Kineret

anakinra

Kineret

Indications

Action

Pharmacokinetics

Time/action profile (clinical response)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• headache

Gastrointestinal

• diarrhea
• nausea

Hematologic

• neutropenia

Local

• injection site reactions (most frequent)

Miscellaneous

• infections (life-threatening)
• hypersensitivity reactions (rare)

Interactions

Drug-Drug interaction

Route/Dosage

Rheumatoid Arthritis

Neonatal-Onset Multisystem Inflammatory Disease

Availability

Nursing implications

Nursing assessment

• Assess for signs and symptoms of infection (fever, elevated WBC) prior to and periodically during therapy. Screen for latent TB prior to beginning therapy; treat if screen is positive. Anakinra should not be instituted in patients with active infections and should be discontinued if patient develops a serious infection.
• Observe patient for hypersensitivity reactions (urticaria, dyspnea, hypotension). Discontinue anakinra if severe reaction occurs. Medications (antihistamines, acetaminophen, corticosteroids, epinephrine) and equipment should be readily available in the event of a severe reaction.
• Rheumatoid Arthritis: Assess patient’s range of motion and degree of swelling and pain in affected joints before and periodically during therapy.
• Neonatal-Onset Multisystem Inflammatory Disease: Assess symptoms of NOMID (fever, rash, joint pain, vomiting, headache) prior to and periodically during therapy.
• Lab Test Considerations: Monitor neutrophil count prior to and during therapy, then monthly for 3 mo and quarterly thereafter for up to 1 yr.

Potential Nursing Diagnoses

Implementation

• Administration of higher than recommended doses did not result in higher responses.
• Subcutaneous: Administer 1 dose/day. Do not administer solutions that are discolored or contain particulate matter or are beyond expiration date. Provided in single-use prefilled syringes. Store in refrigerator; do not freeze. Remove from refrigerator and allow to reach room temperature for 30 min prior to injection. Avoid injecting into areas that are red or swollen.

Patient/Family Teaching

• Instruct patient in correct technique for injection and care and disposal of equipment. Advise patient/parent to read Patient Information and Instructions for Use prior to starting therapy and with each Rx refill, in case of changes.
• Inform patient of the signs and symptoms of hypersensitivity reactions and injection site reactions (pain, erythema, swelling, purities, brusing, mass, inflammation, dermatitis, edema, urticaria, vesicles, warmth, and hemorrhage). Advise patient of appropriate actions if reactions occur.
• 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 patients not to receive live vaccines during therapy with anakinra without consulting health care professional.
• Advise female patients to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.
• Home Care Issues: Instruct patient and family on preparation and correct technique for administration of injection and care and disposal of equipment. Caution patients and caregivers not to reuse needles, syringes, or drug product.

Evaluation/Desired Outcomes

• Reduction of signs and symptoms and slowed progression of moderate to severe active rheumatoid arthritis.
• Decrease in signs and symptoms of NOMID.