Nursing Implications for Ustekinumab Stelara

Ustekinumab Stelara (us-te-kin′u-mab)

Classification: IMMUNOMODULATOR; MONOCLONAL ANTIBODY; INTERLEUKIN-12 AND INTERLEUKIN-23 RECEPTOR ANTAGONIST

Therapeutic: IMMUNOSUPPRESSANT

Prototype: Basiliximab

Pregnancy Category: B

AVAILABILITY

Solution for injection

ACTION & THERAPEUTIC EFFECT

A human monoclonal antibody that disrupts IL-12 and IL-23 mediated signaling and cytokine cascades. Inhibits inflammatory and immune responses associated with plaque psoriasis thereby improving psoriasis.

USES

Treatment of moderate to severe plaque psoriasis.

CONTRAINDICATIONS

Clinically significant hypersensitivity to ustekinumab; active infection (e.g., active TB); live vaccines; BCG vaccines within 1 y prior to, during, or l y following drug treatment; reversible posterior leukoencephalopathy syndrome (RPLS).

CAUTIOUS USE

Chronic infection or history of recurrent infection (e.g., latent TB); prior malignancy; phototherapy; older adults; pregnancy (category B); lactation. Safety and efficacy under 18 y not established.

ROUTE & DOSAGE

Psoriasis

Adults 100 kg or less:

Subcutaneous 45 mg initially and 4wk later, followed by 45 mg q12wk

Patients over 100 kg:

Subcutaneous 90 mg initially and 4 wk later, followed by 90 mg q12wk

ADMINISTRATION

Subcutaneous

• Solution may contain a few small translucent or white particles. Do NOT shake.
• Note: Needle cover on prefilled syringe is natural rubber and should not be handled by latexsensitive persons.
• When using a single-use vial, withdraw dose using a 27 gauge syringe with a one-half inch needle.
• Rotate injection sites and do not inject into an area that is tender, bruised, red, or irritated.
• Store unopened vials upright in refrigerator. Discard unused portions in single-use vials.

Nursing Implications for Ustekinumab Stelara

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ADVERSE EFFECTS (≥1%)

CNS: Depression, dizziness, fatigue, headache. GI: Diarrhea, pharyngolaryngeal pain. Musculoskeletal: Back pain, myalgia. Respiratory: Nasopharyngitis, upper respiratory tract infection. Skin: Injection-site erythema, pruritis.

INTERACTIONS

Drug: LIVE VACCINES should not be administered concurrently with ustekinumab

therapy. Closely monitor use with narrow therapeutic index drugs (e.g., warfarin, cyclosporine).

PHARMACOKINETICS

Peak: 7–13.5 days. Metabolism: Degraded to smaller proteins. Half-Life: 14.9–45.6 days.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Monitor for and promptly report S&S of TB or other infection.
• Monitor neurologic status and report promptly: Seizures, problems with vision, headaches, or confusion.
• Note: BCG vaccines should not be given during treatment, for one year prior to initiating treatment, or one year following discontinuation of treatment.
• Montior lab tests: Prior to initiation of therapy, test for latent TB.

Patient & Family Education

• Do not accept vaccinations with live vaccines while taking this drug. Note that non-live vaccines may not be effective if given during a course of ustekinumab.
• You should be tested for TB prior to taking this drug.
• Report promptly S&S of infection including: Chills, fever, cough, shortness of breath, diarrhea, stomach or abdominal pain, burning on urination, sores anywhere on your body, unexplained or excessive fatigue.
• Report immediately seizures, problems with vision, headaches, or confusion.

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Ditulis oleh Unknown pada tanggal Monday, August 24, 2015