Abatacept Orencia
Nursing Considerations
• Screen patient for latent tuberculosis with
a tuberculin skin test before starting abatacept.
If test is positive, expect to provide
treatment, as ordered, before starting abatacept.
Also screen patient for hepatitis B. If
present, expect abatacept to be withdrawn
because anti-rheumatic therapies such as
abatacept may reactivate hepatitis B.
• Review patient’s immunization record,
and make sure all immunizations are current
before therapy starts. Drug may blunt
effectiveness of some vaccines and increase
the risk of infection with live viruses.
• Use cautiously in patients with a history of
recurrent infections, underlying conditions
that may predispose them to infection,
or existing chronic, latent, or localized
infection. They have an increased risk
of infection with abatacept therapy.
• Use cautiously in patients with COPD and
monitor respiratory status closely because
abatacept may worsen COPD and increase
the risk of adverse respiratory reactions.
• Tumor necrosis factor antagonists shouldn’t
be given with abatacept because of an
increased of serious infection.
• Reconsititue each vial with 10 ml of sterile
water for injection. Use only the siliconefree
disposable syringe provided with each
vial because a siliconized syringe may
cause translucent particles to form in solution.
After injecting sterile water into vial,
gently swirl vial until contents are completely
dissolved. To minimize foaming,
don’t shake. Vent the vial with a needle to
dissipate any foam that may be present.
• Further dilute reconstituted solution with
0.9% sodium chloride injection to achieve
a final solution of 100 ml. Slowly add
solution into infusion bag or bottle using
the same silicone-free disposable syringe
provided with each vial.Mix gently. Do
not shake the bag or bottle.
• Give entire dose of fully diluted drug over
30 minutes using an infusion set and a
sterile, nonpyrogenic, low protein-binding
filter with a pore size of 0.2 μm.
• Once fully diluted, solution may be kept
for 24 hours at room temperature or
refrigerated. If reconstituted solution isn’t
used within 24 hours, discard.
• After giving abatacept, monitor patient
closely for evidence of hypersensitivity
reaction such as rash, pruritus, urticaria,
dyspnea, or wheezing. If present, stop drug
immediately, notify prescriber, and provide
emergency care, as ordered.
•Monitor patient closely for evidence of
infection or malignancy because abatacept
inhibits T-cell activation, increasing the
risk of these disorders.
PATIENT TEACHING
• Instruct patient not to receive immunizations
with live vaccines during abatacept
therapy and for 3 months afterward.
• Stress need to report any evidence of
infection or hypersensitivity to prescriber.
• Alert patient that abatacept may increase
the risk of maligancy.
•Warn patient to avoid crowds and people
with infections.
