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Adverse Reactions/Side Effects
CV: arrhythmias, hypertension. Hemat: anemia, neutropenia, thrombocytopenia.
MS: transient increase in bone pain.
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samarium Sm 153 lexidronam
(sa-mar-ee-yum lex-i-droe-nam)
Interactions
Drug-Drug: Additive bone marrow toxicity with antineoplastics or previous ra-
Quadramet
Classification
Therapeutic: nonopioid analgesics
Pharmacologic: radiopharmaceuticals
Pregnancy Category D
diation therapy.
Route/Dosage
IV (Adults): 1 millicuries (mCi)/kg.
NURSING IMPLICATIONS
Assessment
Indications
Treatment of bone pain in patients with confirmed osteoblastic skeletal metastases
that enhance on radionuclide bone scan. Unlabeled Use: Ankylosing spondylitis,
Paget’s disease, rheumatoid arthritis.
Action
Preferentially taken up by bone tumors and metastatic bone lesions, where selective
irradiation takes place. Therapeutic Effects: Decreased pain from bony metastases.
Pharmacokinetics
Absorption: IV administration results in complete bioavailability.
Distribution: Taken up and is selectively retained by metastatic bone lesions.
Metabolism and Excretion: Unbound drug is excreted in urine.
Half-life: 65 min (radioactivity).
TIME/ACTION PROFILE (pain relief)
ence a transient increase in bone pain for 2– 3 days beginning 2– 3 days after administration. This is normal, and increasing analgesic doses may be required.
Pain should begin to diminish after 1– 2 wk or longer and may allow for reduction
or discontinuation of analgesics. Effects may continue for several months.
● Lab Test Considerations: Beginning 2 wk after administration of samarium,
monitor hematologic parameters (WBC, platelets) weekly for at least 8 wk and until adequate recovery of bone marrow function.
Potential Nursing Diagnoses
Acute pain (Indications)
Deficient knowledge (Patient/Family Teaching)
Implementation
● Should be administered only in facilities with personnel experienced in the safe
use and handling of radiopharmaceuticals.
ROUTE
ONSET
PEAK
DURATION
IV
1–2 wk
unknown
unknown
Contraindications/Precautions
Contraindicated in: Hypersensitivity; OB, Lactation: Pregnancy or lactation.
Use Cautiously in: Women with childbearing potential; Diminished bone marrow
reserve or other chronic debilitating illness (allow recovery from previous treatments); Patients with a life expectancy ⬍6 mo; Pedi: Children ⬍16 yr (safety not established).
⫽ Canadian drug name.
● Assess pain (intensity, location) periodically during therapy. Patient may experi-
⫽ Genetic Implication.
● Patient should drink or receive IV a minimum of 500 mL of fluids prior to injec-
tion. Instruct patient to void as often as possible following injection to minimize
radiation exposure to bladder.
● Incontinent patients should have urinary catheters placed prior to administration
to minimize the risk of radioactive contamination of clothing, linens, and the environment.
IV Administration
● Direct IV: Thaw at room temperature prior to administration; use within 8 hours
of thawing or within 48 hours after time of calibration noted on the product label,
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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whichever is earlier. Rate: Administer by slow injection over 1 min. Follow with
a saline flush. A flushing sensation may be experienced following a rapid (⬍30
sec) injection.
● Additive Incompatibility: Do not dilute or mix with other solutions or medications.
Patient/Family Teaching
● Instruct patient to continue taking pain medication until samarium becomes effec-
tive. Analgesic doses may be decreased once the effects of samarium are known.
● Advise patient that no change in eating or drinking is necessary. Alcohol and caf-
feine need not be avoided unless advised by health care professional.
● Samarium is excreted in the urine for several hr after administration. Advise pa-
●
●
●
●
tient to use a normal toilet rather than a urinal if possible and to flush twice after
use. Spilled urine or blood from a cut should be wiped up with a tissue and
flushed. Good handwashing should be observed, and any linen contaminated with
blood or urine should be immediately washed separately from other items and
rinsed thoroughly or stored for 1– 2 wk to allow for decay of samarium. If any
urine collection device is used, the instructions on its use should be followed.
Instruct male and female patients to use an effective form of contraception following samarium administration. May be harmful to fetus. Women of childbearing age
should have a negative pregnancy test prior to administration of samarium.
Instruct patient to notify any health care professional or caregiver of samarium
therapy prior to treatment.
Advise patient to contact health care professional if the effects of samarium decrease and pain returns.
Emphasize the importance of periodic blood tests.
Evaluation/Desired Outcomes
● Decrease in pain due to bony metastases.
Why was this drug prescribed for your patient?
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