pegaspargase

pegaspargase

 [peg-as´pahr-jās]

l-asparaginase derived from Escherichia coli and covalently linked to polyethylene glycol; used as an antineoplastic in the treatment of acute lymphoblastic leukemia, administered intramuscularly or intravenously.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

pegaspargase (PEG-L-asparaginase)

Oncaspar

Pharmacologic class: Enzyme

Therapeutic class: Antineoplastic

Pregnancy risk category C

Action

Stimulates production of effector proteins, such as serum neopterin and 2', 5' oligodenylate synthetase; raises body temperature and reversibly lowers white blood cell and platelet counts

Availability

Injection: 750 international units/ml, 5-ml vial in phosphate-buffered saline solution

Indications and dosages

➣ Acute lymphoblastic leukemia

Adults and children with body surface area (BSA) greater than 0.6 m²: 2,500 international units/m² I.M. or I.V. q 14 days

Adults and children with BSA less than 0.6 m²: 82.5 international units/m² I.M. or I.V. q 14 days

Contraindications

• Hypersensitivity or previous serious allergic reaction (such as generalized urticaria, bronchospasm, laryngeal edema, hypotension) to drug

• Pancreatitis or history of pancreatitis

• Previous hemorrhagic events related to L-asparaginase therapy

Precautions

Use cautiously in:

• renal or hepatic disease, CNS disorders

• concurrent use of hepatotoxic agents, anticoagulants, aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)

• pregnant or breastfeeding patients.

Administration

☞ Follow facility protocol for handling, preparing, and disposing of chemotherapeutic drugs.

☞ Avoid inhaling vapors and contact with skin or mucous membranes.

☞ Keep resuscitation equipment, epinephrine, oxygen, steroids, and anti-histamines readily available.

• Know that I.M. route is preferred because it's less likely to cause hepato-toxicity, coagulopathy, and GI or renal disorders. For single I.M. injection, don't exceed volume of 2 ml.

• For I.V. use, dilute in 100 ml of normal saline solution or dextrose 5% in water. Infuse over 1 to 2 hours.

☞ Don't freeze; freezing inactivates drug.

Adverse reactions

CNS: dizziness, headache, confusion, hallucinations, emotional lability, drowsiness, neuritis, Parkinson-like syndrome, malaise, coma, seizures

CV: hypertension, hypotension, chest pain, peripheral edema, tachycardia, endocarditis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, anorexia, pancreatitis GU: glycosuria, polyuria, urinary frequency, hematuria

Hematologic: hemolytic anemia, leukopenia, pancytopenia, thrombocy-topenia, disseminated intravascular coagulation

Hepatic: jaundice, fatty liver deposits, hepatotoxicity, hepatomegaly

Metabolic: hypoproteinemia, hyperuricemia, hyperammonemia, hyponatremia, hyperglycemia, hypoglycemia Respiratory: dyspnea, cough, bronchospasm

Skin: rash, urticaria, pruritus, night sweats, alopecia

Other: increased appetite and thirst, weight loss, chills, fever, injection site reaction, facial or lip edema, hypersensitivity reactions including anaphylaxis, septic shock

Interactions

Drug-drug. Aspirin, dipyridamole, heparin, NSAIDs, warfarin: increased risk of bleeding or thrombosis

Methotrexate: decreased methotrexate action

Drug-diagnostic tests. Amylase, blood urea nitrogen, creatinine, lipase, uric acid: increased levels

Glucose: increased or decreased level

Liver function tests: abnormal results

Lymphoblasts: decreased count

Plasma proteins: altered levels

Patient monitoring

☞ Watch for anaphylaxis and other hypersensitivity reactions, especially during first hour of therapy.

• Monitor CBC (including platelet count); fibrinogen; prothrombin and partial thromboplastin times; International Normalized Ratio; and serum amylase, lipase, and uric acid levels.

☞ Assess neurologic status. Stay alert for decreased level of consciousness and evidence of impending seizure.

• Check for signs and symptoms of bleeding, infection, and hyperglycemia.

• Monitor heart rate, blood pressure, respiratory rate, temperature, and fluid intake and output.

Patient teaching

☞ Teach patient to recognize and immediately report signs and symptoms of hypersensitivity reactions, bleeding, infection, and other adverse reactions.

• Tell patient drug is likely to cause reversible hair loss.

• Stress importance of undergoing follow-up laboratory tests.

• Advise patient to avoid situations that increase risk for infection.

• Instruct patient to consult pre-scriber before taking other prescription drugs or over-the-counter preparations.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved