Details About Generic Salt ::  Alprosta

Main Medicine Class:: Prostaglandin,patent ductus arteriosus, agent for impotence   

(al-PRAHST-uh-dill)
Caverject, Edex, Muse, Prostin VR Pediatric,  Prostin VR
Class: Prostaglandin/patent ductus arteriosus, agent for impotence

 

Drugs Class ::

 Action Relaxes smooth muscle of ductus arteriosus. Produces vasodilation, inhibits platelet aggregation and stimulates intestinal and uterine smooth muscle. Induces erection by relaxation of trabecular smooth muscle and by dilation of cavernosal arteries.

Indications for Drugs ::

 Indications Palliative therapy to maintain patency of ductus arteriosus temporarily, until surgery can be performed, in neonates who have congenital heart defects (eg, pulmonary stenosis, tricuspid atresia) and who depend on patent ductus for survival. Treatment of erectile dysfunction due to nerogenic, vasculogenic, psychogenic, or mixed etiology.

Drug Dose ::

 Route/Dosage

Ductus Arteriosus

NEONATES: IV 0.01 to 0.4 mcg/kg/min. Drug is infused for shortest time and at lowest effective dose.

Impotence Intracavernosal

Erectile dysfunction of vasculogenic, psychogenic, or mixed etiology – Initiate dose titration at 2.5 mcg. If there is a partial response, the dose may be increased by 2.5 mcg to a dose of 5 mcg and then in increments of 5 to 10 mcg, depending on erectile response, until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 hour is reached. If there is no response to the initial 2.5 mcg dose, the second dose may be increased to 7.5 mcg, followed by increments of 5 to 10 mcg. If there is no response, then the next higher dose may be given within 1 hour. If there is a response, then there should be a 1-day interval before the next dose is given.

Erectile dysfunction of pure neurogenic etiology (spinal cord injury)

Initiate dosage titration at 1.25 mcg. The dose may be increased by 1.25 mcg to a dose of 2.5 mcg, followed by an increment of 2.5 mcg to a dose of 5 mcg, and then in 5 mcg increments until the dose that produces an erection suitable for intercourse and not exceeding a duration of 1 hour is reached. If there is no response, then the next higher dose may be given within 1 hour. If there is a response, then there should be at least a 1-day interval before the next dose is given. Maintenance therapy—The first injections of alprostadil must be done at the physician’s office by medically trained personnel. Self-injection therapy by the patient can be started only after the patient is properly instructed and well-trained in the self-injection technique. The physician should make a careful assessment of the patient’s skills and competence with the procedure. INTRAURETHRAL Administer as need to achieve an injection. The onset of injection is 5 to 10 min after administration. Duration of effect is » 30 to 60 min. Dose should be titrated under the supervision of physician.

Contraindication ::

 Contraindications Standard considerations.

Caverject: Conditions that might predispose patients to priapism (eg, sickle cell anemia or trait, multiple myeloma leukemia); patients with anatomical deformation of the penis (eg, angulation, cavernosal fibrosis, Peyronie’s disease); patients with penile implants; use in women, children or newborns; use in men for whom sexual activity is inadvisable or contraindicated.

Drug Precautions ::

 Precautions

Hemostatic effects: Use cautiously in neonates with bleeding tendencies because alprostadil inhibits platelet aggregation. Respiratory status: Apnea has occurred in some neonates treated with alprostadil. Priapism (erection lasting ³ 6 hours): Prolonged erection has been known to occur following intracavernosal administration of vasoactive substances, including alprostadil. To minimize the chances of priapism, titrate slowing to the lowest effective dose. If priapism is not treated immediately, penile tissue damage and permanent loss of potency may result. Penile fibrosis: Discontinue treatment in patients who develop penile angulation, cavernosal fibrosis, or Peyronie’s disease.

PATIENT CARE CONSIDERATIONS


Drug Side Effects ::

 Adverse Reactions

CV: Flushing; bradycardia; hypotension; tachycardia; cardiac arrest; edema. Other rare, but serious cardiovascular effects include CHF; hyperemia; second-degree heart block; shock; spasm of right ventricle infundibulum; supraventricular tachycardia; ventricular fibrillation. CNS: Fever; seizures; cerebral bleeding. GI: Diarrhea. GU: Muse only: Urethral pain; urethral burning; urethral bleeding/spotting; testicular pain. HEMA: DIC; bleeding. RESP: Apnea. OTHER: Cortical proliferation of long bones; sepsis. Caverject only: Penile pain; prolonged erection; penile fibrosis; injection site hematoma; penis disorder; injection site ecchymosis. Muse only: back pain; pain; pelvic pain; accidental injury.

Drug Mode of Action ::  

 Action Relaxes smooth muscle of ductus arteriosus. Produces vasodilation, inhibits platelet aggregation and stimulates intestinal and uterine smooth muscle. Induces erection by relaxation of trabecular smooth muscle and by dilation of cavernosal arteries.

Drug Interactions ::

 Interactions None well documented.

Drug Assesment ::

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess infant’s cardiac status before administration.
  • Do not administer if infant is in respiratory distress.
  • Obtain baseline CBC, ABGs, PT, PTT, and pulmonary function tests.
  • Monitor arterial pressure intermittently. If pressure decreases significantly, notify physician immediately. Infusion rate will need to be decreased.
  • Monitor respiratory status throughout treatment. Have ventilatory equipment at bedside.
  • Monitor BP during administration.
  • Notify physician and decrease or stop infusion if infant develops: (1) increased respiratory distress; (2) bleeding, bruising or hematoma formation; (3) sudden changes in cardiac status (eg, decreased BP, bradycardia, cardiac arrest, cyanosis). Decrease or stop infusion until physician gives new orders.
  • Caverject Exercise careful follow-up of the patient while in the self-injection program. This is especially true for the initial self-injections, since adjustments in the dose of alprostadil may be needed. While on self-injection treatment, it is recommended that the patient visit the prescribing physician’s office every 3 months. At that time, assess the efficacy and safety of the therapy and adjust the dosage.
OVERDOSAGE: SIGNS & SYMPTOMS
  Apnea, bradycardia, pyrexia, hypotension, flushing

Drug Storage/Management ::

 Administration/Storage

Prostin VR Pediatric

  • Drug is to be given only by trained personnel in PICU via continuous IV infusion into large vein or through umbilical artery catheter.
  • Dilute medication with normal saline or D5W only.
  • Use volumetric IV pump to regulate delivery.
  • Monitor infant closely during administration.
  • Discard preparation after 24 hr and mix new solution.

Caverject

  • Bacteriostatic water for injection or sterile water, both preserved with benzyl alcohol 0.945% w/v, must be used as the diluent for reconstitution.
  • After reconstitution, immediately use the solution and do not store or freeze.
  • Do not shake the contents of the reconstituted vial.
  • Discard vials with precipitates or discoloration.
  • The intracavernosal injection must be done under sterile conditions. The site of injection is usually along the dorsolateral aspect of the proximal third of the penis. Avoid visible veins. The side of the penis that is injected and the site of injection must be alternated; the injection site must be cleansed with an alcohol swab.

Muse

  • The max frequency of use is no gt; 2 systems per 24-hr period.
  • Store unopened foil pouches in a refrigerator at 2° to 8°C (36° to 46°F). It may be kept at room temperature (below 30°C; 86°F).

Drug Notes ::

 Patient/Family Education

Prostin VR Pediatric

  • Explain to parents about infant’s congenital heart disease and purpose and expected outcome of treatment.
  • Keep parents/family informed of course of treatment; alert them to usual side effects (eg, flushing of skin).
  • Promote parent-infant bonding by encouraging parent involvement in infant’s care.
  • Encourage parents to express their emotions. Show compassion and understanding, and help parents to cope.

Caverject

  • Thoroughly instruct and train patient in the self-injection technique before beginning intracavernosal treatment at home. Establish the desired dose in the physician’s office.
  • Inform patient that the established dose should not be changed without consulting the physician or health care provider.
  • The patient may expect an erection to occur within 5 to 20 min. A standard treatment goal is to produce an erection lasting no longer than 1 hr.
  • Instruct patient that alprostadil generally should be used no > 3 times per wk, with ³ 24 hr between each use.
  • Instruct patient to seek immediate medical attention if an erection persists for > 6 hr.
  • Patient should report any penile pain that was not previously present or that increased in intensity, as well as the occurrence of nodules or hard tissue in the penis to physician as soon as possible.
  • Advise patient that the use of intracavernosal alprostadil offers no protection from the transmission of STDs. Counsel individuals who use alprostadil about the protective measures necessary to guard against the spread of STDs, including HIV.
  • The injection can induce a small amount of bleeding at the site of injection. In patients infected with blood-borne diseases, this could increase the risk of transmission of blood-borne diseases between partners.

Intraurethral

  • A medical professional should instruct each patient on proper technique for administering alprostadil prior to self-adminstration.

Muse

  • A medical professional should instruct each patient on the proper technique for administering alprostadil prior to self administration.
  • The maximum frequency of use is no > 2 systems per 24-hr period.

Disclaimer ::

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