University of Colorado Hospital Policy and Procedure

Administration of Inhaled Iloprost (Ventavis) Inhaled Prostacyclins

Related Policies and Procedures:
Aerosol Therapy
Use of Patients Own Medications and Dietary Supplements
Approved y: Professional Practice Policy and Procedure Committee
Effectie: !"#"$ %&enter date '%%%%%%
(eised: )#!! %&enter date'%%%%%%%
!escription: This policy#procedure descri*es how to safely administer the inhaled
prostacylins+ iloprost &,entais-' and treprostinil + &Tyaso-'+ iloprost in Pulmonary Arterial
.ypertension patients/
Accountaility: The Pulmonary .ypertension Attendin0 is responsi*le for writin0 orders for
inhaled iloprost prostacyclins in the inpatient settin0/ 1heneer possi*le+ the patient will *e
responsi*le for self2administerin0 each dose of medication throu0h their own administration
deice/ 3f for any reason+ the patient is una*le to self2administer the medication+ the (espiratory
Therapist and (e0istered 4urse should contact the Pulmonary .ypertension (e0istered 4urse to
ma5e recommendations/ The patients inhalation will occur under the oersi0ht direct
o*seration of the (espiratory Therapist/ Colla*oratiely+ the (espiratory Therapist and the
(e0istered 4urse will *e responsi*le for monitorin0 side effects of treatment/ 6inally+ the
medication will *e supplied and dispensed *y Central Pharmacy while the patient is in the
hospital/
!efinitions:
Pulmonary Arterial Hypertension: a rare disorder characteri7ed *y eleation of the mean
pulmonary artery pressure 0reater than 8$ mm .0/
Inhaled iloprost: 3nhaled iloprost is a sta*le prostacyclin analo0ue approed in Decem*er of
8""9 *y the 6DA for treatment of Pulmonary Arterial .ypertension/ 3t is also 5nown as
,entais-/ 3t is deliered throu0h a speciali7ed deliery system+ the I"#e AA! device/
Inhaled treprostinil: 3nhaled treprostinil &Tyaso-' is a sta*le prostacyclin analo0ue approed
in :uly of 8""; *y the 6DA for treatment of Pulmonary Arterial .ypertension/ 3nhaled
treprostinil is deliered throu0h the Optine* apparatus/
Procedures:
A/ Administration of inhaled prostacyclins in the inpatient settin0 &Esta*lished patients'
!/ 3nhaled prostacylcins are a lon02term therapy and should not *e interrupted unless
specifically recommended *y the Pulmonary .ypertension Attendin0/
8/ The dose of inhaled prostacyclin is determined *y the Pulmonary .ypertension
Attendin0 and should not re<uire ad=ustment after the initial titration/
>/
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Administration of Inhaled Iloprost (Ventavis) Prostacyclins
9/ The patient will self administer ) to ; eenly spaced aerosoli7ed treatments durin0 the
wa5in0 hours eery day+ under the direct o*seration of the (espiratory Therapist/ 3t is
not intended+ *ut may in some cases *e necessary for the patient to ta5e an inhalation
durin0 the ni0ht/ The Pulmonary .ypertension Attendin0 will determine when this is
necessary/
$/ Treatments should *e ta5en eery 82> hours &no sooner more fre<uently than eery two
hours'/
)/ 3nhaled prostacyclins hae a half2life of 8"2>" minutes after inhalation/ 3nhaled iloprost
was 0enerally not detected in the plasma >" minutes to ! hour after treatment/
?/ Common side effects are asodilation &flushin0'+ increased cou0h+ headache+ =aw pain+
nausea+ and hypotension/
@/ Aderse eents that are to *e reported to the Pulmonary .ypertension Attendin0
immediately are:
a/ Systolic AP falls 0reater than 8" mm .0 from *aseline or re0isters at @" mm .0 or
*elow+ si0ns and symptoms of hypotension or hypertension+ seere nausea+ di77iness+
li0htheadedness+ shortness of *reath+ or chest pain/
*/ 3ncrease in heart rate *y 0reater than 8" *eats per minute from *aseline or reaches
!8" *eats per minute/
c/ Syncope/
A/ Usin0 either the 324e* AAD deice or the the Optine* deice
!/ 3nhaled iloprost is dosed with a deice specific dosin0 dis5 &8/$mc0 or $/" mc0' ia an
I"#e AA! device (ne*uli7er deice specifically desi0ned for inhaled iloprost'/ 1hen
a patient on inhaled iloprost is admitted to the hospital+ it is their responsi*ility to *rin0
with them the dis5s and I"#e AA! device/
8/ 3nhaled treprostinil is deliered throu0h the $ptine deice/ This deice contains a
mouthpiece+ filters+ a medication cham*er and a medication cone/ 3t is the patientBs
responsi*ilty to proide all of these accessories
>/ 3nhaled iloprost is supplied in indiidual 8 ml ampules+ with a concentration of !" mc0
per ml/ The entire contents of one ampule are used for each inhalation+ re0ardless of the
dose/ The dosin0 dis5 filter within the 324e* AAD deice will deteremine the prescri*ed
dose which is deliered/ to the patient/ Central Pharmacy will supply the ampules of
inhaled iloprost while the patient is hospitali7ed
9/ The followin0 ideo clip tutorial details the full procedure for settin0 up+ operatin0+ and
cleanin0 the I"#e AA! device and the $ptine !evice/
%in&: http:''((()youtue)com'(atch*v+A,-./ao"/(A
C/ Procedure for the Administration for 3nitial Start of 3nhaled Prostacyclin therapy in the
inpatient settin0 3loprost in the .ospital Settin0
!/ 1hen possi*le+ the (4 from the specialty pharmacy will *e present for patient
instruction and administratin0 the patients initial dose of inhaled prostacyclin/ ed
iloprost/
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Administration of Inhaled Iloprost (Ventavis) Prostacyclins
8/ The Pulmonary .ypertension Attendin0 and Pulmonary .ypertension 4urse on call will
*e immediately aaila*le *y telephone/
>/ The patients ital si0ns will *e chec5ed immediately *efore the administration of
medication+ and $ minutes+ !$ minutes and >" minutes post administration/
9/ The Pulmonary .ypertension Attendin0 will *e notified immediately for :
a/ Systolic AP falls 0reater than 8" mm .0 or decreases to less than @$ mm .0 systolic/
*/ Aderse eents of di77iness+ li0htheadedness+ increased shortness of *reath+ chest
pain+ and#or seere nausea/
c/ 3ncreased heart rate 0reater than 8" *eats per minute or reaches !8" *eats per minute/
d/ Syncope/
$/ The second treatment dose will *e 0ien 8 hours after the initial dose is completed with
the (4 from the specialty pharmacy to superise the patient for the second
administration/ The Pulmonary .ypertension Attendin0 will *e contacted to determine if
the dose is to *e titrated to the $/" mc0 or remain at the 8/$ mc0 dose/
)/ ,ital si0ns will *e ta5en immediately *efore the second dose of inhaled iloprost+ and $
minutes+ !$ minutes and >" minutes post administration/
?/ Patients that tolerate the initial treatments with inhaled iloprost will then ta5e their
treatments eery 8 hours durin0 their wa5in0 hours+ under the superision of the
(espiratory Therapist+ with colla*oratie monitorin0 *y the (e0istered 4urse and
(espiratory Therapist for aderse eents/
D/ Document Patient Safety Statement: Assess patient for possi*le safety issues+ interene as
necessary+ and document/
!ocumentation:
!/ Document the time of treatment on the scheduled Medical Administration (ecord &MA('/
8/ Document itals si0ns and response to treatment as outlined a*oe with inhaled iloprost/
Additional Resources:
Inhaled Prostacyclins
Presentation.pptx
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Administration of Inhaled Iloprost (Ventavis) Prostacyclins
References:
!/ Olschews5i+ ./ &8"";'/ 3nhaled iloprost for the treatment of pulmonary hypertension/
European (espiratory (eiew + !@&!!!'+ 8;2>9/COE: 33
8/ Aenedict+ 4+ Sey*ert+ A+ D Mathier+ M/ &8""?'/ Eidenced2*ased pharmacolo0ic
mana0ement of pulmonary arterial hypertension/ Clinical Therapeutics + 8;&!"'+ 8!>92
8!$>/COE:,
>/ Eru0+ S+ Sa*lot75i+ A+ .ammerschmidt+ S+ 1irt7+ .+ D .ans2:uer0en+ S/ &8"";'/ 3nhaled
iloprost for the control of pulmonary hypertension/ ,ascular .ealth and (is5 Mana0ement+ $+
9)$29?9/ COE: 3,
9/ Ewert+ (+ Schaper+ C+ .alan5+ M+ Flaser+ S+ D Opit7+ C/ &8"";'/ 3nhalatie iloprost2
pharmacolo0y and clinical application/ EGpert Opinion+ !"&!>'+ 8!;$288"?/ COE: ,3
c8)9?!!
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