teniposide

teniposide

Vumon

Indications

Action

Pharmacokinetics

Time/action profile (effects on blood counts)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• acute CNS depression
• confusion
• headache

Cardiovascular

• hypotension

Gastrointestinal

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

Dermatologic

• alopecia
• rash

Endocrinologic

• gonadal suppression

Fluid and Electrolyte

• metabolic acidosis

Hematologic

• neutropenia (most frequent)
• anemia (most frequent)
• leukopenia (most frequent)
• thrombocytopenia (most frequent)

Local

• phlebitis at IV site

Neurologic

• peripheral neurotoxicity

Miscellaneous

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

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Monitor BP prior to and every 15 min during infusion. If hypotension occurs, stop infusion and notify health care professional. After BP is stabilized with IV fluids and supportive measures, infusion may be resumed at slower rate.
• Monitor for hypersensitivity reaction (fever, chills, pruritus, urticaria, bronchospasm, tachycardia, rash, hypotension), especially during first 60 min after start of infusion. If these signs occur, stop infusion and notify physician. Keep epinephrine, antihistamine, and resuscitative equipment close by in the event of an anaphylactic reaction.
• Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.
• Monitor intake and output, appetite, and nutritional intake. Teniposide causes nausea and vomiting in up to 30% of patients. Antiemetics may be used prophylactically. Adjust diet as tolerated to help maintain fluid and electrolyte balance and nutritional status.
• Monitor infusion and infusion site frequently. Extravasation may cause tissue necrosis and/or thrombophlebitis. Occlusion of central venous access devices has occurred during 24-hr teniposide infusions in concentrations of 0.1–0.2 mg/mL.
• Lab Test Considerations: Monitor CBC and differential prior to and periodically throughout therapy. Nadirs for leukopenia and thrombocytopenia occur on days 16–18 of therapy. Recovery occurs in approximately 15 days. Notify physician or other health care professional if the leukocyte count is <1000/mm³ or if the platelet count is <75,000/mm³. Therapy may be discontinued if platelet count is <50,000/mm³ or if absolute neutrophil count is <500/mm³.
  • Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, creatinine) prior to and periodically throughout therapy to detect hepatotoxicity and nephrotoxicity.
  • May cause ↑uric acid. Monitor levels periodically during therapy.

Potential Nursing Diagnoses

Implementation

• high alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double check single, daily, and course-of-therapy dose limits; have second practitioner independently double check original order, dose calculations and infusion pump settings.
• Avoid contact with skin. Use Luer-Lok tubing to prevent accidental leakage. If contact with skin occurs, immediately wash skin with soap and water.
  • Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in designated containers (see ).
  • Administration of live-virus vaccines to immunocompromised patients should be avoided.

• Intravenous Administration

• Intermittent Infusion: Diluent: Dilute with D5W or 0.9% NaCl. Concentration: Final concentration will be 0.1, 0.2, 0.4, or 1 mg/mL depending on amount of diluent added. Concentrations of 1 mg/mL should be administered within 4 hr of dilution.Concentrated teniposide is clear but may develop a slight opalescence when diluted in solution. Precipitation may occur at recommended concentrations. Solution must be prepared and administered in nonplastic equipment to prevent cracking of plastic and possible drug leakage. Glass or polyolefin plastic bags or containers should be used; PVC containers are not recommended. Diluted solutions are stable for 24 hr at room temperature. Do not refrigerate.
• Rate: Administer over 30–60 min or longer. Do not give by rapid infusion; may result in hypotension.
• Y-Site Compatibility: ayclovir, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B colloidal, amphotericin B lipid complex, ampicillin, ampicillin/sulbactam, anidulafungin, argatroban, atracurium, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium acetate, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, cladribine, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daptomycin, daunorubicin hydrochloride, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, diazepam, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl+, floxuridine, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, hetastarch, hydralazine, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin calcium, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, metaraminol, methotrexate, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine edisylate, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, topotecan, trastuzumab, trimethoprim/sulfamethoxazole, vancomycin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
• Y-Site Incompatibility: amphotericin B liposome, dantrolene, phenytoin
• Additive Incompatibility: Do not admix with other medications or solutions.

Patient/Family Teaching

• Advise patient to notify health care professional if fever; chills; sore throat; signs of infection; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor.
• Patient should be cautioned not to drink alcoholic beverages or take products containing aspirin or NSAIDs.
• Instruct patient to notify health care professional if abdominal pain, yellow skin, weakness, paresthesia, or gait disturbances occur.
• Instruct patient to inspect oral mucosa for redness and ulceration. If mouth sores occur, advise patient to use sponge brush and rinse mouth with water after eating and drinking.
• Discuss with patient the possibility of hair loss. Explore coping strategies.
• Instruct patient not to receive any vaccinations without advice of health care professional.
• Advise patient to use a nonhormonal method of contraception throughout therapy.
• Emphasize the need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes

• Improvement of hematologic status in leukemias.