Nursing Implications for ZIV-AFLIBERCEPT Zaltrap

ZIV-AFLIBERCEPT

(ziv-a-fli’ber-cept)

Zaltrap

Classification: BIOLOGICAL RESPONSE MODIFIER; GROWTH FACTOR INHIBITOR; SIGNAL TRANSDUCTION INHIBITOR; RECOMBINANT FUSION PROTEIN; ANTINEOPLASTIC

Therapeutic: ANTINEOPLASTIC

Prototype: Alefacept

Pregnancy Category: C

AVAILABILITY 
Solution

ACTION & THERAPEUTIC EFFECT 
Binds to certain vascular growth factors thus inhibiting their binding to and activation of receptors that stimulate neovascularization (new blood vessel growth) and increased vascular permeability. Decreased neovascularization in tumors slows growth of metastatic colorectal tumors.

USES 
Treatment of metastatic colorectal cancer in combination chemotherapy with 5-flurouracil, leucovorin, and irinotecan in patients whose condition has progressed or is resistant to an oxaliplatin-containing combination

CONTRAINDICATIONS 
Severe hemorrhage; GI perforation; compromised wound healing; fistula development; 4wk before or after elective surgery; hypertensive crisis or hypertensive encephalopathy; drug induced arterial thromboembolic event or nephrotic syndrome; reversible posterior leukoencephalopathy syndrome (RPLS); lactation.

CAUTIOUS USE
Hypersensitivity to ziv-aflibercept; hemorrhage; history of GI perforation; poor wound healing; severe hypertension or hypertension; thromboembolic events; proteinuria; infection; diarrhea and dehydration; older adults; pregnancy (category C). Safety and efficacy in children younger than 18 y are not established.

ROUTE AND DOSAGE 
Colorectal Cancer 
Adult: IV 4 mg/kg q2wk; administer prior to 5-flurouracil, leucovorin, and irinotecan

Toxicity Dosage Adjustments 
Recurrent of severe hypertension: Hold therapy until hypertension is controlled; permanently reduce dose to 2 mg/kg for subsequent cycles

Proteinuria: Hold therapy until proteinuria is less than 2 g/24 h; permanently reduce dose to 2 mg/kg for subsequent cycles

NURSING IMPLICATIONS ZIV-AFLIBERCEPT

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ADMINISTRATION 
Intraveneous 
PREPARE: IV Infusion: 
Withdraw required dose of ziv-aflibercept and dilute to a final concentration of 0.6–8 mg/mL in NS or D5W (enter vial only once to withdraw dose). Dilute in PVC infusion bags containing bis (2-ethylhexyl) phthalate (DEHP) or polyolefin.

ADMINISTER: IV Infusion: 
Infuse over 1 h through a 0.2 micron polyethersulfone filter (do NOT use filter made of PVDF) or nylon. Do NOT give IV push or as bolus dose. Use an infusion set made of PVC containing DEHP or one of the other materials approved by manufacturer.

INCOMPATIBILITIES: 
Solution/additive: Do not combine ziv-aflibercept with other drugs in the same IV solution. Y-site: Do not administer ziv-aflibercept in the same IV line with other drugs

• Store diluted solution at 2°–8° C (36°–46° F) for up to 4 h. 

ADVERSE EFFECTS 
(≥1%) Body as a Whole: Asthenia, fatigue, catheter site infection, hypersensitivity, injection site hemorrhage, injection site pain, pneumonia. CNS: Headache. CV: Deep venous thrombosis, pulmonary embolism, hypertension. GI: Abdominal pain, diarrhea, hemorrhoids, proctalgia, rectal hemorrhage, stomatitis, GI perforation. Hematological: Leukopenia, neutropenia, thrombocytopenia, hemorrhage. Metabolic: Decreased appetite, dehydration, increased ALT and AST, weight decreased. Respiratory: Dysphonia, dyspnea, epistaxis, nasopharyngitis, oropharyngeal pain, pulmonary embolism, rhinorrhea, upper respiratory tract infection. Skin: Palmar-plantar erythrodysesthesia syndrome, skin hyperpigmentation. Special Senses: Blurred vision, cataract, conjunctival hemorrhage, conjunctival hyperemia, corneal edema, corneal erosion, detachment of the retinal pigment epithelium, eye pain, eyelid edema, foreign body sensation in the eyes, increased intraocular pressure, increased lacrimation, retinal pigment epithelium tear, tooth infection, vitreous detachment, vitreous floaters. Urogenital: Proteinuria, serum creatinine increased, urinary tract infections.

PHARMACOKINETICS 
Peak: 1–3 d. Metabolism: Via proteolysis. Half-Life: 5–6 d.

NURSING IMPLICATIONS 
Black Box Warning
Ziv-aflibercept has been associated with severe, sometimes fatal hemorrhage, GI perforation, and seriously compromised wound healing.

Assessment & Drug Effects

• Monitor vital signs, especially BP for exacerbation of hypertension.
• Monitor for and report immediately S&S of bleeding and GI perforation
• Monitor for diarrhea and dehydration, especially in the older adult. 
• Montior lab tests: Baseline and prior to each cycle, CBC with differential; periodic LFTs, renal function tests, and urinalysis for proteinuria; 24 h urine when urinary protein creatinine ratio is greater than 1. 

Patient & Family Education 

• Report promptly any of the following: S&S of bleeding including light-headedness; S&S of hypertension including severe headache, or dizziness; severe diarrhea, vomiting, or abdominal pain. 
• Frequent monitoring of BP is advised. Contact prescriber if BP is elevated beyond usual parameters. 
• Men and women should use effective means of birth control during therapy and for at least 3 mo following completion of therapy. 
• Contact your prescriber immediately if you or your partner becomes pregnant during treatment with ziv-aflibercept. 
• Do not breast-feed while receiving this drug without consultation with prescriber.

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Ditulis oleh Unknown pada tanggal Wednesday, June 24, 2015