Nursing Implications for Vinorelbine Tartrate Navelbine

VINORELBINE TARTRATE

(vin-o-rel′been)

Navelbine

Classifications: ANTINEOPLASTIC; MITOTIC INHIBITOR; VINCA ALKALOID

Therapeutic: ANTINEOPLASTIC

Prototype: Vincristine

Pregnancy Category: D

AVAILABILITY

Intravenous solution

ACTION & THERAPEUTIC EFFECT

A semisynthetic vinca alkaloid with antineoplastic activity. Inhibits polymerization of tubules into microtubules, which disrupts mitotic spindle formation. Arrests mitosis at metaphase, thereby inhibiting cell division in cancer cells.

USES

Non–small-cell lung cancer.

UNLABELED USES

Breast cancer, ovarian cancer, Hodgkin’s disease.

CONTRAINDICATIONS

Hypersensitivity to vinorelbine, infection; severe bone marrow suppression; granylocyte counts greater than or equal to 1000 cells/mm3; pulmonary toxicity to drug; constipation, ileus; pregnancy (category D), lactation.

CAUTIOUS USE

Hypersensitivity  to vincristine or vinblastine; leucopenia or other indicator(s) of bone marrow suppression; chickenpox or herpes zoster infection; hepatic insufficiency, severe liver disease; pulmonary disease; preexisting neurologic or neuromuscular disorders; older adults. Safety and efficacy in children are not established.

ROUTE & DOSAGE

Non–Small-Cell Lung Cancer

Adult: IV 25–30 mg/m2 weekly; may require toxicity adjustment

Hepatic Impairment Dosage Adjustment

Bilirubin 2.1–3 mg/dL: Use 50% of dose;

greater than 3 mg/dL: Use 25% of dose
 

Nursing Implications for Vinorelbine Tartrate Navelbine

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ADMINISTRATION

Intravenous

Use caution to prevent contact with skin, mucous membranes, or eyes during preparation.

PREPARE: Direct: Dilute each 10 mg in a syringe with either 2 or 5 mL of D5W or NS to yield 3 mg/ mL or 1.5 mg/L, respectively.

IV Infusion: Dilute the required dose in an IV bag with D5W, NS, or LR to a final concentration of 0.5–2 mg/mL (example: 10 mg diluted in 19 mL yields 0.5 mg/mL).

ADMINISTER: IV Infusion: Give diluted solution over 6–10 min into the side port closest to an IV bag with free-flowing IV solution; follow by flushing with at least 75–125 mL of IV solution over 10 min.

• Take every precaution to avoid extravasation. If suspected, discontinue IV immediately and begin in a different site.

INCOMPATIBILITIES:

 Solution/additive: Acyclovir, aminophylline, amphotericin B, ampicillin, cefazolin, cefoperazone, ceforanide, cefotaxime, cefotetan, ceftazidime, ceftriaxone, cefuro - xime, fluorouracil, furosemide, ganciclovir, methylprednisolone, mitomycin, piperacillin, sodium bicarbonate, thiotepa.

Y-site: Acyclovir, allopurinol, aminophylline, amphotericin B, amphotericin B cholesteryl complex, ampicillin, cefazolin, cefepime, cefoperazone, cefotetan, cefoxitin, ceftriaxone, cefuroxime, chloramphenicol, dantrolene, diazepam, fluorouracil, foscarnet, furosemide, ganciclovir, heparin, ketorolac, lansoprazole, methohexital, methylprednisolone, mitomycin, nitroprusside, pantoprazole, phenobarbital, pheny - toin, piperacillin, sodium bicarbonate, SMZ/TMP, thiotepa.

• Store at 2°–8° C (36°–46° F).

ADVERSE EFFECTS (≥1%)

CNS: Decreased deep tendon reflexes, paresthesia, fatigue, asthenia, peripheral neuropathy, myalgia, jaw pain. Hematologic: Anemia, neutropenia, granulocytopenia, thrombocytopenia.

GI: Paralytic ileus, constipation, nausea, vomiting, diarrhea, stomatitis, mucositis, hepatotoxicity (elevated LFT). Body as a Whole: Pain on injection, venous pain, thrombophlebitis, alopecia, myalgia, muscle weakness.

INTERACTIONS

Drug: Increased severity of granulocytopenia in combination with cisplatin; increased risk of acute pulmonary reactions in combination with mitomycin; paclitaxel may increase neuropathy.

PHARMACOKINETICS

Distribution: 60–80% bound to plasma proteins (including platelets and lymphocytes); sequestered in tissues, especially lung, spleen, liver, and kidney, and released slowly. Metabolism: In liver (CYP3A4). Elimination: Primarily in bile and feces (50%), 10% in urine. Half-Life: 42–45 h.

NURSING IMPLICATIONS

Vinorelbine has been associated with severe granulocytopenia and increased risk of infection, and extravasation has been associated with severe local tissue necrosis.

Assessment & Drug Effects

• Withhold drug and notify prescriber if the granulocyte count is less than 1000 cells/mm3.
• Monitor for neurologic dysfunction including paresthesia, decreased deep tendon reflexes, weakness, constipation, and paralytic ileus.
• Monitor for S&S of infection, especially during period of granulocyte nadir 7–10 days after dosing.
• Montior lab tests: Monitor CBC with differential throughout therapy and on the day of treatment prior to each infusion. Periodic LFTs, kidney functions, and serum electrolytes.

Patient & Family Education

• Be aware of potential and inevitable adverse effects.
• Women should use reliable forms of contraception to prevent pregnancy.
• Notify prescriber of distressing adverse effects, especially symptoms of leukopenia (e.g., chills, fever, cough) and peripheral neuropathy (e.g., pain, numbness, tingling in extremities).
• Report changes in bowel habits as soon as manifested.

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Ditulis oleh Unknown pada tanggal Saturday, July 18, 2015