Anesthesia and Anesthetics, IV Therapy, and Immune System Drug Therapy

General Nerve Impulse & Anesthetic Concepts: 1/4

Transmission occurs with influx of __________ from the voltage-gated __________ channels on the neuronal membrane open

sodium, sodium

General Nerve Impulse & Anesthetic Concepts: 2/4

Local anesthetics block the nerve impulse transmission in the _____________ and ________ nervous system. No CNS or MS _______________.

peripheral, central, depression

General Nerve Impulse & Anesthetic Concepts: 3/4

Occurs in a stepwise fashion depending on local anesthetic __________ and _______________: autonomic-sensory-motor

volume and concentration

General Nerve Impulse & Anesthetic Concepts: 4/4

Local anesthetics used to anesthetize skin, ________________ tissue, and ______________ nerves for invasive or surgical procedures

subcutaneous, peripheral

Indications:

1. Surgical or invasive procedure will dictate ________ used

2. Liposomal bupivacaine-recent FDA approval for __________________ analgesia

3. Lidocaine IV injection may serve to suppress __________ (systemic _________ concern)

1. agent

2. postoperative

3. tinnitus, toxicity

Mechanism of Action & Pharmacokinetics:

Local anesthetics block voltage-gated ___________ channels, which prevents sodium influx into the cell and blocks _________ transmission

Also considered class __ antiarrhythmic drugs by blockading __________ sodium (lidocaine class IB)

sodium, impulse

I, cardiac

Action duration: 30 min-12 hours or more, depending on block location:

1. High blood supply = _________ duration

2. Specific ______ anesthetic used

3. Preparation (liposomal preparations create ____________-release drugs)

30 min - 12 hours

1. shorter

2. local

3. extended

Metabolism depends on the anesthetic drug _____ (both results in _____________ once metabolized). ____ pH can delay action onset.

class, deactivation, low

Metabolism depends on the anesthetic drug class (both results in deactivation once metabolized). Low pH can delay action onset:

⚬Ester-type: metabolized in blood by esterase enzymes

￭Injectables: ____________ (Novocain) (prototype), chloro________, tetracaine,

￭Topicals: _____________ (Oral gel) (prototype), cocaine (prototype), tetracaine

⚬esterase

￭ Procaine, -propane

￭ Benzocaine

Metabolism depends on the anesthetic drug class (both results in deactivation once metabolized). Low pH can delay action onset:

⚬Amide-type: metabolized by liver enzymes

￭Injectables: bupivacaine, mepivacaine, etidocaine, levobupivaine, ropivacaine, lidocaine (prototype)

￭Topicals: dibucaine, lidocaine (prototype)

⚬ liver

￭ lidocaine

￭ lidocaine

Metabolism depends on the anesthetic drug class (both results in deactivation once metabolized). Low pH can delay action onset:

⚬Other non-classified types: ____________ and ___________

Dyclonine and pramoxine

______________ often added to local anesthetic solution (vasoconstrictor [controls ___________ ] & delays anesthetic _____________ )

epinephrine, bleeding, absorption

Epinephrine often added to local anesthetic solution (vasoconstrictor [controls bleeding] & delays anesthetic absorption):

1. Do not use more than 1 to ________ concentration ( __rrhythmias, ____viability)

2. Conflicting messaging on using it on ____, nose, penis, toes, _________

1. 100,000, a-, flap

2. ear, fingers

Local Anesthetics: Individual Properties:

Procaine (ester type)- _____________. Maybe combined w/ ________________ to delay absorption. Higher r/f __________ reaction. System toxicity is _____.

injectable, epinephrine, allergic, rare

Local Anesthetics: Individual Properties:

Lidocaine (amide type)- introduced in 1948. Most WIDELY used ______ anesthetic (topical & injection). More rapid, intense, & prolonged compared to an equal dose of ___________. ____________ are rare. Watch for high _______ levels=toxicity (CNS/CV). Can be used for ____rhythmias (blocks __________ channels)

local, procaine, allergies, plasma, dys-, sodium

Local Anesthetics: Individual Properties:

Cocaine ( ______ type)- first ______ anesthetic. _________ for anesthesia of ears, nose, throat. Causes intense vasoconstriction ( __________ treatment). Do ____ give w/ other vasoconstrictive meds. Pronounced effects on SNS and CNS from blocking the reuptake of ________________ by the adrenergic neurons.

ester, local, topical, epistaxis, NOT, norepinephrine

Adverse Effects:

1. Hypersensitivity/allergic is _____ but (higher with _______ group) from para-aminobenzoic _____

2. Significant systemic toxicities with excessive ___ /_____ dosages

1. rare, ester, acid

2. IV/oral

Adverse Effects: Significant systemic toxicities with excessive IV/oral dosages: 1/3

⚬CNS- Excitation (may have _________ ) followed by ______________ (drowsiness, unconsciousness, coma, death from respiratory depression)

￭Excessive excitation can be managed w/ IV __________________ (diazepam or midazolam)

⚬ seizures, depression

￭ benzodiazepine

Adverse Effects: Significant systemic toxicities with excessive IV/oral dosages: 2/3

CV- Suppresses _______________ excitability & conduction system - _____cardia, heart block, reduced contractile _____, _________ arrest. Relaxes vascular smooth muscle causing vasodilation = _______________

myocardium, brady-, force, cardiac, hypotension

Adverse Effects: Significant systemic toxicities with excessive IV/oral dosages: 3/3

Overdose treatment- IV _____ emulsion ___% at 1.5 mL/kg over 1 _______ followed by 0.25 mL/kg/min infusion (may increase to ____ mL/kg/min for CV improvement but still ____tensive). Bolus maybe repeated up to __ times for refractory CV compromise

lipid, 20%, minute, 0.5, hypo-, 2

Isotonic is the fluid that most resembles the _______ and does not shrink or swell cells. This keeps the cells in the __________ space.

- Memorize....0.9% __________ chloride; __ % dextrose in water; lactated __________ (LR) are all isotonic

plasma, vascular

sodium, 5%, ringers

HypErtonic -

Anything more than the isotonic concentration (E for Extra) is hypErtonic:

1. __% sodium chloride (has a ________ sodium concentration than the isotonic 0.9% sodium chloride); ___% dextrose in water; 5% dextrose in ____% sodium chloride.

2. This _______ cells and displaces the fluid into the vascular and interstitial space potentially causing fluid volume OVERLOAD and pulmonary ________.

more

1. 3%, higher, 10%, 0.45%

2. SHRINKS, edema

HypOtonic:

1. Anything _____ than the isotonic concentration (O looks like a swollen cell) is hypOtonic

2. ____% sodium chloride; ____% sodium chloride; ___% dextrose in water; ____% dextrose in water

3. This is DANGEROUS in __________ edema.

1. less

2. 0.45%, 0.33%, 10%, 2.5%

3. cerebral

Central venous access devices (CVADs) versus midline versus peripheral:

CVADs should not be accessed until ______ x-ray verifies the tip is positioned in the ___________ of the cavo-atrial junction (CAJ) where the lower third of the SVC and the upper ___ is located.

chest, proximity, RA

Hypotonic Solutions: These solutions have a __________ concentration of _________ compared to plasma, leading to fluid movement into cells. They're used to treat cellular _____________ but are contraindicated in patients at risk for increased _____________ pressure or ______-space fluid shifts.​

lower, solutes, dehydration, intracranial, third

Isotonic Solutions: Having the same solute concentration as plasma, these solutions move the _____cellular fluid volume without causing fluid shifts between compartments. They're commonly used for ______ resuscitation.

extra-, fluid

Hypertonic Solutions: With a __________ solute concentration than plasma, these solutions draw fluid ____ of cells into the extracellular space. They're used to manage ____natremia and _________ edema but require careful monitoring due to the risk of ______ overload.​

higher, out, hypo-, cerebral, fluid

Microdrip sets (typically 60 drops/mL) are suitable for _________, ____-volume infusions, often used in pediatric or _________ patients. Macrodrip sets (10-20 drops/mL) are used for ______ fluid administration.​

precise, low, elderly, rapid

IV Tubing Change Intervals - standard practices include:​

1. Primary and Secondary Tubing: Typically changed every ___–___ hours, depending on institutional policies.

2. Blood Products: Tubing should be changed after each _____ or every __ hours.​

3. Fat Emulsions: Tubing is usually changed every ___ hours.

1. 72-96

2. unit, 4

3. 24

Central Line Risks:

1. Phlebitis: Inflammation of the _____, presenting with redness, warmth, and ______________.

2. Infection: Central lines pose a higher risk for _____________ infections due to their placement in major vessels.​

3. Air Embolism: ____ entering the bloodstream, which can be life-threatening.​

4. Thrombosis: Formation of blood _____ at the catheter site.

1. vein, tenderness

2. bloodstream

3. air

4. clots

Types of Peripheral IV vs. Central Lines:

1. Peripheral IVs (PIVs): _____ catheters inserted into peripheral veins, suitable for short-term therapy (less than __ days) and administration of non-____________ solutions.

2. Central Venous Catheters (CVCs): Longer catheters inserted into central veins (e.g., subclavian, jugular) with the tip residing in the ___________ vena cava. They're used for _____-term therapy, administration of ___________ drugs, or when peripheral access is ______________.

1. short, 6, irritating

2. superior, long, vesicant, inadequate

Birth Through 6 Years of Age Vaccinations: 1/2

Vaccinations for infants and children from birth through six years of age include Hepatitis __ and __, ____virus, also called RV, diphtheria, tetanus, and acellular ____________, known as DTaP, and Haemophilus influenzae type b, or ____, which prevents a serious type of ____________ commonly seen in young children, and inactivated poliovirus vaccine, or IPV. Vaccinations for this age group also include the ______coccal vaccine, also called PCV, which prevents meningitis, pneumonia, and ________ ear infections caused by Strepto______ pneumoniae.

A and B, rota-, pertussis, Hib, meningitis, pneumo-, middle, -coccus

Birth Through 6 Years of Age Vaccinations: 2/2

Other vaccines include the measles, mumps, and rubella vaccine, known as ____, and the varicella or ___________ vaccine. All children at least __ months old should take the influenza, or flu, vaccine each year. Children should begin receiving COVID-19 vaccinations at the age of __ months. For current recommendations on administration intervals and dosages, refer to CDC clinical guidance for COVID-19 immunizations.

MMR, chickenpox, 6, 6

Age 7 Through 18 Years of Age Vaccinations: 1/3

Children aged seven through 18 years of age also need certain immunizations. A booster dose of diphtheria, tetanus, and acellular pertussis, or _____, should be received between ages ___ and ___ after completing the earlier series of DTaP vaccinations. Three doses of the vaccine for human papillomavirus, called ____, are recommended for adolescents ages ___ to ___. Children who have not received the vaccine which prevents infectious _____________, the meningococcal conjugate or MenACWY, should receive the vaccine between ages ___ and ___.

Tdap, 11-12, HPV, 11-12, meningitis, 11-12

Age 7 Through 18 Years of Age Vaccinations: 2/3

A MenACWY booster dose should also be given at age ___. Starting at age 16, teens should receive the MenB vaccine, which protects against type B meningococcal ____________. The MenB vaccination is a ____-dose series. Some children whose immune systems have been compromised and are at higher risk for infection may have received meningitis vaccination as early as age ____.

16, bacterium, two, two

Age 7 Through 18 Years of Age Vaccinations: 3/3

Children should continue to receive a yearly influenza vaccination. Children ages seven through eighteen years of age should also receive __________ vaccinations. For current recommendations on administration intervals and dosages, For current recommendations on administration intervals and dosages, refer to CDC clinical guidance for COVID-19 immunizations.

influenza, COVID-19

Age 7 Through 18 Years of Age Vaccinations:

If a child did not receive a recommended vaccination or ________ of vaccinations at an earlier age, they can take these vaccinations at this time.

series

Adult/Older Adult:

1. ___________ [annually]

2. Tetanus and Diphtheria (TD) [every ___ years]

3. Pneumococcal [ ___ years and older, younger adults who _______ ]

4. HEB A & B, Measles, Mumps, Rubella, ___________ for at risk adults as needed

5. Herpes zoster (shingles vaccine) [ ___ years and older]

1. infuenza

2. 10

3. 65, smoke

4. varicella

5. 50

A nurse is caring for a client who has a new prescription for topotecan therapy to treat resistant, small-cell lung cancer. The nurse should advise the client against taking which of the following types of OTC medications while receiving the therapy?

A. folic acid

B. St. John's wort

C. ibuprofen

D. aluminum hydroxide

C. ibuprofen

A nurse is considering medication therapy options for a client who has metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2). Which of the following medications should the nurse expect the provider to prescribe?

A. Imatinib

B. Trastuzumab

C. Leuprolide

D. Flutamide

B. Trastuzumab

A nurse is preparing to administer paclitaxel IV to a client who has ovarian cancer. Which of the following actions should the nurse take? (SATA)

A. give the client an antihistamine

B. infuse the drug over 1 hr

C. administer the drug through non-PVC tubing

D. use an in-line filter

E. add heparin to the paclitaxel solution

A. give the client an antihistamine

C. administer the drug through non-PVC tubing

D. use an in-line filter

A nurse should recognize that raltegravir is used to treat clients who have which of the following conditions?

A. hairy cell leukemia

B. thyroid cancer

C. kaposi's sarcoma

D. resistant HIV

D. resistant HIV

The nurse is caring for a client who has a new prescription for efavirenz therapy to treat HIV-1. The nurse should instruct the client to report which of the following adverse reactions to the medication?

A. polyuria

B. neuropathy

C. rash

D. alopecia

C. rash

A nurse is caring for a client who is receiving vincristine to treat lung cancer. The nurse should monitor the client and recognize which of the following manifestations as an indication that the client is experiencing an adverse effect of the medication?

A. Constricted pupils

B. Weak hand grasps

C. Bradycardia

D. Crackles

B. Weak hand grasps

A nurse is caring for a client who has a new prescription for ritonavir and zidovudine therapy to treat HIV-1. The nurse should inform the client that zidovudine is prescribed with ritonavir for which of the following reasons?

A. To prevent an infusion reaction

B. To increase platelet production

C. To protect healthy cells from the toxic effects of ritonavir

D. To prevent drug resistance

D. To prevent drug resistance

A nurse is caring for a client who has a new prescription for maraviro therapy. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.)

A. Paresthesia

B. Cough

C. Tinnitus

D. Jaundice

E. Fever

A. Parenthesia

B. Cough

D. Jaundice

E. Fever

A nurse is caring for a client who has a new prescription for intrathecal cytarabine therapy to treat meningeal leukemia. The nurse should inform the client that they will also receive which of the following medications to reduce the risk of neurotoxicity?

A. Diphenhydramine

B. Leucovorin

C. Folic acid

D. Dexamethasone

D. Dexamethasone

A nurse is teaching a client about recommended immunizations. Which of the following immunizations should the nurse recommend the client receive starting at 50 years of age?

A. Herpes zoster vaccine

B. Human papillomavirus vaccine (HPV)

C. Pneumococcal vaccine

D. Haemophilus influenzae type B vaccine (Hib)

A. Herpes zoster vaccine

A nurse is assessing a client following a trastuzumab infusion to treat metastatic breast cancer. Which of the following findings should the nurse recognize as an indication that the client is experiencing an adverse reaction to the medication? (Select all that apply.)

A. Wheezing

B. Dysrhythmias

C. Hypotension

D. Fever

E. Ascites

A. Wheezing

B. Dysrhythmias

C. Hypotension

D. Fever

A nurse is teaching a guardian of a child about the recommended age range to receive the human papillomavirus (HPV) vaccine. Which of the following age ranges should the nurse include?

A. 11 to 12 years old

B. 7 to 9 years old

C. 13 to 15 years old

D. 15 to 17 years old

A. 11 to 12 years old

A nurse is teaching a client about maraviroc. Which of the following instructions should the nurse include?

"It is important to report any noticeable rash immediately as it might indicate an issue with your liver."

"Make sure you take this medication without any other medications first thing in the morning."

"You might experience flu-like symptoms for which you can take any over-the-counter medication."

"The side effects of this medication are minimal, so you can continue to work and drive as normal."

"It is important to report any noticeable rash immediately as it might indicate an issue with your liver."

A nurse is teaching a client who has a new prescription for imatinib to treat chronic myeloid leukemia. Which of the following instructions should the nurse include? (Select all that apply.)

A. Clean fruits and vegetables thoroughly.

B. Increase calcium intake.

C. Weigh yourself daily.

D. Perform hand hygiene frequently.

E. Avoid grapefruit and grapefruit juice.

A. Clean fruits and vegetables thoroughly.

C. Weigh yourself daily.

D. Perform hand hygiene frequently.

E. Avoid grapefruit and grapefruit juice.

A nurse is teaching a client who has a new diagnosis of breast cancer about the medication tamoxifen. The nurse should tell the client that which of the following conditions is a contraindication for taking tamoxifen?

A. COPD

B. Deep vein thrombosis

C. Diabetes mellitus

D. Alcohol use disorder

B. Deep vein thrombosis

A nurse is teaching the guardian of a 4-month-old infant about recommended immunizations for the infant. Which of the following immunizations should the nurse include?

A. Meningococcal conjugate vaccine (MCV4)

B. Varicella vaccine

C. Haemophilus influenzae type B vaccine (Hib)

D. Tetanus-diphtheria-acelluar pertussis vaccine (Tdap)

C. Haemophilus influenzae type B vaccine (Hib)

A nurse is caring for a client who has a new prescription for cisplatin to treat testicular cancer. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.)

A. Paresthesia

B. Sore throat

C. Flank pain

D. Tinnitus

E. Conjunctivitis

A. Paresthesia

B. Sore throat

C. Flank pain

D. Tinnitus

A nurse is preparing to administer the measles, mumps, and rubella (MMR) vaccine to a child. The nurse should recognize that the MMR vaccine provides which of the following types of immunity?

A. Passive

B. Active

C. Artificial active immunity

D. Artificial passive immunity

C. Artificial active immunity

A nurse is instructing a client how to self-administer enfuvirtide. Which of the following instructions should the nurse include?

A. "Allow the vial to sit until the solution is completely clear and without particulates."

B. "After reconstituting with sterile water, vigorously shake the vial to mix the solution."

C. "Use the medication immediately upon removing from the refrigerator."

D. "Use the same location for five injections before rotating to a new site."

A. "Allow the vial to sit until the solution is completely clear and without particulates."

A nurse is preparing to administer enfuvirtide to a client. Which of the following actions should the nurse should plan to perform? (Select all that apply.)

A. Administer the medication subcutaneously.

B. Discard the unused portion.

C. Roll the vial gently to reconstitute the solution.

D. Inject the solution at room temperature.

E. Expect a cloudy solution.

A. Administer the medication subcutaneously.

C. Roll the vial gently to reconstitute the solution.

D. Inject the solution at room temperature.

A nurse is teaching a client about immunizations. Which of the following information should the nurse include in the teaching?

"You should not receive the influenza immunization if you have a common cold."

"You should receive a tetanus booster every 10 years."

"You do not have to receive the shingles vaccine if you have received two doses of the varicella virus vaccine."

"As long as you don't have risk factors, you will start receiving the pneumococcal vaccine when you are 50 years old."

"You should receive a tetanus booster every 10 years."

A nurse is teaching a client who has a new prescription for mercaptopurine to treat leukemia. Which of the following instructions should the nurse include? (Select all that apply.)

A. Use contraception if pregnancy is a risk.

B. Perform oral hygiene frequently.

C. Avoid activities that require mental alertness.

D. Perform hand hygiene frequently.

E. Avoid activities that can cause injury.

A. Use contraception if pregnancy is a risk.

B. Perform oral hygiene frequently.

D. Perform hand hygiene frequently.

E. Avoid activities that can cause injury.

A nurse is preparing to administer vaccines. Which of the following immunizations are recommended for an infant at 2 months of age?

Select all that apply.

A. Influenza (flu)

B. Polio (IPV)

C. Hepatitis B

D. Herpes zoster (shingles)

E. Covid 19

F. Rotavirus (RV)

B. Polio

C. Hepatitis B

F. Rotavirus

Folic Acid Analog: methotrexate (Trexall) Class?

Antineoplastic

Folic Acid Analog: methotrexate (Trexall) MOA:

blockage of folic acid _____________ [inhibition of the ________ dihydrofolate]

synthesis, enzyme

Folic Acid Analog: methotrexate (Trexall) ADR REACTIONS:

1. SEVERE ______ marrow suppression (decreased thrombocytes/___________),

2. decreased _____________ (WBCs),

3. decreased ______________ (RBCs),

4. ______-toxicity, ___ Ulcers,

5. pulmonary damage/_________,

6. ______cytopenia,

7. _____________ (bad for baby!)

1. bone, platelets

2. leukocytes

3. erythrocytes

4. hepato-, GI

5. fibrosis

6. thrombo-

7. TERATOGENIC

Folic Acid Analog: methotrexate (Trexall) Nursing Implications: 1/3

1. CBC (Plts, Erythro/Leukocytes, H&H) Before, ________ , and After therapy.

2. Signs of __________ (Fever/sore throat/cough).

3. Anticipate "________-stimulating" drugs [Filgrastim] (minimizes ____ suppression).

4. Monitor for ____________ (↓Plts) especially in places prone to bleeding ( _____ ), bruising precautions for ____________ (prolonged pressure at injection site, ______ gauge needles).

1. CBC, during

2. infection

3. colony, WBC

4. bleeding, gums, injections, pressure, small

Folic Acid Analog: methotrexate (Trexall) Nursing Implications: 2/3

5. Monitor for _____________ (oral and GI, can cause bleeding and discomfort) as well as blood in ______/vomit.

6. ________ FUNCTION TESTS (S/S ___________ ).

7. Respiratory _________ /_____________ oxygenation (pulmonary _________ /damage), report signs of difficulty ____________.

5. ulcerations, stool

6. LIVER, JAUNDICE

7. distress, decreased, fibrosis, breathing

Folic Acid Analog: methotrexate (Trexall) Nursing Implications: 3/3

8. Instruct women and men to use appropriate _________________ while taking this medication.

9. Avoid ______ feeding. May also affect _________.

8. contraceptives

9. breast, fertility

Folic Acid Analog: methotrexate (Trexall) ADMINISTRATION:

Oral, IM, IV, Intrathecal (in the _____ ); administered with leucovorin [reduced ______ acid] when used for ______-dose cancer therapy. Requires a dedicated ___ line (multiple drug interactions)

spine, folic, high, IV

Folic Acid Analog: methotrexate (Trexall) CONTRAINDICATIONS:

_____________/breastfeeding, ______ insufficiency/hepatis, _____ insufficiency, _____________ (PUD, Ulcerative Colitis), existing ____________.

pregnancy, liver, renal, ulcerations, infections

Folic Acid Analog: methotrexate (Trexall): DRUG INTERACTIONS

Digoxin, ________, salicylates, _____namides, Alcohol, ______ acid supplements.

NSAIDS, sulfo-, folic

Understand "Nadir" definition:

The time following chemotherapy when blood cell counts, especially the _____________ and ___________, reach their lowest level. ( __-___ days)

leukocytes, platelets, 7-10

Why cancer meds cause nausea & vomiting (patho): 1/2

Many drugs used for chemotherapy cause N/V due to stimulation of the chemoreceptor ________ zone (CZT) in the brain. ____________ can occur prior to chemotherapy in anticipation of the drug, during chemotherapy, and several days after therapy for certain drugs. May last for several _____.

trigger, vomiting, days

Why cancer meds cause nausea & vomiting (patho): 2/2

Anti______ + ____methasone + anti_______

-emetic, dexa-, -anxiety

Nitrogen mustards and alopecia - ____________ : Cyclophosphamide

prototype

Nitrogen mustards and alopecia - Prototype: Cyclophosphamide MOA:

Damages ____ by affecting the nitrogenous _______ that chemically link strands. Non-specific to the cell cycle (works at any point in the cells _____ cycle); most effective treatment when paired with on that is cell cycle __________

DNA, bases, life, specific

Nitrogen mustards and alopecia - Prototype: Cyclophosphamide ADR REACTIONS:

1. ___________ (Not serious but may be distressing to pts),

2. N/V [Severe, worse in __________ doses],

3. ________________ [Bone Marrow Suppression],

4. _____kalemia,

5. ____natremia,

6. _______ Loss (Teratogenic)

1. alopecia

2. higher

3. leukocytosis

4. hyper-

5. hypo-

6. fetal

Nitrogen mustards and alopecia - Prototype: Cyclophosphamide ADMINISTRATION:

Oral/IV; Oral WITHOUT food for best _______________ but may be given w/ food to help with _________

absorption, nausea

Nitrogen mustards and alopecia - Prototype: Cyclophosphamide NURSING:

1. Report ____.

2. Have pt void _________ and increase _____ intake (prevents _________ ).

3. Report ____uria or _________voiding.

4. Report __________weakness/twitching and _____________ (electrolyte imbalance).

1. N/V

2. before, fluid (cystitis)

3. hemat-, painful

4. muscle, palpitations

Nitrogen mustards and alopecia - Prototype: Cyclophosphamide CONTRAINDICATIONS:

pregnancy/______________, _____ virus vaccines, ___________ (herpes/chickenpox/viral infections), extreme fluid volume ________

lactation, live, infection, deficit

Nitrogen mustards and alopecia - Prototype: Cyclophosphamide CAUTIONS:

hx ___________/other chemotherapies, hepatic/______ impairment, recent use of cortico_________, ______ marrow malignancy, hx of ______ [hyperuricemia], current leukopenia/_______cytopenia

radiation, renal, -steroids, bone, gout, thrombo-

Nitrogen mustards and alopecia - Prototype: Cyclophosphamide DRUG INTERACTIONS:

Doxorubicin ( __________ toxicity), Succinylcholine ( ________________ blocking)

cardiac, neuromuscular

Anthracyclines: Doxorubicin MOA:

Binds to ____ and Enzymes (topoisomerase ___ ) to damage cells and prevent repair leading to cell _______

DNA, II, death

Anthracyclines: Doxorubicin ADR REACTIONS:

1. ______________ (Bone marrow suppression),

2. _______cytopenia,

3. __________

4. __________ (loss of hair)

5. ____ URINE/TEARS (Not severe but distressing, last 1-2 days),

6. _________ Toxicity [irreversible cardiac symptoms] (May begin immediately after transfusion or may manifest months/_____ later),

7. ______toxicity,

8. _______toxicity,

9. ______phlebitis/extravasation ( __________ of drug, may damage surrounding tissue) at IV site

1. leukocytosis

2. thrombo-

3. anemia

4. alopecia

5. RED

6. cardiac, years

7. hepato-

8. renal

9. thrombo-, leakage

Anthracyclines: Doxorubicin

Assist client emotionally with _____ loss and red ________, assess cardiac function/dysrhythmias, AST/LFT Testing (reduced dosing for impaired ________ function)

hair, urine, liver

Anthracyclines: Doxorubicin ANTIDOTES:

____ Inhibitor for cardiac toxicity ( _____zoxane specifically)

ACE, dexra-

Anthracyclines: Doxorubicin ADMINISTRATION:

IV; wear _______ when administering, flush area with ________ if drug touches bare skin, watch for _____ flushing

gloves, water, skin

Anthracyclines: Doxorubicin CLIENT INSTRUCTION: 1/2

_______ is 10-14 days, watch for ____________ at this time. Inform client about hair loss and discoloration of urine for up to __ days. Cardiac function testing, signs of cardiotoxicity, signs of ______toxicity, ___ site interactions, ________________ for women

Nadir, infection, 2, cardiac, hepato-, IV, contraceptives

Anthracyclines: Doxorubicin CLIENT INSTRUCTION: 2/2

Watch for signs of Super___________ ___-___ days into treatment

-infections, 10-14

Gonadotropin-releasing hormone agonists = leuprolide INDICATION: 1/2

Advanced ____________ cancer (most common type of cancer in males); used as a palliative treatment by _____________ progression, and helping to treat _____; NOT A _____

prostate, slowing, pain, CURE

Gonadotropin-releasing hormone agonists = leuprolide INDICATION: 2/2

May also be used for women with ________________ and uterine nonmalignant ________ (but its main use is prostate related)

endometriosis, tumors

Gonadotropin-releasing hormone agonists = leuprolide MOA:

Desensitizes the ___________ gland to gonadotropin-releasing hormone ( ______________ hormone), causing the pituitary to eventually stop producing _____________ causing the prostate to shrink (both healthy can cancerous cells)

pituitary, Luteinizing, testosterone

Estrogen receptor blockers- tamoxifen MOA: 1/2

Prevents ___________ from being activated on estrogen-receptor positive ______ cells preventing new cells from being formed as existing tumor cells die

estrogen, breast

Estrogen receptor blockers- tamoxifen MOA: 2/2

Because tamoxifen activates estrogen receptors (instead of blocks), this drug helps to maintain _____ density and increase ____. However, it also increases endometrial proliferation ( ________ risk) and _______ clotting.

bone, HDL, cancer, blood

Estrogen receptor blockers- tamoxifen ADR REACTIONS:

1. N/V,

2. ____ flashes,

3. ________ vision,

4. _________ cancer,

5. _______phlebitis/embolism,

6. pulmonary ___________,

7. ______ (CVA)

8. ______ loss (teratogenic)

1. ---

2. hot

3. blurred

4. uterine

5. thrombo-

6. embolism

7. stroke

8. fetal

Estrogen receptor blockers- tamoxifen NURSING:

Endometrial __________; monitor ____ pain, sudden ______ pain or

SoB, unilateral weakness ( ____ ). Monitor ______ density and ______________

levels.

biopsies, leg, chest, DVT, bone, cholesterol

Estrogen receptor blockers- tamoxifen ADMINISTRATION:

_____ once or twice _______

oral, daily

Estrogen receptor blockers- tamoxifen PT TEACHING:

1. regular ____________ exams,

2. irregular ___________ (sign of _________ malignancy),

3. ____ pain/swelling on one side,

4. chest pain/ ____

1. ophthalmic

2. bleeding, uterine

3. leg

4. SOB

Estrogen receptor blockers- tamoxifen CONTRAINDICATIONS:

Pregnancy/___________, anti_________ therapy, hx _______cytopenia, hx endometrial ___________

lactation, -coagulant, thrombo-, hyperplasia

Estrogen receptor blockers- tamoxifen CAUTION:

1. pt with vision problems ( __________ ),

2. _____ marrow suppression,

3. _____calcemia,

4. _____ cholesterol,

5. ductal ____________

1. cataracts

2. bone

3. hyper-

4. high

5. carcinoma

Estrogen receptor blockers- tamoxifen DRUG INTERACTIONS:

_________ (anticoag), anticancers (increased risk thrombo_________ )

Warfarin, -embolism