Prialt

ziconotide

Prialt

Indications

Action

Pharmacokinetics

Time/action profile

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• meningitis (life-threatening)
• confusion (most frequent)
• dizziness (most frequent)
• drowsiness (most frequent)
• headache (most frequent)
• impaired memory (most frequent)
• weakness (most frequent)
• aphasaia
• ↓ alertness/responsiveness
• cognitive impairment
• hallucinations
• memory impairment
• psychiatric symptoms
• speech disorder

Cardiovascular

• changes in BP

Ear, Eye, Nose, Throat

• nystagmus (most frequent)
• abnormal vision

Gastrointestinal

• nausea (most frequent)
• anorexia
• vomiting

Local

• catheter/injection site reactions

Musculoskeletal

• hypertonia (most frequent)
• urinary retention (most frequent)
• ↑ creatine kinase

Neurologic

• abnormal gait (most frequent)
• ataxia (most frequent)

Miscellaneous

• fever

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess level of pain prior to and periodically during therapy.
• Assess mental status during therapy. If psychiatric symptoms (cognitive impairment, hallucinations, changes in mood or level of consciousness) or neurological impairment. Discontinuation of therapy may be required, but other causes should be considered. Ziconotide may be discontinued abruptly without withdrawal symptoms.
• Monitor for signs of meningitis (fever, headache, stiff neck, altered mental status, nausea, vomiting, seizures) frequently during therapy. May occur within 24 hr of breach in sterility. If meningitis occurs, obtain CSF cultures and institute antibiotic therapy. Usually requires removal of microinfusion system, catheter, and any other foreign body within the IT space.
• Lab Test Considerations: Monitor serum CK levels every other week for the first month, monthly thereafter, and if neuromuscular symptoms (myalgias, myasthenia, muscle cramps, asthenia, reduction in physical activity) occur. May cause ↑CK levels. If symptoms continue and CK remains ↑ or continues to rise, dose reduction or discontinuation may be required.

Potential Nursing Diagnoses

Implementation

• Ziconotide is not an opioid and cannot prevent or relieve symptoms of opioid withdrawal. Do not discontinue opioids abruptly. For withdrawal from IT opioid, gradually taper opioid IT infusion over several weeks, and replace with an equianalgesic dose of oral opioids. Ziconotide does not potentiate opioid-induced respiratory depression.
  • Ziconotide should be administered under the direction of a physician experienced in IT therapy. Do not administer IV.
• Intrathecal: IT dose is delivered using a programmable implanted variable-rate microinfusion device or an external microinfusion device and catheter. Ziconotide may be administered undiluted (25 mcg/mL in 20-mL vial) or diluted (100 mg/mL in 1-, 2-, or 5-mL vials). Dilute with 0.9% NaCl (preservative—free) using aseptic technique. 100 mg/mL formulation may be administered undiluted once an appropriate dose is established. Refrigerate, but do not freeze, after preparation; administer within 24 hr. Discard solution if discolored or containing particulate matter or any unused portion in vial. Pump refills should be done every 40 days if diluted solution is used or every 60 days if solution is undiluted. Pump should be rinsed and filled according to manufacturer's directions.
• Rate: Dose should be adjusted according to patient's severity of pain, response to therapy, and occurrence of side effects.

Patient/Family Teaching

• Instruct patient on correct technique for care of equipment.
• May cause dizziness and drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to ziconotide is known.
• Advise patient to avoid taking alcohol and other CNS depressants during ziconotide therapy. Consult health care professional prior to taking Rx, OTC, or herbal products during therapy.
• Instruct patient and caregiver to contact health care professional immediately if changes in mental status (lethargy, confusion, disorientation, decreased alertness), changes in mood or perception (hallucinations, including unusual tactile sensations in oral cavity), symptoms of depression or suicidal ideation, or nausea, vomiting, seizures, fever, headache, or still neck occur; may be symptoms of developing meningitis.
• Advise patient to consult health care professional if new or worsening muscle pain, soreness, or weakness with or without darkened urine occur.

Evaluation/Desired Outcomes

• Decrease in pain intensity.