The Immune System

Methotrexate

class: Folic acid analog / antineoplastic

action: treats acute leukemia; lymphomas; choriocarcinoma; cancer of the head, neck, pelvis; RA & psoriasis

adverse effects:

• severe bone marrow suppression

• decrease thrombocytes

• liver damage

• GI ulceration

• pulmonary damage

• pulmonary fibrosis

interventions:

• monitor bone marrow depression

• monitor for fever

• filgrastrim may be ordered to minimize dec. in WBC

• monitor for bleeding

• monitor for oral & GI ulceration

• liver function tests monitored

• monitor for respiratory distress, dec. oxygenAtion

contraindications:

• pregnancy

• liver insufficiency

• hepatitis

• renal insufficiency

• caution = PUD, ulcerative colitis’s, GI ulceration, bleeding, active bacterial , viral infections

Cytarabine

other: 5-fluorouracil, floxuridine, gemcitabine, azacytidine, capecitabine, decitabine, trifluridine, tipiracil

class: antimetabolite

action: treats both acute myelocytic and acute lymphocytes leukemias, often as part of a multiple medication regimen, as well as Hodgkins lymphomas; prevents and treats meningitis caused by leukemia and maintains remission in the above cancers

adverse effects:

• GI effects

• bone marrow suppression

• arachnoiditis (inflammation of spinal cord)

interventions:

• monitor & reporting GI effects

• monitor weight

• antiemetic administered for nausea

• monitor clients CBC, hemoglobin, hematocrit

• intraethcal form be prepared to give dexamethasone

• glucocorticoid given to decrease inflammation

contraindications:

• pregnancy

• hx myelosuppresssion

• meningeal infection

• caution = renal/hepatic dysfunction, gout, neurologic disorders, during periods of myelosuppression, older adults

Mercaptopurine

class: purine antagonist

other: thioguanine, fludarabine, cladribine, clofarabine, nelarabine, dacarbazine

action: treats acute lymphocytes and acute myelogenous leukemia in adults & children; may cause temporary remission in chronic granulocytic leukemia

adverse effects:

• GI symptoms

• bone marrow suppression

• liver toxicity

interventions:

• monitor GI symptoms

• administer antiemetics as prescribed

• monitor clients weight

• intake & output

• monitor CBC

• monitor elevated levels of bilirubin, liver transaminase

contraindications:

• lactation, pregnancy

• active infections

• caution = liver / kidney impairment

Cyclophosphamide

other: mechlorethamine, chlorambucil, ifosfamide, melphalan, thiotepa

class: alkylating agents

action: treats leukemias; multiple myeloma; lymphomas; solid tumors of head, ovary, breast and lung cancer

adverse effects:

• hair loss / alopecia

• nausea / vomiting

• bone marrow suppression

• kidney toxicity

• electrolyte imbalances

• hyperkalemia

• hyponatremia

interventions:

• monitor for alopecia

• premeditate antiemetics

• encourage fluid intake

• monitor clients weight

• monitor CBC

• report wound drainage

• monitor clients temperature

• administer mesna

• monitor electrolyte levels

contraindications:

• pregnancy, lactation

• live virus vaccines

• fluid volume deficit

• severe infection

• viral infection

• caution = hx radiation or chemotherapy, liver/kidney impairment, recent corticosteroid use, cause immunosuppression, bone marrow malignancy, hyperuricemia, gout, current leukopenia, thrombocytopenia

Carmustine

class: cytotoxic anti cancer agent

other: lomustine, carmustine, streptozodin

action: treats primary and metastatic brain tumors, lymphomas, multiple myeloma, melanoma, hepatoma, GI adrenocarcinoma

adverse effects:

• GI effects

• bone marrrow suppression

• decreased lung function

• local thrombophlebitis

• extravasation

interventions:

• premedicated antiemetics

• monitor CBC

• monitor for lung infections

• monitor IV site, tissue damage will occur if infiltrated

contraindications:

• pregnancy, lactation

• hx impaired lung function

• severe bone marrow suppression

• preexisting infection

• caution = previous radiation, chemotherapy, kidney/liver disease, hx of here infections

Cisplatin

class: antineoplastics

other: carboplatin, oxaliplatin

action: used in combo with other chemotherapy agents to treat metastatic testicular or ovarian cancer; used off-label to treat head and neck cancers or carcinoma of the bladder or uterine lining

adverse effects:

• kidney toxicity, ototoxicity

• nausea / vomiting

• peripheral neuropathy

• anaphylactic reactions

• bone marrow suppression

interventions:

• baseline audio metric & kidney function tests

• monitor weight

• ensure adequate hydration

• pre-medicate with antiemetic

• monitor CBC

• monitor for peripheral neuropathy

• monitor for signs of allergy

contraindications:

• pregnancy

• allergy to platinum-containing substances

• severe impaired kidney function

• heparin impairment

• sever bone marrow suppression

• hx gout or renal stones

• concurrent use of loop diuretics

• raynauds syndrome

• caution = chemotherapy, radiation therapy, peripheral neuropathy, high uric acid level or electrolyte imbalance, mild to moderate kidney impairment, liver impairment, hx of circulatory disorder

Topotecan

class: antioneoplastic

action: treats cancers that other anticancer medications have failed to treat, metastatic ovarian cancer and small-lung cancer

adverse effects:

• GI symptoms

• bone marrow suppression

interventions:

• premedicate antiemetics

• monitor bone marrow

• transfusions for thrombocytopenia & anemia

• monitor for alopecia

contraindications:

• pregnancy, lactation

• severe bone marrow depression

• neutrophil count less than 1,500 cells per cubic millimeter

• current infection

• severe thrombocytopenia

• caution = bone marrow suppression, kidney disease/failure, hx bleeding disorders, previous cancer therapy

Flutamide

class: antiandrogens

action: treat prostate cancer in early stages and after metastasis

adverse effects:

• liver toxiciy

• gynecomastia

• hot flashes

• dec. libido

• impotence

interventions:

• monitor baseline liver function

contraindications:

• hypersensitivity

• severe liver failure

• caution = lactase deficiency, bone marrow suppression, active infections, assigned male at birth use condoms, assigned female at birth do not take, pregnant, lactating

Tamoxifen

class: estrogen receptor blocker

action: treats estrogen receptor positive metastatic breast cancer; prevents occurrence

adverse effects:

• n/v

• hot flashes

• blurred vision

• inc. risk of uterine cancer

• inc. risk thrombophlebitis

interventions:

• monitor GI effects

• endometrial biopsies

• monitor for leg pain

• monitor bone density & cholesterol levels

contraindications:

• pregnancy, lactation

• on anticoagulant therapy

• hx thrombocytopenia

• endometrial hyperplasia

• caution = visual disturbances, bone marrow suppression, hypercalcemia, high blood cholesterol, ductal carcinoma in situ of breast

Interferon alfa-2A

class: interferon

action: treats hairy cell leukemia, chronic myelogenous leukemia, malignant myeloma, kaposis sarcoma; chronic hep C

adverse effects:

• flu-like symptoms

• CNS symptoms

• bone marrow suppression

• GI symptoms

interventions:

• monitor flu-like symptoms

• monitor CNS symptoms

• monitor GI symptoms

• monitor CBC

contraindications:

• allergy

• inflammation of colon or pancreas or SI

• caution = existing cardiac, renal or hepatic disorder, chronic lung disease, COPD, DM, slotting disorder, bone marrow suppression, hx depression

Zidovudine

class: nucleoside reverse transcriptase inhibitors (NRTI’s)

action: treat symptoms of HIV infection; prevents maternal HIV transmission to fetus

adverse effects:

• bone marrow suppression

• anemia

• neutropenia

• GI symptoms

• CNS effects

• fever

• myalgia

• muscle aches

interventions:

• monitor hgb, neutrophil baseline & monthly

• may require transfusions of RBC

• monitor & report GI or CNS symptoms

• monitor weight regularly

• HIV testing beginning, every 3 months during

contraindications:

• allergy

• presence of lactic acidosis

• hepatic effect

• caution = kidney/liver dysfunction, alcoholism, bone marrow suppression, anemia, undergoing anticancer treatments

Ritonavir

class: protease inhibitor

action: treats both HIV-1 & HIV-2 in combo with at least one RTI to prevent resistance; increase therapeutic effects of antiretroviral medications

adverse effects:

• hyperglycemia

• inc. risk for diabetes

• fat redistribution

• inc. cholesterol & triglyceride levels

• GI symptoms

interventions:

• monitor baseline blood glucose testing

• give antidiabetic meds

• monitor for fat redistribution

• monitor cholesterol & triglycerides

• monitor bone density tests

• monitor baseline transaminase and other liver tests

• monitor persistent GI effects

• monitor for weight loss

contraindications:

• resistance to protease inhibitor

• pancreatitis

• lactation

• statins

• caution = liver disorders, elevated liver enzymes, DM, elevated cholesterol, renal insufficiency, hemophilia