final exam

chemotherapy goals

to kill cancer cells with limited injury to normal tissues

cure, control, or palliation (relieve pain)

chemotherapy barriers

not possible to know if 100% of cells are killed

limited dosing due to toxicity and damage to normal cells

drug resistance over time

solid tumours have low growth fraction

high tumor load hard to treat

strategies to help chemotherapry

intermittent therapy

• allow normal cells to grow between treatment

combination therapy

• reduce resistance, inc cancer cell kill, less toxicity to normal cells

dosing schedules

regional drug delivery

• localized delivery to decrease systemic effects

chemotherapy toxicities

myelosuppresion

• neutropenia, thrombocytopenia, anemia

GI dysfunction

• stomatitis, diarrhea, n/v

alopecia

• hair loss

reproductive toxicity

etraversion

• Iv therapy become interstital

carcinogensis

• can inmate or promote cancer

bone marrow suppression with chemotherapy

myelosuppression - chemo toxic to bone marrow due to tissue rapidly proliferating and active

reduce neutrophil, erthtrocytes and plateletes

risk for infection (low neutrophil) bleeding (low platelet) + anemia (low erythrocyte)

use hematopoietic growth factor for medh

hematopoietic growth factors

colony stimulating factors / biologic response modifiers - stimulate hematopoietic stem cells of bone marrow

• erythropoietic growth factors / erythropoietin - stem RBC production, rarely for cancer patients

• leukopoteic growth factors / filgrastim - neutrophil production stimulated

• thromboporietic growth factors - stimulate platelet prodcution

neutropenia

neutrophils below 500, life span 2-3 days - with cytotoxic drugs, neutropenia first happens

Nadir - lowest neutrophil count at day 10-14

at highest risk during nadir + risk from normal flora of body

neutrophils monitored carefully, hold chemotherapy until improve

• signs of infection, 38 C, pus, abscesses, infiltrates

nursing considération w neutropenia

educate infection + risk + avoiding others

38 C report immediately

hygiene

reverse isolation (protect patient)

avoid food w pathogen risk - meat, veggies, fruit

cultures on patient

filgarastrim (Neupogen)

leukoporietic growth factor therapy

identical to naturally occurring granulocyte colony stimul factor

elevates neutrophil count, acto n bone marrow

dec risk of injfection

caution with cancer originating in bone marrow

IV or SC

thrombocytoponea

low circulating platelets, inc risk of bleeding

common - bleeding gum and nose

monitor hematuria, gi bleed, hemoptysis (cough blood)

avoid meds that inc bleeding, vigour tooth brush, shaving, iv insert, avoid injections, overinflated bp - bruising

oprelevekin / neumega

thromboporietic growth factor therapy - identical to cytokine prod in bone marrow

stim platelet production, proliferation of hematopoietic stem cells and inc megakaryocytic synthesis (become platelets)

not for patients with myeloid cancers (bone marrow/blood cancer)

dec thrombocyopenia and dec need for platelet transfusion

SC

anemia

dec erythrocyte

less common than neutropenia and thrombocypotneia (long life span 120 days) - full recovery happen before levels go low

monitor signs of anemia - fatigue, pallor, SOB, HGB

o2 if needed

erythropoietin/ Epoetin alpha

ertyhopoeitic growth factor therapy - hormone, stimulate RBC production in bone marrow

not for patients with myeloid malignancies + leukemias (blood/bone marrow)

admin iv or SC

increases risk of stroke, HF, blood clot, MI, death

can accelerate tumour progression + shorten life in some patients

not for patients except palliative

stomatitis

inflamed oral mucous, 2-3days after chemo - continue up to more than 2 weeks

inflammation to ulcer, lead to infection

pain when eating, speaking, swallowing - weigh patient and intake

diarrhea with chem

destruction of epithelial lining - impaired absorption of nutrient, fluid lead to diarrhea

impair nutrition, hydration, lead to infection

nausea and vomitting with chemo

with chemotherapy due to stimulation of CTZ, immeidcatley with first dose and contiue for hours to days

• anticipatory emesis (prior), acute emesis (within treatment 24 Horus), delayed (1 day after to a few days

use antiemetics 30 min prior to chemo

aprepitatnt and dexamethasone and ondastron - high risk emesis comb

alopecia

hair loss, from injury to follicles because rapid proliferation

with many cytotoxic meds

7-10 days start of treatment, peak at 1-2 months

1-2 month after, reverse alopecia (grow back)

reproductive toxicity

cytoxitoc med interfere w early embryo development

fetal malformation, death (first trim common)

low risk after 18 weeks

irreversible sterility in men

affects ovaries - amenorrhea (no period) + menopausal symptom

extravasation

vesicants, highly reactive

admin via central line to lower risk of direct contact to tissues

extroversion - leakage / infliltration of drug (vesicant) from blood vessel to surrounding area, major tissue damage

pain, infection, loss of mobility, necrosis, sloughing

carcinogenesis

cytotoxic drugs damage DNA, promote cancer to develop, years after treatment

with alkylating agents comonly

type of anticancer cytotoxic drug / chemotherapry

cell cycle phase specific - toxic to cells passing through phases of cell cycle

• bc its cell phase specific, cannot target inactive cells in g0 phase

cell cycle phase nonspecific - act at any part of phase including g0

given in combination

doxorubicin

treats leukaemia, lymphoma and solid breast and ovarian tumours in adult and paediatric patients

cardiotoxicity - acute (arythmias last 2 weeks) or delayed and lead to HF

assess egg changes, chest pain, irregular HR, signs of HF, VS

paclitaxel

used in advanced ovarian cane,r breast cancer, non smalll cell lung cancer

cardiotoxitcity - acute (arthymias, Brady) or delayed HF

• ekg changes, chest pain, HR, vs, HF signs

neuropathy - autonomic nerve dysfunction, in 30-50% of people - contipaiton, urinary hesitancy

risk of severe hypersensitive reactions - hypotension, dynspea, hives, angioedema (rapid swelling skin, mucous, airways)

• consider glucocorticoid or histamine receptor antagonist

• monitor signs of hypersensitivity

vincristine

chemo for hematologic cancers (Hodgkin and non-hodghkin) - little effect on bone marrow

toxic to peripheral nerves, neuropathy - autonomic nerve dysfunction, in 30-50%. of people, constipation and urianry hesitancy

almost all patients experiences sensory or motor dyfynciton

minimal brain injury bc rarely enter CNS

assess reflex, sensory and motor nerve injruy

cisplatin

chemo - treat bladder, ovarian, testicular cancer

toxic to peripheral nerves

• assess reflex, sensory and motor nerve injury

major nephrotoxic properties - Renal damage and renal failure

assess I and o, serum cr, fluid overload, uremias,

• minimize renal damage with pre infusion iv hydration (also help with fluid loss due to vomitting)

highly emetic properties

ocular toxic and otoxic - vision and hearing loss

risk of severe hypersensitive reactions - hypotension, dynspea, hives, angioedema (rapid swelling skin, mucous, airways)

• consider glucocorticoid or histamine receptor antagonist

• monitor signs of hypersensitivity

cyclophosphamide

commonly used with combination to treat variety of ccancer

hard on bladder, lead to bladder injury - hemorrhagic cystitis - inflammation and bleeding of bladder lining

• assess urine output, hematuria, increase fluids

bleomycin

treats testicular cancer and Hodgkin lymphoma

canc cause severe injury to lungs in 10% patients

starts as pneuomintis (inflammation) progress to fibrosis or scarring, respiratory failure/death

• assess pulmonary function, CXR (chest X-ray), vital signs

tamoxifen

breast cancer hormonal therapy - anti estrogen

used for premenopausal women mainly

block estrogen receptor on breast cancer

• risk of endometrial cancer and thrombosis

• hot flash, fluid retention, menstrual irregularities, vaginal discharge, n/v

• not safe with pregnancy

oral, adjuvant therapy to suppress growth of cancer cells after surgery for years

longer treatment decrease reuccurance

not same toxicity as other chemotherapy agents

anastrozole

aromatase inhibitor

ONLY for post menopausal women - block production of estrogen from adrgenic precursors

does not block estrogen production from ovaries - why they dont benefit premenopausal women (they produce estrogen from ovaries)

• less hot flashes, weight gain, N/V

• no estrogen at all = no endometrial cancer or thromboembolic events

• musk pain, osteoperiois, fracture risk

Septra / trimethoprim / sulfamethoxazole

anti infective - bacterostatic, inhibit growth of bacteria

for treating uncomplicated uti + recurrent uti

side effects - n/v, rash.

rare: anemia, renal damage, birth defects, hyperkalemia

• ask about sulpha allergy

• take with water

• finish all doses

• gi assessment, adverse reactions - fever, malaise

oxybutynin / ditropan xl

anticholinergic - block muscrinic receptor on bladder, inhibits bladder contractions

for; overactive bladder, bladder spasms w/ kidney stones + uti

side effects: dry mouth, blurred vision, constipation, tachycardia, urinary retention, hallucination, confusion + sedation in older adutls

• transdermal patch, gel, tablet

• monitor urinary retention, uti, constipation

• caution w hazardous activities and alcohol

• assess confusion

mirabgeron / myrbetriq

selective beta 3 adrenergic agonist - cause relaxation of muscles in bladder, inc filling

• modest effect, used when cant handle an anticholinergic (oxybutynin)

for; overactive bladder

side effects - include hr, bp, dig levels

• monitor urinary retention, vital signs

ketorolac / toreador

NSAID - inhibit prostaglandin synthesis

for mod to sev pain associated with passing renal calculi

effects: drowsiness, bleeding, Steven Johnson syndrome

• pain assessment, sign of bleeding, allergic reaction - muscle pain, rash, blister

mild hyperkalemia medications

kayexelate

dietary emasures

diuretics

salbutamol

moderate hyperkalemia

iv glucose/dextrose with iv insulin

iv sodium bicarbonate

dialysis

• mild treatments

severe hyperkelamia treatment

iv calcium gluconate - protects from cardiac arythmias

and moderate and mild treatments

calcium gluconate

for hyperkalemia treatment with kidney issues

reduces cardiac arrhythmia effect of K by stabilizing cardiac membrane potential

• risk of hypotension, arythmias, continuous monitoring of cardiac

given IV for severe potassium levels

iv insulin and dextrose

given for moderate hyperkalemia

insulin iv lowers serum potassium - pushes K into cells

dextrose - given with insulin to prevent hypoglycemic

sodium bicarbonate

given for moderate hyperkelamia

basic/alkaline, prevents acidosis with hyperkalemia

kayexelate

used for mild hyperkalemia

removes k+ by exchanging for Na+ in large intestine

diuretics for hyeprkelamia

treats mild hyperkelamia

depending on renal function, uses k wasting diuretics like loop and thiazide duretics

salbutamol for hyperkalemia

treat mild hyperkealmea

inhaled, shifts k+ into cells to decrease potassium serum levels

captopril

ACE inhibitor - reduces angiotensin 2 levels (which raise bp)

used: hypertension, HF, MI, nephropathy (kidney damage), prevent cardiac events

effect = dilate blood vessels, reduce BV, dec cardiac remodelling + decrease bradykinin breakdown - increase bradykinin levels

contraindication - pregnant, breastfeed, artery stenosis, prev reaction

adv effects: hypotension, cough, hyperkalemia, angioedema, neutropenia

• assess BP with first dose esp

• fluid volume and hydration status

• blood work; na, k, urea, creatnine

• cough

candestartin

ARB - angiotensin receptor blocker

for; hypertension, HF, MI, diabetic nephropathy

effect - blood vessel dilation, reduced BV

contradinciation; preg, breatfeeding, artery stenosis, angioedema

effect; hypotension, hyperkalemia

• monitor BP

• fluid volume

• blood work; NA, K, urea, creatnine

atorvastatin lipitor

HMG coa reductase inhibitor - blocks, increases dld receptor and removal of LDL

for; dyslipidemia

effects reduce LDL cholesterol, elevate HDL cholesterol, reduce triglyceride

effect ; well tolerated, headache, rash, memory loss, GI

• myopathy + rhabdomyolysis

• hepatotoxicity

contraindications; pregnancy

• dose given in evening

• GI assessment - pain, cramp, dyspepsia

• monitor LFT

• ovbesve muscle pain

furosemide / lasix

diuretic - block reabsorption at loop of hence ascending limb

for; pulmonary edema, hypertension, edema from (hepatic, cardiac, renal, unresponsive)

effect - dirueisis

contraindication - anuria and sensitivity

effect; hyponatremia, hypochloremia, hypokelamia, dheydraiton, hypotension, ototoxicity

• ins and outs, daily weights

• postural BP

• dehydration

• hearing changes

hydrochlorothiazide / microzide

diuretic - block na and cl in distal cov tubule reabsorption

for; hypertension, edema - HF, liver, kidney disease

effect - duiresis, ineffective at low GFR

contraindication - anuria, sensitivity

effects: hyponatremia, hypochleormia, hypokalemia, dehydration, hypotension

• ins and outs, daily weights, bp postural, dehydration

PO = onset 2 hours

spironolactone / aldactone

potassium sparing diuretic - block aldosterone in distal nephron

for; hypertension, edema, HF

effect; potassium retention, sodium excretion, diuresis

contraindication - hypersensitivity, anuria, renal disease, hyperkalemia, pregnancy/breastfeeding

adverse effects - hyperkalemia, endocrine effects - gynomastia (male breasts), menstrual irregularities, impotence (cant errect), hirsutism (female facial hair), deepen voice

• signs of hyperkelmai

• in/out + daily weight and bp

calcium carbonate TUMS

calcium phospahte binders

MOA - bind to phsophate in GI tract, get excreted in stool

for: hyperphosphatemia

effect: lower serum phosphate, increase serum calcium

contraindication: hypercalcemia, severe cardiac disease

effects: constipation, Gi irritation, calcium deposits, hypercalcemia, cardiac dysrhythmias

• monitor blood work, GI , give w meals

sodium polystyrene sultanate / kayexalate

potassium binding agent - exchange sodium for potassium in large intestine

for; hyperkalemia

effect - lower potassium

contraindication - gi obstruction

effect; constipation, nausea, vomitting, diarrhea, na/h2o retention

• assess hyperkalemia, Gi assessment, hours to days

erythropoietin/ Epogen

hematopoietic agents - glycoprotein hormone stimulate production of RBC in bone marrow

for; anemia with CKD

effects; elevation of erythrocyte count, decrease transfusion need

contraindication - sensitivity, uncontrolled HTN

effects ; HTN, cardiovascular events

• routine bloodwork, BP monitor 2 -3 weeks

ferrous sulfate / feosol

iron preparation - replace iron store for RBC development

for; iron deficiency enamia, nutritional supplements t

effect - improve anemia

effect - nausea, constipation, epigastric pain, black stool

• monitor hub, gi assessment, avoid admin with phosphate binder, dark stools

calcitriol / rocaltrol

vit d hormone - inc intestinal absorption of calcium

for hypocalcemia with CKD

effect - treat vit d defiency

contraindicaition - hyperphosphatemia, hypercalcemia

effect - gi upset, hypercalcemia, calcification deposit

nurse - monitor blood - Ca, phos, abd assessment

NSAID for mobility

block prostaglandins cox1 and cox2

decrease symptoms of pain, inflammation, fever with condition like arthritis

combination med for management, doesn’t slow disease

use higher doses than OTC

side effects

• cox 1 = gastric erosion, ulceration, risk of bleeding, renal impairment

• cox 2 = renal impairment, promote mi + stroke (suppress vasodilation)

• ibuprofen - Steven johnson syndrome

admin with food, watch renal function, monitor BP, monitor sx of bleeding

contraindications

• pregnancy

• sulpha allergy 2nd gen

• alcohol (bleeding risk)

• asa under 18

1st gen NSAID

inhibits cox 1 and 2

ibuprofen/advil + naproxen/aleeve + aspirin/ASA

aspirin dec platelet aggregation

2nd gen NSAID

celecoxib / celebrix

only inhibit cox 2

no effect on platelet aggregation, lower risk of stomach ulcer

prednisone /deltason

corticosteroid, mimic cortisol, anitinflammatory + immunosuppresant - for autoimmune disorder like rheumatoid arthritis

rapidly work for short period use

side effects

• fluid retention, high bp, weight gain

• hypokalemia (inc secretion)

• mood swing

• hyperglycaemia - weight gain

• infection risk + mask (decreased body response)

• slow wound healing

• peptic ulcers

• osteoporosis (suppresses bone form)

caution:

• active infections, immune compromised

• peptic ulcer

• long term use + taper

prednisone assessment + consideraiton

monitor ins and outs for fluid retetnion

• weight gain, skin assessment, lung sounds

skin assessment / breakdown

serum electrolytes + glucose

• high glucose, low potassium, low calcium

with meals to avoid gi irritaiton

adrenal suppression - n/v, anorexia, weakness, fatigue, dypnsea, low bp, hypoglycemmia

methotrexate/rhuematrex

DMARD - disease modifying antirhuematic drug

inhibit folic acid metabolism via dna synthesis, cell reproduction, immunosuppressive of b and t lymphocytes + kill diving cells like skin, hair, gi mucosa

for rheumatic arthritis, psoiorias, cancer

slow disease progression, fast acting 3-6 weeks

contraindication

• immunosuppression, hepatic impairment, prgenenat, breastfeeding

caution = renal impairment + active infeciton

side effects

• hepatic fibrosis, bone marrow suppression, gi ulcer, pneumonia

methotextrate consideration

vs

gi assessment (gi ulcer side effect)

suppresses bone marrow = risk of bleeding - signs of bleeding

pulmonary toxicity - dry cough, sob

labs - liver, cr/bun, cbc

cytotixic medication

inflixmab/remicade

DMARD - disease modifying antiruehtmic drug

block/neutralise tumour necrosis factor (immune mediator in rheumatic arthritis) - suppressing inflammation

for'; rheumatic arthritis, crohns disease, ulcerative colitis, psiorias

dec pain, swelling, joint destruction rate, improve funciton

used with methatrxate commonly

side effects

• immunosuppression- inc serous infection risk (m. tuberculosis), fungal, opportunitis

• heart failure

contraindications

• hypersensitivity

• active infection, immunocompromised (diabetes, hx HIV)`

• history of tuberculosis + recurrent infections

nursing consideration for infliximab

neutropenia (low neutrophils) - check CBC

infection - onset of fever, chills, screen

heart failure - sob, weight gain, crackle, edema

infusion reaction from IV

effectiveness of drug

allopurinol / zolyprin

xanthine oxidase inhibitor - enzyme for uric acid formation. reduce uric acid produciton

• dissolve urate crystal, prevent formation, prevent disease progression, attack frequency, improve life

for gout

side effects

• well tolerated, hypersensitivy = rash, fever, liver + kidney dysfunction

• gi upset

• worsen gout attack initially

• kidney stones

contraindication - patient with kidney dysfunction

nursing consideration

• discontinue if hypersensitivity signs, encourage fluids, check renal function

calcium

normal function - NS, MSK system, Cardiovascular

calcium needed for structural integrity of bone

• calcium not met in diet (dairy, nveggie, calcium forted) in postmenopausal women take supplements

calcium absorbed in small intestine, vitamin d increase absorption + decrease excretion

• some meds can decrease absorption

bones have continuous remodelling

calcium absorption

absorbed in small intestine (inc by vitamin d, dec by some meds)

excreted really

bone resoprtion - release calcium when serum calcium low

calcium side effect + nursing

side effect hypercalcemia - 3-4g per day, common with vitamin d supplements

gi disturbance

renal dysfunction - polyuria, nephrolithiasis, nocturne, polydipsia

cns effect - lethargy, depression

msk - changes skeletal muscle tone

cardiac dysarthmias

vascular calcifiacion risk - mi, stroke

nursing consideration

• consider amount of supplement and dietary intake

vitamin d

increase plasma calcium levels by

• inc calcium absorption form intestine, dec calcium resorption from bone, dec calcium excretion in kidney

naturally from sunlight, D2 from plants for medication + supplements

for osteoporosis

side effect

• hypercalcemia

alendronate / fosamax

bisophosanate - reduce number and activity of osteoclasts

for osteoporosis in postmenopausal women, men, glucocorticoritid induced osteoporosis

strengthen and reduce risk of low impact fracture from osteoporosis

side effects

• esophagitis - with long contact if drug doesn’t pass completely into stomach - take w water, dont lay down

• msk pain - initial dose or soon, resolves

• rare - ocular inflammation, atypical femur fractures

nursing consideration

• maximize bioavailability (empty stomach, only water, no food / drink after)

• minimize esophageal injury - take with water, upright for 30 min after, no chew/sucking on tablet

levodopa

enter brain, convert into exogenous dopamine, restore ach and dopamine balance

for parkinson’s disease - reduce symptoms severity

response within a few months, most effective drug - loses over time (within 2 years)

taken as combination (sinemet = levodopa/carbidopa) to inc absorption

side effects

• N/V - activated CTZ

• dyskinesia - movements, tics, jerks

• postural hypotension

• psychosis - hallucination, dream, paranoia

• cns - anxiety, agitation, memory loss, cognitive impariement, impulse control

• darken sweat + urine

sinemet - levodopa/carbidopa

levodopa - exogenous dopamine, only small portion reach CNS on its own

carbidopa - delay peripheral drug metabolism, allow more levodopa to enter brain

• no therapeutic effect/side effects on its own (carbidpoa)

• inhibits enzyme decarboxylase to allow absorption

nursing consideration of sinemet (levodopa/cardiopa)

avoid high protein meals (competes for absorption in gut)

assess Parkinsonism + extrapyramidal symptoms before/during therapy

monitor BP

not transfer standing suddenly

levodopa acute loss of effect - on/off

abrupt sudden return of PD symptoms

anytime during dosing even if drug still high (does not depend on dose/dose independent)

on - therapeutic effects

off - sudden return, inc intensity + frequency over time

• add dopamine agonist or MAO inhibitor to levodopa therapy

• avoid high protein

levodopa acte loss effect - wearing off phenomon

gradual return of PD symptom from gradual loss of effect of levodopa - when drug levels are low

• increase dose frequency + shorter intervals

• adding medication to prolong half life

• add mediciaotn to inc action of levodopa - dopamine agonist

pramipexole / mirapex

non ergot dopamine receptor agonist - stimulate dopamine in stratium

for Parkinson disease - improve motor symptoms by reducing fluncuations + help with ADL

early - used on its own. combination with other parkinson’s drugs in advanced PD, adding to levodopa + reduce on/off + warning off phenomon

weeks to work

side effects

• activate dopamine receptor - Nausea, dizzy, sleepy, hallucination, confusino

• no dyskinsea

• inc risk of orotstatic hypotension, hallucination, dyskinesia with levodopa

• sleep attacks

• impulse control disorder

nursing assessment mirapex/pramipexole

warned about drowsiness, no sedating med or alcohol + know about sleep disorder history

no driving/dangerous activities until know side effect

sleep attacks = discontinue medication

monitor bp regular, change position slowly

selegline / deprenyl

MAO inhibitor (enzyme that inactivate dopamine) - used with levodopa, suppress destruction of levopa dopamine + prolong effects, decrease fluncuation (on/off + wearing off phenomon)

for parkinsons disease, depression - improve motor funciton

newly diagnosed PD - first line

effect wear off within 12-24 month when used with levodopa

side effects

• insomnia (take appropriate time)

• hypertensive crisis - high doses (high risk younger people)

• with levodopa - worsen orthostatic hypotension, dyskinesia, psychiatric symptom

• not taken with merepidine or ssri (selective serotonin reupatke inhibit)

selegiline / deprenyl nursing consideraiton

assess gait, motor for treatment and dyskinesia side effect

look at behaviour, psychiatric symptoms

monitor BP and risk for fall with levodopa

anticholinergics for neuromuscular condition

block ach - focus on ach imbalance

for parkinons (used with other med) asthma, copd, incontinence, dizziness, diarrhea

improve tremor not bradykinsea

side effects - blurred vision, dry mouth, constipaiton, urinary retention

risk of cognitive decline in elder, only for 70 and under

methylprednisolone - solu medrol

mimic cortisol, anti inflammatory + immunosuppressant, work rapidly for short treatments

for MS exacerbation - inc impairements

IV or IM

monitor signs of acute infection - fever, abc, cough, tissue pain/swelling, UTI symptoms) - can exacerbate infection

interferon beta drugs - betaseron

disease modifiying drugs

immunomodulator - natural glycoprotein, inhibit proinflammtory leukocyte migration to BBB + CNS and inhibit t - helper activity

for multiple sclerosis

• decrease frequency + severity of relapse and delay progress

interferon beta adverse effects + contraindication + drug interactino

flu like symptoms - dec over time, minimized with low dose starting

hepatotoxicity - damage liver cells

myelosuppresion - suppress bone marrow function, dec RBC production

depression, suicidal ideation

contraindications

• hypersensitivity

• depression/suicidie history

• liver disease, alcoholism

not combined with alcohol, hepatotixc med, immunosuppressant

nursing consideration for interferon beta

assess MS symptoms

monitor LFT + CBC before treatment and 1, 3, 6 months

signs of depression

education about flu symptoms, depression, anxiety

mitoxantrone / novantrone

immunosuppressant, cytotoxic (kill all cells in body)

bind to DNA, inhibit synthesis, breaks dna strands - lethal to cells that divide fast - hair skin, mucous, bone marrow

suppress immune system destruction of myelin

for cancer and MS

• delays relapse, disease progression and lesions

side effects

• hair loss, N/v, mouth sores (stomatitis)

• myelosuppresion - toxic to bone marrow cell, dec blood cell production all tyeps

• cardiotoxicity - reduce left ventricular ejection fraction - HF risk

• teratogenic - potential fetal harm

caution - cardiac disease, active infeciton

mitoxantrone / novatrone nursing consideration

monitor bone marrow depression - bleeding + bruise (dec platelets) sign of infection (dec neutrophils) anemia signs (dec RBC)

monitor GI symptoms - antiemetic

look for mouth sores

assess f/e, in/out, nutrition

baseline EKG, chest xray, echo for EF + cardiac status

signs of HF - crackles, edema, SOB, chest pain

careful IV admin (cytotoxic)

monitor IV site

baclofen / lioresel

skeletal muscle relaxant - relieve muscle spasticity + spasm and resistance to passive movement with MS and spinal cord injuries

• suppress hyperactive reflex in CNS and regulate muscle movement - mimic NT GABA inhibitory on spinal neuron

intrathecal - pump into spinal fluid + PO

side effect

• CNS depression - drowsy, dizzy, weak, fatigue, improve with long term

• sudden withdrawal - hallucination, seizure, paranoid

• risk of severe symptoms with intrathecal - fever, muscle rigidity, exaggerated spasticity, organ failure, death

• N/V, constiaption, urinary retention

  • orthostatic hypotension

bacleofen nursing assessment and consideration

caution with other CNS depressants - alcohol, opioid, antihistamine - educate pateint

overdose with other CNS depressant - respiratory depreesion

• monitor resp status

• no antidose

monitor withdrawal symptoms

monitor infusion rate

gabapentin / neurontin

GABA analog - anti seizure

MOA unkown, enhance GABA release, inc GABA inhibiton

for anti seizure, postherpatic neuralgia, off label neuropathic pain

side effect

• well tolerated

• somnolence, dizzy, ataxia, fatigue, peripheral edema, nystagmus

• caution other CNS depressants - resp depression

• mood change, suicidal ideation

• withdrawal after abrupt

monitor CNS depression, pain improvement, change in mood, depression, suicidal ideation

dabigatran etexilate / pradaxa

direct oral anticoagulant for stroke prevention, DVT, PE, VTE ppx + MI

bind to + inhibit thrombin that is free in blood and bound to clot, direct + irreversible inhibition of thrombin

• prevent conversion of fibrinogen to fibrin

• prevent activation of factor xiii + prevent conversion of fibrin into insoluble fibrin

side effects - bleeding (less than other anticoagulant) + GI disturbances (dyspepsia, gastritis symptoms)

nurs

• monitor bleeding

• rapid onset, no bloodwork needed (fixed dose)

• monitor renal function (excreted in urine)

• take with food to dec GI effects

atorvastatin lipitor

statin - lipid lowering drug, lowers lipoprotein LDL + total cholesterol, increase HDL - reduction in 2 weeks but effect stops when done use

lowers risk of HF, MI, sudden death

blocks coenzyme to increase LDL receptor in hepatocyte - inc removal of LDL

for: hypercholesteremia, 1/ + 2nd prevention of CV events, diabetes, stroke prevention

atorvastatin side effects + nursing consideraion

gen well tolerated

GI disturbances

headache, memory loss

myopathy / rhabdomyolysis (kidney)

hepatotoxicity (liver)

nursing:

• dose in evening (cholesterol synthesis)

• GI assessment

• monitor liver + renal function

• obersve muscle pain

aspirin for stroke

prevent and treatment following stroke - dec arterial thrombosis + clot

inhibit cox 1 - thromboxane a2 (dec) which stimulate activation of platelet + inc aggregation

• prevent platelet adhesion, aggregation, inhibit thromboxane a2 formation by platelets

• relax vasoconstriction

for: inflammatory disorder, fever, ppx MI + stroke, angina, analgesic

aspirin side effects + nurs

side effects

• heart burn, nausea - take with glass/food

• Gi bleed - anemia w/ occult blood loss

• gast ulcers, perforation, bleed, hemoraghe (use with PPI)

• bleeding

nurse

• bleeding, gi assessment

• bleeding: hypotension, tachycardia, dizzy, weak, pallor, bruising, bleeding gum, epistaxis, hematuria, melena, labs

• procedures

• renal function monitor

TPA bp guidelines

ischemic stroke = can use TPA, keep systolic less or equal 185, diastolic 110

ischemic stroke = can’t use TPA, keep systolic 220, diastolic 120

hemoraghic stroke - cannot use TPA. goal is systolic 140-160

labetalol / trandate

manage HTN

block beta 1 + 2 and alpha 1 receptor sites

• 1 - HR

• 2 - vasodilator, bronchodilate

• A1 - vasodilation happens

given IV - for acute stroke hypertension

high alert med, lay supine 3 hr after given, vitals every 5-15 min

side effects - weak, bronchospasm, bradycardia, arythmias, HF, pulmonary edema, prosthetic hypotension

precaution

• hypersensitivity, HF, edema, lung diseases, bradycardia, heart block, renal / liver dysfunction

nursing consideration

• admin w meals to absorb better

• monitor BP + pulse q5-15

• apical pulse less than 50 = hold med

• assess hypotension, in/outs, daily weight, fluid overload

• diabetic patients watch BGL

tissue plasminogen activator / alteplase TPA

bind to fibrin in clot, activate plasminogen, forms plasminogen to breakdown and dissolve clot

for: acute MI, ischemic stroke, pulmonary embolus

effect: breakdown clot, restore blood flow

adverse effects - bleeding

• breakdown clots - can reopen healed bleeding site

• dec ability to clot when injury occur

contraindications

• previous inter cranial bleeding, known inter cranial lesion/tumour

• active bleeding (except menses)

• aortic dissection

relative contraindciations

• HTN more than 185 / 110

• current anticoagulants

• trauma/sugery/CPR

• recent internal bleeding

• peptic ulcer

• pregnancy

nursing consideraiton

• confirmed ischemic stroke (not hemoraghic)

• given within 3-4.5 hour of symptoms

• baseline coagulation bloodwork

• monitor VS, EKG

• hold anticoagulants, anti platelets, pokes / needles

• GCS and neurochecks for inter cranial bleeding

unfractioned heparin

enhance antithrombin activity , inactivates clotting factors, reduced thrombin + factor xa

for: pulmonary embolism, DVT, post stroke Dvt ppx, acute MI

prevents new clots

side effects

• bleeding, hemorrhage

• epidural hemayoma

• HIT - reduced platelets, inc thrombotic events

nurs consideration

• VS, labs, signs of bleeding

• hand/feet for CWCM (pt with long term wound) - signs of clots

mannitol / osmitrol

osmotic diuretic - inhibit reabsorption of water at nephrons, create osmotic force that draw fluid from brain cells /tissue into blood

• IV injection, mannitol distrubute to extracellular water

for: acute: renal failure, inc intraocular pressure, increased ICP

will reduce ICP + inc urine

adverse effects

• pulmonary edema

contraindications

• anuria

• dehydrated

• pulmonary edmea/congestion

• HF

nurs consideraiton

• VS, urine, IV site

• dehydration, fluid overload, electrolyte imbalance, labs

• therapeutic - GCS, orientaiton

glutamate vs GABA

glutamate - exictatory

inhibitory - gaba

lorazepam / antivan

benzodiazepine - potentiate GABA

for; anxiety, insomnia, Eton withdrawal, seizures

decreases seizures

seizure rescue med - status epileptics

side effects

• CNS Depression, apnea, resp depression

• abuse

contraindications

• pre existing CNS depression

• hypotension

• sleep apnea

• pregnancy/lactation

nursing consideraiton

• flumazenil antidode

• patient education with cons depression

• LOC, vitals, Resp, siezures `

phenobarbital / ancalixir

barbiturates - CNS depression, inhibit impulse transmutation, inc seizure threshold, inc GABA receptor intensity

for; seizures, sedation - anticonvulsant

2-3 weeks for steady plasma levels - need certain range for therapeutic effect - give loading dose

side effects

• CNS depression, resp depression

• hypotension IV

• physical dependence/addicition

• teratogenic - fetal abnormalities

contraindications

• CNS depression, resp disease

• pregnancy

nurs:

• Resp status, pulse, BP, LOC

• dec dose gradually

• patient education