Review of Exam 2 Prototype Meds

Cyclophosphamide (Cytoxan)

Drug class: Antineoplastic (slow down the growth of cancer cells); Alkylating Agent; nitrogen mustard 

MOA: A nitrogen mustards (group of chemotherapy drugs) to fight cancers; Damages the DNA inside cancer cells by attaching to the DNA to stop them from growing (change the shape of the DNA)

SE: N/V, anorexia, diarrhea, hemorrhagic cystitis, skin reactions, bone marrow suppression

Nursing Intervention: Monitor for sepsis & infection, discontinue if RBC, WBC, or platelet decreases, Monitor for hearing loss

Pt Education: take meds WITH meals, HYDRATE before chemo, AVOID crowds, report fever or blood in urine, potential adverse impact. on fertility

Methotrexate (Rheumatrex, Trexall)

Drug class: Antineoplastic (slow down the growth of cancer cells); Antimetabolite (stops the harmful cells from growing), folic acid analog 

MOA: Blocks the activity of folic acid, which SLOWS down the growth of fast-growing cancer or immune cells (Folic acid is necessary for cancer cells to replicate) - also used to rheumatoid arthritis

SE: hepatotoxicity which can lead to liver cirrhosis, ulcerative stomatitis, diarrhea, N/V, bone marrow suppression, HIGH growth fraction

• CONTRAINDICATION: pregnant

Nursing Intervention: Monitor for sepsis & infection, Monitor for extravasation in IV site, discontinue if RBC, WBC, or platelet decreases, Monitor for hearing loss

Pt Education: AVOID skin exposure & alcohol

Doxorubicin (Adriamycin)

Drug class: Antineoplastic (slow down the growth of cancer cells); Antitumor Antibiotic

MOA: Attaches to the DNA to prevent normal DNA and RNA synthesis

SE: cardiotoxicity, dysrhythmia, bone marrow suppression, LOW growth fraction

• CONTRAINDICATION: pregnant

Nursing Intervention: Monitor EKG (cardiac monitoring for QT prolongation), Monitor for extravastation on the IV site

Pt Education: Report SOB or chest pain

vincristine (Oncovin)

Drug class: Antineoplastic (slow down the growth of cancer cells); Natural product, Vinka alkaloid, Mitotic inhibitor

MOA: Prevents microtubule formation to prevent completion of mitosis

SE: neurotoxicity, paresthesia, neuropathy, constipation

• CONTRAINDICATION: pregnant

Nursing Intervention: Monitor for extravastation on the IV site

Pt Education: Consume HIGH fluids & fiber for constipation

tamoxifen (Nolvadex)

Drug class: Antineoplastic (slow down the growth of cancer cells); Hormone Antagonist (Estrogen receptor antagonist)

MOA: Blocks estrogen receptors on breast cancer cells

SE: N/V, hot flashes, fluid retention, vaginal discharges

• CONTRAINDICATION: pregnant

Nursing Intervention: Monitor for leg swelling

Pt Education: take WITH food, do NOT crush or chew meds, AVOID antacids for 1-2 hr AFTER drug

Cyclosporine (Gengraf, Neoral, Sandimmune)

Drug class: Immunosuppressant; Calcineurin inhibitor (slows down the immune system by blocking the T immune cells)

MOA: Inhibits the T cells (CD4 receptor) to reduce the activity of T cells to weaken the immune system

SE: nephrotixicity, ↓ urine output, HTN, tremor, hyperlipidemia

Nursing Intervention: Monitor for renal function

Pt Education: NO grapefruit juice

efavirenz (Sustiva)

Drug class: Antiretroviral; Nonnucleoside reverse transcriptase inhibitor (NNRTI)

MOA: Binds directly to reverse transcriptase, disrupting enzyme’s active site in order to STOP the HIV RNA (Blocks the conversion of HIV RNA to DNA)

SE: rash, mitochondrial toxicity (muscle pain, weakness, unusual fat distribution)

• CONTRAINDICATION: pregnant

Nursing Intervention: Monitor for liver function

Pt Education: administer in EMPTY stomach at bedtime (same time every day)

zidovudine (Retrovir, AZT)

Drug class: Antiretroviral; Nucleoside reverse transcriptase inhibitor (NRTI)

MOA: Virus mistakenly uses retrovir as nucleoside which creates defective DNA strands

• Recommened med for most pregnant women bc it rapidly crosses the placenta, which provides protection for the fetus

SE: headache, fatigue, hepatomegaly (liver palpable), bone marrow suppression

Nursing Intervention: Monitor CBC, anemia

Pt Education: administer at the same time every day in EMPTY stomach, AVOID fruit juice

lopinavir with ritonavir (Kaletra)

Drug class: Antiretroviral; Protease inhibitor

MOA: Inhibits HIV protease (Blocks NEW HIV from becoming mature HIV)

SE: Lipodystrophy (abnormal changes in fat distribution), diarrhea

Nursing Intervention: Monitor for S/S of infection

Pt Education: administer WITH food at the same time every day

dolutegravir (DTG, Tivicay)

Drug class: Antiretroviral; Integrase strand transfer inhibitor 

MOA: Inhibits HIV integrase, blocking the strand transfer of retroviral DNA, which interrupts the HIV replication cycle (blocks the virus from multiplying)

SE: rash, insomnia, hepatotoxicity, nephrototoxicity

Nursing Intervention: Monitor for liver & kidney function

Pt Education: administer at the same time every day, 2 hrs BEFORE or 6 hrs AFETR calcium with or without food