asparaginase Erwinia chrysanthemi

(a-spare-a-ji-nase) asparaginase,

Erwinaze

(trade name)

Classification

Therapeutic: antineoplastics
Pharmacologic: enzymes
Pregnancy Category: C

Indications

Part of combination chemotherapy in the treatment of acute lymphocytic leukemia (ALL) in patients who developed hypersensitivity to E. coli-derived asparaginase.

Action

Catalyst in the conversion of asparagine (an amino acid) to aspartic acid and ammonia.Depletes asparagine in leukemic cells.

Therapeutic effects

Death of leukemic cells.

Pharmacokinetics

Absorption: Is absorbed from IM sites.Distribution: Remains in the intravascular space. Poor penetration into the CSF.Metabolism and Excretion: Slowly sequestered in the reticuloendothelial system.Half-life: IV: 8–30 hr; IM: 39–49 hr.

Time/action profile

ROUTE	ONSET	PEAK†	DURATION
IM	unknown	unknown	unknown

Contraindications/Precautions

Contraindicated in: Previous hypersensitivity;History of pancreatitis with prior L-asparaginaseHistory of serious thrombosis or hemorrhagic events with prior L-asparaginase Lactation: Lactation.Use Cautiously in: Obstetric: Use only if the potential benefit justifies the potential risk to the fetus.

Adverse Reactions/Side Effects

Gastrointestinal

pancreatitis (life-threatening)
↑ liver function tests
nausea
vomiting

Endocrinologic

hyperglycemia

Hematologic

hemorrhage
thromboembolic events

Miscellaneous

hypersensitivity reactions including anaphylaxis (life-threatening)
fever

Interactions

Drug-Drug interaction

None known

Route/Dosage

Intramuscular (Adults and Children) Substitution for E.coli-derived asparaginase—25,000 International Units/m² substituted for each dose of E.coli-derived asparaginase; Substitution for pegasparagase—25,000 International Units/m² 3 times a week (Mon/Wed/Fri) for 6 doses substituted for each dose of pegasparagase

Availability

Powder for injection: 10,000 International Units/vial

Nursing implications

Nursing assessment

Monitor vital signs before and periodically during therapy; may cause fever.
Monitor for signs and symptoms of pancreatitis (abdominal pain, nausea, vomiting, ↑ serum amylase) during therapy. If abdominal pain > 72 hrs and serum amylase ↑ ≥ 2.0 x upper limit of normal occur, discontinue therapy. If mild pancreatitis occurs, withhold asparaginase Erwinia chrysanthemi until symptoms and serum amylase return to normal; then restart.
Monitor for hypersensitivity reaction (urticaria, diaphoresis, facial swelling, joint pain, hypotension, bronchospasm). Epinephrine and resuscitation equipment should be readily available.
Lab Test Considerations: Monitor CBC and coagulation studies before and periodically throughout therapy. May ↓ fibrinogen, protein C activity, protein S activity, and anti-thrombin III. If thrombotic or hemorrhagic event occurs, withhold asparaginase Erwinia chrysanthemi until symptoms resolve; then resume therapy.
- Hepatotoxicity may be manifested by ↑ AST, ALT, bilirubin, or cholesterol. Liver function test results usually return to normal after therapy. May cause pancreatitis; monitor frequently for ↑ amylase or glucose.
- Monitor blood glucose prior to and periodically during therapy. May cause hyperglycemia treatable with fluids and insulin.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

high alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double-check single, daily, and course-of-therapy dose limits; have second practitioner independently double check original order and dose calculations.
Solution should be prepared in a biologic cabinet. Wear gloves, gown, and mask while handling medication. Discard equipment in specially designated containers. See.
Intramuscular: Prepare for IM dose by adding 1 or 2 mL of 0.9% NaCl for injection (without preservatives) against inner wall of the 10,000-IU vial. Swirl vial gently; do not shake or invert. Administer no more than 2 mL per injection site. Concentration: Reconstitution with 1 mL = 10,000 IU/mL; with 2 mL = 5,000 IU/mL. Solution is clear and colorless; do not administer solutions that are discolored or contain a precipitate. Withdraw dose needed into a polypropylene syringe and administer within 15 min of reconstitution. Do not refrigerate or freeze; administer within 4 hrs or discard. Inject IM with no >2 mL/site. Do not save unused portions; discard.

Patient/Family Teaching

Instruct patient to notify health care professional if signs and symptoms of hypersensitivity reaction, pancreatitis, thrombosis or hemorrhage (headache, arm or leg swelling, shortness of breath, chest pain) or hyperglycemia (excess thirst or increase in frequency or volume of urination), occur.
Advise female patients to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
Emphasize need for periodic lab tests to monitor for side effects.

Evaluation/Desired Outcomes

Improvement of hematologic status in patients with leukemia.