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INTRODUCTION

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drotrecogin (droe-tre-koe-jin)

Xigris

Classification

Therapeutic: anti-infectives

Pharmacologic: activated protein C, human

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Indications
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To reduce mortality in adult patients with sepsis.

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Action
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Probably acts by suppressing widespread inflammation associated with sepsis. Therapeutic Effects: Decrease mortality due to sepsis.

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Adverse Reactions/Side Effects
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Hemat: BLEEDING.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure). Notify physician or nursing staff immediately if this drug causes excessive anticoagulation.

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Interventions
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Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

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Patient/Client-Related Instruction
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  • Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: Unknown.

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TIME/ACTION PROFILE (activity)

ROUTE ONSET PEAK DURATION
IV unknown end of infusion unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Patients with a high risk of bleeding, including those with active internal bleeding, recent (within 3 mo) stroke, recent (within 2 mo) intracranial or intraspinal injury or severe head trauma, any trauma associated with an increased risk of life-threatening bleeding, presence of an epidural catheter, intracranial neoplasm/mass lesion/cerebral herniation; Patients not expected to survive due to preexisting medical condition(s); HIV-positive patients with CD4 cell counts ≤50/mm3; Chronic dialysis patients; Patients who have undergone bone marrow, lung, liver, pancreas, or small bowel transplantation; OB: Lactation.

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Use Cautiously in: Concurrent therapeutic heparin therapy (≥15 units/kg/hr), recent (within 3 days) thrombolytic therapy, recent (within 7 days) oral anticoagulants or glycoprotein IIb/IIIa inhibitors, recent (within 7 days) aspirin therapy >650 mg/day or other platelet inhibitors; Platelet count <30,000 × 106/L; Prothrombin time—INR >3; Recent (within 6 wk) GI bleeding; Recent (within 3 mo) ischemic stroke; Intracranial arteriovenous malformation or aneurysm; Known bleeding diathesis; Chronic severe hepatic disease; Any other serious bleeding risk; Surgical procedures (discontinue 2 hr before; resume 12 hr after if hemostasis is achieved); OB: Pregnancy (use only if clearly needed); Pedi: Children (safety not established).

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Interactions
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Drug-Drug: Risk of serious bleeding may be ↑ by antiplatelet agents, anticoagulants, thrombolytic agents, or other agents that may affect coagulation.

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Drug-Natural: Risk of bleeding may be ↑ by arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, Panax ginseng, and others.

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Route/Dosage
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