centruroides immune F2 Iinjection

centruroides (scorpion) immune F(ab’)₂ (equine) Iinjection

(sen-troo-roy-dees im-myoon fab),

Anascorp

(trade name)

Classification

Therapeutic: antidotes
Pharmacologic: antivenom
Pregnancy Category: C

Indications

Treatment of clinically important signs of scorpion envenomation which may include loss of muscle control, roving/abnormal eye movements, slurred speech, respiratory distress, excessive salivation, frothing at the mouth and vomiting.

Action

Binds/neutralizes venom toxins, promoting removal from target tissues and elimination.

Therapeutic effects

Resolution of symptoms of envenomation.

Pharmacokinetics

Absorption: IV administration results in complete bioavailabilityDistribution: Unknown.Metabolism and Excretion: Unk.Half-life: 159 hr.

Time/action profile (resolution of systemic symptoms)

ROUTE	ONSET	PEAK	DURATION
IV	within 4 hr	unknown	unknown

Contraindications/Precautions

Contraindicated in: No contraindications noted.Use Cautiously in: Known allergies to horse protein (↑ risk of serious hypersensitivity reactions); sensitization may develop from previous treatment; Lactation: Use cautiously, secretion into breast milk is not known; Obstetric: Use during pregnancy only if clearly needed.

Adverse Reactions/Side Effects

Central nervous system

fatigue
headache
lethargy

Ear, Eye, Nose, Throat

rhinorrhea

Respiratory

cough

Gastrointestinal

nausea (most frequent)
vomiting (most frequent)
diarrhea

Dermatologic

pruritus (most frequent)
rash (most frequent)

Local

localized reactions (from cresol excipient)

Musculoskeletal

generalized myalgias (from cresol excipient)
myalgia

Miscellaneous

severe hypersensitivity reactions including anaphylaxis
delayed hypersensitivity reactions including serum sickness
fever (most frequent)

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Intravenous (Adults) 3 vials initially, followed by 1 vial every 30–60 min as needed

Availability

Lyophilized powder for injection (requires reconstitution) made from equine plasma: not more than 120 mg total proteint and not less than 150 LD₅₀(mouse) neutralizing units/vial

Nursing implications

Nursing assessment

Assess for signs and symptoms of scorpion envenomation (loss of muscle control, roving/abnormal eye movements, slurred speech, respiratory distress, excessive salivation, frothing at the mouth and vomiting). Monitor patient during and for at least 60 min following infusion to determine resolution of symptoms.
Monitor for signs and symptoms of hypersensitivity reactions (rash, shortness of breath, swelling of lips, face, or throat). Patients allergic to horse protein are especially at risk. Have IV epinephrine, corticosteroids, and diphenhydramine available. If reactions occurs, discontinue infusion and treat symptoms.
Monitor patient for signs and symptoms of delayed reactions (rash, fever, myalgia, arthralgia) with follow up visits. Treat symptomatically.

Potential Nursing Diagnoses

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

Implementation

Initiate treatment as soon as possible after scorpion sting.
Intermittent Infusion: Reconstitute 3 vials with 5 mL of 0.9% NaCl and swirl gently to mix. Diluent: Combine contents of 3 vials promptly and dilute further with 50 mL of 0.9% NaCl.Do not administer solutions that are discolored or contain particulate matter. Discard partially used vials. Store at room temperature; do not freeze.
Rate: Infuse over 10 min.
May infuse additional doses at 30–60 min intervals, 1 vial at a time.

Patient/Family Teaching

Explain purpose of medication to patient.
Instruct patient to notify health care professional or emergency department immediately if signs and symptoms of delayed reactions (rash, pruritus, joint pain, fever, lymphadenopathy, malaise) occur. May occur for up to 14 days following treatment.
Advise female patient to notify health care professional if pregnant or pregnancy is suspected, or if breastfeeding.

Evaluation/Desired Outcomes

Resolution of symptoms of scorpion sting.