pegfilgrastim
pegfilgrastim
[peg″-fil-gras´tim]pegfilgrastim
Pharmacologic class: Granulocytic colony stimulating factor
Action
Binds to specific cell-surface receptors on hematopoietic cells, stimulating their proliferation and differentiation in bone marrow
Availability
Injection: 6 mg/0.6 ml in prefilled syringes
Indications and dosages
➣ To reduce risk of infection in non-myeloid cancer patients who are receiving myelosuppressive drugs
Adults: 6 mg subcutaneously as a single dose once per chemotherapy cycle
Contraindications
• Hypersensitivity to drug, Escherichia coli-derived proteins, filgrastim, or other drug components
Precautions
Use cautiously in:
• myeloid cancers, sickle cell disease
• patients undergoing chemotherapy or radiation
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
• Inspect solution for particles; discard if particles or discoloration appear.
• Don't give 14 days before to 24 hours after administration of cytotoxic chemotherapy.
Adverse reactions
CNS: headache, weakness, fatigue, dizziness, insomnia
CV: peripheral edema
GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, stomatitis, splenic rupture
Hematologic: leukocytosis, granulo-cytopenia
Musculoskeletal: bone pain, myalgia, joint pain
Respiratory: adult respiratory distress syndrome (ARDS) in septic patients
Skin: alopecia, mucositis
Other: taste perversion, allergic reaction, increased pain, fever, neutropenic fever, aggravation of sickle cell disease
Interactions
Drug-drug. Lithium: potentiation of neutrophil release
Drug-diagnostic tests. Alkaline phosphatase, lactate dehydrogenase, uric acid: increased levels
Patient monitoring
See Assess for signs and symptoms of impending splenic rupture, such as left upper abdominal quadrant or shoulder pain and splenic enlargement.
• Monitor vital signs and temperature.
See Watch for signs and symptoms of sepsis, ARDS, and neutropenic fever.
• Monitor CBC, uric acid level, and liver function tests.
Patient teaching
• Teach patient or caregiver how to administer injection and dispose of syringes at home, if appropriate.
See Teach patient to recognize and immediately report respiratory distress or signs and symptoms of splenic rupture.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Instruct patient to have follow-up laboratory tests as needed.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
pegfilgrastim
(peg-fil-gra-stim) pegfilgrastim,Neulasta
(trade name)Classification
Therapeutic: colony stimulating factorsIndications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Subcut | unknown | unknown | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Respiratory
- adult respiratory distress syndrome (ards) (life-threatening)
Gastrointestinal
- splenic rupture (life-threatening)
Hematologic
- sickle cell crisis (life-threatening)
- leukocytosis
Musculoskeletal
- medullary bone pain (most frequent)
Miscellaneous
- allergic reaction including anaphylaxis (life-threatening)
Interactions
Drug-Drug interaction
Simultaneous use with antineoplastics may have adverse effects on rapidly proliferating neutrophils; avoid use for 24 hr before and 24 hr following chemotherapy.Lithium may potentiate the release of neutrophils; concurrent use should be undertaken cautiously.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Assess patient for bone pain throughout therapy. Pain is usually mild to moderate and controllable with nonopioid analgesics, but may require opioid analgesics.
- Assess patient periodically for signs of ARDS (fever, lung infiltration, respiratory distress). If ARDS occurs, treat condition and discontinue pegfilgrastim and/or withold until symptoms resolve.
- Lab Test Considerations: Obtain CBC and platelet count before chemotherapy. Monitor hematocrit and platelet count regularly.
- May cause elevated LDH, alkaline phosphatase, and uric acid.
Potential Nursing Diagnoses
Risk for infection (Indications)Acute pain (Side Effects)
Implementation
- Do not confuse Neulasta (pegfilgrastim) with Lunesta (eszopiclone) or Neumega (oprelvekin).
- Pegfilgrastim should not be administered between 14 and 24 days after administration of cytotoxic chemotherapy.
- Keep patients with sickle cell disease receiving pegfilgrastim well hydrated and monitor for sickle cell crisis.
- Subcutaneous: Administer subcut once per chemotherapy cycle. Do not administer solutions that are discolored or contain particulate matter. Do not shake. Store refrigerated; may be allowed to reach room temperature for a maximum of 48 hr, but protect from light.
- Supplied in prefilled syringes. Following administration, activate UltraSafe Needle Guard to prevent needle sticks by placing hands behind needle, grasping guard with one hand, and sliding guard forward until needle is completely covered and guard clicks into place. If audible click is not heard, guard may not be completely activated. Dispose of by placing entire prefilled syringe with guard activated into puncture-proof container.
Patient/Family Teaching
- Advise patient to notify health care professional immediately if signs of allergic reaction (shortness of breath, hives, rash, pruritus, laryngeal edema) or signs of splenic rupture (left upper abdominal or shoulder tip pain) occur.
- Emphasize the importance of compliance with therapy and regular monitoring of blood counts.
- Home Care Issues: Instruct patient on correct disposal technique for home administration. Caution patient not to reuse needle, syringe, or drug product. Provide patient with a puncture-proof container for disposal of prefilled syringe.
Evaluation/Desired Outcomes
- Decreased incidence of infection in patients who receive bone marrow–depressing antineoplastics.
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