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Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
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abatacept (a-bat-a-cept)
Orencia
Classication
Therapeutic: antirheumatics (DMARDs)
Pharmacologic: fusion proteins
Pregnancy Category C
Indications
Reduction of signs/symptoms and disease progression in moderate to severely active
rheumatoid arthritis in adults (to be used as monotherapy or in with other disease
modifying antirheumatic drugs (DMARDS), other than tumor-necrosis factor (TNF)
inhibitors. Reduction of signs/symptoms in children (6 yr) with moderate to se-
verely active polyarticular juvenile idiopathic arthritis (to be used as monotherapy or
with methotrexate).
Action
Inhibits T cell activation (and the inammatory process) by binding to specic recep-
tors. Therapeutic Effects: Decreased progression of rheumatoid arthritis.
Pharmacokinetics
Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
MetabolismandExcretion: Unknown.
Half-life: 13 days.
TIME/ACTIONPROFILE (improvement in symptoms)
ROUTE ONSET PEAK DURATION
IV within 15 days3 mo 612 mo 3 yr (maintenance of re-
sponse)
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Concurrent use of tumor necrosis factor
(TNF) antagonists or anakinra; Lactation: Discontinue drug or provide formula.
Use Cautiously in: Patients with chronic obstructive pulmonary disease (qrisk of
exacerbations and other adverse events); Geri:qrisk of adverse reactions; Pedi:
Children 6 yr (safety not established); OB: Use only if clearly needed.
AdverseReactions/SideEffects
CNS: headache, dizziness. Misc: hypersensitivity reactions including ANAPHYLAXIS,
INFECTIONS, infusion-related events.
Interactions
Drug-Drug: Concurrent use with tumor necrosis factor (TNF) antagonists
mayqrisk and severity of infections. Mayqincidence and risk of adverse reactions
fromlive-virus vaccines.
Route/Dosage
RheumatoidArthritis
IV (Adults): 60 kg500 mg initially; repeat dose at 2 wk and 4 wk after initial
dose, then q 4 wk thereafter; 60100 kg750 mg initially; repeat dose at 2 wk and
4 wk after initial dose, then q 4 wk thereafter; 100 kg1000 mg initially; repeat
dose at 2 wk and 4 wk after initial dose, then q 4 wk thereafter.
Subcut (Adults): Patient should receive single IV dose (according to weight-based
dosing guidelines above), then give 125 mg subcut within 1 day, then give 125 mg
subcut once weekly; if patient cannot receive IV dose, initiate once weekly subcut in-
jections; if transitioning from IV therapy, administer next scheduled dose as subcut
injection.
JuvenileIdiopathic Arthritis
IV (Children 617 yr and 75 kg): 75100 kg750 mg initially; repeat dose
at 2 wk and 4 wk after initial dose, then q 4 wk thereafter; 100 kg1000 mg ini-
tially; repeat dose at 2 wk and 4 wk after initial dose, then q 4 wk thereafter.
IV (Children 617 yr and 75 kg): 10 mg/kg initially; repeat dose at 2 wk and 4
wk after initial dose, then q 4 wk thereafter.
NURSINGIMPLICATIONS
Assessment
Assess range of motion, degree of swelling, and pain in affected joints before and
periodically during therapy.
Assess for infusion-related reaction (dizziness, headache, hyperten-
sion) and signs of allergic reaction (hypotension, urticaria, dyspnea).
Infusion-related reactions usually occur within 1 hr of start of infusion.
Keep epinephrine, an antihistamine, and resuscitation equipment close
by in case of an anaphylactic reaction.
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Assess for latent tuberculosis with a tuberculin skin test. If positive, tuberculosis
should be treated prior to abatacept therapy.
Assess health status at each session. Monitor patients whodevelop a new
infection while taking abatacept closely. Discontinue therapy in patients
who develop a serious infection or sepsis. Do not initiate therapy in pa-
tients withactive infections.
Lab Test Considerations: Pre-screen patient for viral hepatitis prior to ther-
apy; may reactivate hepatitis. If test is positive, do not start abatacept.
Patients receiving IV abatacept may record false positive blood glucose due tomal-
tose in injection; discuss with health care professional.
Potential Nursing Diagnoses
Impaired physical mobility (Indications)
Acute pain (Indications)
Implementation
Donot confuse Orencia withOracea.
Subcut: Remove prelled syringe fromrefrigerator and allowto reach roomtem-
perature for 3060 min; do not use other methods to warm solution. Leave nee-
dle cover on during warming. Inspect solution; do not administer solutions that
are discolored, contain particulate matter; are expired, or do not have the correct
amount of uid in syringe. Front of thigh is the preferred site; abdomen except for
2 inches from navel or upper arm if administered by caregiver, may also be used.
Pinch skin and inject at a 45 angle. Do not rub injection site. Rotate eachinjection
at least 1 inch from last injection, avoid areas where skin is tender, bruised, red,
or hard, or contains scars or stretch marks.
IVAdministration
Intermittent Infusion: Reconstitute each vial with 10 mL of Sterile Water for
Injection, using ONLY the SILICONE-FREE DISPOSABLE SYRINGE PRO-
VIDED WITHEACHVIAL and an 1821 gauge needle for a concentration of 25
mg/mL. Discard solutions prepared using siliconized syringes. Additional sili-
cone-free syringes are available frommanufacturer. Direct streamof sterile water
to side of vial. Rotate vial by gently swirling to minimize foaming. Do no shake.
Upon dissolution, vent vial to dissipate foam. Solution should be clear and color-
less to pale yellow. Do not use solutions that are discolored or contain particulate
matter. Diluent: Further dilute solution to 100 mL of 0.9% NaCl by withdrawing
volume of abatacept solution from 100 mL infusion bag or bottle. Slowly add re-
constituted solution using the same SILICONE-FREE DISPOSABLE SYRINGE PRO-
VIDED WITH EACH VIAL. Mix gently. Concentration: Concentration will be 5,
7.5, or 10 mg/mL depending on whether 2, 3, or 4 vials were used. Discard un-
used portion of vial. Infusion must be completed within 24 hr of reconstitution.
Diluted solution may be stored at room temperature or refrigerated before use.
Rate: Administer over 30 min with a sterile non-pyrogenic, low-protein-binding
lter with a 0.21.2 micron pore size.
Y-Site Incompatibility: Do not infuse in same infusion line as other agents.
Patient/Family Teaching
Instruct patient on purpose of abatacept. Advise patient to read the Orencia Pa-
tient Information leaet prior to each session. Provide an opportunity for patient
to ask questions. If a dose is missed, ask health care professional when to sched-
ule next dose.
Advise patient not to receive live vaccines during or 3 mo following therapy. Par-
ents should be advised that children should complete immunizations to date be-
fore initiation of abatacept.
Advise patient that methotrexate, analgesics, NSAIDs, corticosteroids, and salicy-
lates may be continued during therapy.
Instruct patient that abatacept should not be taken with TNF antagonists may in-
crease risk for infections.
Instruct patient to notify health care professional if upper respiratory or
other infections occur. Therapy may need to be discontinued if serious
infection occurs.
Advise patient to notify health care professional if pregnancy is planned or sus-
pected. Caution patient to avoid breast feeding during therapy.
Evaluation/DesiredOutcomes
Reduction in symptoms of rheumatoid arthritis.
Why was this drug prescribedfor your patient?