Nursing Implications for Valrubicin Valstar

VALRUBICIN (val-roo′bi-sin) Valstar

Classification: ANTINEOPLASTIC; (ANTIBIOTIC) ANTHRACYCLINE

Therapeutic: ANTINEOPLASTIC

Prototype: Doxorubicin hydrochloride

Pregnancy Category: C

AVAILABILITY 

Solution

ACTION & THERAPEUTIC EFFECT

A cytotoxic agent that inhibits the incorporation of nucleosides in DNAand RNA, resulting in extensive chromosomal damage. It arrests the cell cycle of the HIV virus in the G2 phase by interfering with normal DNA action of topoisomerase II, which is responsible for separating DNA strands and resealing them. Valrubicin has higher antitumor efficacy and lower toxicity than doxorubicin.

USES 
Intravesical therapy of BCGrefractory carcinoma in situ of the urinary bladder.

CONTRAINDICATIONS 
Hypersensitivity to valrubicin, doxorubicin, anthracyclines, or castor oil; patients with a perforated bladder, concurrent UTI, active infection; severe irritable bladder symptoms; severe myelosuppression; lactation.

CAUTIOUS USE 
Within 2 wk of a transureteral resection; compromised bladder mucosa; mild to moderate myelosuppression; history of bleeding disorders; GI disorders, renal impairment; pregnancy (category C).

ROUTE & DOSAGE

BCG-Refractory Bladder Carcinoma in situ Adult: Intravesically 800 mg once/wk × 6 wk

ADMINISTRATION

Instillation

Avoid skin reactions by using gloves during preparation/administration.

• Use only glass, polypropylene, or polyolefin containers and tubing. 

PREPARE: 
Slowly warm 4 vials (5 mL each) to room temperature.

• When a precipitate is initially present, warm vials in hands until solution clears.
• Add contents of 4 vials to 55 mL of 0.9% NaCl injection to yield 75 mL of diluted solution.

Nursing Implications for Valrubicin Valstar

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ADMINISTER:
Aseptically insert a urethral catheter and drain the bladder.

• Use gravity drainage to instill valrubicin slowly over several min. 
• Withdraw catheter; instruct patient not to void for 2 h.
• Note: Do not leave a clamped catheter in place.
• Refrigerate. Do not freeze.

ADVERSE EFFECTS (≥1%) 
Body as a Whole: Abdominal pain, asthenia, back pain, fever, headache, malaise, myalgia. CNS: Dizziness. CV: Vasodilation. GI: Diarrhea, flatulence, nausea, vomiting. Urogenital: Urinary frequency, urgency, dysuria, bladder spasm, hematuria, bladder pain, incontinence, cystitis, UTI, nocturia, local burning, urethral pain, pelvic pain, gross hematuria, urinary retention. Respiratory: Pneumonia. Skin: Rash. Other: Anemia, hyperglycemia, peripheral edema.

PHARMACOKINETICS 
Absorption: Not absorbed. Distribution: Penetrates bladder wall. Metabolism: Not metabolized. Elimination: Almost completely excreted by voiding the instillate.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Therapeutic effectiveness: Indicated by regression of the bladder tumor.
• Notify prescriber if bladder spasms with spontaneous discharge of valrubicin occur during/ shortly after instillation.

Patient & Family Education

• Expect red-tinged urine during the first 24 h after administration.
• Report prolonged passage of redcolored urine or prolonged bladder irritation.
• Drink plenty of fluids during 48 h period following administration.
• Use reliable contraception during therapy period (approximately 6 wk).

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Ditulis oleh Unknown pada tanggal Wednesday, August 12, 2015