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for injection, lyophilized 1,000 mg Dosage: Pancreatic Adenocarcinoma Adults IV 1,000 mg/m 2 once weekly for 7 wk followed by 1 wk of rest. Storage/Stability Store at controlled room temperature (68° to 77°F). Reconstituted solutions are stable for up to 24 h at controlled room temperature (68° to 77°F). Do not refrigerate reconstituted product; crystals may form in the bag or bottle. Pregnancy Category: D
CLASSIFICATION Antineoplastic Agent; Antimetabolite; Immunosuppresan t
MECHANISM OF ACTION Exhibits cell phase specificity, primarily killing cells undergoing DNA synthesis in the Sphase. It also blocks the progression of cells through the G1/Sphase boundary.
INDICATIONS & CONTRAINDICATIONS INDICATIONS Locally or metastatic adrenocarcinoma of the pancreas CONTRAINDICATION S
SIDE EFFECTS The following adverse reactions are for weekly administration of single-agent gemcitabine as a 30min infusion for treatment of a wide variety of malignancies. Cardiovascular Hemorrhage (17%); mild blood loss, petechiae (16%); arrhythmias, CHF, gangrene, MI, peripheral vasculitis (postmarketing). CNS Somnolence (11%); paresthesia (10%); asthenia (common). Dermatologic Rash (30%); alopecia (18%); pruritus (13%); bullous skin eruptions, cellulitis, desquamation (postmarketing). GI Nausea and vomiting (71%); constipation (31%); diarrhea (30%); stomatitis (14%); anorexia (common). Genitourinary
NURSING RESPONSIBILITIES • Reconstitute with
- Hypersensitivity to
gemcitabine, severe thrombocytopenia, acute infection, pregnancy, lactation
preservative-free sodium chloride 0.9%. • Reconstituted solution may be administered directly or further diluted with sodium chloride 0.9% to a final gemcitabine concentration at least 0.1 mg/mL. • Administer by IV infusion over 30 min. Prolonging infusions past 60 min increases the risk of myelosuppressio n. • Reconstituted gemcitabine is a clear, colorless to light strawcolored solution. Do not administer if particulate matter or
discoloration is found. • Store at controlled room temperature (68° to 77°F). Reconstituted solutions are stable for up to 24 h at controlled room temperature (68° to 77°F). Do not
elevated ALT (72%). elevated creatinine (8%). Monitor and record BP carefully after initial dose. HematologicLymphatic Anemia (73%). Respiratory Dyspnea (23%). pulmonary fibrosis (postmarketing). Monitor baseline and periodic renal and hepatic function Monitor Input and Output quantitatively Inform patient about common adverse effects and measure to control or minimize when possible. hemolytic uremic syndrome (0. increased alkaline phosphatase (77%). liver failure (postmarketing). Miscellaneous • • • • • • • • refrigerate reconstituted product. . crystals may form in the bag or bottle. and periodically here after Monitor Lab Tests: CBC with differential and platelet count prior to each dose. renal failure (postmarketing). Report any significant side effects immediately to the physician Report pregnancy to physician immediately Do not breastfeed while taking this drug without consulting physician. Hepatic Elevated AST (78%). pulmonary edema. interstitial pneumonitis. thrombocytopenia (47%). increased BUN (16%). parenchymal toxicity including adult respiratory distress syndrome.Proteinuria (45%).25%). elevated bilirubin (26%). leukopenia (71%). elevated gamma-glutamyl transferase. neutropenia (63%). hematuria (35%). bronchospasm (2%).
. edema (13%). injection-site reaction (4%).Pain (48%). peripheral edema (20%). fever (41%). radiation recall reactions (postmarketing). infection (16%). flulike syndrome (19%).
anorexia. rash. edema. or vomiting • Onset or worsening of unexplained shortness of breath or cough • Eye irritation • Given that skin • Inform patient . Kinase Inhibitor MECHANISM OF ACTION The mechanism of clinical antitumor action of erlotinib is not fully characterized. abdominal pain. nausea. pyrexia. weight decrease. Pregnancy Category: D CLASSIFICATION Antineoplastic Agent. stomatitis myalgia. NURSING RESPONSIBILITIES • Teach or provide the training and support to ensure the safety of patients taking on the responsibility of taking oral chemotherapy at home. vomiting. 100 mg and 150 mg erlotinib Dosage: ORAL Pancreatic Cancer The recommended daily dose of TARCEVA for pancreatic cancer is 100 mg taken on an empty stomach at least one hour before or two hours after the ingestion of food. patients should be: • advised to seek medical advice • Onset or worsening of skin rash • Severe or persistent diarrhea.NAME Generic Name: Erlotinib Brand Name: Tarceva Availability: available in three dosage strengths 25 mg. Erlotinib inhibits the intracellular phosphorylation of tyrosine kinase associated with the epidermal growth factor receptor (EGFR). Specificity of inhibition with regard to other tyrosine kinase receptors has not been fully characterized. EGFR is expressed on the cell surface of normal cells and cancer cells. diarrhea. in combination with gemcitabine. bone pain. infection. The following signs or symptoms occur. constipation. nausea. dyspnea. INDICATIONS & PRECAUTIONS INDICATIONS TARCEVA monotherapy is indicated for the maintenance treatment of patients with locally advanced or metastatic nonsmall cell lung cancer whose disease has not progressed after four cycles of platinumbased first-line chemotherapy CONTRAINDICATION S NONE PRECAUTIONS AND WARNING • Pulmonary toxicity • Renal failure • Hepatotoxicity • Patients with hepatic impairment • Gastrointestinal perforation • Bullous and exfoliative skin disorders • Ocular disorders • Elevated International Normalized Ratio and potential ADVERSE REACTIONS • The most common adverse reactions (>20%) in pancreatic cancerare fatigue. Reiterate the importance of compliance in taking the medication tarceva should be taken on an empty stomach at least one hour before or two hours after the ingestion of food. anorexia.
• Women of childbearing potential should be advised to avoid becoming pregnant while taking TARCEVA • Smokers should be advised to stop smoking while taking TARCEVA . • The management of rash should be discussed with the patient. • Acne preparations with drying properties may aggravate the dry skin and erythema.bleeding • Use in pregnancy (adequate contraceptive methods should be used during therapy and for at least 2 weeks after completing therapy) reactions are anticipated when taking TARCEVA. This may include topical corticosteroids or antibiotics with anti-inflammatory properties. Treatment of rash has not been formally studied and should be based on rash severity. proactive intervention may include alcoholfree emollient cream and use of sunscreen or avoidance of sun.
as plasma concentrations of erlotinib are reduced due to the effect of cigarette smoking .