Mosby's 2014 Nursing Drug Reference (68 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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boric acid otic

See
Appendix B

 

HIGH ALERT
bortezomib (Rx)

(bor-tez′oh-mib)

Velcade

Func. class.:
Antineoplastic—miscellaneous

Chem. class.:
Proteasome inhibitor

ACTION:

Reversible inhibitor of chymotrypsin-like activity in mammalian cells; causes delay in tumor growth by disrupting normal homeostatic mechanisms

USES:

Multiple myeloma previously untreated or when at least 2 other treatments have failed; mantle cell lymphoma who have received ≥1 prior therapy

Unlabeled uses:
Non-Hodgkin’s lymphoma (NHL)

CONTRAINDICATIONS:

Pregnancy (D), breastfeeding; hypersensitivity to product, boron, mannitol

Precautions:
Children, geriatric patients, peripheral neuropathy, renal/hepatic disease, hypotension, tumor lysis syndrome, thrombocytopenia, infection, diabetes mellitus, bone marrow suppression

DOSAGE AND ROUTES
Calculator
Multiple myeloma (previously untreated)

• Adult: IV BOL/SUBCUT
Give for nine 6-wk cycles; cycles 1-4, 1.3 mg/m
2
/dose given on days 1, 4, 8, 11, then a 10-day rest period (days 12-21), then give again on days 22, 25, 29, 32, then a 10-day rest period (days 33-42); given with melphalan (9 mg/m
2
/day on days 1-4) and predniSONE (60 mg/m
2
/day on days 1-4); during cycles 5-9, give bortezomib 1.3 mg/m
2
/dose on days 1, 8, 22, 29 with melphalan (9 mg/m
2
/day on days 1-4) and predniSONE (60 mg/m
2
/day on days 1-4); this 6-wk cycle is considered 1 course; at least 72 hr should elapse between consecutive doses

Mantle cell lymphoma

• Adult: IV BOL/SUBCUT
1.3 mg/m
2
/dose on days 1, 4, 8, 11 followed by a 10-day rest period (days 12 to 21); max 8 cycles

Hepatic dose

• Adult: IV
bilirubin >1.5 × ULN, reduce to 0.7 mg/m
2
during cycle 1; consider dose escalation to 1 mg/m
2
or further reduction to 0.5 mg/m
2
during next cycles based on tolerability

Non-Hodgkin’s Lymphoma (unlabeled)

• Adult: IV BOL
1.3 mg/m
2
on days 1, 4, 8, 11 repeated every 21 days

Available forms:
Lyophilized powder for inj 3.5 mg

Administer:
IV bolus route

• 
Reconstitute
each vial with 3.5 ml of 0.9% NaCl (1 mg/ml); sol should be clear/colorless;
inj
as bolus over 3-5 sec

• 
Store unopened product at room temperature, protect from light

• 
Wear protective clothing during han
dling, preparation; avoid contact with skin

SIDE EFFECTS

CNS:
Anxiety, insomnia, dizziness, headache,
peripheral neuropathy
, rigors, paresthesia, fever

CV:
Hypotension
, edema,
CHF

GI:
Abdominal pain,
constipation, diarrhea
, dyspepsia,
nausea, vomiting
, anorexia

HEMA:
Anemia
,
neutropenia, thrombocytopenia

MISC:
Dehydration, weight loss, herpes zoster,
rash
, pruritus, blurred vision

MS:
Fatigue, malaise, weakness
, arthralgia, bone pain, muscle cramps, myalgia, back pain,
tumor lysis syndrome

RESP:
Cough, pneumonia, dyspnea, URI

PHARMACOKINETICS

Half-life 9-15 hr, protein binding 83%, metabolized by CYP450 enzymes (3A4, 2D6, 2C19, 2C9, 1A2)

INTERACTIONS

• 
Do not use hematopoietic progenitor cells (sargramostim, filgrastim) within 24 hr of chemotherapy

• 
Oral hypoglycemics: may result in hypo/hyperglycemia

Increase:
risk for bleeding—anticoagulants, NSAIDs, platelet inhibitors, salicylates, thrombolytics

Increase:
hypotension—antihypertensives

Increase:
peripheral neuropathy—amiodarone, antivirals (amprenavir; atazanavir; didanosine, lamiVUDine, 3TC; ritonavir; stavudine, zidovudine), chloramphenicol, CISplatin, colchicine, cycloSPORINE, dapsone, disulfiram, DOCEtaxel, gold salts, HMG-CoA reductase inhibitors, iodoquinol, INH, metroNIDAZOLE, nitrofurantoin, oxaliplatin, PACLitaxel, penicillamine, phenytoin, sulfaSALAzine, thalidomide, vinBLAStine, vinCRIStine, zalcitabine ddc, isoniazid, statins, others

Increase:
toxicity or decrease efficacy when administered with products that induce or inhibit CYP3A4

Drug/Herb

Increase:
toxicity or decrease efficacy—St. John’s wort

NURSING CONSIDERATIONS
Assess:

• 
Hematologic status: platelets, CBC throughout treatment; platelets ≥70 × 10
9
/L and ANC ≥1.0 × 10
9
/L before any cycle; nonhematologic toxicities should be grade 1 or baseline before any cycle

• 
For extravasation at inj site

• 
B/P, fluid status, peripheral neuropathy symptoms

Evaluate:

• 
Therapeutic response: improvement of multiple myeloma symptoms

Teach patient/family:

• 
To use contraception while taking this product (pregnancy [D]); to avoid breastfeeding

• 
To monitor blood glucose levels if diabetic

• 
To contact prescriber about new or worsening peripheral neuropathy, severe vomiting, diarrhea, easy bruising, bleeding, infection

• 
To avoid driving, operating machinery until effect is known

• 
To avoid using other medications unless approved by prescriber

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

bosentan (Rx)

(boh′sen-tan)

Tracleer

Func. class.:
Vasodilator

Chem. class.:
Endothelin receptor antagonist

ACTION:

Peripheral vasodilation occurs via the antagonism of the effect of endothelin on endothelium and vascular smooth muscle

USES:

Pulmonary arterial hypertension with WHO class III, IV symptoms

Unlabeled uses:
Septic shock to improve microcirculatory blood flow, functional class II pulmonary arterial hypertension

CONTRAINDICATIONS:

Hypersensitivity, CVA, CAD

 

Black Box Warning:

Pregnancy X

Precautions:
Breastfeeding, children, geriatric patients, mitral stenosis

 

Black Box Warning:

Hepatic disease

DOSAGE AND ROUTES
Calculator

• Adult and adolescent >40 kg: PO
62.5 mg bid × 4 wk then 125 mg bid

• Adult and adolescent <40 kg: PO
62.5 mg bid

Available forms:
Tabs 62.5, 125 mg

Administer:

• 
Give without regard to meals

• 
Only available through the TAP program; 866-228-3546

• 
Do not stop product abruptly; taper

SIDE EFFECTS

CNS:
Headache, flushing, fatigue, fever

CV:
Hypo/hypertension
, palpitations, edema of lower limbs, fluid retention

GI:
Abnormal hepatic function, diarrhea, dyspepsia,
hepatotoxicity

HEMA:
Anemia, leukopenia, neutropenia, lymphopenia, thrombocytopenia

INTEG:
Pruritus,
anaphylaxis,
rash,
Stevens-Johnson syndrome, toxic epidermal necrolysis

MISC:
Oligospermia,
tumor lysis syndrome

SYST:
Secondary malignancy

PHARMACOKINETICS

Metabolized by inducer of CYP2C9, CYP3A4, possibly CYP2C19; metabolized by the liver; terminal half-life 5 hr; steady state 3-5 days

INTERACTIONS


 
Do not coadminister cycloSPORINE with bosentan; bosentan is increased, cycloSPORINE is decreased


 
Do not coadminister glyBURIDE with bosentan; glyBURIDE is decreased significantly, bosentan is also decreased, hepatic enzymes may be increased

Increase:
bosentan effects—CYP2C9, CYP3A4 inhibitors

Increase:
bosentan level—ketoconazole

Decrease:
effects of warfarin, hormonal contraceptives, statins

Drug/Lab Test

Increase:
ALT, AST

Decrease:
Hgb, Hct

NURSING CONSIDERATIONS
Assess:

• 
Serious skin toxicities:
Angioedema occurring 8-21 days after initiating therapy

• 
B/P, pulse during treatment until stable

• 
Blood studies: Hct, Hgb after 1 month, 3 months, then every 3 months may be decreased

• 
Pulmonary hypertension/CHF: Fluid retention, weight gain, increased leg edema; may occur within weeks

 

Black Box Warning:

Hepatic toxicity:
vomiting, jaundice; product should be discontinued; hepatic studies: AST, ALT, bilirubin; hepatic enzymes may increase; if ALT/AST >3× and ≤5× ULN, decrease dose or interrupt treatment and monitor AST/ALT q2wk; if bilirubin >2× ULN or signs of hepatitis or hepatic disease are present, stop treatment

Perform/provide:

• 
Storage at room temp

Evaluate:

• 
Therapeutic response: decrease in pulmonary hypertension

Teach patient/family:

• 
To report jaundice, dark urine, joint pain, fatigue, malaise, bruising, easy bleeding

 

Black Box Warning:

Pregnancy (X), monitor pregnancy test monthly

• 
To avoid pregnancy; to use nonhormonal form of contraception, hormonal contraceptives may not be effective

• 
That lab work will be required periodically

• 
To take without regard to food

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