azaCITIDine
Print| Trade Name(s): Vidaza; AzaCITIDine; Onureg | |
| Group 1: Antineoplastic Hazardous | AHFS Class: Antineoplastic Agents |
| Formweb: azaCITIDine | |
| Info Links: Chemotherapy Extravasation Policy | |
Administration:
Injectable = vial, syringe, IV solution, irrig solution, non-ampule, AN (LH)
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) | CSTD |
| Administration |  |  |
If splashing possible |
If inhalation possible |  |
| Waste/Disposal of drug | | |  If splashing possible |
Nursing Antineoplastic Drugs PPE and Work Practices (Link to a file uploaded to Rhazdrugs or to a file on your intranet, or a shared drive.)
Patient Care Activities:
AN- PPE During Handling of Bodily Fluids, contaminated materials (LH)
Handling of bodily fluids and/or contaminated materials
| Drug Form | Glove | Gown | Eye | Mask (N95/PAPR) | Shoe |
| All forms | | | If splashing possible |
Extravasation:
Imflammitant: These medications are generally described as causing mild to moderate inflammation when extravasation occurs. Due to some references not using this classification, the only drugs listed in this section are ones which were unclassified by some resources, yet classified by others as inflammitants.
Reference: Hemonc.org
Disposal:
Antineoplastic Agents (LH)
Receiving and Storage:
AN-Receiving & Storage (LH)
| Form | Receipt Packaging | Environment | Glove | Storage |
| Intact tablet/capsule from UD package | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area |  | Final dosage forms of AN may be stored with normal inventory. Refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Non-intact, repackaged tablet or capsule | N/A | N/A | | Segregated area, negative pressure room, externally ventilated, minimum 12 ACH; refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Oral liquid drug or feeding tube | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area | | Final dosage forms of AN may be stored with normal inventory. Refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Powder for oral liquid | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area | | Segregated area, negative pressure room, externally ventilated, minimum 12 ACH; refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Topical drug | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area | | Final dosage forms of AN may be stored with normal inventory. Refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Powder, solution for inhalation | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area | | Final dosage forms of AN may be stored with normal inventory. Refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Vial; ampule; pre-filled syringe | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area | | Final dosage forms may be stored with normal inventory. AN requiring manipulation must be segregated area, negative pressure room, externally ventilated, minimum 12 ACPH; refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Intravenous solution | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area | | Final dosage forms may be stored with normal inventory. AN requiring manipulation must be segregated area, negative pressure room, externally ventilated, minimum 12 ACPH; refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
| Irrigation solution | Separate totes, plastic wrap | Neutral/normal or negative pressure room, not in sterile compounding area | | Final dosage forms may be stored with normal inventory. AN requiring manipulation must be segregated area, negative pressure room, externally ventilated, minimum 12 ACPH; refrigerated AN must be stored in dedicated fridge in negative pressure area with minimum 12 ACPH. |
Spill Containment | Notes/Instructions | PPE Required |
 | Wear N95 or PAPR mask if you see powders present |  |
Preparation:
Injectable (AN), or any bulk powder of any group (LH)
| Glove | Gown | Eye | Mask | Shoe | Head Cover | Hood/Cabinet | CSTD | Notes/Instructions |
(outer layer should be sterile) |
(outer layer should be chemo rated) |
|  |  |
| | Any secondary layers of PPE should be removed/discarded prior to exiting the C-PEC |
Transport:
Transport of AN
| Form | Prep Instructions | Pneumatic Tube |
| Intact tablet/capsule from UD package | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Non-intact, repackaged tablet or capsule | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Oral liquid drug or feeding tube | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Topical drug | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Powder, solution for inhalation | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Vial; ampule; pre-filled syringe | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Intravenous solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Irrigation solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
Assessment of Risk:
| Dosage Form | Risk of Exposure | Packaging | Pharmacy Manipulation |
| Injectable | May occur when compounding and administration | Not eligible for AoR | Not eligible for AoR |
PPE:
PPE Guidelines
| |  | | |  | | |
| Chemotherapy rated/tested (tested to ASTM D6978-05 (2013), Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs) | Disposable
| Should be worn in situations where eye, mouth, or nasal splashing is possible (i.e., during a bladder instillation of a hazardous drug) | Goggles protect the eyes, but not the face, against spraying. | Certified N95 | Powered air purifying respirator | required for compounding sterile and nonsterile hazardous drugs | required for compounding sterile and nonsterile hazardous drugs |
| Powder-free | Shown to resist permeation by hazardous drugs
| N95 offers no protection against gases and vapors. | For events such as large spills when an IV bag breaks or a line disconnects and leaks, or where there is known or suspected airborne exposure to vapors or gases | Double booties required for HD preparation areas, top layer is doffed before exiting the HD buffer room. | |||
| Inspect for visible defects | Must close in the back (no open front) | Surgical masks do NOT provide respiratory protection from drug exposure | Hazardous drugs with potential to vaporize at room temperature: • Carmustine • Cisplatin •Cyclophosphamide • Etoposide • 5-Fluorouracil • lfosfamide • Thiotepa | ||||
| Double gloving is recommended for all activities involving hazardous drugs except for handling intact, unit-dose oral agents, when one pair of chemotherapy-tested gloves is acceptable | Long sleeves with closed cuffs that are elastic or knit | ||||||
| When wearing double gloves, tuck the cuff of the inner glove under the gown sleeve and the cuff of the outer glove over the gown sleeve. | No seams or closures that could allow hazardous drugs to pass through | ||||||
| During medication manipulation/compounding the outer layer should be sterile | In preparation areas gowns should be changed every 2-3 hours or immediately after a spill or splash | ||||||
Change gloves every 30 minutes unless permeation testing has noted shorter time limits
| Gowns worn in hazardous drug handling areas must NOT be worn to other areas |
Sequence for Donning & Doffing PPE
References: Oncology Nursing Society, NIOSH
Mechanism of Action:
Azacitidine (5-azacytidine) is a chemical analogue of the cytosine nucleoside used in DNA and RNA. Azacitidine is thought to induce antineoplastic activity via two mechanisms; inhibition of DNA methyltransferase at low doses, causing hypomethylation of DNA, and direct cytotoxicity in abnormal hematopoietic cells in the bone marrow through its incorporation into DNA and RNA at high doses, resulting in cell death. As azacitidine is a ribonucleoside, it incoporates into RNA to a larger extent than into DNA. The incorporation into RNA leads to the dissembly of polyribosomes, defective methylation and acceptor function of transfer RNA, and inhibition of the production of protein. Its incorporation into DNA leads to a covalent binding with DNA methyltransferases, which prevents DNA synthesis and subsequent cytotoxicity.
Reference: Drug Bank
Exposure Risk:
- Harmful if swallowed.
- May cause cancer.
Reference: SDS - Cayman Chemical
Safety Data Sheet(s):
Approved on September 12, 2024
