Pharm II: Exam #2

Bevacizumab Therapeutic Class

Antineoplastic

Bevacizumab Pharmacologic Class

* angiogenesis inhibitor


* monoclonal antibody
* vascular endothelial growth factor (VEGF) inhibitor
* antineoplastic agent

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block the growth of blood vessels that support tumor growth rather than blocking the growth of tumor cells themselves

Bevacizumab Action

binds to VEGF which prevents endothelial cell proliferation (reproduction) and formation of new blood vessels which suppresses tumor growth

Bevacizumab Use

* colorectal cancer
* lung cancer
* glioblastoma
* renal cancer

Bevacizumab Adverse Effects

* GI perforation
* Hemorrhage
* Wound dehiscence
* Arterial thrombotic events
* Hypertensive Crisis

Bevacizumab Nursing Care

* monitor for adverse effects
* look for infusion reactions
* have pt report syncope dyspnea or edema in legs/abdomen
* illogical thinking
* rash

Cyclophosphamide Therapeutic Class

Antineoplastic

Cyclophosphamide Pharmacologic Class

Alkylating agent, nitrogen mustard

Cyclophosphamide Route

PO or IV

Cyclophosphamide Action

Attaches to DNA and disrupts replication

* cell death occurs when the cell attempts to divide

Cyclophosphamide Use

* leukemia


* multiple myeloma

Cyclophosphamide Adverse Effects

Toxic to tissues with high growth fraction

* **Dermatologic**: alopecia 3-6 weeks after therapy, hair will usually regrow
* **Fertility**: may cause sterility
* **Gastrointestinal**: nausea & vomiting, anorexia, diarrhea, mucositis and stomatitis
* **Hematologic:** thrombocytopenia, anemia, leukopenia

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Cyclophosphamide Nursing Considerations

* May be toxic to heart and kidney
* Risk of severe, potentially fatal hemorrhagic cystitis (7-40%)
* May cause secondary malignancies or severe infections/sepsis
* Vesicant/extravasation risk: monitor infusion site
* Hazardous agent: use precautions disposing of drug
* Monitor CBC, platelets, BUN, UA, Creatinine
* Keep patient well hydrated to decrease renal damage
* Numerous drug-to-drug interactions especially with St. John’s Wort

Methotrexate Therapeutic Class

Antineoplastic

Methotrexate Pharmacologic Class

Antimetabolite, folic acid analog

Methotrexate Action

closely resembles normal folic acid metabolites, acts as a “counterfiet” that fools the cell and stops cell division

Methotrexate Use

* acute lymphatic
* leukemia
* cancer of colon, breast, stomach, and pancreas
* Rheumatoid Arthritis
* Etopic pregnancy

Methotrexate BBW

* acute renal failure
* bone marrow suppression
* anemia
* leukopenia
* neutropenia
* thrombocytopenia
* fatal skin reactions
* diarrhea
* stomatitis
* death from hemorrhage
* fatal infections
* hepatotoxicity

Methotrexate Nursing Care

* monitor for adverse effects
* discuss signs and symptoms of neutropenia
* Nadir 7-10 days

Doxorubicin Therapeutic Class

Antineoplastic

Doxorubicin Pharmacologic Class

antitumor antibiotic

Doxorubicin Action

inhibits DNA and RNA synthesis and results in cell death

Doxorubicin Use

* solid tumors
* ovarian cancer
* multiple myeloma
* Kaposi’s sarcoma
* Hodgkin’s disease
* non-Hodgkin’s lymphoma
* Leukemia

Doxorubicin Route

IV only into body cavity

Doxorubicin Side Effects

* bone marrow depression
* nausea/vomiting
* alopecia
* stomatitis
* heart failure
* septic shock

Doxorubicin BBW

* myelosuppression
* irreversible cardiotoxicity
* heart failure
* arrhythmias

Doxorubicin Nursing Care

monitor for septicemia and extravasation at injection site or ulceration

* wash hands with soap and water if exposure occurs

Vincristine Therapeutic Class

Antineoplastic

Vincristine Pharmacologic Class

vinca alkaloid

* from vinca rosea plant

Vincristine Action

blocks cellular mitosis (M-phase specific)

* decreases cell replication
* interferes with cell division

Vincristine Use

in combo for…

* Hodgkin’s or non-Hodgkin’s lymphoma


* leukemia
* Wilms tumor

Vincristine BBW

vesicant, avoid extravasation (leakage of blood into tissue from vessel)

Vincristine Nursing Considerations

* constipation
* paralytic ileus
* intestinal necrosis or perforation
* all pts should be on prophylactic bowel management regimen

Tamoxifen Therapeutic Class

Antineoplastic agent

Tamoxifen Pharmacologic Class

hormonal antagonist

Tamoxifen Action

blocks estrogen receptors in some tissues and slows tumor growth

* estrogen receptors are over-expressed in many breast cancers

Tamoxifen Use

* metastatic breast cancer
* prophylactically for those who are high risk for breast cancer

Tamoxifen Side Effects

* not cytotoxic so less side effects
* nausea/vomiting
* hot flashes
* hypercalcemia
* jaundice
* vaginal dryness

Tamoxifen BBW

* increased incidence of uterine or endometrial cancers (report abnormal vaginal bleeding)
* stroke
* pulmonary emboli (use cautiously in those with thromboembolic events)

Epoetin alfa Class

erythropoiesis stimulating drug

Epoetin alfa Action

stimulates RBC production in bone marrow when matured

* results in elevated Hgb and Hct

Epoetin alfa Use

anemia due to chemotherapy

Epoetin alfa Route

SQ 3x/week for 2-6 weeks

* do not shake vial

Epoetin alfa Side Effects

* hypertension
* seizures
* thrombosis
* headache
* nausea
* angina

Epoetin alfa BBW

* thromboembolic events (TIA, MI, DVT)

Epoetin alfa Contraindications

* with myeloid leukemia, may increase tumor growth

Filgrastim Class

leukopoietic growth factor

* stimulates neutrophil production

Filgrastim Action

increases neutrophil production and enhances phagocytic and cytotoxic functions of existing neutrophils

Filgrastim Use

chemotherapy induced neutropenia

* decrease risk of infection
* use only in myeloid malignancies

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Filgrastim Route

IV or SQ

Filgrastim Adverse Effects

* bone pain
* leukocytosis (WBC > 100,000/mm3)

Filgrastim Nursing Care

* do not give within 24hrs of chemo
* monitor CBC prior to treatment

Ondansetron (Zofran) Therapeutic Class

Antiemetic

Ondansetron Pharmacologic Class

5-HT3 serotonin receptor antagonist

Ondansetron Use

* indicated for prevention of CINV


* radiation induced emesis
* post-operative nausea/vomiting
* hyperemesis gravium

Ondansetron Action

blocks 5-HT3 receptors on vagal nerve terminals and chemoreceptor trigger zone

Ondansetron Route

PO or parenteral

Ondansetron Side Effects

* headache
* sedation
* diarrhea
* constipation
* transient elevations in liver enzymes

Ondansetron Nursing Care

* more effective at preventing CINV than suppressing CINV so should not be given PRN but on a schedule
* give 30min prior to chemo

Ondansetron Caution

Risk for EKG changes

* no single dose should exceed 16mg

Metoclopramide Therapeutic Class

antiemetic

Metoclopramide Pharmacologic Class

* prokinetic
* GI stimulant

Metoclopramide Action

* blocks dopamine receptors and serotonin receptors in chemoreceptor trigger zone of the CNS
* enhances motility and accelerates gastric emptying

Metoclopramide Route

PO or parenteral

Metoclopramide Use

* GERD
* Chemo induced nausea/vomiting
* diabetic gastroparesis
* delayed gastric emptying
* persistent hiccups

Metoclopramide Adverse Effects

**Extrapyramidal**: effects with chronic use = restlessness and anxiety

Metoclopramide BBW

* may cayse tardive dyskinesia (irreversible)

Metoclopramide Nursing Care

* monitor CNS for EPS
* avoid activities requiring mental alertness
* take 30min before meals

Pancrealipase Class

pancreatic enzyme

Pancrealipase Action

enzyme acts locally in the GI tract to help digest fat

Pancrealipase Use

replacement therapy for patients with insufficient pancreatic exocrine secretions

* including pancreatitis and cystic fibrosis

Pancrealipase Nursing Care

* do not crush enteric coated tablets
* powder formulas may be sprinkled in food
* give 1-2hrs before or with meds

Ursodiol Class

gallstone dissolution agent

Ursodiol Indications

* used to dissolve gallstones in patients who do not need to have their gallbladders removed or in those in whom surgery should avoided because of other medical problems

Ursodiol Use

to dissolve gallstones and prevent occurrence for patients losing weight quickly

* may take up to 2 years to dissolve

Ursodiol Action

decreasing the production of cholesterol and by dissolving the cholesterol in bile so that it cannot form stones

Ursodiol Side Effects

* dizziness
* headache
* back pain
* nausea
* constipation
* diarrhea

Ursodiol Nursing Care

* give orally 2-4 times a day
* do not give with aluminum-based antacids (or separate dosage by 2hrs

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Lactulose Class

osmotic laxative

Lactulose Use

prevention and treatment of portal systemic encephalopathy and consitpation

Lactulose Action

non-digestible synthetic disaccharide that is hydrolyzed in the gut to an osmotically active compound that lowers colonic pH → acidifies colonic contents → favors conversion of NH3 → eliminated into feces

* decreases metabolism of ammonia
* draws H20 into the colon = laxative action → induces defecation

Lactulose Nursing Care

* monitor frequency and consistency of stool
* adjust dose based on diarrhea
* monitor ammonia levels

Metronidazole Class

anti-infective and antiprotozoan

Metronidazole Action

* lethal to anaerobic organisms
* Interacts with DNA to cause strand breakage that result in inhibition of nucleic acid synthesis resulting in cell death

Metronidazole Use

* Used in combination with clarithromycin or tetracycline to treat H-pylori in PUD


* Used to treat c-difficile infections causing diarrhea.

Metronidazole Side Effects

* nausea
* anorexia
* metallic taste
* diarrhea
* can cause bone marrow suppression

Metronidazole Contraindicated

* pts w/ blood dyscrasias
* anemias
* blood disorders

Metronidazole Nursing Care

* take on empty stomach
* may cause drug upset
* monitor side effects

Metronidazole Caution

* liver impairment
* may result in super-infection such as C.diff

Ranitidine Therapeutic Class

antiulcer drug

Ranitidine Pharmacologic Class

(H2 receptor) histamine antagonist

Ranitidine Actions

reduce acid production, blocking H2 receptors in stomach (parietal cells)

Ranitidine Admin

* gastric ulcers take 4-8 weeks to heal


* might be taken long term to prevent recurrence of ulcer

Ranitidine Adverse Effects

* can cause rare blood disorders so use for as short time as possible
* may cause B12 deficiency

Omeprazole Therapeutic Class

antiulcer drug

Omeprazole Pharmacologic Class

proton pump inhibitor

Omeprazole Actions

reduce acid secretion by binding to H+K+- ATPase (pump that releases acid)

* work better than H2 blockers and longer duration of action
* short term therapy for peptic ulcers (4-8 weeks)
* if used longer, increased osteoporosis risk

Omeprazole Use

* used for pts w/ GERD and erosive esophagitis

Omeprazole Admin

Give 30min before meal

* many give once daily

Omeprazole Adverse Effects

* can cause rare blood disorders so use for a short time as possible


* may cause B12 deficiency
* headache
* nausea
* diarrhea (c-difficele)
* Increased risk of pneumonia
* Increased osteoporosis risk and hypomagnesemia in long-term use
* Drug-drug effects with medications used to treat AIDS/HIV and antifungal. Reduces effectiveness of clopidogrel.