Term
Epoetin Alfa (Epogen, Procrit)
indications |
|
Definition
Used to treat chronic anemia from chronic renal disorder, increase RBC’s, decrease need for transfusion, anemia r/t HIV or Ca treatment
Might also be used for severe heart disease- this cause the kidney to be unable to prefuse well |
|
|
Term
Epoetin Alfa (Epogen, Procrit)
MOA |
|
Definition
| stimulates production of RBC’s in the bone marrow |
|
|
Term
Epoetin Alfa (Epogen, Procrit)
Pharmacokinetics |
|
Definition
| IV or SQ, eliminated by kidneys, ½ life not affected by dialysis; dosage and frequency vary |
|
|
Term
Epoetin Alfa (Epogen, Procrit)
Contra/Precautions |
|
Definition
uncontrolled HTN, allergy to mammalian cell-derived products or albumin, anemia r/t Fe or folate def.
Caution as may cause thromboembolic events in some patients.
cant give to people with bone marrow failures
can be given to Jehovah Witnesses |
|
|
Term
Epoetin Alfa (Epogen, Procrit)
Drug interactions |
|
Definition
|
|
Term
Epoetin Alfa (Epogen, Procrit)
Nursing interventions |
|
Definition
Assess for any contraindications: uncontrolled HTN, anemia r/t Fe & folate def etc, vascular disease, patient’s iron and transferrin
Monitor BP
Determine pregnancy (category C)
Safety not established in children (off-label use in premature infants (USE for W/O benzyl alcohol); Older Adult increased potential for adv effects
Nutritional support (Fe rich diet)
Teach pt proper self-administration of drug
Cultural tip: can be used in Jehovah Witness pt
DO NOT SHAKE drug after reconstituting-will denature the glycoprotein-make ineffective!!!
DO NOT DILUTE. Give direct IV at end of dialysis
Monitor H & H in 2-6 wks (might want to do a full CBC) ; rise in Hgb should not exceed 1g/dL in 2 wks up to 11g/dL; HOLD and check with HCP if Hgb >11g/dL (had more complications when pts Hgb raised past 11)
1mL vial no preservation, discard after one dose; 2mL vial has preservative refrigerate btwn doses, discard after 21 days |
|
|
Term
Epoetin Alfa (Epogen, Procrit)
outcomes |
|
Definition
Improved Hgb (between 10-11g/dL) and Hct 40%
Increased retic count
Reduction in anemia s/s
Fatigue
Pallor
Sometimes tachycardic |
|
|
Term
Filgrastim (Neupogen)
indications |
|
Definition
| neutropenia r/t chemotherapy, idiopathic causes; off-label in AIDS, aplastic anemia, hairy-cell leukemia & drug induced neutropenia |
|
|
Term
|
Definition
| stimulates production and release of WBC’s from bone marrow (made by e.coli w/ G-CSF gene inserted) helps bone marrow make WBC cuz their count is too low |
|
|
Term
Filgrastim (Neupogen)
Pharmacokinetics |
|
Definition
| not clearly understood, elimination ½ life is ~3.5 hrs; given IV or SC daily |
|
|
Term
Filgrastim (Neupogen)
Contra/Precautions |
|
Definition
| sensitivity to e coli proteins or any part of drug; myeloid malignancy; w/in 24 hrs pre or post chemo; caution in pts w/ ARDs, sickle cell dz or crisis, pregnancy category C |
|
|
Term
Filgrastim (Neupogen)
Adverse side effects |
|
Definition
| medullary bone pain (that's where it is working), H/A, increased Alk Phos, anemia, mild to mod MS symptoms, splenic rupture, ARDS |
|
|
Term
Filgrastim (Neupogen)
Nursing interventions |
|
Definition
Assess WBC count 2-3 x wk, temp daily
Teach pt how to administer if in home setting
Refrig do not freeze; allow to rise to room temp before administering; discard if at room temp >24 hrs; single use vials ONLY
IV dilute in 5% dextrose with albumin added (prevents absorption by plastic materials); DO NOT dilute in saline MAY PRECIPITATE)
DO NOT SHAKE damages protein
Discontinue/Hold if absolute neutrophil count > 1,000/mm3 for 3 days
Teach infection control practices (Box 33.2 on pg 685) (extra careful cuz they are already at risk for infection!!!!)
Do not administer 24 hr before or after chemotherapy |
|
|
Term
Filgrastim (Neupogen)
outcome |
|
Definition
Absence of infection
Afebrile? Any other signs of infection including redness, swelling, cough, congestion?
Increased WBC
ANC (absolute neutrophil count) >1000/mm3 |
|
|
Term
Cyclosporine (Sandimmune, Neoral)
indiciatons |
|
Definition
| to prevent organ rejection in transplants |
|
|
Term
Cyclosporine (Sandimmune, Neoral)
pharmacokinetics |
|
Definition
| varied absorption; Sandimmune and Neoral not bioequivalent w/o dose adj; metabolized by P-450 enz sys |
|
|
Term
Cyclosporine (Sandimmune, Neoral)
MOA |
|
Definition
| inhibits normal immune responses by inhibiting interleukin-2; does not depress bone marrow function |
|
|
Term
Cyclosporine (Sandimmune, Neoral)
Contra/precautions |
|
Definition
| IV form contraindicated if hypersensitive to polyoxyethylated castor oil; IV and PO forms contain alcohol avoid w/ disulfram therapy |
|
|
Term
Cyclosporine (Sandimmune, Neoral)
adverse effects |
|
Definition
nephrotoxicity, infection, hepatotoxcity
Common: renal dysfunction, tremor, hirsutism, HTN, gum hyperplasia |
|
|
Term
Cyclosporine (Sandimmune, Neoral)
nursing interventions |
|
Definition
monitor VS esp temp; baseline CBC CMP labs and periodically q 2-4 weeksSee Box 34-1 pg 663
Drug levels should be monitored to maintain adequate dosing
Avoid taking with food esp high fat
Avoid grapefruit |
|
|
Term
glatiramer (Copaxone)
indication |
|
Definition
|
|
Term
|
Definition
| unclear, may act like a decoy |
|
|
Term
glatiramer (Copaxone)
Contra/precautions |
|
Definition
| NO IV admin; hypersensitivity to mannitol; caution in immunocompromised pts and w/ vaccinations; category B preg |
|
|
Term
glatiramer (Copaxone)
Adverse effects |
|
Definition
| common- lumps, pain and redness at site; Immediately report-chest pain, breathing diff, hives/rash, unusual muscle weakness, palpitations |
|
|
Term
glatiramer (Copaxone)
drug effects |
|
Definition
|
|
Term
glatiramer (Copaxone)
nuring interventions |
|
Definition
Keep in refrig but allow to reach room temp 20 min before injecting
If powder, teach proper reconstitution
Teach aseptic technique SQ; site rotation (no one spot used more than once a week); proper disposal of syringes |
|
|
Term
glatiramer (Copaxone)
pharamcokinetics |
|
Definition
| readily absorbed after SQ injection |
|
|
Term
General Chemotherapy agents
indications |
|
Definition
| mostly for malignant tumors and cancers |
|
|
Term
General Chemotherapy agents
MOA |
|
Definition
| Different agents will exert their affect at different points in the cell cycle or non-cell cycle specific and can attack cells in any phase of the cell cycle. Targets rapidly dividing cells |
|
|
Term
| General Chemotherapy agents |
|
Definition
What are the handling and proper disposal guidelines of chemo agents? See pg 695
What are the general pt & Family education concern? Box 56.2 pg 1226 |
|
|
Term
General Chemotherapy agents
adverse effects |
|
Definition
| horrible stomatitis, myelosuppression (dec RBC & WBC) , thrombcytopenia, n/v,d may be severe, hair loss (depends on drug) |
|
|
Term
General Chemotherapy agents
nursing interventions |
|
Definition
Most chemo is IV. Be sure IV site is patent and large vein or central line.
Patient must be monitored for infection, bleeding, fluid & nutrition risks.
What are the guidelines for managing chemo-induced emesis? Pg 1253-1254
When should chemotherapy be held? Very very low WBC count |
|
|
