Nursing Implications for Vincristine Sulfate Vincasar PFS

VINCRISTINE SULFATE

(vin-kris′teen)

Vincasar PFS

Classifications: ANTINEOPLASTIC; MITOTIC INHIBITOR; VINCA ALKALOID

Therapeutic: ANTINEOPLASTIC

Pregnancy Category: D

AVAILABILITY

Intravenous solution

ACTION & THERAPEUTIC EFFECT

Cell cycle–specific vinca alkaloid arrests mitosis at metaphase by inhibition of mitotic spindle function, thereby inhibiting cell division. Induction of metaphase arrest in 50% of cells results in inhibition of cancer cell proliferation.

USES

Acute lymphoblastic and other leukemias, Hodgkin’s disease, lymphosarcoma, neuroblastoma, Wilms’ tumor, lung and breast cancer, reticular cell carcinoma, and osteogenic and other sarcomas.

UNLABELED USES

Idiopathic thrombocytopenic purpura, alone or adjunctively with other antineoplastics, breast cancer, colorectal cancer, thymoma.

CONTRAINDICATIONS

Obstructive jaundice; active infection; adynamic ileus; radiation of the liver; patient with demyelinating form of Charcot-Marie-Tooth syndrome; men and women of childbearing potential; pregnancy (category D), lactation.

CAUTIOUS USE

Leukopenia; preexisting neuromuscular or neurologic disease; hypertension; hepatic or biliary tract disease; older adults.

ROUTE & DOSAGE

ALL

Adult: IV 1.4 mg/m2 (max: 2 mg/ m2) at weekly intervals

Child: IVWeight greater than 10 kg: 1.5–2 mg/m2 at weekly intervals; weight less than 10 kg: 0.05 mg/kg initial weekly dose, then titrate

Malignant Glioma/Hodgkin’s Disease/non-Hodgkin’s Lymphoma

Adult/Adolescent/Child: IV

1.4 mg/m2 on days 1 and 8 every 28 days

Neuroblastoma

Child: IV 1 mg/m2/day for 72 hours

Multiple Myeloma

Adult/Adolescent/Child: IV 0.4 mg/day × 4 days

Hepatic Impairment Dosage Adjustment

Bilirubin 1.5–3 mg/dL: Use 50% of dose; 3–5 mg/dL: Use 25% of dose; greater than 5 mg/dL: Skip dose

Nursing Implications for Vincristine Sulfate Vincasar PFS

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ADMINISTRATION

Intravenous

PREPARE: Direct: No dilution is required. Administer as supplied.

• Avoid contact with eyes. Severe irritation and persisting corneal changes may occur. Flush immediately and thoroughly with copious amounts of water. Wash both eyes; do not assume one eye escaped contamination.

ADMINISTER:  

Direct: Drug is usually injected into tubing of running infusion over a 1 min period.

• Stop injection promptly if extravasation occurs. Use applications of moderate heat and local injection of hyaluronidase to help disperse extravasated drug.
• Restart infusion in another vein. Observe injection site for sloughing.

INCOMPATIBILITIES:

Y-site: Amphotericin B colloidal, cefepime, diazepam, furosemide, gemtuzumab, idarubicin, lansoprazole, nafcillin, pantoprazole, phenytoin, sodium bicarbonate.

• Store solution in the refrigerator.

ADVERSE EFFECTS (≥1%) CNS:

Peripheral neuropathy, neuritic pain, paresthesias, especially of hands and feet; foot and hand drop, sensory loss, athetosis, ataxia, loss of deep tendon reflexes, muscle atrophy, dysphagia, weakness in larynx and extrinsic eye muscles, ptosis, diplopia, mental depression.

Special Senses: Optic atrophy with blindness; transient cortical blindness, ptosis, diplopia, photophobia. GI: Stomatitis, pharyngitis, anorexia, nausea, vomiting, diarrhea, abdominal cramps, severe constipation (upper-colon impaction), paralytic ileus (especially in children), rectal bleeding; hepatotoxicity. Urogenital: Urinary retention, polyuria, dysuria, SIADH (high urinary sodium excretion, hyponatremia, dehydration, hypotension); uric acid nephropathy. Skin: Urticaria, rash, alopecia, cellulitis and phlebitis following extravasation (at injection site). Body as a Whole: Convulsions with hypertension, malaise, fever, headache, pain in parotid gland area, weight loss. Metabolic: Hyperuricemia, hyperkalemia. CV: Hypertension, hypotension. Respiratory: Bronchospasm.

INTERACTIONS

Drug: Mitomycin may cause acute shortness of breath and severe bronchospasm; may decrease digoxin, phenytoin levels.

PHARMACOKINETICS

Distribution: Concentrates in liver, platelets, and leukocytes; poor penetration of blood–brain barrier. Metabolism: Partially in liver (CYP3A4). Elimination: Primarily in feces. Half-Life: 10–155 h.

NURSING IMPLICATIONS

Vinchristine extravasation has been associated with severe tissue irritation. Vinchristine is fatal if given intrathecally.

Assessment & Drug Effects

• Monitor I&O ratio and pattern, BP, and temperature daily.
• Monitor respiratory status. Report promptly shortness of breath (bronchospasms) which may occur within minutes or hours of drug infusion.
• Be aware that neuromuscular adverse effects, most apt to appear in the patient with preexisting neuromuscular disease, usually disappear after 6 wk of treatment. Children are especially susceptible to neuromuscular adverse effects.
• Assess for hand muscular weakness, and check deep tendon reflexes (depression of Achilles reflex is the earliest sign of neuropathy). Also observe for and report promptly: Mental depression, ptosis, double vision, hoarseness, paresthesias, neuritic pain, and motor difficulties.
• Provide special protection against infection or injury during leukopenic days.
• Avoid use of rectal thermometer or intrusive tubing to prevent injury to rectal mucosa.
• Monitor ability to ambulate and supply support as needed.
• Start a prophylactic regimen against constipation and paralytic ileus at beginning of treatment (paralytic ileus is most likely to occur in young children).
• Montior lab tests: Baseline and periodic CBC with differential; frequent serum uric acid levels during first 3–4 wk of treatment.

Patient & Family Education

• Notify prescriber promptly of stomach, bone, or joint pain, and swelling of lower legs and ankles.
• Report changes in bowel habit as soon as manifested.
• Report a steady gain or sudden weight change to prescriber.
• Women should use effective means of contraception during treatment.

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Ditulis oleh Unknown pada tanggal Sunday, July 19, 2015