Nursing Implications for ZICONOTIDE PRIALT

ZICONOTIDE

(zi-con′o-tide)

Prialt

Classifications: MISCELLANEOUS ANALGESIC; N-TYPE CALCIUM CHANNEL ANTAGONIST

Therapeutic: MISCELLANEOUS ANALGESIC

Pregnancy Category: C

AVAILABILITY 

Solution for injection

ACTION & THERAPEUTIC EFFECT 

Ziconotide binds to N-type calcium channels located on the afferent nerves in the dorsal horn in the spinal cord. It is thought that these binding blocks of N-type calcium channels lead to a blockade of excitatory neurotransmitter release in the afferent nerve endings. Ziconotide is effective in controlling severe chronic pain that is intractable to other analgesics.

USES 

Management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted.

UNLABELED USES 

Spasticity associated with spinal cord trauma.

CONTRAINDICATIONS 

Hypersensitivity to ziconotide; preexisting history of psychosis; epidural or intravenous administration; sepsis; depression with suicidal ideation; cognitive impairment; bipolar disorder; schizophrenia; dementia; presence of infection at the injection site, uncontrolled bleeding, or spinal canal obstruction that impairs circulation of CSF; coagulopathy; seizures; lactation.

CAUTIOUS USE 

Renal, hepatic, and cardiac impairment; older adults; pregnancy (category C). Safe use in children and infants not established.

NURSING IMPLICATIONS ZICONOTIDE PRIALT

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ROUTE & DOSAGE 

Severe Chronic Pain 

Adult: Intrathecal Initial 0.1 mcg/h; may titrate up 0.1 mcg/h q2–3days to 0.8 mcg/h (19.2 mcg/day)

ADMINISTRATION

Intrathecal 

• May be administered undiluted (25 mcg/mL in 20 mL vial) or diluted using the 100 mcg/mL vials. Diluted ziconotide is prepared with NS without preservatives. 
• Administer using an implanted variable-rate microinfusion device or an external microinfusion device and catheter. 
• Note: Due to serious adverse events, 19.2 mcg/day (0.8 mcg/h) is the maximum recommended dose. 
• Doses should normally be titrated upward by no more than 2.4 mcg/day (0.1 mcg/h) at intervals of 2–3 × wk. 
• Refrigerate all ziconotide solutions after preparation and begin infusion within 24 h. Discard any unused portion left in a vial. 

ADVERSE EFFECTS (≥1%) 

Body as a Whole: Accidental injury, back pain, catheter complication, catheter- site pain, cellulitis, chest pain, chills, fever, flu syndrome, infection, malaise, neck pain, neck rigidity, pain, pump-site complication, pump-site mass, pump-site pain, viral infection. CNS: Abnormal dreams, abnormal gait, agitation, anxiety, aphasia, asthenia, ataxia, CSF abnormal, confusion, depression, difficulty concentrating, dizziness, dry mouth, dysesthesia, emotional lability, headache, hostility, hyperesthesia, hypertonia, incoordination, insomnia, memory impairment, mental slowing, meningitis, nervousness, neuralgia, paranoid reaction, paresthesia, reflexes decreased, somnolence, speech disorder, stupor, abnormal thinking, tremor, twitching, vertigo.

CV: Hypertension, hypotension, postural hypotension, syncope, tachycardia, vasodilation. GI: Abdominal pain, anorexia, constipation, diarrhea, dyspepsia, gastrointestinal disorder, nausea, vomiting. GU: Dysuria, urinary incontinence, urinary retention, urinary tract infection, impaired urination. Hematologic: Anemia, ecchymosis. Metabolic/Nutritional: Creatinine phosphokinase increased, dehydration, edema, hypokalemia, peripheral edema, weight loss. Musculoskeletal: Arthralgia, arthritis, leg cramps, myalgia, myasthenia. Respiratory: Bronchitis, cough increased, dyspnea, lung disorder, pharyngitis, pneumonia, rhinitis, sinusitis. Skin: Cutaneous surgical complication, dry skin, pruritus, rash, skin disorder, sweating. Special Senses: Abnormal vision, diplopia, nystagmus, photophobia, taste perversion, tinnitus. 

INTERACTIONS 

Drug: Ethanol and other CNS DEPRESSANTS may increase drowsiness, dizziness, and confusion. 

PHARMACOKINETICS 

Distribution: 50% protein bound. Metabolism: Hydrolyzed by peptidases. Half-Life: 4.6 h

NURSING IMPLICATIONS 

Black Box Warning
Ziconotide has been associated with severe psychiatric symptoms and neurologic impairment. 

Assessment & Drug Effects 

• Monitor for and report S&S of meningitis, cognitive impairment, hallucinations, changes in mood or consciousness, or other psychiatric symptoms. 
• Montior lab tests: Serum creatine kinase every other week for first month and monthly thereafter. 

Patient & Family Education 

• Report any of the following to prescriber: Muscle pain, soreness, or weakness, confusion, unusual behavior, symptoms of depression or suicidal thoughts, fever, headache, stiff neck, nausea or vomiting, seizures. 
• Note: Taking this drug with other depressants (e.g., alcohol, sedatives, tranquilizers) will increase the risk of side effects.

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Ditulis oleh Unknown pada tanggal Monday, June 29, 2015