Mosby's 2014 Nursing Drug Reference (388 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

tesamorelin

Egrifta

Func. class.:
Pituitary hormone, growth hormone modifiers

ACTION:

Binds to growth hormone releasing factor receptors on the pituitary somatotroph cells; binding stimulates the production, release of endogenous growth hormone (GH)

USES:

Treatment of excess abdominal fat in HIV-infected patients with lipodystrophy

CONTRAINDICATIONS:

Hypersensitivity to this product or mannitol, neoplastic disease, pregnancy X,
disruption of the hypothalamic-pituitary axis
(hypothalamic-pituitary-adrenal (HPA) suppression) due to hypophysectomy, hypopituitarism, pituitary tumor/surgery, radiation therapy of the head or head trauma, IV/IM administration

Precautions:
Breastfeeding, CABG, diabetes, diabetic retinopathy, edema, geriatrics, children, infants, adolescents

DOSAGE AND ROUTES
Calculator

• Adult:
SUBCUT 2 mg/day

Available forms:
Powder for injection 1 mg

Administer:
Subcut route:

• 
Visually inspect parenteral products for particulate matter and discoloration before use

• 
To reconstitute, inject 2.1 ml sterile water for inj into the 2-mg vial; use syringe with needle already attached; to avoid foaming, push plunger in slowly with needle on a slight angle so sterile water goes down the inside wall of vial; with needle and syringe attached to vial, keep vial upright and gently roll vial for 30 sec until mixed; do not shake; withdraw 2.1 ml of the reconstituted sol

• 
To administer, take syringe out of vial, place needle cap on its side against a clean flat surface, do not touch needle, hold syringe and slide needle into cap, push cap all the way or until it snaps shut; do not touch cap until it covers needle completely; remove needle, insert a 0.5 inch 27-G safety injection needle onto syringe; use immediately; throw away any unused product or used sterile water for inj, sol should be clear, do not use if discolored, cloudy, or has particles; slight foaming is acceptable; inject subcut into abdomen; avoid scar tissues, bruises, or navel; rotate inj sites in abdomen; slowly push plunger down until all sol has been injected

• 
After removing needle from skin, flip back needle shield until it snaps, covering the injection needle completely; keep pressing until you hear a click, which means the injection needle is protected

• 
Use a piece of sterile gauze to rub the inj site clean; if bleeding, apply pressure to site with gauze for 30 sec; if bleeding continues, apply a bandage to site

• 
Properly dispose of used syringe, needles, vial, and sterile water for injection bottle in a sharps container

SIDE EFFECTS

CNS:
Depression, peripheral neuropathy paresthesias, hypoesthesia, spasms, flushing, night sweats, insomnia, headache

CV:
Chest pain, palpitations, hypertension, edema, peripheral edema

GI:
Nausea, vomiting, upper abdominal pain, dyspepsia, diarrhea

INTEG:
Pruritus, urticaria, rash, flushing, injection site reactions

MS:
Arthralgia, joint swelling, stiffness, myalgias, carpal tunnel syndrome

RESP:
Upper respiratory tract infection

SYST:
Secondary malignancy

PHARMACOKINETICS

Half-life 26 min in healthy patients, 38 min and those with HIV infection; peak 0.15 hr

INTERACTIONS

Decrease:
effect of—simvastatin, ritonavir, cortisone, prednisone

NURSING CONSIDERATIONS
Assess:

• 
Lipodystrophy:
Assess for sunken cheeks, thinning arms and legs, fat accumulation in the abdomen, jaws and back of neck; after treatment these should lessen

• 
Monitor glycosylated hemoglobin A1c (HbA1c), serum IGF-1 concentrations, ophthalmologic exam

Evaluate:

• 
Decreasing lipodystrophy in HIV patients

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

testosterone cypionate (Rx)

Depo-Testosterone

testosterone enanthate (Rx)

Delatestryl

testosterone gel (Rx)

AndroGel, FORTESTA, Testim

testosterone pellets (Rx)

Testopel

testosterone
transdermal (Rx)

Androderm

testosterone buccal (Rx)

Striant

testosterone topical
solution

Axiron

Func. class.:
Androgenic anabolic steroid

Chem. class.:
Halogenated testosterone derivative

 

Controlled Substance Schedule III
ACTION:

Increases weight by building body tissue; increases potassium, phosphorus, chloride, nitrogen levels, bone development

USES:

Female breast cancer, hypogonadism, eunuchoidism, male climacteric, oligospermia, impotence, vulvar dystrophies, low testosterone levels, delayed male puberty (inj)

Unlabeled uses:
Weight loss in AIDS patients, andropause, anemia, cryptorchidism, lichen sclerosis, microphallus, transsexualism

CONTRAINDICATIONS:

Pregnancy (X), breastfeeding, severe cardiac/renal/hepatic disease, hypersensitivity, genital bleeding (rare), male breast/prostate cancer

Precautions:
Diabetes mellitus, CV disease, MI, urinary tract disorders, prostate cancer, hypercalcemia

 

Black Box Warning:

Children, accidental exposure

DOSAGE AND ROUTES
Calculator
Replacement

• Adult:
IM (enanthate or cypionate)
50-400 mg q2-4wk; topical sol (Axiron) 60 mg (2 pump actuations), apply each
AM

• Adult (male) and child:
SUBCUT (pellets)
150-450 mg (2-6 pellets) inserted q3-6mo

• Adult:
TRANSDERMAL (Testoderm, Androderm)
4-6 mg applied q24hr;
GEL (AndroGel)
1% 5 mg applied q24hr, once daily; 1.62% 40.5 mg (2 pump actuations) q
AM
; topical sol
(Axiron)
30 mg/actuation
BUCCAL
1 buccal system (30 mg) to the gum region q12hr before meals/
PM

Breast cancer

• Adult:
IM
200-400 mg q2-4wk (cypionate or enanthate)

Delayed male puberty

• Child >12 yr:
IM
≤100 mg/mo for ≤6 mo

Available forms:
Enanthate:
inj 200 mg/ml;
cypionate:
inj 100, 200 mg/ml; pellets 75 mg;
transdermal
2, 4, mg/24 hr;
gel
1%, 1.62%, 10 mg/actuation;
buccal system
30 mg;
topical sol
30 mg/actuation

Administer:

• 
Titrated dose; use lowest effective dose

• 
IM inj deep into upper outer quadrant of gluteal muscle

• 
Transdermal patches:
Testoderm to skin of scrotum; Androderm to skin of back, upper arms, thighs, abdomen; area must be dry shaved; may be reapplied after bathing, swimming

• 
Gel:
products not interchangeable, dosage and administration for AndroGel 1% differs from that of AndroGel 1.62%; apply daily to clean, dry area on shoulders, upper arms, or abdomen; women, children should not touch treated skin

Buccal system route

• 
Do not chew or swallow buccal system

• 
Rotate sites; place above incisor tooth on either side of mouth

• 
Open packet; place rounded side of surface against gum and hold firmly in place with finger over lip for 30 sec; if product falls off, replace with new system; discard in trash can away from children or pets

Topical solution route

• 
Using the provided applicator, apply the solution to clean, dry, intact skin of the axilla, preferably at the same time each morning; do not apply to any other part of the body; allow the solution to dry completely before dressing; if an antiperspirant or deodorant is used, apply at least 2 min before applying the solution; the pump must be primed before the first use by fully depressing the pump mechanism 3×, discard any solution that is released during the priming; to dispense the solution, position the nozzle over the applicator cup and carefully depress the pump once fully; the cup should be filled with no more than 1 pump actuation (30 mg); with the applicator upright, place it up into the axilla and wipe steadily down and up into the axilla; do not use fingers or hand to rub the solution; if multiple applications are necessary for the required dose, alternate application between the left and right axilla; when repeat application to the same axilla is necessary, allow the solution to dry completely before the next application; after use, rinse the applicator under running water and pat dry with tissue; wash hands with soap and water

• 
Following application, allow the site to dry before putting on clothing

• 
Direct contact of the medicated skin with the skin of another person can result in the transfer of residual testosterone and absorption by the other person;
to reduce accidental transfer, the patient should cover the application site(s) with clothing (eg, a T-shirt) after the solution has dried; the application site should be washed with soap and water prior to any skin-to-skin contact regardless of the length of time since application; in the case of direct contact, the other person should wash the area of contact with soap and water as soon as possible

• 
Patients should be advised that the topical solution is flammable; therefore, fire, flame, and smoking should be avoided during use

• 
Advise patients to avoid swimming or washing the application site until 2 hr following application of solution

SIDE EFFECTS

CNS:
Dizziness, headache, fatigue, tremors, paresthesias, flushing, sweating, anxiety, lability, insomnia, carpal tunnel syndrome

CV:
Increased B/P

EENT:
Conjunctival edema, nasal congestion

ENDO:
Abnormal glucose tolerance test

GI:
Nausea, vomiting, constipation, weight gain,
cholestatic jaundice

GU:
Hematuria, amenorrhea, vaginitis, decreased libido, decreased breast size, clitoral hypertrophy, testicular atrophy, gynecomastia, large prostate

HEMA:
Polycythemia

INTEG:
Rash, acneiform lesions, oily hair/skin, flushing, sweating, acne vulgaris, alopecia, hirsutism

MS:
Cramps, spasms

PHARMACOKINETICS

PO:
Metabolized in liver; excreted in urine, breast milk; crosses placenta

INTERACTIONS

• 
Edema: ACTH, adrenal steroids, buPROPion

Increase:
effects of oxyphenbutazone

Increase:
PT—anticoagulants

Decrease:
glucose levels may alter need for oral antidiabetics, insulin

Drug/Lab Test

Increase:
serum cholesterol, blood glucose, urine glucose

Decrease:
serum calcium, serum potassium, T
4
, T
3
, thyroid
131
I uptake test, urine 17-OHCS, 17-KS, PBI

NURSING CONSIDERATIONS
Assess:

• 
Weight daily; notify prescriber if weekly weight gain >5 lb

• 
B/P q4hr, Hgb/HCT

• 
I&O ratio; be alert for decreasing urinary output, increasing edema

• 
Growth rate, bone age in children; growth rate may be uneven (linear/bone growth) with extended use

• 
Electrolytes: K, Na, Cl, Ca; cholesterol

• 
Hepatic studies: ALT, AST, bilirubin

• 
Edema, hypertension, cardiac symptoms, jaundice

• 
Mental status: affect, mood, behavioral changes, aggression

• 
Signs of masculinization in female:
increased libido, deepening of voice, decreased breast tissue, enlarged clitoris, menstrual irregularities; male: gynecomastia, impotence, testicular atrophy

• 
Hypercalcemia:
lethargy, polyuria, polydipsia, nausea, vomiting, constipation; product may have to be decreased

• 
Hypoglycemia
in diabetic patients; oral antidiabetic action is increased

Perform/provide:

• 
Diet with increased calories, protein; decrease sodium if edema occurs

Evaluate:

• 
Therapeutic response: 4-6 wk with osteoporosis

Teach patient/family:

• 
That product must be combined with complete health plan: diet, rest, exercise

• 
To notify prescriber if therapeutic response decreases, if edema occurs

• 
About changes in sex characteristics: priapism, gynecomastia, increased libido

• 
That women should report menstrual irregularities, voice changes, acne, facial
hair growth; if pregnancy is planned or suspected

• 
That 1-3-mo course is necessary for response with breast cancer

• 
About the proper application of patches

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

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