Question

What are the nursing implications for Ripretnib?

Answer 1

Nursing implications with ripretinib

Introduction:

Cancer chemotherapy is different from other normal medications in that is an anticancer drug affects the rapidly dividing cells and may also affect the normal body cells in addition to the cancer cells causing many side effects. This implies that the nurse must be herself aware of the Potential toxicity and side effects of these drugs and must also educate the patient regarding the the drug action and the possible side effects

Ripretinib is an anticancer agent which is used for GIST tumors (not responsive to the other three drugs of the same group)and gained approval recently for the medical use.it is a new drug which is used as an advanced treatment for late stage gastrointestinal stromal tumor.

Rationale for the nursing implications with the Ripretinib:As the potential toxicity of anticancer drugs exists due to their inhibition of proliferation of the normal body cells, the understanding of the nursing implications of administration of Ripretinib becomes highly significant

Generic name: Ripretinib

brand name qinlock

Drug classification: kinase inhibitors.,PDGFR-alpha inhibitors.

usual dose:The tablet comes in a strength of 50 milligrams and is usually given orally in a daily dose of 100-150mg daily.

action of the drug: switch pocket inhibitor with dual mechanism of action.Ripretinib acts by inhibiting the KIT enzyme and the PDGFR alpha kinase required for the proliferation and progression of the tumor.cells.

indications: Gist tumor advanced stage, failed therapy with other kinase inhibitors

common side effects: nausea, vomiting ,diarrhea,abdominal pain ,constipation anorexia alopecia. heachache,elevated clotting time(bleeding tendencies) and a rare condition called palmar-plantar erythrodysesthesia syndrome.

Serious adverse effects hypertension. decreased ejection fraction due to cardiac dysfunction and cutaneous cancers,neutropenia 10%,renal dysfunction.

Nursing implications {what the nurse should focus on }:

Following aspects of the drug administration are very important to the nursing process and form the nursing implications for Ripretinib.

Contraindications and warning. The drug is contraindicated in patients having severe allergy from the drug,drug hypersensitivity reactions and pregnancy. It is contraindicated in case of preexisting conditions like severe cardiac dysfunction,renal dysfuntion,liver dysfunction or hypertensive crisis.

Drug warning: The drug is contraindicated in pregnancy and breastfeeding as it can affect the developing fetus and newborn respectively. The nurse must confirm the pregnancy status from the patient who has been prescribed the drug as it cannot be given to the pregnant women.

Drug interactions : Concomitant use of antiepileptic drugs like carbamazepine. phenytoin sodium, rifampicin and herbal medications like Saint John's wort causes alteration in the the elimination of Ripretinib leading to increased drug levels and predisposition to side-effects and toxicity and these interactions must be watched for. In the patients receiving any of these drugs along with Ripretinib , the drug levels and the side effects of the drug must be monitored closely and dose adjustment be made as per physician advice in case of suspected toxicity.

Lab value altered by Ripretinib:Complete blood count and renal function tests, liver function tests must be done in all patients receiving cancer chemotherapy as there is a possibility of myelosuppression,decreased blood cell count ,renal dysfunction and elevation of liver enzymes due to the anticancer effect of the drugs.

As Ripretinib causes decreased ejection fraction, 2D echo must be done to monitor the ejection fraction of the cardiac patients receiving Ripretinib .

Pre administration nursing assessment :

The baseline blood pressure ,heart rate and other vital signs of the patient along with lung and cardiac auscultation must be done to rule out the presence of any pre-existing hypertensive or cardiac dysfunctional status as a part of the administration nursing assessment.

The drug dosage and the route of administration must be confirmed. The use of other medications in the patient which can significantly interact with the drug must be studied and dose alteration sought from the physician if required.

The patient must be assessed for Pregnancy status,skin conditions ,renal status,cardiac status along with assessment of the kidney and liver function tests and complete blood count before the drug is started

The patient must be asked to take the drugs as prescribed orally, to take it within eight hours of a missed dose and skip the drug if the patient forgets to take the drug for more than 8 hours from the prescribed dose timing.

nursing assessment during drug administration:The nurse must assess for any allergy or hypersensitivity reaction to the patient being administered Ripretinib

The nurse must assess for concomitant administration of the drugs which can raise the levels of Ripretinib and cause the toxicity

Due to the effects of the drug on the blood pressure and the cardiac function, the nurse must closely monitor for signs of hypertension such as headaches and signs of cardiac dysfunction such as fatigue, breathlessness, edema

There is propensity of the drug to cause a rare skin reaction hand foot skin reaction {the palmar plantar erythrodysesthesia}. and also cutaneous tumors and hence thorough skin examination must be done for all the patients receiving Ripretinib.

Patient teaching and education:The patient must be educated to take the drug regularly at a fixed time at the prescribed dose.

The patient must be explained about the side effects of the drug which are possible including the common and the serious adverse side effects.

The patient must also be warned about the possibility of allergy and Cardiac dysfunction while taking the drug and should report back to the physician in case of any breathlessness ,fatigue or skin swelling or reaction.

The patient must be evaluated for pregnancy and asked to use reliable birth control while taking the medication. Breastfeeding is contraindicated during the drug administration as the effects the drug on the newborn are harmful.One week gap must be kept between the discontinuation of the drug and starting of breastfeeding.

Pregnant women or breastfeeding women in the family of the patient using ripretinib must be warned against handling of the drug or inhalation of the drug powder as the drug is absorbed through the skin and lungs and can harm the fetus.

Patient must be educated about the safety precautions due to increased bleeding tendency with use of repretinib and also general hygiene precautions as there is an increased risk of infections in some patients due to neutropenia and depressed immunity.

Alopecia associated with the drug use is generally temporary andreversible and patient must be educated about that.

The patient must be educated about the hand foot skin reaction {the palmar plantar erythrodysesthesia} and the precautionary measures of prevention.

This condition is characterized by redness and blisters appearance on the skin of the the hand and the foot with tingling and burning of the hands and feet. in order to prevent this patient must limit the sun exposure. exposure to hot oven or microwave, hot dishwasher, hot baths, sauna,always wear a sunscreen and avoid pressure on the the hands and the feet as a precautionary measure.

nursing evaluation:

The nurse must evaluate regularly that the patient is taking the medication regularly and not experiencing any adverse effects like hypersensitivity reaction, hypertension. cardiac dysfunction,renal impairment, hand foot skin disease,cutaneous tumors.

The laboratory test for complete blood count ,liver, kidney function test and 2D echo reports must be monitored at regular intervals along with the vitals, blood pressure, skin examination and signs of cardiac dysfunction and drug toxicity.