Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (236 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(loo-koe-vor′in)
Func. class.:
Vitamin, folic acid/methotrexate antagonist antidote
Chem. class.:
Tetrahydrofolic acid derivative
Do not confuse:
leucovorin
/Leukeran/leukine
folinic acid
/folic acid
Needed for normal growth patterns; prevents toxicity during antineoplastic therapy by protecting normal cells
Megaloblastic or macrocytic anemia caused by folic acid deficiency, overdose of folic acid antagonist, methotrexate/pyrimethamine/ trimetrexate/trimethoprim toxicity, pneumocystosis, toxoplasmosis
Hypersensitivity to this product or folic acid, benzyl alcohol; anemias other than megaloblastic not associated with vit B
12
deficiency
Precautions:
Pregnancy (C), neonates, breastfeeding, geriatric patients, seizures, stomatitis, vomiting
Calculator
• Adult and child:
PO/IV/IM
up to 6 mg/day
• Adult and child:
IM
≤1 mg/day until adequate response
• Adult and child:
PO/IM/IV Normal elimination
given 6 hr after dose of methotrexate (10 mg/m
2
) until methotrexate <5 × 10
−8
m, CCr >50% above prior level, or methotrexate level 5 × 10
−8
m at 24 hr or >9 × 10
−8
m at 48 hr; give leucovorin 100 mg/m
2
q3hr until level drops to <10
−8
m
• Adult and child:
PO/IM
5-15 mg/day
• Adult:
IV
200 mg/m
2
, then 5-FU 370 mg/m
2
or leucovorin 20 mg/m
2
, then 5-FU 425 mg/m
2
; give daily × 5 days q4-5wk
Available forms:
Tabs 5, 10, 15, 25 mg; inj 3, 5 mg/ml; powder for inj 10 mg/ml
•
Within 1 hr of folic acid antagonist
•
Do not give concurrently with systemic methotrexate
•
No reconstitution needed
•
For treatment of megaloblastic anemia
•
Reconstitute 50 mg/5 ml bacteriostatic or sterile water for inj (10 mg/ml) or (100 mg/10 ml); use immediately if sterile water used
•
Give over 160 mg/min or less (16 ml of 10 mg/ml sol/min)
•
Give after diluting in 100-500 ml of 0.9% NaCl, D
5
W, D
10
W, LR, Ringer’s sol
Y-site compatibilities:
Amifostine, aztreonam, bleomycin, cefepime, CISplatin, cladribine, cyclophosphamide, DOXOrubicin, DOXOrubicin liposome, filgrastim, fluconazole, fluorouracil, furosemide, granisetron, heparin, methotrexate, metoclopramide, mitoMYcin, piperacillin/tazobactam, tacrolimus, teniposide, thiotepa, vinBLAStine, vinCRIStine
HEMA:
Thrombocytosis (intraarterial)
INTEG:
Rash, pruritus, erythema, urticaria
RESP:
Wheezing
Increase:
metabolism of barbiturates, hydantoins, primidone
Decrease:
effect of—sulfamethoxazole, trimethoprim
•
CCr, creatinine before leucovorin rescue, daily to detect nephrotoxicity; methotrexate level
•
I&O; urine pH q6hr, maintain >7 to prevent neurotoxicity; watch for nausea and vomiting
•
Other products taken:
alcohol, hydantoins, trimethoprim may cause increased folic acid use by body
•
Neurologic status (rescue): weakness, fatigue
•
Monitor calcium levels
•
Megaloblastic anemia, plasma lactic acid, leticulocyte count, Hct, Hgb
•
Hypersensitivity:
rash, urticaria, wheezing; notify prescriber
•
Increased fluid intake if used to treat folic acid inhibitor overdose
•
Protection from light and heat
•
Therapeutic response: increased weight; improved orientation, well-being; absence of fatigue; reversal of toxicity (methotrexate, folic acid antagonist overdose)
•
For leucovorin rescue
to drink 3 L fluid/day of rescue
•
For folic acid deficiency,
to eat folic-acid–rich foods: bran; yeast; dried beans; nuts; fresh, green leafy vegetables
•
To take product exactly as prescribed
•
To notify prescriber of side effects
•
To report signs of hyposensitivity reaction immediately
•
To avoid breastfeeding
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTleuprolide (Rx)
(loo-proe′lide)
Eligard, Lupron Depot, Lupron Depot-Ped, Viadur
Func. class.:
Antineoplastic hormone
Chem. class.:
Gonadotropin-releasing hormone
Do not confuse:
Lupron
/Nuprin/Lopurin
Causes initial increase in circulating levels of LH, FSH; continuous administration results in decreased LH, FSH; in men, testosterone is reduced to castrate levels; in premenopausal women, estrogen is reduced to menopausal levels
Metastatic prostate cancer (inj implant), management of endometriosis, central precocious puberty, uterine leiomyomata (fibroids)
Unlabeled uses:
Breast cancer, recurrent priapism, benign prostatic hyperplasia
Pregnancy (X), breastfeeding, hypersensitivity to GnRH or analogs, thromboembolic disorders, undiagnosed vaginal bleeding; Viadur implant or Eligard should not be used in women, children
Precautions:
Edema, hepatic disease, CVA, MI, seizures, hypertension, diabetes mellitus, CHF, depression, osteoporosis, spinal cord compression, urinary tract obstruction
Calculator
• Adult:
SUBCUT
1 mg/day;
IM
7.5 mg/dose monthly; Viadur implant (72 mg) yearly; or
IM
22.5 mg q3mo; or
IM
30 mg q4mo; or IM 45 mg q6mo
• Adult:
IM
3.75 mg monthly for 6 mo or 11.25 q3mo for 6 mo or 30 mg q4mo
• Child:
SUBCUT
50 mcg/kg/day; may increase by 10 mcg/kg/day as needed
• Child >37.5 kg:
IM
15 mg q4wk
• Child 25-37.5 kg:
IM
11.25 mg q4wk
• Child ≤25 kg:
7.5 mg q4wk
• Adult:
SUBCUT
(sol for inj) 1 mg/day, must be cont; IM (inj susp) 3.75 mg q28day × 24 wk
Available forms:
Powder for inj depot 1 mo 3.75 mg, depot 3 mo/1.25 mg, 22.5 mg; depot 4 mo 30 mg; depot 6 mo 45 mg; depot-ped 7.5, 11.25, 15 mg; sol for inj 1 mg/0.2 ml; susp for inj 7.5, 22.5, 30, 45 mg; implant (Viadur) 65 mg
•
SUBCUT:
No dilution needed if patient self-administering; make sure patient using syringes provided by manufacturer
•
Viadur DUROS Implant:
Insert in inner aspect of arm, remove after 12 mo
•
SUBCUT: Eligard:
bring to room temperature, once mixed, give within 30 min, prepare the 2 syringes for mixing, join the 2 syringes together by pushing in and twisting until secure; mix the product by pushing the contents of both syringes back and forth between syringes until uniform; should be light tan to tan, hold syringes vertically with syringe B on the bottom, draw entire mixed product into syringe B (short, wide syringe) by depressing the syringe A plunger and slightly withdrawing syringe B plunger, uncouple syringe A, while pushing down on syringe A plunger, small air bubbles will remain, hold syringe B upright, remove pink cap, attach needle cartridge to the end of syringe B, remove needle cover, give by subcut
•
Monthly:
reconstitute single-use vial with 1 ml of diluent; if multiple vials used, withdraw 0.5 ml, inject into each vial (1 ml); withdraw all, inject at 90-degree angle (3.75 mg)
•
3-month:
reconstitute microspheres using 1.5 ml of diluent, inject into vial; shake, withdraw, inject
•
12-month:
insert into upper arm; at the end of 12 months, implant must be removed
CNS:
Memory impairment, depression,
seizures
CV:
MI, PE, dysrhythmias,
peripheral edema
GI:
Nausea, vomiting, anorexia, diarrhea,
GI bleeding
GU:
Edema, hot flashes, impotence, decreased libido, amenorrhea, vaginal dryness, gynecomastia,
profuse vaginal bleeding
INTEG:
Alopecia
MS:
Bone pain
RESP:
Dyspnea, pulmonary fibrosis, interstitial lung disease
SUBCUT:
Onset 1-2 wk; peak 2-4 wk; absorbed rapidly (SUBCUT), slowly (IM depot); half-life 3 hr
Increase:
antineoplastic action—flutamide, megestrol
•
Do not use with black cohosh or chaste tree fruit, may interfere with treatment
•
Prostate cancer:
increased bone pain for first 4 wk of treatment; those with metastases in spinal column may exhibit severe back pain
•
Symptoms of endometriosis
(lower abdominal pain)/
fibroids
(pelvic pain, excessive vaginal bleeding, bloating) before, during, after treatment
•
Central precocious puberty (CPP)
diagnosis should have been confirmed by secondary S
4
characteristics in children <9 yr, estradiol/testosterone levels, GnRH test, tomography of head, adrenal steroids, chorionic gonadotropin, wrist x-ray, height, weight
•
Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) monthly, as needed; PSA, calcium, testosterone with prostate cancer; bone mineral density; blood glucose, HbA1c
•
Pituitary gonadotropic and gonadal function during therapy and 4-8 wk after therapy decreased
•
Tumor flare:
worsening of signs and symptoms; normal during beginning therapy
•
Fatigue, increased pulse, pallor, lethargy; edema in feet, joints; stomach pain
Severe allergic reaction:
rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
•
Storage in tight container at room temp
•
Therapeutic response: decreased tumor size and spread of malignancy; decrease in lesions, pain with endometriosis, fibroids, correction of CPP; increased follicle maturation
•
To notify prescriber if menstruation continues; menstruation should stop
•
To notify prescriber if pregnancy is planned or suspected (X), avoid breastfeeding
•
That bone pain will disappear after 1 wk
•
To report any complaints, side effects to nurse, prescriber; hot flashes may occur; record weight, report gain of >2 lb/day
•
How to prepare, give; to rotate sites for SUBCUT inj
•
To keep accurate records of dose
•
That tumor flare may occur:
increase in size of tumor, increased bone pain, will subside rapidly; may take analgesics for pain
•
That voiding problems may increase during beginning of therapy but will decrease in several weeks
