries, renal function. Obtain results of bone density study.

Intervention/evaluation

Monitor electrolytes, esp. serum calcium, alkaline phosphatase. Monitor renal function tests.

Patient/family teaching

• Expected benefits occur only when medication is taken with full glass (6–8 oz) of plain water, first thing in the morning and at least 60 min before first food, beverage, medication of the day. Any other beverage (mineral water, orange juice, coffee) significantly reduces absorption of medication. • Do not lie down for at least 60 min after taking medication (potentiates delivery to stomach, reduces risk of esophageal irritation). • Report swallowing difficulties, pain when swallowing, chest pain, new/worsening heartburn. • Consider weight-bearing exercises; modify behavioral factors (e.g., cigarette smoking, alcohol consumption). • Calcium and vitamin D supplements should be taken if dietary intake inadequate.

ibritumomab

ib-rye-tyoo-mo-mab

(Zevalin)

BLACK BOX ALERT Severe, potentially fatal infusion reactions (angioedema, hypoxia, marked hypotension, myocardial infarction) reported, usually within 30–130 min of rituximab infusion (cotherapy). Prolonged, severe cytopenia occurs in most pts. Severe cutaneous, mucocutaneous reactions (including fatalities) have been reported. Must be administered by personnel trained in administration/handling of radioisotopes.

classification

PHARMACOTHERAPEUTIC: Monoclonal antibody. CLINICAL: Antineoplastic (see p. 86C).

Action

Combines targeting power of monoclonal antibodies (MAbs) with cancer-killing ability of radiation. Therapeutic Effect: Targets CD antigen (present in greater than 90% of pts with B-cell non-Hodgkin’s lymphoma), inducing cellular damage.

Pharmacokinetics

Tumor uptake is greater than normal tissue in non-Hodgkin’s lymphoma. Most of dose cleared by binding to tumor. Minimally excreted in urine. Half-life: 27–30 hrs.

Uses

Treatment of non-Hodgkin’s lymphoma (NHL) in combination with rituximab in pts with relapsed or refractory low-grade, follicular, or CD20-positive transformed B-cell non-Hodgkin’s lymphoma. Pts with previously untreated follicular NHL who achieve a partial or complete response to first-line chemotherapy.

Precautions

Contraindications: None known. Cautions: Platelet count less than 100,000 cells/mm³, neutrophil count less than 1,500 cells/mm³, history of failed stem cell collection.

Lifespan considerations

Pregnancy/Lactation: May cause fetal harm. Pts with childbearing potential should use contraceptive methods during and up to 12 mos after therapy. Pregnancy Category D. Children: Safety and efficacy not established. Elderly: No age-related precautions noted.

Interactions

DRUG: Antiplatelets, anticoagulants increase potential for prolonged/severe thrombocytopenia. HERBAL: Cat’s claw, dong quai, evening primrose, feverfew, garlic, ginkgo, ginseng, horse chestnut, red clover may increase antiplatelet activity. Echinacea may decrease effect. FOOD: None known. LAB VALUES: May decrease platelet count, neutrophil count, Hgb, Hct.

Availability (Rx)

Injection Solution: 3.2-mg vial (1.6 mg/ml).

Administration/handling

Rate of Administration • Give IV push over 10 min through a 0.22-micron, low protein-binding in-line filter. After injection, flush line with 10 ml 0.9% NaCl.

IV incompatibilities

Do not mix with any medications.

Indications/routes/dosage

Non-Hodgkin’s lymphoma

IV: ADULTS, ELDERLY: Regimen consists of two steps: Step 1: Single infusion of 250 mg/m² rituximab at initial rate of 50 mg/hr. Increase infusion by 50 mg/hr q30min up to a maximum of 400 mg/hr. Step 2: Follows step 1 by 7–9 days and consists of a second infusion of 250 mg/m² rituximab preceding (4 hrs or less) a fixed dose of 0.4 mCi/kg of Y-90 ibritumomab administered IV push over 10 min.

◀ ALERT ▶ Reduce dosage to 0.3 mCi/kg if platelet count is 100,000–149,000 cells/mm³. Do not administer if platelet count is less than 100,000 cells/mm³.

Side effects

Frequent (43%–24%): Asthenia (loss of strength, energy), nausea, chills. Occasional (17%–10%): Fever, abdominal pain, dyspnea, headache, vomiting, dizziness, cough, oral candidiasis. Rare (9%–5%): Pruritus, diarrhea, back pain, peripheral edema, anorexia, rash, flushing, arthralgia, myalgia, ecchymosis, rhinitis, constipation, insomnia.

Adverse effects/toxic reactions

Thrombocytopenia (95%), neutropenia (77%), anemia (61%) may be severe and prolonged; may be followed by infection (29%). Hypersensitivity reaction produces hypotension, bronchospasm, angioedema. Severe cutaneous or mucocutaneous reactions (erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis) have been noted.

Nursing considerations

Baseline assessment

Pretreatment with acetaminophen and diphenhydramine before each infusion may prevent infusion-related effects. Offer emotional support. Use strict asepsis. Obtain baseline CBC, serum chemistries. Absolute neutrophil count (ANC) nadir is 62 days before recovery begins.

Intervention/evaluation

Diligently monitor lab values for possibly severe/prolonged thrombocytopenia, neutropenia, anemia. Monitor for hematologic toxicity (fever, sore throat, signs of local infections, unusual bruising/bleeding), symptoms of anemia (excessive fatigue, weakness), infusion-related allergic reaction. Assess for GI symptoms (nausea, vomiting, abdominal pain, diarrhea).

Patient/family teaching

• Do not have immunizations without physician’s approval (drug lowers resistance). • Avoid crowds, persons with known infections. • Report signs of infection at once (fever, flu-like symptoms). • Report if nausea/vomiting continues at home. • Avoid pregnancy during therapy.

ibrutinib

eye-broo-ti-nib

(Imbruvica)

Do not confuse ibrutinib with axitinib, dasatinib, erlotinib, gefitinib, imatinib, nilotinib, ponatinib, sorafenib, sunitinib, or vandetanib.

classification

PHARMACOTHERAPEUTIC: Kinase inhibitor. CLINICAL: Antineoplastic.

Action

Inhibits enzymatic activity of Bruton’s tyrosine kinase (BTK), a signaling molecule that promotes malignant B-cell proliferation and survival. Therapeutic Effect: Inhibits tumor cell growth and metastasis.

Pharmacokinetics

Readily absorbed following PO. Metabolized in liver. Peak plasma concentration: 1–2 hrs. Protein binding: 97%. Excreted in feces (80%), urine (10%). Half-life: 4–6 hrs.

Uses

Treatment of pts with mantle cell lymphoma (MCL) who have received at least one prior therapy.

Precautions

Contraindications: None known. Cautions: Baseline anemia, neutropenia, thrombocytopenia, hepatic/renal impairment, HF, hypertension, hypovolemia, open wounds, pregnancy, recent surgery or dental procedure, concurrent antiplatelet or anticoagulant therapy.

Lifespan considerations

Pregnancy/Lactation: May cause fetal harm. Avoid pregnancy. Unknown if distributed in breast milk. Must either discontinue drug or discontinue breast-feeding. Pregnancy Category D. Children: Safety and efficacy not established. Elderly: Increased risk of cardiac events (atrial fibrillation, hypertension), infections (pneumonia, cellulitis), GI events (diarrhea, dehydration, bleeding).

Interactions

DRUG: Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) may increase plasma concentration/effect; avoid use. Strong CYP3A4 inducers (e.g., rifampin, phenytoin) may decrease plasma concentration/effect; avoid use. Anticoagulants, antiplatelets, NSAIDS may increase risk of bleeding. HERBAL: St John’s wort may decrease concentration/effect. FOOD: Grapefruit products, Seville oranges may increase concentration/effect. All foods may increase absorption/concentration. LAB VALUES: May decrease Hgb, Hct, neutrophils, platelets.

Availability (Rx)

Capsules: 140 mg.

Administration/handling

PO

• Give with water. • Do not break, crush, dissolve, or open capsule.

Indications/routes/dosage

Mantle cell lymphoma

PO: ADULTS/ELDERLY: 560 mg (4 × 140-mg capsules) once daily.

Dose modification

Based on Common Terminology Criteria for Adverse Events (CTCAE).

Any grade 3 or greater nonhematologic event, grade 3 or greater neutropenia with infection or fever, or any grade 4 hematologic toxicities

Interrupt treatment until resolution to grade 1 or baseline, then restart at initial dose. If toxicity reoccurs, interrupt treatment until resolution to grade 1 or baseline, then reduce dose to 420 mg daily (one capsule less). If toxicity reoccurs, interrupt treatment until resolution to grade 1 or baseline, then reduce dose to 280 mg once daily (one capsule less). If toxicity still occurs at 280 mg dose, discontinue treatment.

Concomitant use of moderate CYP3A4 inhibitors (e.g., fluconazole, diltiazem, verapamil)

Start at reduced dose of 140 mg daily. If toxicity occurs, either discontinue treatment or find alternate agent with less CYP3A inhibition.

Concomitant short-term use of strong CYP3A4 inhibitors (≤7 days) (e.g., antifungals, antibiotics)

Interrupt treatment until strong CYP3A medications no longer needed.

Concomitant chronic use of strong CYP3A4 inhibitors or inducers

Treatment not recommended.

Side effects

Frequent (51%–23%): Diarrhea, fatigue, musculoskeletal pain, peripheral edema, nausea, bruising, dyspnea, constipation, rash, abdominal pain, vomiting. Occasional (21%–11%): Decreased appetite, cough, pyrexia, stomatitis, asthenia, dizziness, muscle spasms, dehydration, headache, dyspepsia, petechiae, arthralgia.

Adverse effects/toxic reactions

Anemia, lymphopenia, neutropenia, thrombocytopenia is expected response to therapy. Treatment-emergent myelosuppression (grade 3–4 CTCAE) reported in 41% of pts: neutropenia (29%), thrombocytopenia (17%), anemia (9%). Infections including upper respiratory tract infection, UTI, pneumonia, skin infection, sinusitis were reported. Hemorrhagic events including epistaxis, GI bleeding, hematuria, intracranial hemorrhage, subdural hematoma reported in 5% of pts. Serious and fatal cases of renal toxicity reported: increased serum creatinine 1.5 times upper limit of normal (ULN) (67% of pts), increased serum creatinine 1.53 times UNL (9% of pts). Second primary malignancies including skin cancer (4%), other carcinomas (1%) occurred.

Nursing considerations

Baseline assessment

Obtain baseline vital signs, CBC, serum chemistries, liver function test, PT/INR if on anticoagulants. Question history of arrhythmias, HF, GI bleed, hepatic/renal impairment, peripheral edema, pulmonary disease. Obtain negative urine pregnancy before initiating treatment. Assess hydration status. Receive full medication history including vitamins, herbal products. Assess skin for open/unhealed wounds, lesions, moles. Conduct baseline neurologic exam.

Intervention/evaluation

Monitor CBC monthly; liver function tests, serum chemistries, renal panel routinely. Monitor stool frequency, consistency, characteristics. Immediately report hemorrhagic events: epistaxis, hematuria, hemoptysis, melena. Encourage PO intake. Obtain EKG for arrhythmias, dyspnea, palpitations. Screen for possible intracranial hemorrhage: altered mental status, aphasia, hemiparesis, unequal pupils, homonymous hemianopsia (blindness of one half of vision on same side of both eyes). Monitor for renal toxicity (anuria, hypertension, generalized edema, flank pain). Assess skin for new lesions.

Patient/family teaching

• Blood levels will be monitored routinely. • Difficulty breathing, fever, cough, burning with urination, body aches, chills may indicate an acute infection. • Avoid pregnancy. • Report any black/tarry stools, bruising, nausea, RUQ abdominal pain, yellowing of skin or eyes, palpitations, nose bleeds, blood in urine or stool, decreased urine output. • Avoid alcohol. • Do not take herbal products. • Do not ingest grapefruit products. • Severe diarrhea may lead to dehydration. • Contact doctor before any planned surgical/dental procedures. • Immediately report neurological changes: confusion, one-sided paralysis, difficulty speaking, partial blindness. • Do not receive live vaccines. • Do not break, crush, dissolve, or open capsule.

ibuprofen

eye-bue-pro-fen

(Advil, Advil Children’s, Advil Infants’, Advil Junior, Advil Migraine, Apo-Ibuprofen , Caldolor, Ibu-200, Motrin, Motrin Children’s, Motrin IB, Motrin Infants’, Motrin Junior Strength, NeoProfen, Novoprofen )

BLACK BOX ALERT Increased risk of serious cardiovascular thrombotic events, including myocardial infarction, CVA. Increased risk of severe GI reactions, including ulceration, bleeding, perforation.

Do not confuse Motrin with Neurontin.

Fixed-combination(s)

Children’s Advil Cold: ibuprofen/pseudoephedrine (a nasal decongestant): 100 mg/15 mg per 5 ml. Combunox: ibuprofen/oxycodone (a narcotic analgesic): 400 mg/5 mg. Duexis: ibuprofen/famotidine (an H₂ antagonist): 800 mg/26.6 mg. Reprexain CIII: ibuprofen/hydrocodone (a narcotic analgesic): 200 mg/5 mg. Vicoprofen: ibuprofen/hydrocodone (a narcotic analgesic): 200 mg/7.5 mg.

classification

PHARMACOTHERAPEUTIC: NSAID. CLINICAL: Antirheumatic, analgesic, antipyretic, antidysmenorrheal, vascular headache suppressant (see p. 129C).

Action

Inhibits prostaglandin synthesis. Produces vasodilation acting on heat-regulating center of hypothalamus. Therapeutic Effect: Produces analgesic, anti-inflammatory effects; decreases fever.

Pharmacokinetics

Route	Onset	Peak	Duration
PO (analgesic)	0.5 hr	N/A	4–6 hrs
PO (antirheumatic)	2 days	1–2 wks	N/A

Rapidly absorbed from GI tract. Protein binding: 90%–99%. Metabolized in liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 2–4 hrs.

Uses

Treatment of fever, juvenile rheumatoid arthritis (JRA), osteoarthritis, minor to moderate pain, primary dysmenorrhea. Caldolor: Mild to moderate pain; severe pain in combination with an opioid analgesic; fever. NeoProfen: Closes clinically significant patent ductus arteriosus (PDA) in premature infants weighing between 500 and 1,500 g who are no more than 32 wks gestational age when usual medical management is ineffective. OFF-LABEL: Treatment of gout, migraine headaches, migraine prophylaxis, cystic fibrosis, ankylosing spondylitis.

Precautions

Contraindications: History of hypersensitivity to aspirin, NSAIDs (asthma, urticaria, allergic-type reaction). Treatment of perioperative pain in coronary artery bypass graft (CABG) surgery. NeoProfen: Infants with proven or suspected untreated infection, elevated total bilirubin, congenital heart disease in whom patency of the patent ductus arteriosus is necessary for satisfactory pulmonary or systemic blood flow (e.g., pulmonary atresia), bleeding, thrombocytopenia, coagulation defects, suspected necrotizing enterocolitis, significant renal impairment. Cautions: Active peptic ulcer, chronic inflammation of GI tract, GI bleeding disorders, smoking, alcohol use, HF, hypertension, renal/hepatic impairment, dehydration, asthma, concurrent aspirin, anticoagulant use, elderly, debilitated.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Avoid use during third trimester (may adversely affect fetal cardiovascular system: premature closure of ductus arteriosus). Pregnancy Category B (D if used in third trimester or near delivery). Children: Safety and efficacy not established in those younger than 6 mos. Elderly: GI bleeding, ulceration more likely to cause serious adverse effects. Age-related renal impairment may increase risk of hepatic/renal toxicity; reduced dosage recommended.

Interactions

DRUG: May decrease effects of antihypertensives, diuretics. Aspirin, other salicylates may increase risk of GI side effects, bleeding. May increase effects of oral anticoagulants. May increase concentration, risk of toxicity of lithium, methotrexate. HERBAL: Cat’s claw, dong quai, evening primrose, feverfew, garlic, ginkgo, ginseng, horse chestnut, red clover may increase antiplatelet activity. FOOD: None known. LAB VALUES: May prolong bleeding time. May alter serum glucose level. May increase BUN, serum creatinine, potassium, AST, ALT. May decrease serum calcium, glucose, Hgb, Hct, platelets.

Availability (Rx)

Caplets (Advil, Ibu-200, Motrin IB): 200 mg. Capsules (Advil, Advil Migraine): 200 mg. Gelcaps (Advil): 200 mg. Injection, Solution (NeoProfen): 10 mg/ml. (Caldolor): 100 mg/ml. Suspension, Oral (Advil Children’s, Motrin Children’s): 100 mg/5 ml. Suspension, Oral Drops (Advil Infants’, Motrin Infants’): 40 mg/ml. Tablets: 200 mg, 400 mg, 600 mg, 800 mg. Tablets, Chewable (Motrin Junior Strength): 100 mg.

Administration/handling

IV (caldolor)

Reconstitution • Dilute with D₅W or 0.9% NaCl to final concentration of 4 mg/ml or less.

Rate of Administration • Infuse over at least 30 min.

Storage • Store at room temperature. • Stable for 24 hrs after dilution.

IV (neoprofen)

Reconstitution • Dilute to appropriate volume with D₅W or 0.9% NaCl. • Discard any remaining medication after first withdrawal from vial.

Rate of Administration • Administer via IV port nearest the insertion site. • Infuse continuously over 15 min.

Storage • Store at room temperature. • Stable for 30 min after dilution.

PO

• Give with food, milk, antacids if GI distress occurs.

Indications/routes/dosage

Fever

PO: ADULTS, ELDERLY, CHILDREN 12 YRS AND OLDER: 200–400 mg q4–6h prn. Maximum: 1,200 mg/day. CHILDREN 6 MOS–11 YRS: 5–10 mg/kg/dose q6–8h prn. Maximum: 40 mg/kg/day.

IV: ADULTS, ELDERLY: 400 mg q4–6h or 100–200 mg q4h prn. Maximum: 3.2 g/day.

Osteoarthritis, rheumatoid arthritis (RA)

PO: ADULTS, ELDERLY: 400–800 mg/dose 3–4 times/day. Maximum: 3.2 g/day.

Pain

PO: ADULTS, ELDERLY, CHILDREN 12 YRS AND OLDER: 200–400 mg q4–6h prn. Maximum: 1,200 mg/day. CHILDREN 6 MOS–11 YRS: 4–10 mg/kg q6–8h prn. Maximum: 40 mg/kg/day.

Primary dysmenorrhea

PO: ADULTS: 200–400 mg q4–6h prn. Maximum: 1,200 mg/day.

Juvenile rheumatoid arthritis (JRA)

PO: CHILDREN: 30–50 mg/kg/day in 3–4 divided doses. Maximum: 2.4 g/day.

Patent ductus arteriosus (PDA)

IV: INFANTS: Initially, 10 mg/kg then 2 doses of 5 mg/kg, after 24 hrs and 48 hrs. All doses based on birth weight.

Side effects

Occasional (9%–3%): Nausea, vomiting, dyspepsia, dizziness, rash. Rare (less than 3%): Diarrhea or constipation, flatulence, abdominal cramps or pain, pruritus, increased B/P.

Adverse effects/toxic reactions

Overdose may result in metabolic acidosis. Rare reactions with long-term use include peptic ulcer, GI bleeding, gastritis, severe hepatic reaction (cholestasis, jaundice), nephrotoxicity (dysuria, hematuria, proteinuria, nephrotic syndrome), severe hypersensitivity reaction (particularly in pts with systemic lupus erythematosus or other collagen diseases). NeoProfen: Hypoglycemia, hypocalcemia, respiratory failure, UTI, edema, atelectasis may occur. Caldolor: Abdominal pain, anemia, cough, dizziness, dyspnea, edema, hypertension, nausea, vomiting.

Nursing considerations

Baseline assessment

Assess onset, type, location, duration of pain, inflammation. Inspect appearance of affected joints for immobility, deformities, skin condition. Assess temperature.

Intervention/evaluation

Monitor for evidence of nausea, dyspepsia. Monitor CBC, hepatic/renal function tests. Assess skin for rash. Observe for bleeding, bruising, occult blood loss. Evaluate for therapeutic response: relief of pain, stiffness, swelling; increased joint mobility; reduced joint tenderness; improved grip strength. Monitor for fever.

Patient/family teaching

• Avoid aspirin, alcohol during therapy (increases risk of GI bleeding). • If GI upset occurs, take with food, milk, antacids. • May cause dizziness. • Report ringing in ears, persistent stomach pain, respiratory difficulty, unusual bruising/bleeding, swelling of extremities, chest pain/palpitations.

icatibant

eye-kat-i-bant

(Firazyr)

classification

PHARMACOTHERAPEUTIC: Bradykinin B₂ receptor antagonist. CLINICAL: Angioedema agent.

Action

Inhibits bradykinin from binding to B₂ receptor. Inhibits effects of hereditary angioedema (HAE), an autosomal dominant disorder that causes rapid inflammation of skin and mucosal membranes. Therapeutic Effect: Reduces rapid swelling of submucosal tissues during episodic attack of HAE.

Pharmacokinetics

Metabolized by proteolytic enzymes into inactive enzymes. Primarily excreted in urine. Peak plasma: 45 min. Half-life: 1.4 hrs.

Uses

Treatment of acute attacks related to hereditary angioedema.

Precautions

Contraindications: None known. Cautions: Airway obstruction during acute laryngeal HAE attack may occur.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Use caution when administering to nursing mothers. Pregnancy Category C. Children: Safety and efficacy not established in those younger than 18 yrs. Elderly: Increased risk of higher systemic exposure due to lower medication clearance.

Interactions

DRUG: May decrease effectiveness of ACE inhibitors. HERBAL: None significant. FOOD: None known. LAB VALUES: May increase serum AST, ALT.

Availability (Rx)

Injection Solution: 30 mg/3 ml in prefilled syringes.

Administration/handling

Subcutaneous

• Inject into left or right anterolateral abdominal wall. • Introduce entire length of needle (1/2 inch) into skin fold between thumb and forefinger, holding skin fold during injection. • Rotate injection sites if applicable. • Inject over 30 sec.

Storage • Refrigerate until time of use. • Visually inspect syringe for particulate matter. • Solution should appear clear, colorless. • Do not freeze.

Indications/routes/dosage

Acute hereditary angioedema

Subcutaneous: ADULTS, ELDERLY: Initially, 30 mg once. May repeat 30 mg dose at intervals of at least 6 hrs. Maximum: 90 mg/24 hrs.

Side effects

Frequent (97%): Injection site reactions: bruising, hematoma, burning, erythema, hypoesthesia, irritation, numbness, edema, pain, pressure sensation, pruritus, urticaria. Rare (3%): Dizziness, allergic reaction, nausea, vomiting, rash, headache, pyrexia.

Adverse effects/toxic reactions

Positive anti-icatibant antibodies reported in 4% of pts.

Nursing considerations

Baseline assessment

Assess characteristics of inflammatory attacks (location, severity, history of drooling, difficulty breathing/swallowing). Question history of laryngeal-associated angioedema. Question possibility of pregnancy or plans of breastfeeding. Assess full medication history, esp. ACE inhibitors.

Intervention/evaluation

Assess O₂ saturation, airway patency for mouth, tongue, throat inflammation. If applicable, monitor ACE inhibitor effectiveness, B/P. Frequently monitor for symptom improvement after injection. Notify physician if inflammation remains after 3 doses.

Patient/family teaching

• Avoid tasks that require alertness, motor skills until response to drug is established. • Instruct proper self-administration techniques. • If applicable, inform pt of decreased ACE inhibitor effectiveness. • Report suspected pregnancy. • Seek medical attention immediately if throat swelling, drooling, difficulty breathing occurs during acute attacks. • Symptoms that do not improve or recur will require additional interval doses. • Do not use more than 3 doses in 24 hrs. • Educate pt about common injection site reactions. Seek medical attention in health care facility if laryngeal symptoms occur after administration of icatibant.

icosapent

eye-koe-sa-pent

(Vascepa)

Do not confuse icosapent with icatibant or Vascepa with Vaseretic.

classification

PHARMACOTHERAPEUTIC: Omega-3 fatty acid. CLINICAL: Antihypertriglyceride agent (see p. 59C).

Action

Potential mechanisms of action include increased B-oxidation, decreased lipogenesis in liver, increased plasma lipoprotein lipase activity. Therapeutic Effect: Reduces hepatic very-low density lipoprotein triglyceride (VLOL-TG) synthesis.

Pharmacokinetics

Absorbed in small intestine; enters systemic circulation via thoracic duct lymphatic system. Protein binding: 99%. Metabolized in liver. Half-life: 89 hrs.

Uses

Adjunct to diet to reduce serum triglyceride levels in adult pts with serum hypertriglyceridemia (500 mg/dl or greater).

Precautions

Contraindications: None known. Cautions: Known sensitivity or allergy to fish, shellfish; hepatic impairment, coagulopathy, pts receiving therapeutic anticoagulation.

Lifespan considerations

Pregnancy/Lactation: Distributed in breast milk. Pregnancy Category C. Children: Safety and efficacy in children younger than 18 yrs not established. Elderly: No age-related precautions noted.

Interactions

DRUG: None significant. HERBAL: None significant. FOOD: None known. LAB VALUES: May increase serum ALT, AST, low-density lipoprotein (LDL) cholesterol. May alter bleeding time.

Availability (Rx)

Capsules, Soft Gelatin: 1 g.

Administration/handling

PO

• Give with food. • Capsule(s) should be swallowed whole. • Instruct pt not to chew capsule. • Do not break open, crush, or dissolve medication.

Indications/routes/dosage

◀ ALERT ▶ Before initiating therapy, pt should be on appropriate cholesterol-lowering diet and regimen of physical activity. Continue diet and activity program throughout therapy.

Usual dosage

PO: ADULTS, ELDERLY: 4 g per day, given as 2 capsules twice daily with food.

Side effects

Rare (2%): Arthralgia. (Less Than 1%): Oropharyngeal pain.

Adverse effects/toxic reactions

Increased bleeding time has been noted.

Nursing consideration

Baseline assessment

Obtain diet history. Obtain baseline chemistries, hepatic function tests, fasting lipid profile. In patients with hepatic impairment, ALT, AST, serum triglyceride, and lipid levels should be monitored periodically.

Intervention/evaluation

Monitor serum triglyceride level for therapeutic response. Monitor LDL cholesterol periodically. For those taking antiplatelets, monitor bleeding time. Discontinue therapy if no response after 3 mos of treatment.

Patient/family teaching

• Continue to adhere to lipid-lowering diet (important part of treatment). • Periodic lab tests are essential part of therapy to determine drug effectiveness.

idarubicin

eye-da-roo-bi-sin

(Idamycin PFS)

BLACK BOX ALERT Cardiotoxicity may occur (HF, arrhythmias, cardiomyopathy). Severe myelosuppressant. Must be administered by personnel trained in administration/handling of chemotherapeutic agents. Severe local tissue damage, necrosis if extravasation occurs.

Do not confuse Idamycin with Adriamycin, or idarubicin with daunorubicin, doxorubicin, or epirubicin.

classification

PHARMACOTHERAPEUTIC: Anthracycline antibiotic. CLINICAL: Antineoplastic (see p. 87C).

Action

Inhibits nucleic acid synthesis by interacting with enzyme topoisomerase II, promoting DNA strand supercoiling. Therapeutic Effect: Produces death of rapidly dividing cells.

Pharmacokinetics

Widely distributed. Protein binding: 97%. Rapidly metabolized in liver. Primarily eliminated by biliary excretion. Not removed by hemodialysis. Half-life: 12–27 hrs.

Uses

Treatment of acute myeloid leukemia (AML). OFF-LABEL: Acute lymphocytic leukemia (ALL).

Precautions

Contraindications: Arrhythmias, cardiomyopathy, preexisting myelosuppression, pregnancy, severe HF, bilirubin greater than 5 mg/dL. Cautions: Renal/hepatic impairment, concurrent radiation therapy.

Lifespan considerations

Pregnancy/Lactation: If possible, avoid use during pregnancy (may be embryotoxic). Unknown if drug is distributed in breast milk (advise to discontinue breast-feeding before drug initiation). Pregnancy Category D. Children: Safety and efficacy not established. Elderly: Cardiotoxicity may be more prevalent. Caution in pts with inadequate bone marrow reserves. Age-related renal impairment may require dosage adjustment.

Interactions

DRUG: May decrease effects of antigout medications. Bone marrow depressants may increase myelosuppression. Live virus vaccines may potentiate virus replication, increase vaccine side effects, decrease pt’s antibody response to vaccine. HERBAL: None significant. FOOD: None known. LAB VALUES: May increase serum alkaline phosphatase, bilirubin, uric acid, AST, ALT. May cause EKG changes.

Availability (Rx)

Injection Solution: 1 mg/ml in 5-ml, 10-ml, 20-ml vials.

Administration/handling

◀ ALERT ▶ Give by free-flowing IV infusion (never subcutaneous or IM). Gloves, gowns, eye goggles recommended during preparation/administration of medication. If powder/solution comes in contact with skin, wash thoroughly. Avoid small veins, swollen/edematous extremities, areas overlying joints/tendons.

IV

Reconstitution • May give undiluted or dilute with 0.9% NaCl or D₅W.

Rate of Administration • Administer IV push into tubing of freely running IV infusion of D₅W or 0.9% NaCl, preferably via butterfly needle, slowly over 3–5 min. • May give intermittent infusion over 10–15 min. • Extravasation produces immediate pain, severe local tissue damage. Terminate infusion immediately. Apply cold compresses for 30 min immediately, then q30min 4 times a day for 3 days. Keep extremity elevated.

Storage • Refrigerate vials. • Diluted solutions in 0.9% NaCl or D₅W are stable for 72 hrs at room temperature or 7 days if refrigerated.

IV incompatibilities

Acyclovir (Zovirax), allopurinol (Aloprim), ampicillin and sulbactam (Unasyn), cefazolin (Ancef, Kefzol), cefepime (Maxipime), ceftazidime (Fortaz), clindamycin (Cleocin), dexamethasone (Decadron), furosemide (Lasix), hydrocortisone (Solu-Cortef), lorazepam (Ativan), methotrexate, piperacillin and tazobactam (Zosyn), sodium bicarbonate, teniposide (Vumon), vancomycin (Vancocin), vincristine (Oncovin).

IV compatibilities

Diphenhydramine (Benadryl), granisetron (Kytril), magnesium, potassium.

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Tags: Saunders Nursing Drug Handbook 2015

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

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