Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (176 page)
Stimulates proliferation and differentiation of neutrophils
To decrease infection in patients receiving antineoplastics that are myelosuppressive; to increase WBC in patients with product-induced neutropenia; bone marrow transplantation
Unlabeled uses:
Neutropenia with HIV infection, aplastic anemia, ganciclovir-induced neutropenia, zidovudine-induced neutropenia
Hypersensitivity to proteins of
Escherichia coli
Precautions:
Pregnancy (C), breastfeeding, cardiac conditions, children, myeloid malignancies, radiation therapy, sepsis, sickle cell disease, chemotherapy, respiratory disease
Calculator
• Adult and child:
IV/SUBCUT
5 mcg/kg/day in a single dose × 14 days; may increase by 5 mcg/kg with each cycle
• Adult:
IV/SUBCUT
10 mcg/kg/day as
INF (IV)
over 4 hr or 24 hr, begin 24 hr after chemotherapy and 24 hr after bone marrow transplantation
• Adult:
10 mcg/kg/day as bolus or
CONT INF
× ≥4 days before leukapheresis, continue to last leukapheresis; may alter dose if WBC >100,000 cells/mm
3
• Adult:
SUBCUT
5 mcg/kg daily
Available forms:
Inj 300 mcg/ml, 480 mcg/1.6 ml, 480 mcg/0.8 ml, 3000 mcg/0.5 ml
•
Given by subcut inj, short IV inf, or continuous SC or IV inf
•
Avoid use within 24 hr before or after chemotherapy
•
Do not shake commercial single-dose vials before withdrawing the dose. If the vial is shaken and froth or bubbles form, allow the vial to stand undisturbed for a few minutes until the froth or bubbles dissipate
•
Before injection, filgrastim may be allowed to reach room temperature for a maximum of 24 hr. Any vial or syringe exposed to room temperature for more than 24 hr should be discarded
•
Visually inspect for particulate matter and discoloration before use
•
Subcut inj:
No dilution is necessary; inject by rapid subcut inj, taking care not to inject intradermally
•
Subcut continuous inf:
Infuse subcut at a rate not to exceed 2 ml/hr
•
May be diluted with 5% dextrose. Do not dilute with NS; product can precipitate
•
May be diluted to concentrations 5–15 mcg/ml; should be protected from adsorption to plastic by the addition of albumin to a final albumin concentration of 2 mg/ml. Do not dilute filgrastim to a concentration <5 mcg/ml
•
IV inf:
Infuse IV over 15–30 min or as a continuous infusion over 24 hr
Y-site compatibilities:
Acyclovir, allopurinol, amikacin, aminophylline, ampicillin, ampicillin/sulbactam, aztreonam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefoTEtan, cefTAZidime, chlorproMAZINE, cimetidine, CISplatin, cyclophosphamide, cytarabine, dacarbazine, DAUNOrubicin, dexamethasone, diphenhydrAMINE, DOXOrubicin, doxycycline, droperidol, enalaprilat, famotidine, floxuridine, fluconazole, fludarabine, gallium, ganciclovir, granisetron, haloperidol, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, leucovorin, LORazepam, mechlorethamine, melphalan, meperidine, mesna, methotrexate, metoclopramide, miconazole, minocycline, mitoXANtrone, morphine, nalbuphine, netilmicin, ondansetron, plicamycin, potassium chloride, promethazine, ranitidine, sodium bicarbonate, streptozocin, ticarcillin, ticarcillin/clavulanate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vinBLAStine, vinCRIStine, vinorelbine, zidovudine
CNS:
Fever, headache
GI:
Nausea
, vomiting, diarrhea, mucositis, anorexia
HEMA:
Thrombocytopenia,
excessive leukocytosis
INTEG:
Alopecia, exacerbation of skin conditions, urticaria, cutaneous vasculitis
MS:
Osteoporosis, skeletal pain
OTHER:
Chest pain, hypotension
RESP:
Acute respiratory distress syndrome,
wheezing,
alveolar hemorrhage
SUBCUT:
Onset 5-60 min, peak 2-8 hr, duration up to 1 wk
IV:
Onset 5-60 min, peak 24 hr, duration up to 1 wk
Increase:
adverse reactions—do not use this product concomitantly with antineoplastics, lithium
Increase:
uric acid, LDH, alk phos, WBC
•
Blood studies: CBC, platelet count before treatment and twice weekly; neutrophil counts may be increased for 2 days after therapy
•
B/P, respirations, pulse before and during therapy
•
Bone pain; give mild analgesics
•
CBC with differential, platelets
•
Storage in refrigerator; do not freeze; may store at room temp up to 24 hr
•
Therapeutic response: absence of infection
•
About the technique for self-administration: dose, side effects, disposal of containers and needles; provide instruction sheet
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(fin-ass′te-ride)
Propecia, Proscar
Func. class.:
Hormone, androgen inhibitor, hair stimulant
Chem. class.:
5-α-Reductase inhibitor
Do not confuse:
finasteride
/furosemide
Proscar
/ProSom/PROzac
Inhibits 5-α-reductase and reduction in DHT; DHT induces androgenic effects by binding to androgen receptors in the cell nuclei of the prostate gland, liver, skin; prevents development of BHP
Symptomatic benign prostatic hyperplasia (Proscar); male-pattern baldness (Propecia)
Unlabeled uses:
Hirsutism, prostate cancer prophylaxis
Pregnancy (X), breastfeeding, children, women who are pregnant or who may become pregnant should not handle tabs, hypersensitivity
Precautions:
Large residual urinary volume, severely diminished urinary flow, hepatic function abnormalities
Calculator
• Adult:
PO
5 mg/day × 6-12 mo (Proscar)
• Adult:
PO
1 mg/day for 3 mo or more for results (Propecia)
• Adult (nonpregnant):
PO
5 mg/day alone or in combination with oral contraceptives
• Adult (male):
PO
5 mg/day
Available forms:
Tabs (Propecia) 1 mg, (Proscar) 5 mg
•
Without regard to meals
•
For a minimum of 6 mo; not all patients will respond
GU:
Impotence, decreased libido, decreased volume of ejaculate, sexual dysfunction
INTEG:
Rash
MISC:
Breast tenderness,
secondary malignancy
Bioavailability 63%; readily absorbed from GI tract; plasma protein binding 90%; metabolized in the liver; excreted in urine (metabolites) 39%, feces (57%); crosses blood-brain barrier; peak 1-2 hr; duration 24 hr
Decrease:
finasteride effect—theophylline, adrenergic bronchodilators, anticholinergics
Decrease:
PSA levels
•
BPH:
urinary patterns, residual urinary volume, severely diminished urinary flow
•
PSA levels and digital rectal exam prior to initiating therapy and periodically thereafter
•
Hepatic studies before treatment; extensively metabolized in liver
•
Storage <86° F (30° C); protect from light; keep container tightly closed
•
Therapeutic response: increased urinary flow; decreased postvoiding dribbling, frequency, nocturia or hair growth within 3-6 mo; regression of prostate size
That pregnant women or women who may become pregnant should not touch crushed tabs or come into contact with the semen of a patient taking this product; that product may adversely affect developing male fetus
•
That volume of ejaculate may be decreased during treatment; that impotence and decreased libido may also occur and may continue after discontinuing treatment
•
That Propecia results may not occur for 3 mo
•
That Proscar results may not occur for 6-12 mo
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
