Home Drug Guide Ustekinumab

Drug Guide

Generic Name

Ustekinumab

Brand Names Stelara

Classification

Therapeutic: Immunosuppressant, Monoclonal Antibody

Pharmacological: Interleukin-12 and Interleukin-23 Antagonist

FDA Approved Indications

  • Psoriasis (plaque psoriasis in adult patients)
  • Psoriatic Arthritis
  • Crohn's Disease
  • Ulcerative Colitis

Mechanism of Action

Ustekinumab binds to the p40 subunit of interleukin-12 and interleukin-23, inhibiting their activity and thereby modulating inflammatory and immune responses.

Dosage and Administration

Adult: For plaque psoriasis: 45 mg or 90 mg administered via subcutaneous injection at weeks 0 and 4, then every 12 weeks; dosage may vary based on weight and indication.

Pediatric: Not approved for patients under 18.

Geriatric: Adjusted doses not typically required; however, caution in elderly with comorbidities.

Renal Impairment: No specific dose adjustment indicated.

Hepatic Impairment: No specific dose adjustment indicated.

Pharmacokinetics

Absorption: Subcutaneous administration with peak serum concentrations in about 13 days.

Distribution: Limited data; presumed peripheral distribution.

Metabolism: Catabolized into small peptides and amino acids.

Excretion: Primarily via catabolic pathways; not through renal excretion.

Half Life: Approximately 3 weeks (23 days).

Contraindications

  • Hypersensitivity to ustekinumab or any of its components.

Precautions

  • Increased risk of infections, including tuberculosis; screening recommended before therapy.
  • Avoid live vaccines during treatment.
  • Caution in patients with a history of malignancy.

Adverse Reactions - Common

  • Upper respiratory infections (Common)
  • Headache (Common)
  • Fatigue (Common)

Adverse Reactions - Serious

  • Serious infections (e.g., pneumonia, cellulitis) (Uncommon)
  • Malignancies, including lymphoma and non-melanoma skin cancer (Rare)
  • Hypersensitivity reactions including anaphylaxis (Rare)

Drug-Drug Interactions

  • Other immunosuppressants, live vaccines, biologics that target similar pathways.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of infection, TB screening prior to initiation, and patient history of allergies.

Diagnoses:

  • Risk for infection
  • Impaired skin integrity
  • Risk for bleeding

Implementation: Administer as per prescribed schedule, monitor for adverse effects, educate patient on infection risks.

Evaluation: Assess skin lesions, symptom improvement, and adverse reactions.

Patient/Family Teaching

  • Report signs of infection or unusual symptoms immediately.
  • Do not receive live vaccines during therapy.
  • Adhere to scheduled injections and follow-up appointments.
  • Maintain good skin hygiene and infection prevention measures.

Special Considerations

Black Box Warnings:

  • Serious infections leading to hospitalization or death, including tuberculosis, bacterial, viral, fungal, and parasitic infections.
  • Malignancies, including lymphomas and other cancers.

Genetic Factors: None specific.

Lab Test Interference: May affect immune function tests; monitor as guided by clinical indication.

Overdose Management

Signs/Symptoms: Unknown, but excessive immunosuppression may increase infection risk.

Treatment: Supportive care, monitor for infections, no specific antidote.

Storage and Handling

Storage: Store in a refrigerator (2°C to 8°C); do not freeze.

Stability: Stable until expiry date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.