Flolan

epoprostenol

Flolan

Prostacyclin

Prostaglandin I2 (PGI2)

Prostaglandin X (PGX)

Veletri

Indications

Action

Pharmacokinetics

Time/action profile (hemodynamic effects)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• anxiety (most frequent)
• headache (most frequent)
• dizziness (most frequent)

Respiratory

• dyspnea
• pulmonary edema

Cardiovascular

• tachycardia (most frequent)
• chest pain (most frequent)
• hypotension (most frequent)
• bradycardia

Gastrointestinal

• nausea (most frequent)
• vomiting (most frequent)
• abdominal pain (most frequent)
• diarrhea (most frequent)

Dermatologic

• flushing (most frequent)
• rash

Musculoskeletal

• myalgia (most frequent)
• jaw pain (most frequent)

Hematologic

• bleeding
• thrombocytopenia

Neurologic

• hypesthesia/hyperesthesia/paresthesia (most frequent)

Miscellaneous

• flu-like symptoms (most frequent)
• injection site reactions
• sweating

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Monitor hemodynamic parameters (cardiac index, mean pulmonary arterial pressure, pulmonary vascular resistance, total pulmonary resistance, mean systemic arterial pressure) frequently during acute dose ranging and periodically during chronic infusion.
• Acute Dose Ranging: Monitor for dose-limiting side effects (nausea, vomiting, headache, hypotension, flushing, chest pain, anxiety, dizziness, bradycardia, dyspnea, abdominal pain, musculoskeletal pain, tachycardia) frequently.
• Chronic Infusion: Monitor BP (supine and standing) and heart rate closely for several hours after dose adjustments.
  • Make dose adjustments during chronic therapy at the first sign of recurrence or worsening of symptoms of pulmonary hypertension or adverse effects of epoprostenol. Most common adverse effects occurring during chronic therapy include headache, jaw pain, flushing, diarrhea, nausea, vomiting, flu-like symptoms, and anxiety.
• Lab Test Considerations: May cause thrombocytopenia.

Potential Nursing Diagnoses

Implementation

• Intravenous Administration

• Anticoagulant therapy is usually administered concurrently, unless contraindicated, to decrease the risk of pulmonary or systemic embolism.
  • Administer via peripheral infusion during acute dose ranging and by chronic continuous infusion via Broviac or Hickman central venous catheter using a programmable ambulatory infusion pump for chronic administration.
• Continuous Infusion: Diluent: For either the 3000- or 5000-ng/mL concentration, dissolve contents of one 0.5-mg vial with 5 mL of sterile diluent for epoprostenol. Withdraw 3 mL for the 3000-ng/mL concentration and the entire vial contents for the 5000-ng/mL concentration and add to a sufficient quantity of sterile diluent for epoprostenol to make a total of 100 mL. Concentration: 3000 ng/mL or 5000 ng/mL. Diluent: For the 10,000-ng/mL concentration, dissolve the contents of two 0.5-mg vials with 5 mL each of sterile diluent for epoprostenol. Withdraw the entire vial contents, and add to a sufficient quantity of sterile diluent for epoprostenol to make a total of 100 mL. Concentration: 10,000 ng/mL. Diluent: For the 15,000-ng/mL concentration, dissolve the contents of the 1.5-mg vial with 5 mL of sterile diluent for epoprostenol or with 5 mL of 0.9% NaCl or Sterile Water for Injection if using Veletri. Withdraw the entire contents of the vial, and add to a sufficient quantity of sterile diluent for epoprostenol to make a total of 100 mL; use same diluent as for reconstitution with Veletri. Use only sterile diluent provided by manufacturer for dilution (except with Veletri). Do not reconstitute or mix with any other parenteral medications or solutions. Concentration: 15,000 ng/mL.
  • May require more than one solution strength during acute dose ranging. Usually 3000 and 10,000 ng/mL are used to deliver an infusion rate between 2–16 ng/kg/min.
  • Unopened vials and reconstituted solutions must be protected from light. Reconstituted solutions are Stable for 8 hr at room temperature or 48 hr if refrigerated. Do not freeze. Discard any reconstituted solution that has been frozen, has been refrigerated more than 48 hr, or has been at room temperature for more than 8 hr.
  • Solutions have been administered while in cold pouches. May be administered while in cold pouches with frozen gel packs over 24 hr, with gel packs changed every 12 hr.
• Rate: Infusion rate usually ranges from 2–16 ng/kg/min in adults.

Patient/Family Teaching

• Home Care Issues: Instruct patient on reconstitution, administration, and care of the permanent central venous catheter.
• Advise patient of the importance of continuous therapy. Inform patient that even brief interruptions of the infusion may cause symptoms of rebound pulmonary hypertension (dyspnea, dizziness, asthenia). Provide patient with access to a backup infusion pump and intravenous infusion sets to prevent potential interruptions in drug delivery. Also inform patients that therapy may be prolonged, possibly lasting years.

Evaluation/Desired Outcomes

• Increase in cardiac index and stroke volume and decrease in pulmonary vascular resistance, total pulmonary resistance, and mean systemic arterial pressure in patients with PPH.