belatacept

belatacept

Nulojix

Indications

Action

Pharmacokinetics

Time/action profile

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• Progressive multifocal leukoencephalopathy (PML) (life-threatening)
• headache (most frequent)

Respiratory

• cough (most frequent)

Cardiovascular

• hypertension (most frequent)
• peripheral edema (most frequent)

Gastrointestinal

• constipation (most frequent)
• diarrhea (most frequent)
• nausea (most frequent)
• vomiting (most frequent)

Genitourinary

• proteinuria

Endocrinologic

• new-onset diabetes mellitus

Fluid and Electrolyte

• hyperkalemia (most frequent)
• hypokalemia (most frequent)

Hematologic

• anemia (most frequent)
• leukopenia (most frequent)

Miscellaneous

• post-transplant lymphoproliferative disorder (PTLD) (life-threatening)
• ↑ risk of malignancy (life-threatening)
• serious infections (life-threatening)
• fever (most frequent)
• graft dysfunction (most frequent)

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess for symptoms of organ rejection throughout therapy.
• Assess for signs of progressive multifocal leukoencephalopathy (hemiparesis, apathy, confusion, cognitive deficiencies, and ataxia) periodically during therapy.
• Monitor for signs and symptoms of infection (fever, dyspnea) periodically during therapy.
• Assess for signs and symptoms of post-transplant lymphoproliferative disorder (changes in mood or usual behavior, confusion, problems thinking, loss of memory, changes in walking or talking, decreased strength or weakness on one side of the body, changes in vision) during and for at least 36 mo post-transplant.
• Monitor for infusion reactions (hypotension, hypertension) during therapy.
• Lab Test Considerations: May cause hyperkalemia, hypokalemia, hypophosphatemia, hyperglycemia, hypocalcemia, hypercholesterolemia, hypomagnesemia, and hyperuricemia.

Potential Nursing Diagnoses

Implementation

• Pre-medication is not required.
• Cortisone doses should be consistent with clinical trials experience. Cortisone doses were tapered to between 10–20 mg/day by first 6 wks after transplant, then remained at 10 mg (5–10 mg) per day for first 6 months after transplant.
• Treat patient for latent tuberculosis prior to therapy.
• Prophylaxis for Pneumocystis jiroveci is recommended after transplant.
• Intermittent Infusion: Calculate number if vials required for total infusion dose. Reconstitute contents of each vial with 10.5 mL of 0.9% NaCl or D5W using the silicone-free disposable syringe provided and an 18–21 gauge needle for a concentration of 25 mg/mL. Direct stream of diluent to wall of vial. Rotate and invert vial gently; do not shake to avoid foaming. Solution is clear to slightly opalescent and colorless to pale yellow; do not use of opaque particles, discoloration, or other particles are present. Calculate total volume needed for infusion dose. Diluent: Dilute further with 0.9% NaCl or D5W if reconstituted with sterile water for injection, 0.9% NaCl if reconstituted with 0.9% NaCl, or with D5W if reconstituted with D5W.Concentration: 2 mg/mL. Withdraw amount of diluent from infusion container equal to volume of infusion dose. Using same silicone-free disposable syringe used for reconstitution, withdraw required amount of belatacept solution from vial, inject into infusion container, and rotate gently to mix. Typical infusion volume is 100 mL, but may range from 50–250 mL. Transfer from vial to infusion container immediately; infusion must be completed within 24 hr of reconstitution. May be refrigerated and protected from light for 24 hr. Do not administer solutions that are discolored or contain particulate matter. Discard unused solution in vials.
• Rate: Infuse over 30 min using a non-pyrogenic, low-protein-binding filter with 0.2–1.2 micron pore size.
• Y-Site Incompatibility: Do not mix or infuse in same line with other agents.

Patient/Family Teaching

• Reinforce the need for lifelong therapy to prevent transplant rejection. Review symptoms of rejection for the transplanted organ, and stress need to notify health care professional immediately if signs of rejection or infection occur.
• Advise patient to avoid contact with persons with contagious diseases.
• Inform patient of the increased risk of skin cancer and other malignancies. Advise patient to use sunscreen with a high protection factor and wear protective clothing to decrease risk of skin cancer.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise patient to notify health care professional immediately if signs or symptoms of infection, post-transplant lymphoproliferative disorder or progressive multifocal leukoencephalopathy occur.
• Advise patients to avoid live vaccines during therapy.
• Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding. Encourage patients who become pregnant or whose partners have received belatacept to register with the National Transplant Pregnancy Registry (NTPR) by calling 1-877-955-6877.
• Emphasize the importance of routine follow-up laboratory tests.

Evaluation/Desired Outcomes

• Prevention of rejection of transplanted kidneys.