pegloticase

pegloticase

Krystexxa

Indications

Action

Pharmacokinetics

Time/action profile (effects on serum uric acid)

Contraindications/Precautions

Adverse Reactions/Side Effects

Cardiovascular

• chest pain

Ear, Eye, Nose, Throat

• nasopharyngitis

Gastrointestinal

• nausea (most frequent)
• constipation
• vomiting

Dermatologic

• contusion/ecchymoses (most frequent)

Metabolic

• gout flare (most frequent)

Miscellaneous

• allergic reactions including anaphylaxis (life-threatening)
• infusion reactions

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Monitor for joint pain and swelling. Gout flares frequently occur upon initiation of therapy, but do not require discontinuation. Administer prophylactic doses of colchicine or an NSAID at least 1 wk before and concurrently during the first 6 mo of therapy.
• Monitor for signs and symptoms of anaphylaxis (wheezing, peri-oral or lingual edema, hemodynamic instability, rash, urticaria) during and following infusion. May occur with any infusion, including initial infusion; usually occurs with 2 hr of infusion. Delayed reactions have also been reported. Risk is higher in patients with uric acid level >6 mg/dL.
• Monitor for infusion reactions (rash, redness of skin, dyspnea, flushing, chest discomfort, chest pain) during and periodically after infusion. If infusion reaction occurs, slow or stop infusion; restart at slower rate. If severe reaction occurs, discontinue infusion and treat as needed. Risk is greater in patients who have lost therapeutic response. Monitor patient for at least 1 hr following infusion.
• Lab Test Considerations: Monitor serum uric acid levels prior to infusion. Consider discontinuing therapy if levels ↑ to >6 mg/dL, especially if 2 consecutive levels are >6 mg/dL.

Potential Nursing Diagnoses

Implementation

• Premedicate patient with antihistamines and corticosteroids prior to infusion to minimize risk of anaphylaxis and infusion reaction. Administer in a setting with professionals prepared to manage anaphylaxis and infusion reactions.
  • Discontinue all oral urate-lowering medications prior to and during therapy.

• Intravenous Administration

• pH: 4.4–5.6.
• Intermittent Infusion: Withdraw 1 mL of pegloticase from vial and inject into 250 mL bag of NaCl; discard unused portion. Invert bag several times to mix; do not shake. Solution is clear and colorless; do not administer solutions that are discolored or contain a precipitate. Solution is stable for 4 hr if refrigerated or at room temperature. Store in refrigerator and protect from light; do not freeze. Allow solution to reach room temperature before administering; do not use artificial heating.
• Rate: Infuse over 120 min. Do not administer via IV push or bolus.
• Additive Incompatibility: Do not mix with other medications.

Patient/Family Teaching

• Explain purpose of pegloticase to patient. Instruct patient to read Medication Guide before starting therapy before each infusion.
• Advise patient to notify health care professional immediately if signs of anaphylaxis or infusion reaction occur.
• genetic implication Advise patient not to take pegloticase if they have G6PD deficiency.
• Inform patient that gout flares may initially ↑ at the start of pegloticase. Advise patient to not to stop therapy but to take medication (colchicine, NSAID) to reduce flares regularly for the first few months of pegloticase therapy.
• Instruct patient to not to take oral urate-lowering medications before or during therapy.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

• ↓ in uric acid levels with resultant improvement in gout symptoms in patients with chronic gout.